Radiotherapy and Oncology最新文献

{"title":"A prospective study of immune responses in patients with lung metastases treated with stereotactic body radiotherapy with or without concurrent systemic treatment","authors":"Eleni Gkika ,&nbsp;Elke Firat ,&nbsp;Sonja Adebahr ,&nbsp;Erika Graf ,&nbsp;Ilinca Popp ,&nbsp;Alexandra Eichhorst ,&nbsp;Gianluca Radicioni ,&nbsp;Simon S. Lo ,&nbsp;Simon K.B. Spohn ,&nbsp;Ursula Nestle ,&nbsp;Nils H. Nicolay ,&nbsp;Gabriele Niedermann ,&nbsp;Anca-L. Grosu ,&nbsp;Dan G. Duda","doi":"10.1016/j.radonc.2025.110889","DOIUrl":"10.1016/j.radonc.2025.110889","url":null,"abstract":"<div><h3>Background and purpose</h3><div>We evaluated the longitudinal effects of stereotactic body radiotherapy (SBRT) on circulating immune cells.</div></div><div><h3>Materials and methods</h3><div>Patients with oligometastatic/oligoprogressive pulmonary lesions were treated with ablative SBRT with (cSBRT) or without (SBRT group) concurrent systemic treatment (chemotherapy or immune checkpoint blockade, ICB) using different fractionation regimes. Immunoprofiling of peripheral blood cells was performed at baseline, during, and at the end of SBRT, and during the first (FU1) and second follow-ups (FU2). The primary endpoint was the increase in CD8⁺ T cells at FU1 compared to baseline.</div></div><div><h3>Results</h3><div>The study accrued 100 patients, 80 with evaluable samples. At FU1 12 % and 20 % of the patients experienced an increase in CD8⁺ T-cell counts in the SBRT and cSBRT groups, respectively. With a median follow-up of 30 months, the median OS was 30 months in the SBRT group and 53 months for the cSBRT group. Lower doses per fraction led to a significant increase in the proportion of proliferating CD4⁺ and CD8⁺ T cells. The effect size of standardized changes from baseline in proliferating T cells was considerably more significant in the SBRT group. The increased T-cell proliferation was prominent at the end of treatment and maintained at FU1 (SBRT, cSBRT) and FU2 (SBRT). The addition of ICBs did not lead to an augmentation of this systemic immunomodulatory effect.</div></div><div><h3>Conclusion</h3><div>In oligometastatic/oligoprogressive disease, the optimal dose and fractionation for ablative SBRT might be with less than 10 Gy per fraction and the optimal timing of systemic treatment may be post-SBRT to leverage the immune-modulating effects of SBRT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110889"},"PeriodicalIF":4.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase II trial of organ preservation program using short-course radiation and FOLFOXIRI for rectal cancer (SHORT-FOX): Two-Year primary outcome analysis","authors":"Daniella Klebaner ,&nbsp;Eleanor Brown ,&nbsp;George A. Fisher ,&nbsp;Andrew Shelton ,&nbsp;Tyler P. Johnson ,&nbsp;Shagufta Shaheen ,&nbsp;Christopher Chen ,&nbsp;Gregory Heestand ,&nbsp;Thomas Holden ,&nbsp;Jeffrey Bien ,&nbsp;Daniel A. King ,&nbsp;Aaron J. Dawes ,&nbsp;Arden M. Morris ,&nbsp;Natalie Kirilcuk ,&nbsp;Cindy Kin ,&nbsp;John Gahagan ,&nbsp;Vipul Sheth ,&nbsp;Pejman Ghanouni ,&nbsp;Sara Richter ,&nbsp;Lucas Vitzthum ,&nbsp;Erqi L. Pollom","doi":"10.1016/j.radonc.2025.110884","DOIUrl":"10.1016/j.radonc.2025.110884","url":null,"abstract":"<div><h3>Background and purpose</h3><div>As patients with rectal cancer with clinical complete response (cCR) after neoadjuvant therapy may be safely spared Total Mesorectal Excision (TME), strategies to maximize cCR are needed.</div></div><div><h3>Materials and Methods</h3><div>We conducted a single-arm phase II study to determine whether dose-escalated short-course radiotherapy (25 Gy/5 fractions + 5 Gy/1 fraction boost) followed by eight cycles of FOLFOXIRI increased cCR rates among adult patients with &gt; T2N0M0 or low T2N0 rectal cancer.</div></div><div><h3>Results</h3><div>Between 2020 and 2023, we enrolled 37 patients, of whom 27 (73 %) had at least one high-risk feature (cT4, extramural vascular invasion [EMVI], N2, threatened circumferential resection margin, positive lateral node). At primary endpoint assessment, nine (24 %) patients had cCR on both endoscopy and MRI, and pursued organ preservation (OP). Fourteen (38 %) patients had cCR only on endoscopy, nine of whom pursued OP. Of the 18 patients who pursued OP, nine had local regrowth at two years from radiotherapy start, with two-year TME-free survival of 26 %. Baseline factors significantly associated with not achieving OP included age &lt; 50 years and T4 disease. At mid-treatment restaging, patients who achieved OP were significantly less likely to have persistent node positivity, EMVI, and endoscopically visible tumor. Grade 3+ adverse events at least possibly attributed to chemotherapy and radiotherapy occured in 51% and 43% of patients, respectively.</div></div><div><h3>Conclusion</h3><div>Short-course radiotherapy with a boost followed by FOLFIXIRI results in OP in one-quarter of patients with high-risk rectal cancer, with poorer response among younger patients and T4 disease. Mid-treatment response may help guide timely decision-making regarding treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110884"},"PeriodicalIF":4.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of Prediction models for radiation-induced hypoglossal neuropathy in patients with nasopharyngeal carcinoma","authors":"Zekun Wang ,&nbsp;Lin Li ,&nbsp;Yunpeng Wu ,&nbsp;Zhiqiang Liu ,&nbsp;Runye Wu ,&nbsp;Jingbo Wang ,&nbsp;Jianghu Zhang ,&nbsp;Xuesong Chen ,&nbsp;Yuan Qu ,&nbsp;Kai Wang ,&nbsp;Xiaodong Huang ,&nbsp;Jingwei Luo ,&nbsp;Ye Zhang ,&nbsp;Junlin Yi","doi":"10.1016/j.radonc.2025.110887","DOIUrl":"10.1016/j.radonc.2025.110887","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To establish predictive models for radiation-induced hypoglossal neuropathy (RIHN) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).</div></div><div><h3>Materials and methods</h3><div>Data from 423 NPC patients receiving IMRT-based treatment were retrospectively reviewed. They were randomly (3:2) divided into a training set (n = 256) and a testing set (n = 167). Dosimetric variables were selected by penalized regression and machine learning, with area under the receiver operating curve (AUC) calculated. Clinical variables were selected by the competitive risk analysis. A competitive risk model including clinical and dosimetric variables was performed, and a nomogram was generated as a visualization of the model to predict the incidence of RIHN.</div></div><div><h3>Results</h3><div>During a median follow-up of 102 months (IQR: 89.5 to 112.9 months), the cumulative incidence of RIHN at 3, 5, and 8 years were 2.1 %, 5.4 %, and 10.5 %, respectively. D_1cc and aV₇₅ were the most predictive dosimetric variables. The dose–effect curve plotted with D_1cc indicated the tolerance dose for a 5 % probability of developing RIHN in 8 years (TD5/8) was 77.3 Gy (EQD₂). The restricted cubic spline between aV₇₅ and RIHN indicated a volume threshold of 0.81 cm³. A competitive risk model including hypoglossal canal involvement, concurrent chemotherapy, D_1cc, and aV₇₅ was established, with the C-index of the training set and testing set being 0.726 and 0.691, respectively. The nomogram-defined high-risk group had the higher RIHN incidences in the training and testing sets.</div></div><div><h3>Conclusions</h3><div>This study identified the most critical dosimetric predictors, which is expected to become a feasible dose constraint for hypoglossal nerves in radiation plan. Combining dosimetric and clinical predictors, we further proposed and validated the first nomogram model to quantify the risk of RIHN, contributing to identifying high-risk patients and early intervention. Further multicenter studies are needed to validate or complement our findings.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110887"},"PeriodicalIF":4.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-operative radiotherapy for oral cavity squamous cell carcinoma: Review of the data guiding the selection and the delineation of post-operative target volumes","authors":"Mererid Evans ,&nbsp;Pierluigi Bonomo ,&nbsp;Po Chung Chan ,&nbsp;Melvin L.K. Chua ,&nbsp;Jesper Grau Eriksen ,&nbsp;Keith Hunter ,&nbsp;T.M. Jones ,&nbsp;Sarbani Ghosh Laskar ,&nbsp;Roberto Maroldi ,&nbsp;Brian O’Sullivan ,&nbsp;Claire Paterson ,&nbsp;Luca Tagliaferri ,&nbsp;Silke Tribius ,&nbsp;Sue S. Yom ,&nbsp;Vincent Gregoire","doi":"10.1016/j.radonc.2025.110880","DOIUrl":"10.1016/j.radonc.2025.110880","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>To date, no consensus guidelines have been published that systematically guide delineation of primary and nodal Clinical Target Volumes (CTVs) in patients who require post-operative radiotherapy (PORT) for head and neck squamous cell carcinoma (HNSCC). As a result, significant individual, institutional and national variation exists in the way that CTVs are delineated in the post-operative setting, leading to considerable heterogeneity in radiotherapy treatment.</div></div><div><h3>Methods</h3><div>A multi-disciplinary group of experts was convened by the European Society for Radiotherapy and Oncology (ESTRO), including radiation oncologists from Europe, North America and Asia, as well as surgery, radiology and pathology representatives. Oral cavity squamous cell carcinoma (OCSCC), where surgery followed by PORT is the standard of care, was first selected for focus. The indications for PORT, and the influence of tumour subsite and stage on post-operative treatment volumes, were considered with reference to current evidence, and clinical experience within the group.</div></div><div><h3>Results</h3><div>We present clear recommendations regarding the indications for PORT in OCSCC, and propose a new classification of lateralised and non-lateralised OCSCC, to help guide the delineation of post-operative nodal CTVs.</div></div><div><h3>Conclusions</h3><div>The evidence and expert opinion summarised in this manuscript provides the background and context required to underpin new international consensus guidelines for the delineation of primary and nodal CTVs for OCSCC in the post-operative setting.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110880"},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tubarial gland sparing for oropharyngeal cancer: Feasibility with intensity modulated proton therapy & intensity modulated radiation therapy","authors":"Sreenija Yarlagadda ,&nbsp;Robert M. Rohe ,&nbsp;Valeriane McNeill ,&nbsp;Joanna R. Nemec ,&nbsp;Chelsea P. Tohtz ,&nbsp;Zachary W. Fellows ,&nbsp;Nicole McAllister ,&nbsp;Amy E. Rzepczynski ,&nbsp;Kristen A. McConnell ,&nbsp;Noah S. Kalman","doi":"10.1016/j.radonc.2025.110882","DOIUrl":"10.1016/j.radonc.2025.110882","url":null,"abstract":"<div><div>The feasibility of sparing tubarial glands in oropharyngeal radiotherapy was assessed using IMPT and IMRT. Tubarial gland absolute mean dose differences of up to 18 Gy were observed between clinical and re-optimized plans without compromising target coverage. IMPT plans met tubarial gland mean dose constraints more often than IMRT plans.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110882"},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainable radiation oncology in a world with grand environmental and societal challenges: Society Matters – A new section in the Green Journal","authors":"Kari Tanderup ,&nbsp;Birgitte V. Offersen ,&nbsp;Dietmar Georg ,&nbsp;Rob P. Coppes ,&nbsp;Pierre Blanchard","doi":"10.1016/j.radonc.2025.110876","DOIUrl":"10.1016/j.radonc.2025.110876","url":null,"abstract":"<div><div>Our world faces transformative challenges that will shape the trajectory of healthcare, including radiation oncology, in the coming decades. Our society will need to adapt to global forces, continuously changing in an era of rapid technological change, a warming planet, changing demographics, economic uncertainty, and global conflicts. The new <em>Society Matters</em> section is an initiative from the Green Journal, which will focus on radiation oncology in a societal frame. As its full title clearly states, ‘Society Matters – Sustainability, Education and Health Care Policy” aims to strengthen the radiation oncology profession and the radiation oncology community by being a platform for research, communication, debate, and dialogue within professional and societal matters such as environmental sustainability, social sustainability (equity, diversity, and inclusion), education, health economics, and health care policy. As a kick-off for the new section, this paper discusses sustainable radiation oncology in a world of change. It also aims to present the scope of articles of interest for the new section.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110876"},"PeriodicalIF":4.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration test of biaxially rotational dynamic-radiation therapy for nasopharyngeal carcinoma: Efficacy evaluation and dosimetric analysis","authors":"Shinya Hiraoka ,&nbsp;Hideaki Hirashima ,&nbsp;Mitsuhiro Nakamura ,&nbsp;Fumiya Tanaka ,&nbsp;Hiroki Adachi ,&nbsp;Yuka Ono ,&nbsp;Tomohiro Ono ,&nbsp;Ryota Nakashima ,&nbsp;Aya Nakajima ,&nbsp;Takashi Mizowaki","doi":"10.1016/j.radonc.2025.110879","DOIUrl":"10.1016/j.radonc.2025.110879","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>OXRAY is a new O-ring-shaped radiotherapy system delivering biaxially rotational dynamic-radiation therapy (BROAD-RT), a technique that enables non-coplanar volumetric-modulated arc therapy (VMAT) for large target volumes without requiring couch movement. The purpose of this study was to evaluate the benefits of BROAD-RT and to perform an integration test to confirm the plan deliverability and its accuracy from the treatment planning system to OXRAY for patients with nasopharyngeal carcinoma.</div></div><div><h3>Methods and Materials</h3><div>We compared treatment plans for BROAD-RT and coplanar VMAT (COVMAT) created in RayStation for 15 patients with nasopharyngeal cancer using the Wilcoxon signed-rank test. <em>P</em> values less than 0.05 were considered statistically significant. Additionally, we confirmed the plan delivery accuracy of BROAD-RT from the treatment planning system to OXRAY; gamma passing rates (GPRs) and delivery time were evaluated. The criteria for pass and fail were ≥95 % at γ3%2 mm.</div></div><div><h3>Results</h3><div>BROAD-RT significantly improved the homogeneity and conformity index of planning target volume and reduced dose volume indices compared with COVMAT in D_{0.03 cc} for the brainstem, D_{0.03 cc} for the left optic nerve, D_{0.03 cc} for the brachial plexus, D_mean for each submandibular gland, D_mean for the oral cavity, and D_mean for each parotid gland. All plans for BROAD-RT passed the integration test; the mean GPR (3 %/2 mm) was above 95 % and the median delivery time was 209 s.</div></div><div><h3>Conclusions</h3><div>BROAD-RT delivered by OXRAY passed the integration test, and it demonstrated the potential benefit of improving the dose distribution compared with COVMAT for patients with nasopharyngeal carcinoma.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110879"},"PeriodicalIF":4.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the PTV homogeneity objective in the era of photon advanced dose calculation algorithms: Bridging robust and PTV-based planning","authors":"Diego Jurado-Bruggeman ,&nbsp;Agnes Angerud ,&nbsp;Albin Fredriksson ,&nbsp;Carles Muñoz-Montplet","doi":"10.1016/j.radonc.2025.110878","DOIUrl":"10.1016/j.radonc.2025.110878","url":null,"abstract":"<div><h3>Aim</h3><div>The planning target volume (PTV) homogeneity objective was developed for previous-generation dose calculation algorithms. Advanced algorithms report doses to medium-in-medium (<em>D</em>_m,m) and their values depend on the medium considered, breaking the link between uniform irradiation and dose homogeneity. This work revises the PTV homogeneity objective when high-density heterogeneities are involved. We evaluated robust against PTV-based planning, and a dose reporting method that removes composition dependencies to express doses to muscle in muscle-like medium (<em>D</em>_{muscle,muscle*}).</div></div><div><h3>Methods</h3><div>Four cases featuring bone or metal within the PTV were selected and planned in RayStation with Monte Carlo. Three plans were created for each case: robust optimization for <em>D</em>_m,m (Robust-<em>D</em>_m,m), and PTV-based optimization for <em>D</em>_m,m (PTV-<em>D</em>_m,m) and <em>D</em>_{muscle,muscle*} (PTV-<em>D</em>_{muscle,muscle*}). The plans were reported in <em>D</em>_m,m and <em>D</em>_{muscle,muscle*}, and their dosimetric parameters, robustness, complexities, and optimization times were assessed.</div></div><div><h3>Results</h3><div>Robust-<em>D</em>_m,m and PTV-<em>D</em>_{muscle,muscle*} plans presented similar <em>D</em>_m,m distributions with inhomogeneous PTV doses due to cold spots in high-density regions. PTV-<em>D</em>_m,m plans achieved homogeneous PTV doses but required local fluence compensations that impaired robustness, with significant hot spots, and increased complexity. Robust optimization was 7 to 11 times slower. Reporting in <em>D</em>_{muscle,muscle*} restored consistency between PTV-based and robust evaluations.</div></div><div><h3>Conclusions</h3><div>Robust optimization proves that PTV homogeneity should not be prioritized when advanced algorithms reporting <em>D</em>_m,m are used with high-density heterogeneities. PTV-<em>D</em>_{muscle,muscle*} optimization offers a practical alternative for maintaining PTV-based planning and the PTV homogeneity objective while ensuring consistency with robust optimization. <em>D</em>_{muscle,muscle*} reporting simplifies plan evaluation and aligns with clinical practice, facilitating decision-making in treatment planning.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110878"},"PeriodicalIF":4.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The road to successful implementation of innovation in radiotherapy: A research-based implementation protocol","authors":"Fiona Ho ,&nbsp;Rachelle Swart ,&nbsp;Liesbeth Boersma ,&nbsp;Rianne Fijten ,&nbsp;Paul Cremers ,&nbsp;Frits van Merode ,&nbsp;Maria Jacobs","doi":"10.1016/j.radonc.2025.110874","DOIUrl":"10.1016/j.radonc.2025.110874","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Radiotherapy (RT) is rapidly advancing, yet only 50 % of innovations are implemented promptly. Despite the availability of Implementation Science (ImpSci) theories, models, and frameworks (TMFs), a theory–practice gap persists in effectively applying these insights in RT clinical practice. This study aims to develop a consensus-based implementation protocol for RT innovations using validated ImpSci knowledge.</div></div><div><h3>Material and methods</h3><div>A literature review of TMFs (May–August 2023) and 20 semi-structured interviews with Dutch RT professionals (August–December 2023) identified key RT components for implementation. These insights informed a draft RT implementation protocol, which was refined through a three-round international Delphi study (March–September 2024) involving 11 RT and 5 ImpSci experts. Consensus was determined using a 5-point Likert scale, analysing medians, interquartile ranges (IQRs), and percentage scoring.</div></div><div><h3>Results</h3><div>The Knowledge-to-Action (KTA) Framework and input from expert interviews were used to draft the protocol. Delphi response rates were 100 %, 93.8 %, and 88.9 % across rounds. In round 1, 88.9 % of elements achieved consensus (median = 4.0, IQR = 0.0–1.3); only the application of a prediction model for timely implementation (step 3c) needed revision after rounds 1 and 2. In round 3, also for step 3c consensus was reached (median = 4.0, IQR = 0.3). The protocol includes defining innovation types, stakeholder analysis, tailored implementation strategies, and a phased evaluation plan to ensure sustainability.</div></div><div><h3>Conclusion</h3><div>This is the first consensus-based RT innovation implementation protocol, addressing the theory–practice gap with a structured clinical approach. Future research should validate the protocol and assess the impact of preparation on implementation success.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110874"},"PeriodicalIF":4.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of radiation induced pneumonitis in patients with lung cancer: An ESTRO clinical practice guideline","authors":"Dirk De Ruysscher ,&nbsp;Els Wauters ,&nbsp;Verena Jendrossek ,&nbsp;Andrea Riccardo Filippi ,&nbsp;Marie-Pierre Revel ,&nbsp;Corinne Faivre-Finn ,&nbsp;Jarushka Naidoo ,&nbsp;Sara Ramella ,&nbsp;Matthias Guckenberger ,&nbsp;Umberto Ricardi ,&nbsp;Azza Khalil ,&nbsp;Marieke Schor ,&nbsp;Valentina Bartolomeo ,&nbsp;Paul Martin Putora","doi":"10.1016/j.radonc.2025.110837","DOIUrl":"10.1016/j.radonc.2025.110837","url":null,"abstract":"<div><div>The incidence of radiation pneumonitis (RP) has decreased significantly compared to historical series, mainly due to improved radiotherapy techniques and patient selection. Nevertheless, some patients still develop RP. This guideline provides user-friendly flowcharts to address common clinical practice questions regarding RP.</div><div>We summarize the current state of the art regarding the mechanisms, risk factors, diagnosis and treatment of RP. Dosimetric constraints to minimize the incidence of RP, as well as risk factors for developing RP, such as idiopathic pulmonary fibrosis (IPF) were identified. The combination of radiotherapy and medication as a risk factor for the development of RP was reviewed. RP remains a diagnosis of exclusion, but an algorithm for reaching the diagnosis has been proposed. Finally, practical approaches to the treatment of RP are outlined.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110837"},"PeriodicalIF":4.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}