Radiotherapy and Oncology最新文献

{"title":"Association between dose to cardiac structures and overall survival: A multivariable analysis in a large, multi-institutional database of stage III NSCLC patients with external validation","authors":"Miguel Garrett Fernandes ,&nbsp;Johan Bussink ,&nbsp;Robin Wijsman ,&nbsp;Zeno Gouw ,&nbsp;Albrecht Weiß ,&nbsp;Nanna M. Sijtsema ,&nbsp;Richard Canters ,&nbsp;Andrew Hope ,&nbsp;Dirk De Ruysscher ,&nbsp;Esther G.C. Troost ,&nbsp;Jan-Jakob Sonke ,&nbsp;Barbara Stam ,&nbsp;René Monshouwer","doi":"10.1016/j.radonc.2025.110821","DOIUrl":"10.1016/j.radonc.2025.110821","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Inconsistencies in identifying dose-limiting cardiovascular substructures for treating stage III non-small cell lung cancer (NSCLC) have hindered the implementation of cardiac sparing treatment planning guidelines. This study aims to address these inconsistencies by performing a multivariable survival analysis with overall survival as the endpoint using a large, multinational database, followed by external validation.</div></div><div><h3>Materials and Methods</h3><div>Clinical and dosimetric parameters from 1587 stage III NSCLC patients treated at five institutes were analyzed. The whole heart, four cardiac chambers, great vessels and their combinations were considered. The dataset was divided into a training set (four institutes) and a test set (one institute). The optimal parameter set was identified through cross-validation, and the resulting multivariable Cox regression model was externally validated using the test set. Adjusted hazard ratios (aHRs) for all cardiovascular parameters were evaluated.</div></div><div><h3>Results</h3><div>The strongest associations were found for low Dx% parameters. However, their incremental contribution to model performance, compared to clinical and lung dosimetric parameters only, was low, with small effect sizes. Specifically, the cardiovascular parameter identified by parameter selection was Left Side D5% (aHR: 1.007 Gy⁻¹, 95 % CI: 1.004 – 1.010 Gy⁻¹, <em>p</em> &lt; 0.0001), which provided a slight improvement in model concordance index of 0.0062 (95 % CI: 0.0000–0.0127) in the training set and 0.0037 (95 % CI: −0.0200–0.0280) in the test set.</div></div><div><h3>Conclusions</h3><div>Although significant associations between cardiovascular parameters and survival were found, their small effect sizes should be considered when prioritizing cardiac sparing in stage III NSCLC treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110821"},"PeriodicalIF":4.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493423","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":"Response evaluation and tumor shrinkage pattern post-SBRT for renal cell carcinoma","authors":"Lingling Cai ,&nbsp;Kaicong Chen ,&nbsp;Qiwen Pan ,&nbsp;Xinyue Zhang ,&nbsp;Ruiqi Liu ,&nbsp;Yang Liu ,&nbsp;Jianming Gao ,&nbsp;Zhiling Zhang ,&nbsp;Fangjian Zhou ,&nbsp;Pei Dong ,&nbsp;Li Tian ,&nbsp;Liru He","doi":"10.1016/j.radonc.2025.110802","DOIUrl":"10.1016/j.radonc.2025.110802","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite the promising application of stereotactic body radiotherapy (SBRT) in renal cell carcinoma (RCC), the optimal time and method for assessing tumor responses to SBRT remain unclear. We aimed to compare the utility of Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) in RCC response assessment and clarify the tumor shrinkage pattern post-SBRT.</div></div><div><h3>Materials and methods</h3><div>We retrospectively studied patients with RCC treated with SBRT at our institution between November 2016 and December 2021. Baseline and follow-up images were evaluated using RECIST 1.1 and mRECIST. Landmark analyses were conducted to assess the association between local control and tumor response status evaluated using the above two criteria.</div></div><div><h3>Results</h3><div>Ninety-one RCC patients with 103 primary or metastatic lesions were included. Objective response rates (ORRs) were higher and pseudoprogression was less commonly assessed by mRECIST than by RECIST 1.1 within each time period. The median shrinkage rate of bone lesions was much lower using RECIST 1.1 than that using mRECIST (−0.8 vs −1.7 cm/year). According to both criteria, the ORR tended to be stable on the 9–12 months post-SBRT. Patients with a tumor response at 9–12 months had a lower probability of infield recurrence using mRECIST (P = 0.047), this was not observed using RECIST 1.1 (P = 0.061).</div></div><div><h3>Conclusion</h3><div>mRECIST results in an earlier and more pronounced response evaluation compared to RECIST 1.1 in patients with RCC treated with SBRT. Nine to twelve months post-SBRT may serve as an early landmark for tumor response evaluation by mRECIST.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110802"},"PeriodicalIF":4.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493433","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":"In response to Yu and Chen: Proton FLASH-Arc Therapy: Bridging feasibility to clinical utility","authors":"Bethany Rothwell,&nbsp;Alejandro Bertolet,&nbsp;Jan Schuemann","doi":"10.1016/j.radonc.2025.110803","DOIUrl":"10.1016/j.radonc.2025.110803","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110803"},"PeriodicalIF":4.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493427","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":"Comment on Wu et al’s article on toxicity in patients receiving radiotherapy for ultracentral stage I non-small cell lung cancer","authors":"Andres Huertas ,&nbsp;Drew Moghanaki ,&nbsp;Shankar Siva","doi":"10.1016/j.radonc.2025.110805","DOIUrl":"10.1016/j.radonc.2025.110805","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110805"},"PeriodicalIF":4.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493425","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":"Response to: Comment on Wu et al’s article on toxicity in patients receiving radiotherapy for ultracentral stage I non-small cell lung cancer","authors":"Che Hsuan David Wu ,&nbsp;Timothy J Whelan ,&nbsp;Anand Swaminath","doi":"10.1016/j.radonc.2025.110804","DOIUrl":"10.1016/j.radonc.2025.110804","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110804"},"PeriodicalIF":4.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493435","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":"Rationale, implementation considerations, delineation and planning target objective recommendations for volumetric modulated arc therapy and helical tomotherapy total body irradiation, total marrow irradiation, total marrow and lymphoid irradiation and total lymphoid irradiation","authors":"Bianca A.W. Hoeben ,&nbsp;Simonetta Saldi ,&nbsp;Cynthia Aristei ,&nbsp;Jacob Engellau ,&nbsp;Abrahams Ocanto ,&nbsp;Susan M. Hiniker ,&nbsp;Sarah Misson-Yates ,&nbsp;Daria A. Kobyzeva ,&nbsp;Montserrat Pazos ,&nbsp;N. George Mikhaeel ,&nbsp;Marta Rodriguez-Roldan ,&nbsp;Enrica Seravalli ,&nbsp;Mirjam E. Bosman ,&nbsp;Chunhui Han ,&nbsp;Christoph Losert ,&nbsp;Per E. Engström ,&nbsp;Christian P.L. Fulcheri ,&nbsp;Claudio Zucchetti ,&nbsp;Carlos Ferrer ,&nbsp;Mohammad Hussein ,&nbsp;Jeffrey Y.C. Wong","doi":"10.1016/j.radonc.2025.110822","DOIUrl":"10.1016/j.radonc.2025.110822","url":null,"abstract":"<div><div>As a component of myeloablative conditioning before allogeneic hematopoietic stem cell transplantation (HSCT), Total Body Irradiation (TBI) is employed in radiotherapy centers all over the world. In recent and coming years, many centers are changing their TBI setup to a conformal isocentric technique, providing superior homogeneity and control of the target prescription dose, and more freedom for individualized organ-at-risk sparing or dose-escalation. Also, more specifically bone-marrow- and/or lymphatics-targeted therapies such as Total Marrow (+ Lymphoid) Irradiation (TMI / TMLI), and Total Lymphoid Irradiation (TLI) are established and prospectively evaluated in several centers. With each center developing their own methods, a new practice heterogeneity is arising, as was the case for decades with conventional TBI. To provide a ground base – and therefore more options for more homogeneous and comparable practice − for centers who are implementing conformal isocentric techniques, a group of early adopters of isocentric conformal TBI and TM(L)I came together to convey issues they encountered during clinical implementation, and form consensus recommendations for delineation and planning targets, based on available literature evaluation and shared experience. These recommendations follow previously published recommendations regarding technical setup of conformal isocentric TBI / TM(L)I techniques.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110822"},"PeriodicalIF":4.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493431","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":"Low-dose radiation as a potential strategy for alleviating lung injury caused by radiotherapy combined with immunotherapy: A preclinical study","authors":"Yu Wang ,&nbsp;Jing Zhang ,&nbsp;Yao Liu ,&nbsp;Han Jiang ,&nbsp;Bibo Wu ,&nbsp;Shasha Zhao ,&nbsp;WeiWei Ouyang ,&nbsp;Yinxiang Hu ,&nbsp;Bing Lu ,&nbsp;Shengfa Su","doi":"10.1016/j.radonc.2025.110823","DOIUrl":"10.1016/j.radonc.2025.110823","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Radiotherapy combined with immunotherapy has been shown to improve thoracic tumor outcomes while increasing the risk of lung injury. Low-dose radiotherapy (LD-RT) has been proven efficient in managing inflammatory diseases. This study aims to investigate whether LD-RT might alleviate lung injury induced by radiotherapy combined with immunotherapy, and attempt to explore its underlying mechanisms thereby offering novel insights for clinical application.</div></div><div><h3>Methods</h3><div>To establish a mouse model of lung injury caused by radiotherapy combined with immunotherapy, C57 BL/6J mice received intraperitoneal injections of programmed death 1(PD-1) inhibitor weekly and a single dose of 15 Gy whole thoracic irradiation. Then they received a single dose of LD-RT at 1.0 Gy or 1.5 Gy on Day 14 or 28. The mice were euthanized on Day 42, and lung tissue samples were collected for HE, Masson’s trichrome, and immunohistochemical staining to evaluate lung tissue damage, fibrosis, and lymphocyte infiltration. The expression levels of cytokine were quantified by the enzyme-linked immunosorbent assay.</div></div><div><h3>Results</h3><div>Both low-dose of 1.0 Gy and 1.5 Gy attenuated lung injury caused by radiotherapy combined with PD-1 inhibitors, but 1.5 Gy was more effective. Compared with Day 14, LD-RT at 1.5 Gy on Day 28 was more effective in alleviating alveolar inflammation and reducing collagen deposition, and inhibiting lymphocyte infiltration and secretion of inflammatory cytokine in lung tissue.</div></div><div><h3>Conclusion</h3><div>Low-dose radiation alleviated lung injury caused by radiotherapy combined with PD-1 inhibitor, and the alleviating effect is closely related to the timing and dose of the radiotherapy administered.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110823"},"PeriodicalIF":4.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493429","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":"An ultra-high dose rate Bragg peak tracking technique provides more affordable proton radiotherapy for cancer patients: From principle to experimental validation","authors":"Shouyi Wei ,&nbsp;Haibo Lin ,&nbsp;Chingyun Cheng ,&nbsp;J. Isabelle Choi ,&nbsp;Charles B. Simone II ,&nbsp;Minglei Kang","doi":"10.1016/j.radonc.2025.110800","DOIUrl":"10.1016/j.radonc.2025.110800","url":null,"abstract":"<div><h3>Purpose</h3><div>This work aims to experimentally validate a novel cost-effective solution for achieving both conventional dose-rate and ultra-high dose rate (UHDR) deliveries in pencil beam scanning proton therapy.</div></div><div><h3>Methods</h3><div>A proton therapy delivery solution was previously developed by our group using only a single pristine Bragg peak of the highest energy proton beams from a cyclotron. This approach streamlines upstream beam modifiers, including energy degrader, selection and focusing systems, while utilizing of universal range shifters (URS) and range compensators (RCs) to preserve high beam transmission efficiency for UHDR beam delivery. It achieves the Bragg peak tracking and target dose conformity, making it potentially suitable for FLASH radiation therapy. In the current study, we highlighted the realization of the solution by using URS and customized beam-specific RCs via simulation in an in-house treatment planning software (TPS) which is then fabricated by a 3D printer, facilitating precise beam shaping and Bragg peak tracking. Experimental validation of this method was conducted using a clinical proton system to showcase a practical solution that can be translated into realistic operation. Both dose and dose rate were measured and compared to treatment planning results.</div></div><div><h3>Results</h3><div>The proton convolution superposition (PCS) dose calculation was benchmarked by the Monte Carlo calculation. Matrixx PT measured the delivered dose in the uniform and head-neck (HN) phantom, and the gamma passing rates were &gt; 99 % in the water phantom. The gamma rate was &gt; 98 % for the HN phantom for this distal tracking method. The measured dose difference between the TPS and HN phantom was &lt; 2 %. The implementation of a high temporal resolution strip ion chamber detector array enabled accurate measurement of the spot time structure, facilitating 3D dose rate reconstruction across various beam currents.</div></div><div><h3>Conclusion</h3><div>The experimental validation successfully demonstrated the dosimetric accuracy and robustness of this proposed delivery method. The employment of the Bragg peak tracking method holds great promise for reducing treatment delivery costs for future UHDR and conventional dose rate proton radiation therapy, ultimately benefiting a larger population of patients.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110800"},"PeriodicalIF":4.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484035","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":"Incorporating indirect MRI information in a CT-based deep learning model for prostate auto-segmentation","authors":"Daan Stas ,&nbsp;Geert De Kerf ,&nbsp;Michaël Claessens ,&nbsp;Anna Karlhede ,&nbsp;Jonas Söderberg ,&nbsp;Piet Dirix ,&nbsp;Piet Ost","doi":"10.1016/j.radonc.2025.110806","DOIUrl":"10.1016/j.radonc.2025.110806","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Computed tomography (CT) imaging poses challenges for delineation of soft tissue structures for prostate cancer external beam radiotherapy. Guidelines require the input of magnetic resonance imaging (MRI) information. We developed a deep learning (DL) prostate and organ-at-risk contouring model designed to find the MRI-truth in CT imaging.</div></div><div><h3>Material and Methods</h3><div>The study utilized CT-scan data from 165 prostate cancer patients, with 136 scans for training and 29 for testing. The research focused on contouring five regions of interest (ROIs): clinical target volume of the prostate including the venous plexus (VP) (CTV-iVP) and excluding the VP (CTV-eVP), bladder, anorectum and the whole seminal vesicles (SV) according to The European Society for Radiotherapy and Oncology (ESTRO) and Advisory Committee on Radiation Oncology Practice (ACROP) contouring guidelines. Human delineation included fusion of MRI-imaging with the planning CT-scans in the process, but the model itself has never been shown MRI-images during its development. Model training involved a three-dimensional U-Net architecture. A qualitative review was independently performed by two clinicians scoring the model on time-based criteria and the DL segmentation results were compared to manual adaptations using the Dice similarity coefficient (DSC) and the 95th percentile Hausdorff distance (HD95).</div></div><div><h3>Results</h3><div>The qualitative review of DL segmentations for CTV-iVP and CTV-eVP showed 2 or 3 out of 3 in 96 % of cases, indicating minimal manual adjustments were needed by clinicians. The DL model demonstrated comparable quantitative performance in delineating CTV-iVP and CTV-eVP with a DSC of 89 % with a standard deviation of 3.3 %. HD95 is 4 mm for CTV-iVP and 4.1 mm CTV-eVP with a standard deviation of 2.1 mm for both contours. Anorectum, bladder and SV scored 3 out of 3 in the qualitative analysis in 62 %, 72 % and 55 % of cases respectively. DSC and HD95 are 90 % and 5.5 mm for anorectum, 96 % and 2.9 mm for bladder, and 81 % and 4.6 mm for the seminal vesicles.</div></div><div><h3>Conclusion</h3><div>To our knowledge, this is the first DL model designed to implement MRI contouring guidelines in CT imaging and the first model trained according to ESTRO-ACROP contouring guidelines. This CT-based DL model presents a valuable tool for aiding prostate delineation without requiring the actual MRI information.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110806"},"PeriodicalIF":4.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484052","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":"Improving performance in radiation oncology: An international systematic review of quality improvement interventions","authors":"Joanna Dodkins ,&nbsp;Georgia Zachou ,&nbsp;Adil Rashid ,&nbsp;Jan van der Meulen ,&nbsp;Julie Nossiter ,&nbsp;Alison Tree ,&nbsp;Ajay Aggarwal","doi":"10.1016/j.radonc.2025.110798","DOIUrl":"10.1016/j.radonc.2025.110798","url":null,"abstract":"<div><div>National cancer audits and registers have highlighted significant national and international variation in patient care and outcomes. Quality Improvement (QI) is mandated in radiation oncology but the interventions designed to support QI in this field remain poorly understood. This paper seeks to assess the types of QI interventions in radiation oncology, the QI evaluation design and their impact on process of care measures and patient-related outcomes. MEDLINE and EMBASE were searched systematically for studies of QI interventions in radiation oncology between 2000 and 2024. The studies needed to identify the quantitative or qualitative impact of the QI intervention on process of care measures or patient-related outcomes. Study results were summarised using narrative synthesis and appraised using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). 26 papers were included in the analysis. The majority of studies were conducted in the USA (n = 13) and in Europe (n = 7), with only two studies conducted at a national level. Ten studies covered all tumour types, with six specifically focusing on head and neck cancers, two each on prostate and nasopharyngeal cancers, and one study each examining lung, cervical, rectal, and breast cancers. The aspects of care evaluated most frequently were those relating to reducing waiting times or increasing utilisation of radiotherapy as per guidelines (n = 15), followed by those seeking to reduce radiotherapy contouring variability (n = 5) and those involving the management of symptoms during or after radiotherapy treatment (n = 6). Only 42 % of studies reported funding, with the most frequent funding source being national, government or federal (n = 6). All QI interventions across the 26 studies were successful as they resulted in an improvement in a process or patient-related outcome measure. The studies scored between 10 and 15 out of 16, according to the QI-MQCS criteria. Despite substantial investments in cancer research and development, there is a scarcity of information on how to enhance the quality of care in radiation oncology. While there are examples of national cancer audits and registers in a number of countries, much of the research in QI interventions is being conducted in the USA. This situation underscores the need for more comprehensive, well-funded studies and improved training for clinicians to conduct high-quality improvement activities and research. There should be a greater emphasis on the substantial gains that can be achieved by improving existing care in terms of access and outcomes, rather than solely focusing on innovation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110798"},"PeriodicalIF":4.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477110","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}