Strahlentherapie und Onkologie最新文献

{"title":"Multicentre patterns-of-care analysis of adjuvant and definitive (chemo)radiotherapy for pharyngeal and laryngeal carcinoma in Franconia, Germany.","authors":"Karoline Pollmann, Adriana Salazar Hammann, Jochen Willner, Reinhart Sweeney, Stefan Münch, Thomas Gehrke, Michael Flentje, Andrea Wittig-Sauerwein, Victor Lewitzki","doi":"10.1007/s00066-026-02550-z","DOIUrl":"10.1007/s00066-026-02550-z","url":null,"abstract":"<p><strong>Purpose: </strong>To compare treatment patterns and oncologic outcomes of patients with pharyngeal and laryngeal squamous cell carcinoma treated at a tertiary hospital versus three secondary regional hospitals in Franconia, Germany.</p><p><strong>Methods: </strong>We retrospectively analyzed 308 consecutive patients (tertiary hospital n = 164; secondary regional hospitals n = 144) diagnosed between 01/2017 and 12/2019 and treated with primary or adjuvant radiotherapy (RT), with or without concomitant chemotherapy. Primary endpoints were overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRRFS). Kaplan-Meier estimates, multivariable Cox regression models, and a 1:1 matched-pair analysis were applied. Residual confounding was quantified using E‑values.</p><p><strong>Results: </strong>The cohorts were well balanced, except for a higher prevalence of HPV-negative tumors (52% vs 42%, p = 0.004) and ECOG performance status > 1 (20% vs 9%, p = 0.004) in secondary hospitals. Median follow-up was 34 months. OS (median 35.5 vs 32 months; HR 0.90, 95% CI 0.72-1.12) and PFS (29 vs 21.5 months; HR 0.86, 95% CI 0.69-1.07) did not differ significantly between groups. LRRFS was shorter in secondary hospitals (32 vs 25.5 months; HR 1.25, 95% CI 1.06-1.48; p = 0.05), which may partly be explained by the higher rate of HPV-negative tumors in this cohort. Sensitivity analyses indicated that residual confounding may still have contributed to this difference. Multivariable analysis identified ECOG > 1 (HR 3.29), HPV negativity (HR 2.56), R2 resection status (HR 16.1 for PFS), and a cumulative cisplatin dose < 160 mg/m² (HR > 3) as independent prognostic factors.</p><p><strong>Conclusion: </strong>Radiotherapy for pharyngeal and laryngeal cancer achieved comparable OS and PFS in tertiary and secondary hospitals that adhere to current quality benchmarks. The observed difference in locoregional control, which was limited to the primary (non-surgical) cohort, is consistent with the higher proportion of HPV-negative and functionally impaired patients treated in secondary hospitals. Residual imbalance after adjustment and matching indicates that unmeasured clinical or treatment-related factors may also contribute. Prompt initiation of RT and adequate cumulative cisplatin dosing remain critical.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1037-1047"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inverse treatment planning using deep learning-based organs at risk in radiotherapy for head and neck cancer: a prospective planning study.","authors":"Tristan Bauer, Oliver Weinhold, Ulrich Schratzenstaller, Andrei Bunea, Joshua Giambattista, Jon Giambattista, Alexandros Papachristofilou, Tobias Finazzi","doi":"10.1007/s00066-026-02519-y","DOIUrl":"10.1007/s00066-026-02519-y","url":null,"abstract":"<p><strong>Purpose: </strong>Radiotherapy (RT) planning for head and neck squamous cell carcinoma (HNSCC) is known to be both challenging and time-consuming. Deep learning (DL)-based auto-segmentation of organs at risk (OARs) may streamline this procedure, although studies have mainly evaluated the geometric accuracy of DL-based contours. Here, we report on a prospective study of inverse treatment planning using DL-based OARs in HNSCC.</p><p><strong>Methods: </strong>This prospective single-center study enrolled 25 patients undergoing definitive or postoperative (chemo-)radiotherapy for HNSCC. Deep learning-based OAR contours were generated using a commercially available auto-segmentation software and rated independently by four radiation oncologists. Clinical RT plans were compared with plans that were re-optimized based on DL-based OARs, while the clinical target volumes (CTV) and planning target volumes (PTV) were kept unchanged. Dosimetric parameters for CTV/PTV and manually delineated OARs were compared using Wilcoxon's signed-rank test.</p><p><strong>Results: </strong>A total of 259 DL-based contours were rated, with mean scores of > 4 (acceptable with corrections) for all structures. For CTV/PTV coverage, the mean dosimetric differences between clinical and DL-based plans were < 1 Gy for all parameters (D95%, D98%, D2%, Dmean). Similarly, differences between doses to \"true\" (manual) OARs were largely negligible, with one non-critical outlier observed for the spinal cord. All DL-based treatment plans were deemed clinically acceptable after manual review.</p><p><strong>Conclusion: </strong>Inverse treatment planning using DL-based OARs in head and neck RT is feasible and results in clinically acceptable plans. Larger studies are required to confirm these results and to move further toward fully automated workflows.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1029-1036"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helical intensity-modulated radiation therapy vs. C-arm-based volumetric modulated arc therapy for sinonasal tumours: organ at risk sparing and treatment efficiency.","authors":"Sandeep Singh, Supratik Sen, Dipesh, Abhay Kumar Singh, Manindra Bhushan, Soniya Pal, Anuj Vijay, Benoy Kumar Singh, Raj Pal Singh, Sarthak Tandon, Munish Gairola","doi":"10.1007/s00066-026-02563-8","DOIUrl":"10.1007/s00066-026-02563-8","url":null,"abstract":"<p><strong>Background and purpose: </strong>Sinonasal tumours present major radiotherapy challenges because of their proximity to the optic nerves, chiasm, and brainstem. This study aimed to evaluate helical intensity-modulated radiation therapy (HIMRT) and volumetric modulated arc therapy (VMAT), including coplanar and noncoplanar approaches, by integrating plan quality and treatment efficiency.</p><p><strong>Materials and methods: </strong>A retrospective planning analysis of 467 patients with sinonasal tumours was conducted using HIMRT and VMAT planning techniques, whereby HIMRT with jaw widths of 1.0, 2.5, and 5.0 cm were compared with coplanar and noncoplanar VMAT plans. The planning evaluation included dose coverage (D95, D98, D2, D50%), homogeneity index, and dose spillage metrics (V10-V90%). Organ-at-risk doses were assessed for the optic apparatus, brainstem, and parotids. Efficiency was evaluated via monitor units and beam-on time, whereas delivery accuracy was validated via OSL dosimetry and gamma analysis.</p><p><strong>Results: </strong>Both techniques achieved conformal dose coverage and OAR sparing. While HIMRT with narrow jaws improved conformity, it required substantially longer beam-on times. The VMAT plans provided comparable coverage and OAR protection with fewer hotspots, and they delivered treatment in less time. Noncoplanar VMAT offered only minor gains. Phantom validation confirmed the dose delivery accuracy, with OSLD deviations < 5% and gamma passes rates > 97%.</p><p><strong>Conclusion: </strong>While HIMRT and VMAT are both effective for sinonasal radiotherapy, VMAT offers superior efficiency with comparable plan quality. Therefore, HIMRT may be reserved for anatomically complex cases where marginal conformity benefits justify longer treatment times.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1060-1070"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy for Merkel cell carcinoma: recommendations from the DEGRO Dermatooncology Working Group.","authors":"Khaled Elsayad, Isabel Falke, Maike Trommer, Tina Jost, Alexander Rühle, Ahmed Gawish, Siyer Roohani, André Glowka, Markus Hecht, Eleni Gkika, Kathrin Hering, Laila König, Stefanie Corradini, Hans Theodor Eich, Dirk Vordermark","doi":"10.1007/s00066-026-02587-0","DOIUrl":"10.1007/s00066-026-02587-0","url":null,"abstract":"<p><p>Merkel cell carcinoma (MCC) is a rare malignancy with an annual incidence in Germany of 5.2 per million for men and 3.8 per million for women, predominantly affecting sun-exposed areas in older adults. Despite a frequently unfavorable prognosis, outcomes are multifactorial and depend on tumor site, disease stage, performance status, patient age, sex, and immune competence. The current standard of care prescribes surgical resection followed by adjuvant radiotherapy of the tumor bed, ideally initiated within 8 weeks after surgery to optimize clinical outcomes. In case of lymph node involvement, lymph node dissection and/or radiotherapy of the involved nodal basin are recommended. Furthermore, new evidence supports the effectiveness of shorter radiotherapy approaches, with moderate hypofractionated or even ultrahypofractionated schedules serving as effective options for certain patients, particularly those with frailty or comorbidities, or when it is clinically necessary to minimize the treatment burden. In cases of inoperability, refusal of surgery, or significant frailty, definitive local radiotherapy can achieve sufficient disease control. The synergistic potential of combining immunotherapy with radiation in advanced cases remains a key area for ongoing research.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1003-1010"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Intraprostatic gene therapy with aglatimagene as an adjunct to radiotherapy].","authors":"David Krug, Jürgen Dunst","doi":"10.1007/s00066-026-02573-6","DOIUrl":"10.1007/s00066-026-02573-6","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1094-1096"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendation of the DEGRO Head and Neck Cancer Working Group: proton versus photon radiotherapy for oropharyngeal cancer in the context of contradictory phase III evidence.","authors":"Sabrina Reichl, Sebastian Adeberg, Simon Böke, Patrick Clemens, Benjamin Frey, Maja Guberina, Marlen Haderlein, Markus Hecht, Thomas Held, Mechthild Krause, Annett Linge, Alexander Rühle, Christoph Süß, Silke Tribius, Esther G C Troost, Panagiotis Balermpas","doi":"10.1007/s00066-026-02588-z","DOIUrl":"10.1007/s00066-026-02588-z","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1011-1015"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DEGRO consensus framework for undergraduate radiation therapy teaching in Germany: a white paper with integrated guidance on artificial intelligence in medical education.","authors":"Philipp Linde, Biney Pal Singh, Maria Neu, Johannes Gollrad, Martin Bischoff, Gustavo R Sarria, Annett Linge, Nanna E Wielenberg, Anna-Lena Hillebrecht, Laura Höng, Martin Leu, Jörg Andreas Müller, Lukas Fabian Boehme, Anne Caroline Knöchelmann, Jan-Niklas Becker, Klaus Herfarth, Sonia Drozdz, Matthias Mäurer, Ina Patties, Daniel Fleischmann, Daniel Schmottermeyer, Alexander Fabian, Bernd Frerker, Sebastian Heß, Michael Oertel, Hendrik Dapper","doi":"10.1007/s00066-026-02575-4","DOIUrl":"10.1007/s00066-026-02575-4","url":null,"abstract":"<p><strong>Background and purpose: </strong>Undergraduate medical education is increasingly competency-based, digital, and interprofessional in accordance with the National Competence-Based Learning Objectives Catalogue for Medicine (Nationaler Kompetenzbasierter Lernzielkatalog Medizin, NKLM). Against this background, a nationally relevant, consensus-based framework for undergraduate radiation therapy education in Germany was developed by an expert panel of faculty representatives, aligned with the competencies expected at the end of the practical year (PJ) and in the final state examination context (M3), and complemented by guidance on the responsible educational use of artificial intelligence (AI).</p><p><strong>Methods: </strong>The framework was prepared by the German Society of Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) working group \"Medical Education\" (AG Lehre), including a consolidated master document and 16 teaching portfolios that informed 15 candidate competencies. In a second step, 25 formally delegated representatives from 22 of the 36 university radiation oncology departments in Germany participated in a structured expert consensus process incorporating individual prioritization, small-group refinement, plenary consolidation, predefined voting thresholds, and postworkshop editorial integration.</p><p><strong>Results: </strong>The resulting framework comprised four components: (1) nine prioritized core competencies defining a national minimum standard at the PJ/M3 level; (2) implementation bandwidths (minimal, recommended, best practice) anchored in anonymized site-profile data; (3) a staged A/B/C assessment model aligned with the Miller pyramid; and (4) integrated AI guidance defining permitted use cases, nonnegotiable boundaries, AI literacy goals, and a practical educator-facing implementation logic. The tumor board was identified as a particularly suitable integrative teaching format.</p><p><strong>Conclusion: </strong>This white paper presents a nationally coordinated, competency-oriented framework for undergraduate radiation therapy education that combines a stable core with scalable local implementation options. By linking essential competencies, teaching bandwidths, staged assessment, and responsible AI guidance, greater consistency, coherence, and practical implementation of radiation therapy teaching across heterogeneous faculties is facilitated.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1016-1028"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of late genitourinary toxicity after definitive radiotherapy with or without intraprostatic simultaneous integrated boost in patients with prior transurethral resection of the prostate.","authors":"Cem Onal, Gurcan Erbay, Aysenur Elmali, Isa Gokturk Balci, Birhan Demirhan, Ozan Cem Guler","doi":"10.1007/s00066-026-02611-3","DOIUrl":"https://doi.org/10.1007/s00066-026-02611-3","url":null,"abstract":"<p><strong>Background: </strong>Patients with prior transurethral resection of the prostate (TURP) are considered at increased risk of genitourinary (GU) toxicity following radiotherapy (RT). However, the safety of focal dose escalation using simultaneous integrated boost (SIB) in this surgically altered prostate remains insufficiently defined. This study evaluated late GU toxicity in prostate cancer (PCa) patients with prior TURP treated with definitive RT, compared outcomes between SIB and non-SIB approaches, and identified clinical predictors of late GU toxicity.</p><p><strong>Materials and methods: </strong>We performed a retrospective analysis of a prospectively maintained institutional database including PCa patients with prior TURP treated with definitive external beam RT between October 2012 and March 2023. Patients received conventionally fractionated RT, with 78 Gy in 39 fractions delivered to the prostate in the non-SIB group and an intraprostatic SIB up to 86 Gy in 39 fractions in the SIB group. Late GU toxicity was graded according to CTCAE version 5.0. Time-to-event outcomes were estimated using Kaplan-Meier analysis, and logistic regression models were used to identify predictors of late grade ≥ 2 and grade ≥ 3 GU toxicity.</p><p><strong>Results: </strong>A total of 201 patients were included, of whom 98 (48.8%) received intraprostatic SIB and 103 (51.2%) received standard-dose RT. After a median follow-up of 9.5 years (IQR 8.3-10.7), the overall incidence of late grade ≥ 2 and grade ≥ 3 GU toxicity was 18.0% and 11.9%, respectively. The estimated 5‑year incidence of grade ≥ 2 GU toxicity was 41.8% in the SIB group and 28.5% in the non-SIB group (p = 0.13), while corresponding grade ≥ 3 toxicity rates were 13.8% and 12.1%, respectively (p = 0.98). Acute grade ≥ 2 GU toxicity occurred less frequently with SIB than without SIB (35.7% vs. 51.9%, p = 0.03). Acute grade ≥ 2 gastrointestinal toxicity was also less frequent in the SIB group (5.1% vs. 17.5%, p = 0.006), whereas late grade ≥ 2 gastrointestinal toxicity was comparable between groups (4.1% vs. 5.8%, p = 0.57). On multivariable analysis, anticoagulant use (OR 2.65, 95% CI 1.39-5.09; p = 0.03), acute grade ≥ 2 GU toxicity (OR 3.36, 95% CI 1.66-6.80; p < 0.001), and multiple TURP procedures (OR 2.28, 95% CI 1.04-5.90; p = 0.04) independently predicted late grade ≥ 2 GU toxicity. Multiple TURP procedures were the only independent predictor of grade ≥ 3 toxicity (OR 3.93, 95% CI 1.93-9.23; p < 0.001).</p><p><strong>Conclusions: </strong>In patients with prior TURP treated with definitive RT, no statistically significant association was observed between intraprostatic SIB and late GU toxicity. Multiple TURP procedures were associated with greater late GU morbidity. However, clinically relevant excess toxicity with SIB cannot be excluded, and these findings should not be interpreted as evidence of equivalence or definitive safety.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-adaptational motion during online adaptive radiotherapy: analysis of couch shifts and implications for margin design.","authors":"Johannes Hecking, Hanna Malygina, Jan Palm, Bryan Salazar Zuniga, Sven Knobe, Yvonne Dzierma, Markus Hecht, Hendrik Auerbach","doi":"10.1007/s00066-026-02609-x","DOIUrl":"https://doi.org/10.1007/s00066-026-02609-x","url":null,"abstract":"<p><strong>Purpose: </strong>Online adaptive radiotherapy (oART) minimizes inter-fractional variation, yet intra-fractional motion (IFM) remains a source of uncertainty. We quantified intra-adaptational motion (IAM) using routinely recorded couch shifts between pre-adaptation (CBCT1) and pre-treatment (CBCT2) scans to derive motion-related components of the CTV-PTV margins in a large clinical cohort.</p><p><strong>Methods: </strong>We retrospectively analyzed 1378 fractions from 69 prostate cancer patients treated with 60 Gy in 20 fractions as oART on the Varian Ethos platform (vision 1.1; Varian Medical Systems, Palo Alto, CA, USA). Couch shifts were calculated based on rigid registration targeting the CTV. Systematic and random errors were calculated for right-left (RL), anterior-posterior (AP), and superior-inferior (SI) directions. Margins were estimated using the van Herk formula. Correlations between couch shifts and the CBCT1-CBCT2 time interval were assessed using Spearman's ρ.</p><p><strong>Results: </strong>Couch shifts showed substantial inter-patient variability. Population mean, systematic, and random errors ranged from 0.05 to 1.4 mm, 0.6 to 1.3 mm, and 1.0 to 1.4 mm, respectively. The mean adaptation time was 17.5 ± 5.1 min (median: 16.6 min, interquartile range [IQR]: 14.0-20.3 min). The resulting IAM-related margins were 2.3 (R), 2.2 (L), 2.2 (S), 3.2 (I), 2.9 (A), and 5.7 mm (P). Positive correlations were observed between the time interval and motion in AP (ρ = 0.26), SI (ρ = 0.30), and vector magnitude (ρ = 0.29; all p < 0.001).</p><p><strong>Conclusion: </strong>Intra-adaptational motion varies substantially between patients, supporting the consideration of patient-specific margins. Verification CBCT2 is essential in oART due to potentially large positional shifts occurring during the adaptation process. The calculated margins represent upper bounds for motion-related margins, as they incorporate registration errors and cover longer intervals than actual beam delivery.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in long-term survivors treated with stereotactic cranial radiotherapy for brain metastases.","authors":"Robert Förster, Paul Windisch, Daniel R Zwahlen, Christina Schröder","doi":"10.1007/s00066-026-02608-y","DOIUrl":"https://doi.org/10.1007/s00066-026-02608-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to characterize long-term intracranial control, recurrence patterns, radiation necrosis (RN) risk, and treatment intensity among patients with ≥ 24 months of follow-up after stereotactic cranial radiotherapy (SRT).</p><p><strong>Methods: </strong>We conducted a retrospective review of patients treated with SRT at a single institution from 2018 to 2023. Eligible patients received at least one course of SRT and had ≥ 104 weeks of follow-up. Clinical, treatment, and radiologic data were collected as well as in-field and out-of-field failure, RN incidence and management, survival, and treatment patterns over time.</p><p><strong>Results: </strong>Fifty-one patients met the inclusion criteria, contributing 130 SRT courses treating 241 lesions. Median follow-up was 33.8 months. Most patients (51%) had non-small cell lung cancer, and 80% received systemic therapy after initial SRT. In-field failure occurred in 16.2% of lesions and 47.1% of patients, with higher failure rates in resection cavities than in intact metastases. Out-of-field failure occurred in 47.1% of patients, most commonly managed with additional SRT. The 2‑year in-field and out-of-field recurrence-free rates were 47.7% and 56.6%, respectively. Radiation necrosis developed in 21 lesions (8.7%), with substantially higher incidence in resection cavities (29.4%) and re-irradiated targets. Median time to RN was 11.2 months, and 38% required surgical intervention. Five-year overall survival was 67.8%.</p><p><strong>Conclusion: </strong>Among long-term survivors treated with SRT, both intracranial recurrence and RN remain clinically significant. As patient survival improves, individualized surveillance, careful consideration of cumulative radiation exposure, and optimized re-irradiation strategies are essential to minimize toxicity while maintaining durable intracranial control.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}