Strahlentherapie und Onkologie最新文献

{"title":"Prognostic significance of the mEPE score in intermediate-risk prostate cancer patients undergoing ultrahypofractionated robotic SBRT.","authors":"Lucas Mose, Laura Isabel Loebelenz, Alexander Althaus, Maiwand Ahmadsei, Etienne Mathier, Isabelle Broemel, Daniel M Aebersold, Verena Carola Obmann, Mohamed Shelan","doi":"10.1007/s00066-024-02355-y","DOIUrl":"10.1007/s00066-024-02355-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the prognostic significance of magnetic resonance imaging (MRI) parameters on biochemical failure-free survival (BFS) in patients diagnosed with intermediate-risk prostate cancer and treated with robotic ultrahypofractionated stereotactic body radiotherapy (SBRT) without androgen deprivation therapy (ADT).</p><p><strong>Methods: </strong>A retrospective analysis was conducted in patients with intermediate-risk prostate cancer undergoing robotic SBRT delivered in five fractions with a total radiation dose of 35-36.25 Gy. The primary endpoint was biochemical failure as defined by the Phoenix criteria. Among other clinicopathological data, T stage, Prostate Imaging-Reporting and Data System (PI-RADS) score, and multiparametric magnetic resonance imaging-based extra-prostatic extension (mEPE) score were collected and analyzed using the log-rank test.</p><p><strong>Results: </strong>A total of 74 patients were eligible for analysis. Median age at treatment was 68.8 years and median prostate volume was 47.8 cm³. Fifty-four and 14 patients were diagnosed with Gleason scores 7a and 7b, respectively. In total, 40 patients were classified as having unfavorable intermediate-risk prostate cancer according to American Urological Association/American Society for Radiation Oncology/ Society of Urologic Oncology (AUA/ASTRO/SUO) guidelines. The median follow-up was 30 months (range: 4-91.2 months; interquartile range (IQR): 18.5-48 months). The 3‑year BFS was 92%. A total of 12 (16.2%) biochemical failures were reported. In univariate analysis, an mEPE score of 5, the delivered total radiation dose (35 Gy vs. 36.25 Gy), and a prostate-specific antigen (PSA) nadir >1 ng/ml were associated with lower BFS (mEPE-BFS: p < 0.001, total radiation dose-BFS: p = 0.04, PSA nadir-BFS: p =< 0.001).</p><p><strong>Conclusion: </strong>Patients diagnosed with intermediate-risk prostate cancer with a high mEPE score are more likely to experience biochemical failure after SBRT. Treatment intensification measures, such as administration of concomitant ADT, should be considered.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"808-817"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984827","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":"Analysis of fetal dose exposure by modern radiation therapy in pregnant patients with supradiaphragmatic Hodgkin lymphoma-a phantom-based simulation.","authors":"Gina M Smeets, Isabel Vogt, Heidi Wolters, Christopher Kittel, Dominik A Hering, Fabian M Troschel, Gabriele Reinartz, Burkhard Greve, Uwe Haverkamp, Michael Oertel, Hans T Eich","doi":"10.1007/s00066-025-02440-w","DOIUrl":"https://doi.org/10.1007/s00066-025-02440-w","url":null,"abstract":"<p><strong>Purpose: </strong>Modern involved-site radiotherapy (ISRT) for Hodgkin lymphoma decreases toxicity through reduced field sizes and radiation doses. However, in pregnancy, the therapeutic benefit has to be weighed against putative harm to the mother and the fetus, as even small doses may have deleterious effects. We conducted a phantom-based simulation to analyze uterine dose exposure from cervical and mediastinal ISRT.</p><p><strong>Methods: </strong>Cervical and mediastinal ISRT target volumes were contoured to calculate three comparison plans (3D-conformal radiotherapy [3D-CRT], intensity-modulated radiotherapy [IMRT], volumetric intensity-modulated arc therapy [VMAT]). Thermoluminescent dosimeters (TLD) were placed within a humanoid Alderson phantom to simulate early and late pregnancy. Overall, six measurements (two for every radiotherapy plan) with 38 TLD were conducted.</p><p><strong>Results: </strong>In early pregnancy, cervical ISRT treatment of 19.8 Gray (Gy) resulted in median fetal exposures of 8.8 mGy, 15.4 mGy, and 9.9 mGy for 3D-CRT, IMRT, and VMAT, respectively, with significant differences between the three techniques (p < 0.001) and increased doses in late pregnancy (p < 0.001). For mediastinal ISRT (19.8 Gy), early pregnancy doses were 44 mGy, 63.8 mGy, and 60.5 mGy for 3D-CRT, IMRT, and VMAT, respectively, again with significant differences (p < 0.001) and a significant increase (p < 0.001) in late pregnancy. In comparison, values of 214.2 mGy (3D-CRT), 249.9 mGy (IMRT), and 249.9 mGy (VMAT) were reached using 30.6 Gy, with significant differences between 3D-CRT and VMAT (p < 0.001), 3D-CRT and IMRT (p < 0.001), and IMRT and VMAT (p = 0.004).</p><p><strong>Conclusion: </strong>Using RT during pregnancy may have deleterious effects on the fetus and should be deferred until after birth whenever possible. Theoretical uterine RT doses are low overall and only exceeded safety thresholds with higher-dose intensity-modulated plans. The indication for RT in pregnancy always requires careful risk-benefit consideration and individualized planning.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761390","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":"CBCT-based online adaptive radiotherapy of the prostate bed: first clinical experience and comparison to nonadaptive conventional IGRT.","authors":"J Fischer, L A Fischer, J Bensberg, N Bojko, M Bouabdallaoui, J Frohn, P Hüttenrauch, K Tegeler, D Wagner, A Wenzel, D Schmitt, M Guhlich, M Leu, R El Shafie, G Stamm, A-F Schilling, L H Dröge, S Rieken","doi":"10.1007/s00066-024-02323-6","DOIUrl":"10.1007/s00066-024-02323-6","url":null,"abstract":"<p><strong>Purpose: </strong>Conventional image-guided radiotherapy (IGRT) of the prostate bed is challenged by the varying anatomy due to dynamic changes of surrounding organs such as the bladder and rectum. This leads to changed dose coverage of target and surrounding tissue. The novel online adaptive radiotherapy (oART) aims to improve target coverage as well as reduce dose exposure to surrounding healthy tissues by daily reoptimization of treatment plans. Here we set out to quantify the resulting changes of this adaptation for patients and treatment team.</p><p><strong>Methods: </strong>A total of 198 fractions of radiotherapy of the prostate bed (6 patients) were treated using oART with the Ethos accelerator (Varian Medical Systems, Palo Alto, CA, USA). For each fraction, volumes and several dose-volume parameters of target volumes and organs at risk were recorded for the scheduled plan (initial plan, recalculated based on daily cone beam computed tomography [CBCT]), the adapted plan, and the verification plan, which is the dose distribution of the applied plan recalculated on the closing CBCT after the adaptation process. Clinical acceptability for all plans was determined using given dose-volume parameters of target volumes. Additionally, the time needed for the adaptation process was registered and compared to the time required for the daily treatment of five conventional IGRT patients.</p><p><strong>Results: </strong>Volumes of target and organs at risk (OAR) exhibited broad variation from day to day. The differences in dose coverage D_98% of the clinical target volume (CTV) were significant through adaptation (p < 0.0001; median D_98% 97.1-98.0%) and further after verification CBCT (p < 0.001; median D_98% 98.1%). Similarly, differences in D_98% of the planning target volume (PTV) were significant with adaptation (p < 0.0001; median D_98% 91.8-96.5%) and after verification CBCT (p < 0.001; median D_98% 96.4%) with decreasing interquartile ranges (IQR). Dose to OAR varied extensively and did not show a consistent benefit from oART but decreased in IQR. Clinical acceptability increased significantly from 19.2% for scheduled plans to 76.8% for adapted plans and decreased to 70.7% for verification plans. The scheduled plan was never chosen for treatment. The median time needed for oART was 25 min compared to 8 min for IGRT.</p><p><strong>Conclusion: </strong>Target dose coverage was significantly improved using oART. IQR decreased for target coverage as well as OAR doses indicating higher repeatability of dose delivery using oART. Differences in doses after verification CBCT for targets as well as OAR were significant compared to adapted plans but did not offset the overall dosimetric gain of oART. The median time required is three times higher for oART compared to IGRT.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"767-778"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584351","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":"Intensity modulated radiation therapy in prostate cancer-Better survival with higher total dose?","authors":"Artem Trofymov, Thomas Bschleipfer, Thomas Aigner, Gerhard G Grabenbauer","doi":"10.1007/s00066-025-02392-1","DOIUrl":"10.1007/s00066-025-02392-1","url":null,"abstract":"<p><strong>Background and purpose: </strong>For patients with intermediate and high-risk prostate cancer, radiation treatment is a well-established alternative to surgery. Modern techniques, such as intensity-modulated radiation therapy and volumetric modulated arc therapy, allow for precise dose escalation to the tumor while minimizing exposure to surrounding healthy tissues. The purpose of this analysis was to assess the safety and efficacy of two different radiation treatment protocols (high dose vs low dose) in prostate cancer patients across all risk categories.</p><p><strong>Patients and methods: </strong>Between 2015 and 2021, a total of 300 consecutive patients with localized adenocarcinoma of the prostate underwent intensity-modulated radiation therapy and volumetric modulated arc therapy at this institution. The study's endpoints were overall survival, prostate cancer specific overall survival, metastases-free survival, biochemically no evidence of disease survival rates as well as acute and long-term toxic effects. Influence of patient- and treatment-related parameters, including risk stratification (low and medium vs. high risk), radiation therapy dose levels (< 76 Gy vs. ≥ 76 Gy), radiation therapy duration (≤ 51 days vs. > 51 days), treatment with or without elective node irradiation, and the use of concurrent androgen deprivation therapy was evaluated by the log-rank-test and using multivariate Cox-analysis.</p><p><strong>Results: </strong>Overall survival, prostate cancer specific overall survival, metastases-free survival and biochemically no evidence of disease survival rates were 88%, 96%, 94%, 92% and 56%, 76%, 90%, 75% at 5 and 10 years, respectively. Univariate analysis identified a significant impact of total dose and androgen deprivation therapy. Overall survival rates for patients with a total radiation dose ≥ 76 Gy were 92% and 59% at 5 and 10 years, respectively, in comparison with patients receiving a total dose of < 76 Gy having a 5-year overall survival of 82% and a 10-year of overall survival 52% (p=0.012). Androgen deprivation therapy had an impact on overall survival with a 5-year of 90% and a 10-year of 57% survival rates, in comparison to a group without androgen deprivation therapy that had a significantly lower 5-year overall survival of 79.8% and a 10-year overall survival of 23.8% (p=0.041). In multivariate analysis, total radiation dose remained of significant impact on overall survival (p=0.022) and risk grouping (p=0.026) on biochemically no evidence of disease survival. Regarding toxicity, Grade II and III late genitourinary toxicity was observed in 13 patients (4.3%), and late gastrointestinal toxicity of similar grade affected 12 patients (4%) in the cohort.</p><p><strong>Conclusion: </strong>Data from this retrospective analysis underscore the highly relevant influence of total dose in contemporary radiation treatment of patients with prostate cancer.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"837-845"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014209","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":"Optimizing treatment for Gleason 10 prostate cancer: radiation dose escalation and ⁶⁸Ga-PSMA-PET/CT staging.","authors":"Cem Onal, Ozan Cem Guler, Birhan Demirhan, Petek Erpolat, Aysenur Elmali, Melek Yavuz","doi":"10.1007/s00066-025-02376-1","DOIUrl":"10.1007/s00066-025-02376-1","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the effects of dose escalation through focal boost (FB) to intraprostatic lesions (IPLs) as well as the role of gallium-68 prostate-specific membrane antigen positron-emission tomography (⁶⁸Ga-PSMA-PET/CT) for staging and treatment planning in patients with Gleason score (GS) 10 prostate cancer (PCa) receiving definitive radiotherapy (RT) and androgen deprivation therapy (ADT).</p><p><strong>Materials and methods: </strong>We retrospectively analyzed data of 92 patients with GS 10 PCa who underwent definitive RT and ADT from March 2010 to October 2022. Freedom from biochemical failure (FFBF), prostate cancer-specific survival (PCSS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method. Survival outcomes were compared between patients staged with ⁶⁸Ga-PSMA-PET/CT and those staged with conventional imaging modalities as well as between those who received a simultaneous integrated boost (SIB) and those who did not.</p><p><strong>Results: </strong>At a median follow-up time of 73 months, the 5‑year FFBF, PCSS, DMFS, and OS rates were 59.2%, 77.0%, 62.9%, and 67.6%, respectively. Disease progression was observed in 39 patients (42.4%), with most cases manifesting as distant metastasis (DM). A total of 56 patients (60.9%) were staged using ⁶⁸Ga-PSMA-PET/CT, while 43 patients (46.7%) received FB to IPLs. Patients staged with ⁶⁸Ga-PSMA-PET/CT had better FFBF and PCSS compared to those staged with conventional imaging. Patients undergoing an SIB had improved PCSS and DMFS. In the multivariable analysis, an ADT duration of 18 months or more was associated with improved FFBF, PCSS, DMFS, and OS. Application of an SIB was an additional independent predictor for improved FFBF, while staging with ⁶⁸Ga-PSMA-PET/CT was associated with better PCSS.</p><p><strong>Conclusion: </strong>We found that long-term ADT, increasing the radiation dose to primary tumor, and staging with ⁶⁸Ga-PSMA-PET/CT improved clinical outcomes. Additional research is needed for validation.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"828-836"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531797","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":"[Stereotactic radiotherapy in functionally inoperable but technically resectable pancreatic cancer].","authors":"Gunther Klautke","doi":"10.1007/s00066-025-02429-5","DOIUrl":"10.1007/s00066-025-02429-5","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"857-858"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317872","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":"[HYDRA meta-analysis: hypofractionated radiotherapy for prostate cancer-have we reached our goal?]","authors":"Mohamed Shelan","doi":"10.1007/s00066-025-02427-7","DOIUrl":"10.1007/s00066-025-02427-7","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"854-856"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476697","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":"Prostate motion in magnetic resonance imaging-guided radiotherapy and its impact on margins.","authors":"Johannes Kusters, René Monshouwer, Peter Koopmans, Markus Wendling, Ellen Brunenberg, Linda Kerkmeijer, Erik van der Bijl","doi":"10.1007/s00066-024-02346-z","DOIUrl":"10.1007/s00066-024-02346-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study focused on reducing the margin for prostate cancer treatment using magnetic resonance imaging-guided radiotherapy by investigating the intrafractional motion of the prostate and different motion-mitigation strategies.</p><p><strong>Methods: </strong>We retrospectively analyzed intrafractional prostate motion in 77 patients with low- to intermediate-risk prostate cancer treated with five fractions of 7.25 Gy on a 1.5 T magnetic resonance linear accelerator. Systematic drift motion was observed and described by an intrafractional motion model. The planning target volume (PTV) margin was calculated in a cohort of 77 patients and prospectively evaluated for geometric coverage in a separate cohort of 24 patients.</p><p><strong>Results: </strong>The intrafractional model showed that the prostate position starts out of equilibrium for the anterior-posterior (-1.8 ± 3.1 mm) and superior-inferior (1.7 ± 2.6 mm) directions, with relaxation times of 12 and 15 min, respectively. Position verification scans are acquired at 30 min on average. At that time, the transient drift motion becomes indistinguishable from the residual random intrafractional motion. PTV margins can be reduced to 1.8 mm (left-right), 3.2 mm (anterior-posterior), and 2.9 mm (superior-inferior). Evaluation of the overlap with the clinical target volume (CTV) was performed for a total of 120 fractions of 24 patients. The overlap range between the CTV and the PTV was 93-100% and the applied 3‑mm PTV margin for the CTV had a 99.5% averaged geometric overlap for all patients.</p><p><strong>Conclusion: </strong>A PTV margin reduction to 3 mm is feasible. A patient-specific approach could reduce the margins further.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"799-806"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979877","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":"Development of a model to guide the decision for radiotherapy in deep-inspiration breath-hold in patients with left-sided breast cancer.","authors":"Annett Linge, Carina Ketzmerick, Kristin Gurtner, Cordelia Hoinkis, Steffen Löck, Mechthild Krause","doi":"10.1007/s00066-025-02438-4","DOIUrl":"https://doi.org/10.1007/s00066-025-02438-4","url":null,"abstract":"<p><p>Patients with left-sided breast cancer receiving radiotherapy are at risk of developing chronic cardiac toxicities. Cardiac dose-sparing techniques such as deep-inspiration breath-hold (DIBH) can reduce this risk. In this study, a model has been developed including tumor localization, left lung volume, and the distance between the heart and medial chest wall as well as age and Eastern Cooperative Oncology Group (ECOG) performance status, which may help to guide the decision for or against DIBH after planning computed tomography (CT) in free breathing directly before initiation of radiotherapy planning.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733272","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":"Is less more? Revisiting elective nodal irradiation in head and neck cancer.","authors":"M Haderlein, C Frei, T Weissmann, M Weber, R Lutz, A O Gostian, S K Müller, B Frey, R Fietkau","doi":"10.1007/s00066-025-02437-5","DOIUrl":"https://doi.org/10.1007/s00066-025-02437-5","url":null,"abstract":"<p><strong>Purpose: </strong>Radiotherapy is an important pillar of treatment for patients with locally advanced head and neck squamous cell carcinoma (HNSCC) in both adjuvant and definitive treatment. However, radiotherapy in the head and neck region is associated with relevant acute and late side effects. With the advent of modern radiotherapy and imaging techniques, numerous studies are underway to personalize radiotherapy with the aim of reducing toxicity while maintaining good control rates. Since the side effects of radiotherapy are often directly related to the irradiated volume, an important approach to individualizing radiotherapy is the reduction of elective nodal irradiation (ENI). Our aim was to provide an overview of published and ongoing studies investigating the de-escalation of radiotherapy in the elective lymphatic drainage areas of head and neck tumors.</p><p><strong>Methods: </strong>The literature search in MEDLINE, Web of Science, and clinicaltrials.gov was conducted using the following search terms in various combinations: head and neck cancer, elective nodal irradiation, de-escalation, and radiotherapy. Studies that included nasopharyngeal cancer or carcinomas with non-squamous histology were excluded.</p><p><strong>Results: </strong>Various approaches to deintensifying ENI have been investigated, ranging from ENI dose reduction, general dose reduction, and volume reduction to complete omission of ENI, with some studies using response-adjusted dose and/or volume reduction after induction chemotherapy or dose reduction depending on hypoxia measured by FMISO-PET scan or sentinel lymph nodes measured by SPECT-CT after 99mTc-nanocolloid injection around the primary tumor. All these phase II trials indicate that the recurrence rate outside the radiation field is low (up to 4%). Most recurrences occur in high-risk regions of the clinical target volume (CTV) and in distant regions. However, results of phase III trials are still pending.</p><p><strong>Conclusion: </strong>Reducing or even omitting ENI in patients with HNSCC seems to be a promising approach to de-escalation, but results of phase III trials are still pending.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699564","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}