Strahlentherapie und Onkologie最新文献

{"title":"The impact of vitreous humor: a new perspective on radiation-induced cataractogenesis.","authors":"Ecem Yigit, Irem Koc, Gozde Yazici, Ekim Gumeler, Aysenur Elmali, Alper Kahvecioglu, Fazli Yagiz Yedekci, Samiye Yabanoglu Ciftci, Meltem Karatas, Aysima Sezer, Hayyam Kiratli, Mustafa Cengiz","doi":"10.1007/s00066-025-02468-y","DOIUrl":"10.1007/s00066-025-02468-y","url":null,"abstract":"<p><strong>Purpose: </strong>The precise mechanisms underlying radiation-induced cataractogenesis remain incompletely understood. Increased oxidative stress is known to play a central role in cataract pathogenesis. The vitreous humor contributes to maintaining the hypoxic environment of the lens by regulating oxygen pressure and containing antioxidants. This study aims to explore the effect of radiation-induced changes in the vitreous humor on lens health, with a particular focus on its cataractogenic potential.</p><p><strong>Methods: </strong>In this experimental study, 12 New Zealand rabbits were utilized. A single 20-Gy dose of radiation was administered to the left eye's vitreous humor with a lens-sparing technique, while the right eye served as a control. Monthly ophthalmological evaluations were conducted over a 3-month period. At the end of the follow-up, orbital magnetic resonance imaging (MRI) was performed. Vitreous humor samples were analyzed using spectrophotometric methods to determine total oxidant and antioxidant levels.</p><p><strong>Results: </strong>Cataract formation was observed in two of the eight irradiated eyes (25%). The MRI analysis revealed a significant reduction in signal intensity within the left eye's aqueous humor in non-contrast sequences (p = 0.03), while an increase in signal intensity was observed in late post-contrast sequences (p = 0.04). Spectrophotometric analysis indicated that total oxidant levels (p = 0.04) and the oxidative stress index (p = 0.04) were significantly lower in the treatment group.</p><p><strong>Conclusion: </strong>These findings suggest that radiation-induced changes in the vitreous humor and posterior ocular structures may influence the anterior chamber, contributing to the development of radiation-induced cataracts.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"95-106"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131981","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":"Efficient workflow and clinical validation of in-house 3D-printed vaginal cylinders for high-dose-rate brachytherapy for gynecologic malignancies.","authors":"Shinya Komori, Yoshiaki Takagawa, Akihiko Takeuchi, Hiroki Sato, Takahiro Kato","doi":"10.1007/s00066-025-02451-7","DOIUrl":"10.1007/s00066-025-02451-7","url":null,"abstract":"<p><strong>Purpose: </strong>This study developed an efficient methodology for in-house 3D-printed vaginal cylinders for gynecologic tumor treatment by evaluating their radiation attenuation, geometric accuracy, and efficacy. Ultimately, we aim to establish a simple, cost-effective approach that facilitates broad clinical adoption.</p><p><strong>Methods: </strong>Patient-specific vaginal cylinders were designed based on anatomical contours from the treatment planning system (TPS) using CAD software. The process was optimized to minimize manpower and time costs. Radiation attenuation of the 3D printer material was compared with that of water using the Monte Carlo method. Geometric accuracy was automatically analyzed via an in-house MATLAB program. Efficacy was assessed in cases of postoperative vaginal stump recurrence and vaginal cancer with paravaginal invasion.</p><p><strong>Results: </strong>The tumor shape, delineated by TPS, was imported into CAD software, and the catheter pathway model, designed via subtraction processing, was placed at the optimal position and angle. The design process took approximately 15 min, and the entire workflow was completed within a week, demonstrating its practicality for clinical use. The radiation attenuation error was < 3% compared with water, and the geometric accuracy error was < 0.2 mm. The patient-specific vaginal cylinder provided a favorable dose distribution and was effective in complex cases.</p><p><strong>Conclusion: </strong>A feasible workflow was established, allowing in-house design and manufacturing with reduced manpower and time costs. With no material or processing issues, this approach is safe, practical, and promising for widespread adoption in personalized brachytherapy.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"52-67"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822657","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":"[Dose reduction of elective nodal irradiation in head and neck cancer: is it ready for routine clinical practice?]","authors":"Justus Kaufmann, Alexander Rühle, Simon Böke","doi":"10.1007/s00066-025-02473-1","DOIUrl":"10.1007/s00066-025-02473-1","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"112-114"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287073","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":"Implementing total skin electron irradiation in radiotherapy: a structured change management approach.","authors":"Andrea Baehr, Maximilian Grohmann, Volker Platz, Nina Booken, Cordula Petersen","doi":"10.1007/s00066-025-02408-w","DOIUrl":"10.1007/s00066-025-02408-w","url":null,"abstract":"<p><strong>Background: </strong>Total skin electron irradiation (TSEI) is a specialized radiotherapy technique used to treat cutaneous T‑cell lymphoma, including mycosis fungoides and Sézary syndrome. Despite its clinical benefits, TSEI is rarely implemented in clinical practice due to significant technical and organizational challenges. This study explores a structured approach to integrating TSEI into clinical routines by applying a comprehensive change management framework in a German radiotherapy department.</p><p><strong>Methods: </strong>The implementation process was based on Kotter's eight-step change management model and carried out from 2022 to 2024 by a multidisciplinary team. Key steps included creating a sense of urgency, forming a guiding coalition, developing and communicating a clear vision, and pilot testing to generate short-term successes. A dynamic stakeholder analysis was conducted to continuously identify and manage factors that could promote or hinder the change.</p><p><strong>Results: </strong>The structured approach facilitated integration of TSEI into routine practice. The project enabled comprehensive staff training, adaptation of technical workflows, and development of necessary protocols and equipment. Key milestones were achieved, including initial patient treatments and positive staff feedback, demonstrating the method's feasibility and acceptance. The stakeholder analysis was instrumental in reducing apprehensions and maintaining alignment among team members.</p><p><strong>Conclusion: </strong>This study demonstrates that a structured change management approach is effective in integrating complex techniques like TSEI into clinical practice. The findings highlight that a systematic framework can help to overcome organizational and technical challenges, thereby enhancing patient care and operational efficiency. Future efforts should continue to employ structured methodologies for the sustainable integration of new medical technologies.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"68-73"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080596","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":"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":"23-29"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819490/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic radiotherapy for spinal and non-spinal bone metastases: a patterns-of-care analysis in German-speaking countries as part of a project of the interdisciplinary Radiosurgery and Stereotactic Radiotherapy Working Group of the DEGRO/DGMP.","authors":"F Nägler, N Gleim, I Seiler, A Rühle, K Hering, C Seidel, E Gkika, D Krug, O Blanck, C Moustakis, T B Brunner, A Wittig-Sauerwein, N H Nicolay","doi":"10.1007/s00066-025-02387-y","DOIUrl":"10.1007/s00066-025-02387-y","url":null,"abstract":"<p><strong>Background and purpose: </strong>Bone metastases constitute a common indication for both conventional radiotherapy (RT) and stereotactic body radiotherapy (SBRT). Although in recent years guidelines have been proposed for SBRT of spinal and non-spinal metastases, little is known about the use of bone SBRT and the actual patterns of care in German-speaking countries.</p><p><strong>Material and methods: </strong>We performed an online survey among radiation oncologists (ROs) registered with the interdisciplinary Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and the German Society for Medical Physics (DGMP) to collect valuable and robust cross-sectional data on patterns of care for bone SBRT in German-speaking countries.</p><p><strong>Results: </strong>Of the registered ROs, 35.5% (75/211) completed the online survey. ROs working in high-volume centers irradiating more than 100 patients with bone metastases annually represented the largest group, with 58.7%. Ablative SBRT was mostly performed for bone oligometastases (78.7%). For symptom-directed palliative radiotherapy, the majority of responding physicians (84.3%) still mostly recommend moderately hypofractionated treatment. Nevertheless, 60.9% of participating ROs stated using bone SBRT at least occasionally, also for palliative purposes such as pain control. Our survey also revealed a certain reluctance for the concomitant use of systemic therapies with bone SBRT and heterogeneity regarding target volume definition and dosing for bone SBRT.</p><p><strong>Conclusion: </strong>Our survey demonstrates that bone SBRT for spinal and non-spinal metastases for oligometastatic disease (OMD) is broadly available in clinical routine care in German-speaking countries. A large heterogeneity regarding indications, dose, and fractionation concepts remains, requiring further efforts for standardization of bone SBRT.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"74-83"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658639","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":"Comparison of integral doses to normal tissue and organs at risk between interstitial high-dose-rate brachytherapy and modern external-beam radiotherapy techniques in breast and head and neck cancer patients.","authors":"Tibor Major, Csaba Polgár, Zoltán Takácsi-Nagy","doi":"10.1007/s00066-025-02382-3","DOIUrl":"10.1007/s00066-025-02382-3","url":null,"abstract":"<p><strong>Background: </strong>Although a cornerstone of modern cancer treatment, radiotherapy (RT) is associated with a risk of secondary cancer due to irradiation of non-target tissues. Techniques such as intensity-modulated RT (IMRT), volumetric modulated RT (VMAT), and stereotactic body RT (SBRT) provide highly conformal target dose distributions and reduce doses to nearby organs at risk (OARs), albeit at the cost of larger normal tissue volumes being irradiated with lower doses. In brachytherapy (BT), the low-value isodoses cannot be changed: they are a consequence of the inverse-square law. This study evaluates and compares the normal tissue integral doses (NTIDs) delivered by BT and modern external-beam RT (EBRT) techniques in breast and head and neck (H&N) cancer patients.</p><p><strong>Methods: </strong>Included were the BT and IMRT plans of 34 women with early-stage breast cancer treated with interstitial high-dose-rate (HDR) BT and two groups of head and neck (H&N) patients: 38 patients with mobile tongue, floor of the mouth, and base of the tongue cancer treated definitively with interstitial HDR BT for whom VMAT treatment plans were also prepared and 20 patients with tongue and floor of the mouth tumors who received postoperative interstitial HDR BT for whom VMAT and stereotactic CyberKnife (CK, Accuray Inc., Sunnyvale, CA, USA) plans were also created. The NTIDs for three normal tissue volumes (NT_V10, NT_V5, NT_V2) and OARs were calculated and compared.</p><p><strong>Results: </strong>Brachytherapy resulted in 39%, 32%, and 26% lower NTIDs compared to IMRT for NT_V10, NT_V5, and NT_V2, respectively, in patients with breast cancer. In H&N cancer, the NTIDs were always lower for BT compared to VMAT. The reductions in NTID achieved with BT were 45%, 36% and 27% with the same planning target volumes in BT and VMAT, and 56%, 48% and 37% with larger planning target volumes in VMAT. For CK, the NTID reductions were 54%, 49% and 41% compared to BT. In breast cases, BT resulted in a significant reduction in ipsilateral lung NTID, and in H&N cases, salivary glands NTIDs were always lower with BT than with VMAT.</p><p><strong>Conclusion: </strong>For patients with breast and head and neck cancer, interstitial BT results in lower integral dose to normal tissue and OARs compared to modern EBRT techniques. The clinical implications require further detailed investigation.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"30-39"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650895","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":"Carbon ion radiotherapy optimization techniques for pancreatic cancer: accounting for the effect of bowel gas variation.","authors":"Chaebeom Sheen, Sunghyun Lee, Bitbyeol Kim, Jaeman Son, Kyungsu Kim, Hyeongmin Jin","doi":"10.1007/s00066-025-02450-8","DOIUrl":"10.1007/s00066-025-02450-8","url":null,"abstract":"<p><strong>Background: </strong>Dose variation due to changes in bowel air poses significant challenges for carbon radiotherapy in pancreatic cancer. This retrospective study evaluated a density-override optimization technique to mitigate dosimetric uncertainties caused by bowel air changes.</p><p><strong>Materials and methods: </strong>Planning CT and cone-beam CT data from 8 patients with locally advanced pancreatic cancer undergoing stereotactic ablative radiotherapy were analyzed. Treatment simulations used a dose of 55.2 GyE in 12 fractions with a four-field setup (anterior, lateral, posterior, posterior oblique). Four density-override patterns were compared: pattern 0 (no override), pattern 1 (replacing bowel gas with water), pattern 2 (replacing the entire bowel with mean bowel HU), and pattern 3 (replacing bowel gas with mean bowel HU). Dose evaluations included fraction-wise and accumulated dose analyses, focusing on target coverage, homogeneity index, and organs at risk doses.</p><p><strong>Results: </strong>Pattern 2 achieved the largest clinical tumor volume coverage and the fewest fractions with > 5% coverage loss for the anterior beam, followed by pattern 3. However, pattern 2 demonstrated poorer homogeneity for the lateral beam compared to patterns 1 and 3 and a higher gastrointestinal (GI) dose for the anterior beam.</p><p><strong>Conclusion: </strong>This study evaluated the importance of density overrides to address bowel air variations. For patients where a more uniform dose is desirable or whose tumor is adjacent to the GI tract, a pattern 3 density-override should be considered.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"84-94"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969573","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":"[Is stereotactic radiotherapy a viable alternative to whole-brain irradiation for one to 10 brain metastases even in small cell lung cancer?]","authors":"Yvonne Dzierma, Guido Hildebrandt","doi":"10.1007/s00066-025-02467-z","DOIUrl":"10.1007/s00066-025-02467-z","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"107-108"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287045","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":"Assessment of needle bending and tracking requirements for optimized needle placement in combined intracavitary/interstitial gynecologic brachytherapy.","authors":"Andre Karius, Vratislav Strnad, Michael Lotter, Stephan Kreppner, Ricarda Merten, Rainer Fietkau, Christoph Bert, Claudia Schweizer","doi":"10.1007/s00066-025-02367-2","DOIUrl":"10.1007/s00066-025-02367-2","url":null,"abstract":"<p><strong>Purpose: </strong>Needle tracking using external prediction techniques such as optical tracking is a modern approach aimed at improving implantation accuracy in gynecologic brachytherapy. This study aims to investigate the corresponding impact of needle bending in situ and to analyze needle path deviations from the intended locations occurring in our current clinical workflow that only considers ultrasound imaging without tracking.</p><p><strong>Methods: </strong>We developed a semi-automated approach for reconstructing brachytherapy needles based on planning CTs and compared the respective accuracy to the also determined intra-observer variability of manual reconstructions. Based on this, we measured needle bending in situ for 89 patients and calculated the Euclidean distances between actual needle tips and needle tip predictions both longitudinally and laterally to the insertion direction. Furthermore, we compared actual and intended spacings between inserted needles to estimate implantation uncertainties with respect to our current clinical workflow.</p><p><strong>Results: </strong>Our developed reconstruction featured an accuracy of 0.17 ± 0.08 mm, which was improved compared to the intra-observer variability of 0.21 ± 0.11 mm. Needle bending depended strongly on needle length and ranged from 3.6 ± 2.1 mm for 100-120 mm needles up to 7.9 ± 3.0 mm for 200-220 mm needles. Deflections in the transverse direction were substantially higher than tip deviations in the longitudinal direction. Furthermore, we found deviations from an equidistant spacing between needle paths of 1.4 ± 1.2 mm in the transverse direction.</p><p><strong>Conclusion: </strong>Inserting brachytherapy needles can be substantially affected by transverse needle bending in situ, which should therefore be corrected for in prediction approaches such as optical tracking.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"40-51"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365981","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}