{"title":"Education as a Tool to Navigate Changing Technology in Radiation Oncology","authors":"Caitlin Gillan , Daniel A Low , Srinivas Raman","doi":"10.1016/j.semradonc.2025.150998","DOIUrl":"10.1016/j.semradonc.2025.150998","url":null,"abstract":"<div><div>While technological innovation in radiation therapy (RT) continues to accelerate, safe and equitable adoption of emerging tools is reliant on the readiness of the workforce and the robustness of associated educational frameworks. Early experience with disruptive technologies such as intensity-modulated RT (IMRT) has taught us that fragmented or insufficient education can create an implementation barrier. The IDEPTH framework (as illustrated here using the translation of IMRT from development to mainstream implementation) describes how development and implementation of new technologies requires coordinated involvement across academia, industry, professional associations, and clinical organizations. Emerging technologies, such as artificial intelligence (AI)-enabled workflows, magnetic resonance (MR)-integrated RT, adaptive radiotherapy and particle therapy will similarly require comprehensive and scalable approaches to education. Despite progress, significant heterogeneity still exists in access to education, integration into professional curricula, and ongoing requirements for competence. Central to this challenge is that the rate at which technology is developed often outpaces the rate at which curricula, accreditation standards, and certification processes are updated. Closing this gap will be most effectively met by increased emphasis on adaptable competencies such as technological literacy, critical evaluation, and effective human-technology interaction rather than mere device-specific skills. Also, the increasing role of automation means RT must also identify legacy skills whose education emphasis is reduced to allow time and attention to the latest technologies and treatment methods. The creation and maintenance of robust, forward-oriented education systems is crucial if future innovations within radiation oncology are to be integrated in ways that are safe and of high quality.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"37 ","pages":"Article 150998"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078530","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":"Advancing Equity, Diversity, and Inclusion in Medical Education: Implications For Radiation Oncology","authors":"Amanda Khan MD, PhD, FRCPC , Jennifer Croke MD, MHPE, FRCPC","doi":"10.1016/j.semradonc.2025.150997","DOIUrl":"10.1016/j.semradonc.2025.150997","url":null,"abstract":"<div><div>Equity, diversity and inclusion (EDI) have become foundational principles across healthcare organizations and medical education aiming to address historical systemic biases, promote representation and foster inclusive environments. These efforts have patients benefits including improved care and clinical outcomes, especially in minoritized populations. Despite recent advances, women and minority groups remain underrepresented radiation oncology training programs, leadership roles, and academic positions. Embedding EDI early in medical education and training is essential for diversifying the workforce, reducing barriers to entry, and preparing future physicians to deliver equitable care. Organizational and institutional efforts are also important and require strong leadership commitment, accountability and resource allocation. The paper provides an overview of EDI within medical education, with a focus on radiation oncology, and outlines strategies to advance equity, diversity, and inclusion across the specialty.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"37 ","pages":"Article 150997"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886069","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}
Felix Ehret , Charles Leland Rogers , James Fontanesi , George D. Wilson , Bhargava S. Chitti , John Starner , Baho Sidiqi , Anuj Goenka , Michael Schulder , Anna M.E. Bruynzeel , Joost J.C. Verhoeff , Alexander C. MacDonagh , Hannah I. Park , Helen A. Shih , Lawrence Kleinberg
{"title":"Radiation Therapy for Non-Malignant Central Nervous System Tumors, Disorders, and Illnesses — Current Applications and Future Directions","authors":"Felix Ehret , Charles Leland Rogers , James Fontanesi , George D. Wilson , Bhargava S. Chitti , John Starner , Baho Sidiqi , Anuj Goenka , Michael Schulder , Anna M.E. Bruynzeel , Joost J.C. Verhoeff , Alexander C. MacDonagh , Hannah I. Park , Helen A. Shih , Lawrence Kleinberg","doi":"10.1016/j.semradonc.2025.08.005","DOIUrl":"10.1016/j.semradonc.2025.08.005","url":null,"abstract":"<div><div>Radiation therapy has a central role in the treatment of various malignant central nervous system tumors, including gliomas, high-grade meningiomas, and brain metastases. This also applies to a plethora of non-malignant central nervous system lesions, such as vestibular schwannomas and arteriovenous malformations, and, in specific situations, for selected functional and psychiatric disorders. In patients with these conditions, the goal of radiation therapy is generally to preserve and stabilize function. In addition, as these illnesses, with some exceptions such as arteriovenous malformations, are rarely life-threatening, the risks of radiation therapy must be interpreted in a different context than for patients with malignancy. Given the continuous and growing interest in the use of radiation therapy for non-malignant tumors and functional conditions, this review summarizes the current and future directions in central nervous system applications, addressing its use for the management of vestibular schwannomas, arteriovenous malformations, trigeminal neuralgia, tremor, Alzheimer’s disease, and other psychiatric conditions, such as obsessive-compulsive disorder, addiction, and eating disorders.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 77-94"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747837","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}
Tony Y. Eng , Houda Bahig , Tiffany W. Chen , Karthik P. Meiyappan , David Roberge
{"title":"Radiation Therapy for Benign Diseases and Premalignant Conditions","authors":"Tony Y. Eng , Houda Bahig , Tiffany W. Chen , Karthik P. Meiyappan , David Roberge","doi":"10.1016/j.semradonc.2025.08.006","DOIUrl":"10.1016/j.semradonc.2025.08.006","url":null,"abstract":"<div><div>Radiation therapy (RT), traditionally reserved for malignant conditions, has emerged as a valuable tool in the management of select benign tumors and proliferative disorders. In clinical scenarios where surgery is not feasible, incomplete, or associated with significant morbidity, RT offers a noninvasive and effective alternative, often yielding excellent local control and long-term symptom relief. For instance, although surgery is relatively safe and effective, radiation is the preferred treatment for many patients with acoustic neuroma. Many benign entities have demonstrated favorable responses to radiation [<span><span>1</span></span>]. Among these, paragangliomas (PGL)—notably glomus jugulare tumors—have emerged as prime examples where RT plays a critical role. These tumors, while histologically benign, often present with local invasiveness, cranial nerve involvement, and high recurrence rates, making complete surgical resection difficult and frequently associated with significant morbidity. Beyond PGLs, RT has shown promise in a range of other benign conditions, including many benign vascular and lymphoid disorders [<span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>]. These entities, although benign, may behave in an infiltrative or recurrent manner, necessitating a multidisciplinary approach to treatment. In particular, localized lymphoid lesions may benefit from RT. This section focuses specifically on the role of RT in the management of PGL, pheochromocytoma (PCC), hemangioma, ameloblastoma, angiofibroma, Castleman disease, cutaneous pseudolymphoma, and adamantinoma. Other benign entities are discussed in a separate section of the current issue.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 95-113"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747838","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":"Genetic and Carcinogenic Risks of Radiotherapy for Nonmalignant Diseases","authors":"Jean L. Nakamura MD","doi":"10.1016/j.semradonc.2025.11.001","DOIUrl":"10.1016/j.semradonc.2025.11.001","url":null,"abstract":"<div><div>Radiotherapy is a valuable treatment option for a variety of nonmalignant diseases. As the indications for low-dose radiotherapy to benign conditions evolve, it is prudent to consider risks and how these might weigh against the benefits of therapy. Radiation-induced malignancies are one consideration and are more likely associated with higher doses of radiation and genetic cancer susceptibility. Radiotherapy for nonmalignant diseases typically involves doses much lower than those associated with radiation-induced malignancies. In addition, treatments are employed for conditions that are more common in the older patient population, whereas much of the historical experience with radiation-induced malignancies involves children and young adults. The low doses associated with radiotherapy for nonmalignant diseases and the patient population in whom these treatments are employed makes the estimated risk of radiation-induced carcinogenesis low. Specific factors that increase the concern for radiation-induced malignancies include repeated radiotherapy to the same site, leading to cumulative increasing dosage, radiotherapy in younger individuals, and those with known germline mutations in DNA repair genes.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 18-22"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747841","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}
Bobby N. Koneru , David A. Barron , Ralph Muecke , Richard Shaffer , Tarita O. Thomas , Mathias Sonnhoff , Robert M. Blach , David R. Steike , Lisa Deloch , Pranjal Kumar Singh , Heinrich Seegenschmiedt
{"title":"Periarticular Soft Tissue Disorders: Enthesopathies, Tendinopathies, and Bursitis—Pathophysiology and Radiotherapeutic Approaches","authors":"Bobby N. Koneru , David A. Barron , Ralph Muecke , Richard Shaffer , Tarita O. Thomas , Mathias Sonnhoff , Robert M. Blach , David R. Steike , Lisa Deloch , Pranjal Kumar Singh , Heinrich Seegenschmiedt","doi":"10.1016/j.semradonc.2025.10.002","DOIUrl":"10.1016/j.semradonc.2025.10.002","url":null,"abstract":"<div><div>Periarticular soft tissue disorders, encompassing enthesopathies, tendinopathies, and bursitis, contribute substantially to musculoskeletal pain and disability, particularly in adult populations. This chapter provides a comprehensive overview of the pathophysiology, clinical manifestations, and radiotherapeutic management of major periarticular syndromes, including painful shoulder syndrome, lateral epicondylitis, greater trochanteric pain syndrome, and plantar fasciitis. We detail how these conditions often present as a continuum of overlapping pathology at the enthesis, tendon, and peri‑tendinous structures, frequently driven by repetitive microtrauma, mechanical overload, degenerative changes, and low-grade inflammation. Emphasis is placed on the clinical and imaging features distinguishing key entities such as calcific tendinitis, enthesopathies, and bursitis. Special focus is given to the role of low-dose radiotherapy (LDRT) as an effective treatment option for refractory symptoms unresponsive or contraindicated to conservative management. Contemporary practice patterns, including patient selection, target volume delineation based on imaging, and technical variations between linear accelerator and orthovoltage techniques, are discussed. Data from recent prospective and retrospective studies are summarized, demonstrating notable pain reduction rates and functional improvement with LDRT, and outlining response rates, optimal dosage regimens, timing of re-irradiation, and age-based treatment considerations. The chapter concludes with practical recommendations for integrating radiotherapy into multimodal care pathways for periarticular soft tissue disorders, underscoring its utility in symptom control and functional restoration.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 48-60"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747835","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":"Low-Dose Radiotherapy for Osteoarthritis: Current Evidence, Practical Recommendations and Future Perspectives","authors":"Annika Schlamann , James B. Yu , Alexander Rühle","doi":"10.1016/j.semradonc.2025.07.001","DOIUrl":"10.1016/j.semradonc.2025.07.001","url":null,"abstract":"<div><div>Osteoarthritis (OA) is a widespread degenerative joint disease with increasing prevalence in aging populations. While conservative management such as physiotherapy, NSAIDs, and intraarticular injections form the mainstay of treatment, a significant proportion of patients, particularly elderly individuals or those unfit for surgery, remain symptomatic. Low-dose radiotherapy (LDRT) has re-emerged as a potential noninvasive therapeutic option based on its anti-inflammatory effects and favorable safety profile. This narrative review summarizes current clinical evidence, practical recommendations, and future directions for the use of LDRT in OA. Although some randomized controlled trials have reported no additional benefit of LDRT over sham treatment, these studies have been criticized for limited sample size, short follow-up duration, suboptimal patient selection, and deviation from standard LDRT protocols. Nevertheless, other randomized trials as well as large retrospective studies suggest clinically meaningful benefits in selected patients. Standard dosing regimens typically consist of 3.0-6.0 Gy delivered in 0.5-1.0 Gy fractions over 2-3 weeks, with a second course recommended in nonresponders. Practical considerations including patient selection, joint-specific dose planning, and patient education are essential to optimize outcomes. While the absolute risk of radiation-induced malignancy is considered negligible in elderly populations, safety measures such as shielding and cumulative dose monitoring are advised. Further large-scale, placebo-controlled studies are needed to clarify optimal dose, timing, and synergistic effects with pharmacological therapies to strengthen the role of LDRT in OA management.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 39-47"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747836","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}
Isabel Falke MD , Ulrich Schäfer MD, PhD , Oliver Micke MD, PhD , Ralph Mücke MD, PhD , Jan Kriz MD, PhD
{"title":"Radiotherapy for Other Nonmalignant Diseases","authors":"Isabel Falke MD , Ulrich Schäfer MD, PhD , Oliver Micke MD, PhD , Ralph Mücke MD, PhD , Jan Kriz MD, PhD","doi":"10.1016/j.semradonc.2025.11.003","DOIUrl":"10.1016/j.semradonc.2025.11.003","url":null,"abstract":"<div><div>Radiotherapy is increasingly used for benign diseases, especially in Germany, where over 50% of radiation treatments address nonmalignant conditions such as osteoarthritis, plantar fasciitis, and Dupuytren’s disease. Low-dose regimens have shown good efficacy in pain reduction and disease stabilization, with minimal toxicity. For rarer indications like Gorham-Stout disease, pigmented villonodular synovitis, and lymphatic fistulas, evidence is limited to case series and retrospective studies. Randomized trials remain scarce, and further research is needed to evaluate long-term outcomes and patient quality of life. Radiotherapy appears safe when used appropriately, though concerns about late effects require continued monitoring. For rare diseases, collaborative data collection and biological studies may help address current evidence gaps.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 127-134"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747840","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}
Raffaella De Pietro , Pamela Samson , Maiwand Ahmadsei , Phillip Cuculich , Geoffrey D. Hugo , Marcin Miszczyk , Franziska Nägler , Ardan M. Saguner , Clifford Robinson , Nicolaus Andratschke
{"title":"Radioablation for Ventricular Tachycardia: Current Evidence and Future Perspectives","authors":"Raffaella De Pietro , Pamela Samson , Maiwand Ahmadsei , Phillip Cuculich , Geoffrey D. Hugo , Marcin Miszczyk , Franziska Nägler , Ardan M. Saguner , Clifford Robinson , Nicolaus Andratschke","doi":"10.1016/j.semradonc.2025.10.003","DOIUrl":"10.1016/j.semradonc.2025.10.003","url":null,"abstract":"<div><div>Stereotactic arrhythmia radioablation (STAR) has emerged as a novel, noninvasive therapeutic option for patients with drug- and ablation-refractory ventricular tachycardia (VT). Derived from stereotactic body radiotherapy (SBRT), STAR enables the delivery of a single, high-dose fraction of ionizing radiation to arrhythmogenic myocardial tissue with submillimeter precision while minimizing exposure to surrounding cardiac and extracardiac structures. This review summarizes current evidence regarding mechanisms of action, patient selection, treatment planning, and clinical outcomes of STAR. Preclinical and early clinical studies suggest that STAR exerts rapid antiarrhythmic effects through modulation of cardiac conduction proteins and potential structural remodeling, though long-term efficacy remains under investigation. Clinical trials and prospective registries report substantial reductions in VT burden with acceptable short-term safety, yet recurrence rates and late toxicities require further evaluation. The European STOPSTORM consortium has been established to standardize treatment protocols, harmonize target delineation, and coordinate multicenter clinical validation. As STAR continues to evolve, multidisciplinary collaboration between radiation oncologists, cardiologists, and medical physicists will be essential to define optimal practice standards, ensure patient safety, and assess long-term outcomes. STAR represents a promising paradigm shift in the management of refractory VT, offering a noninvasive alternative when conventional therapies are ineffective or infeasible.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 61-76"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747834","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}
Michael Heinrich Seegenschmiedt , Hans Theodor Eich , Gabriele Reinartz
{"title":"Radiotherapy for Nonmalignant Eye Diseases: Graves’ Ophthalmopathy – Pseudotumor Orbitae","authors":"Michael Heinrich Seegenschmiedt , Hans Theodor Eich , Gabriele Reinartz","doi":"10.1016/j.semradonc.2025.11.005","DOIUrl":"10.1016/j.semradonc.2025.11.005","url":null,"abstract":"<div><div>Orbital radiotherapy (RT) is an effective treatment for moderate-to-severe Graves´ ophthalmopathy (GO), especially when combined with steroids, as it reduces painful eye symptoms associated with retroorbital and eye lid soft tissue swelling, improves eye movement, and can decrease the need for prolonged steroid therapy. It is generally well-tolerated; common side effects include temporary dryness and conjunctivitis, with rare long-term risks like cataracts and a very small theoretical risk of radiation-induced cancer. RT benefits are rarely immediate and improved symptoms are typically observed several weeks to months after the treatment. GO is treated with the retrobulbar space considered as clinical target volume (CTV). Retrobulbar RT is carried out either with lateral opposing fields or with intensity modulated radiotherapy (IMRT) while protecting the radiosensitive lenses considered as organs at risk (OAR). The dose concept should be adapted to the respective phase of the disease: in the <em>early purely inflammatory</em> phase a single dose 0.3-2.0 Gy applied in 8 daily fractions up to a total dose of 2.4-16 Gy is sufficient and well tolerated; in the <em>more advanced</em> inflammatory to fibrotic phase single doses of 1.8-2.0 Gy applied in 8-10 fractions 5 times weekly up to a total dose of 16-20 Gy are required to gain improvement of symptoms. To avoid severe ophthalmologic symptoms, the efficacy of radiation could also be improved by using a reduced single dose of only 1 Gy and extending the duration of therapy with the radiation applied only once a week. In GO with manifest ocular muscle dysfunction, antiproliferative external beam RT has a Grade B recommendation, supported by Level 2 evidence.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 114-126"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747839","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}