Advances in Radiation Oncology最新文献

{"title":"Magnetic Resonance Guided Radical Radiation Therapy for Prostate Cancer in the Presence of Bilateral Hip Prostheses: First Experience With a 1.5 T Magnetic Resonance Linear Accelerator","authors":"Andrea Emanuele Guerini MD , Stefania Nici MSc , Stefano Riga MSc , Luca Nicosia MD , Ludovica Pegurri MD , Paolo Borghetti MD , Marco Lorenzo Bonù MD , Eneida Mataj MD , Paolo Rondi MD , Gianluca Cossali MD , Davide Tomasini MD , Luca Triggiani MD, PhD , Giorgio Facheris MD , Stefano Maria Magrini MD, PhD , Luigi Spiazzi MSc , Michela Buglione di Monale MD, PhD","doi":"10.1016/j.adro.2025.101938","DOIUrl":"10.1016/j.adro.2025.101938","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 5","pages":"Article 101938"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146184918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Spacer-Assisted Stereotactic Body Radiation Therapy for Abdominal Oligometastases: A Novel Technique to Reduce Gastrointestinal Toxicity","authors":"Sasha Ebrahimi MD, PhD, Jonathan Pham PhD, Albert J. Chang MD, PhD","doi":"10.1016/j.adro.2025.101975","DOIUrl":"10.1016/j.adro.2025.101975","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 5","pages":"Article 101975"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single-Dose Intravenous-Contrast Enhanced 4-Dimensional Computed Tomogram Facilitated Accurate Delineation and Tracking Metastatic Tumor Motion Within a Cardiac Chamber in all Breathing Phases for Cardiac Metastasis-Directed Radiation Therapy","authors":"Whoon Jong Kil MD , Wyatt Smith CMD , David Cousins MD , Eugene Muchnik MD , Renee Muchnik MD , Craig Herndon PhD , Haejin Kang PhD","doi":"10.1016/j.adro.2025.101978","DOIUrl":"10.1016/j.adro.2025.101978","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 4","pages":"Article 101978"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical Flow-Guided Analysis of Intrafractional Anatomical Variations in Pancreatic Tumors and Organs at Risk During Magnetic Resonance-Guided Adaptive Radiation Therapy Under Abdominal Compression","authors":"Takanori Adachi PhD ,&nbsp;Nobutaka Mukumoto PhD ,&nbsp;Haruo Inokuchi MD, PhD ,&nbsp;Naoki Mukumoto MD ,&nbsp;Nobunari Hamaura MD ,&nbsp;Hiroshige Itoyama MD ,&nbsp;Yuki Hata MD ,&nbsp;Mutsumi Yamagishi MD ,&nbsp;Mai Sakagami MD, PhD ,&nbsp;Kenji Hayashi MD, PhD ,&nbsp;Ryo Ogino MD, PhD ,&nbsp;Mitsuhiro Nakamura PhD ,&nbsp;Keiko Shibuya MD, PhD","doi":"10.1016/j.adro.2026.102005","DOIUrl":"10.1016/j.adro.2026.102005","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to investigate intrafractional anatomic variations in pancreatic tumors and organs at risk (OARs) during magnetic resonance-guided adaptive radiation therapy (MRgART) using optical flow calculations.</div></div><div><h3>Methods and Materials</h3><div>This study included 732,612 magnetic resonance (MR) slices from 345 fractions obtained from 25 consecutive patients with pancreatic cancer. All patients underwent MRgART using the Elekta Unity MR-Linac under abdominal compression. For each fraction, single-slice 2-dimensional cine MR images were acquired every 600 ms at the tumor center. On the first frames in the coronal and sagittal planes, the OARs (duodenum, stomach, small bowel, and colon) were delineated. Displacements were measured at 30-second intervals using the Farnebäck optical flow in the superior-inferior (SI) direction in the coronal and sagittal planes within the overlapping regions between each delineated structure and the rectangular region, with a side length of 10 cm centered on the tumor. To exclude outliers, range of motion in each direction was defined as the 2.5th–97.5th percentile of displacement, and statistical differences were assessed using the Wilcoxon signed-rank test with Holm-Bonferroni correction (<em>P</em> &lt; .05).</div></div><div><h3>Results</h3><div>The median SI range of motion of the tumor was 5.8 mm in both the coronal and sagittal planes, which was significantly smaller than that of all OARs (<em>P</em> &lt; .05). Among the OARs, the colon and small bowel (median, 8.9-10.2 mm) exhibited larger motion ranges than the duodenum and stomach (median, 6.3-7.6 mm; <em>P</em> &lt; .05). The calculated margins in the SI direction were 3.1 to 3.4 mm for the tumor and 2.1 to 2.9 mm for the OARs.</div></div><div><h3>Conclusions</h3><div>Optical flow-guided analysis of intrafractional variations revealed that pancreatic tumors exhibited smaller ranges of motion than the adjacent OARs. These findings warrant direction-specific margins that account for intrafractional anatomic variations in both the tumors and surrounding OARs during pancreatic MRgART under abdominal compression.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 4","pages":"Article 102005"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging-Directed Stereotactic Body Radiation Therapy Microboost in Concert With Pelvic Nodal Irradiation for Prostate Cancer in the Higher-Risk Spectrum: Toxicity","authors":"Mina Musthafa AB ,&nbsp;Markus Wells MD ,&nbsp;Timothy Kearney MD ,&nbsp;Brianna Vizcaino BA ,&nbsp;Vianca F. Santos MPH ,&nbsp;Astrid Sanchez MS ,&nbsp;Christopher Mendez MA ,&nbsp;Aaron Katz MD ,&nbsp;Keith Kowalcyzk MD ,&nbsp;Ryan Hankins MD ,&nbsp;Mohit Gupta MD ,&nbsp;Herbert Lepor MD ,&nbsp;Jonathan A. Haas MD ,&nbsp;Jonathan W. Lischalk MD","doi":"10.1016/j.adro.2026.101997","DOIUrl":"10.1016/j.adro.2026.101997","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Recent publications have renewed interest in prophylactic pelvic radiation therapy for higher-risk prostate cancer, as well as dose escalation for magnetic resonance imaging (MRI)-defined intraprostatic lesions. Here, we explore the use of pelvic nodal irradiation with a 3-fraction stereotactic body radiation therapy (SBRT) boost to the prostate and seminal vesicles, with a simultaneous MRI-directed focal intraprostatic lesion-ablative microboost (MIB).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods and Materials&lt;/h3&gt;&lt;div&gt;We evaluated an institutional registry of patients undergoing pelvic nodal radiation followed by an SBRT boost to the prostate and seminal vesicles from April 2021 to March 2023. The study was approved by the local institutional review board (study #00001269). All patients were treated with pelvic nodal irradiation followed by a 3-fraction SBRT boost. The prostate SBRT boost dose was primarily 2100 cGy in 3 fractions (an accommodated range of 1800-2100 cGy). A subgroup of 15 patients received an MIB to an additional dose of 2300 cGy in 3 fractions (range, 2100-2400 cGy). The distribution of adverse event grades for acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Fifty-eight patients underwent pelvic nodal irradiation followed by an SBRT boost to the prostate, with the distribution of risk groups as follows: patients were either in the high (36.2%, n = 21) or very high (34.5% n = 20) risk groups, whereas those with known nodal disease (19.0%, n = 11) or intermediate risk (10.3%, n = 6) comprised the rest of the study population. Most patients received androgen-deprivation therapy. The prostate SBRT boost dose was primarily 2100 cGy in 3 fractions. Fifteen patients received an MIB to an additional dose of 2300 cGy in 3 fractions. A median follow-up of 8.7 months was used to document the incidence of GU and GI toxicity. The distribution of GI and GU toxicity showed no significant difference between the MIB and non-MIB subcohorts at either the acute (&lt;90 days) or late (&gt;90 days) time points. Two grade 3 toxicities were observed, both in the non-MIB cohort. Grade 2+ GI and GU toxicities were not significantly different between the 2 groups, as assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In the early follow-up period, we observed no significant difference in GI or GU toxicity between those who underwent MIB and those who did not. These results suggest that MRI-directed SBRT MIB did not increase GI toxicity and may even reduce GU toxicity compared with standard treatment. Future research should explore long-term side effects, with attention to the Expanded Prostate Cancer Index Composite (EPIC) scores and oncologic outcomes of this novel method of dose esca","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 4","pages":"Article 101997"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147385138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 3 vs 5 Fraction Single Isocenter Radiosurgery for Brain Metastases","authors":"Luke A. Moradi ,&nbsp;Richard A. Popple ,&nbsp;Roman L. Travis ,&nbsp;Samuel R. Marcrom ,&nbsp;Kristen O. Riley ,&nbsp;James M. Markert ,&nbsp;Christopher D. Willey ,&nbsp;Michael C. Dobelbower ,&nbsp;D. Hunter Boggs ,&nbsp;Rodney J. Sullivan ,&nbsp;Joel Pogue ,&nbsp;John B. Fiveash","doi":"10.1016/j.adro.2025.101927","DOIUrl":"10.1016/j.adro.2025.101927","url":null,"abstract":"<div><h3>Purpose</h3><div>Single isocenter stereotactic radiosurgery (SRS) efficiently delivers radiation to patients with multiple brain metastases. Although several fractionated SRS (fSRS) regimens show acceptable local control and toxicity, few studies directly compare them. This retrospective study evaluates 2 common regimens—6 Gy × 5 fractions and 9 Gy × 3 fractions—for their effects on local control and toxicity.</div></div><div><h3>Methods and Materials</h3><div>A retrospective review was conducted of 1215 brain tumors from 251 patients receiving either 9 Gy × 3 fx or 6 Gy × 5 fx fSRS. All tumors were treated with single isocenter volumetric modulated arc therapy. Recurrent tumors and postoperative cavities were excluded from the analysis. Local tumor failure was defined as 25% increase in maximum tumor diameter (minimum 3 mm) or more than scant tumor cells at time of salvage surgery. Toxicity included CTCAE V5.0 central nervous system (CNS) grade 3 or greater events. Local tumor control and freedom from toxicity were calculated using Kaplan–Meier method and Cox regression models.</div></div><div><h3>Results</h3><div>Overall local control was 93% at 1 year and 88% at 2 years. The 3-fraction regimen had superior 1-year local control compared with the 5-fraction regimen (97% vs. 91%, <em>P</em> = .001). Tumors &lt;2 cm had significantly better control with 3 fractions (99% vs. 95%, <em>P</em> = .004), whereas tumors 2–4 cm showed no significant difference. One-year freedom from grade 3+ toxicity was similar between regimens (99% for 3-fx vs. 96% for 5-fx, <em>P</em> = .097).</div></div><div><h3>Conclusions</h3><div>In this study, 9 Gy × 3 fx for brain metastases had improved tumor control and comparable toxicity to 6 Gy × 5, particularly among tumors &lt;2 cm. 9 Gy × 3 fx may be the preferred regimen when treating multiple tumors with one prescription using single isocenter radiosurgery as it improves efficiency and local control while having similar toxicity.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 4","pages":"Article 101927"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization and Safety of Concurrent Use of Abemaciclib and Radiation Therapy Among Patients With HR+, HER2− Metastatic Breast Cancer in the Real-World Setting","authors":"Wambui Gathirua-Mwangi PhD, MPH ,&nbsp;Sangmi Kim PhD, MS ,&nbsp;Holly Martin PhD ,&nbsp;Tasneem Lokhandwala PhD ,&nbsp;Shen Zheng PhD ,&nbsp;Eileen Farrelly MPH ,&nbsp;Erich Brechtelsbauer PharmD ,&nbsp;Sarah Rybowski MD ,&nbsp;Kamran A. Ahmed MD","doi":"10.1016/j.adro.2025.101992","DOIUrl":"10.1016/j.adro.2025.101992","url":null,"abstract":"<div><h3>Purpose</h3><div>Real-world data on tolerability of concurrent radiation therapy (RT) and abemaciclib are limited. This study described real-world utilization and safety of concurrent RT and abemaciclib in patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (MBC).</div></div><div><h3>Methods and Materials</h3><div>This retrospective study accessed data from the Flatiron Health United States nationwide deidentified electronic health records-derived longitudinal database. Abemaciclib initiation date was the index date (September 2017-September 2021). Concurrent RT was defined as receipt of any RT with ≥1 day of overlap with abemaciclib therapy. The minimum follow-up time was 90 days. Patient characteristics, treatment patterns, and real-world adverse events (rwAEs) were presented descriptively; Kaplan–Meier methods were used to assess time to treatment discontinuation.</div></div><div><h3>Results</h3><div>This study included 174 female patients with a median follow-up time of 17.5 (IQR, 10.1-26.5) months. The median age was 63.0 (IQR, 54.0-71.0) years, 8.0% had Eastern Cooperative Oncology Group Performance Status ≥ 2 at index and 31.0% had MBC. Prior to abemaciclib use, 20.1% and 28.2% of patients had chemotherapy or other CDK4/6 inhibitors, respectively. About half of the patients (47.7%) received abemaciclib in combination with fulvestrant, and 76.4% initiated abemaciclib at 150 mg twice daily. Overall, 151 patients (86.8%) initiated RT at or after initiation of abemaciclib. During concurrent RT and abemaciclib use, 76.4% of patients had no dose change in abemaciclib; 16.7% and 2.3% had a dose hold or dose reduction, respectively; 4.0% discontinued abemaciclib. The incidence of rwAEs during concurrent abemaciclib + RT were diarrhea (73.0%), fatigue (62.6%), rash (27.6%), and neutropenia (23.0%). The median (95% CI) time to treatment discontinuation was 368 (290-516) days.</div></div><div><h3>Conclusions</h3><div>Most patients did not require a dose modification or interruption with concurrent RT and abemaciclib. These findings suggest that the addition of RT to abemaciclib therapy is well tolerated in patients with HR+, HER2− MBC.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 4","pages":"Article 101992"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kupffer Cell-Derived Interleukin-6 Aggravates Radiation-Induced Liver Disease by Activating Hepatocyte STAT3 to Promote Ccng1 Transcription","authors":"Xing Song MD ,&nbsp;Yingjie Shao MD ,&nbsp;Rui Sun MD ,&nbsp;Wenjie Jiang MD ,&nbsp;Yuan Chen MD ,&nbsp;Mengjiao Liu MD ,&nbsp;Wendong Gu MD ,&nbsp;Xiao Zheng MD, PhD ,&nbsp;Jingting Jiang MD, PhD","doi":"10.1016/j.adro.2026.102003","DOIUrl":"10.1016/j.adro.2026.102003","url":null,"abstract":"<div><h3>Background</h3><div>Radiation-induced liver disease (RILD) is a serious complication of radiation therapy for upper abdominal tumors, the cellular and molecular basis of which remain mostly unclear.</div></div><div><h3>Methods and Materials</h3><div>Single-cell RNA sequencing (scRNA-seq) analysis of rat liver tissues was conducted to identify the key cytokines regulating RILD. Critical downstream target genes of RILD were determined using a chromatin immunoprecipitation (ChIP) assay. The BRL-3A cell line was selected for in vitro experiments.</div></div><div><h3>Results</h3><div>Pathological damage and immune cell infiltration were most severe at 2 weeks after irradiation (IR). ScRNA-seq analysis revealed that Kupffer cells represented the highest proportion of cells after IR (42.4%) and characteristically expressed <em>Il6</em>. Anti-interleukin (IL)-6 could alleviate liver damage and hepatocyte apoptosis after IR, whereas sgp130Fc could not. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that the JAK‒STAT signaling pathway in hepatocytes significantly changed after IR. In hepatocytes, STAT3 was significantly activated after IR. ChIP assays indicated that p-STAT3 bound to the promoter of the <em>Ccng1</em> gene. Flow cytometry revealed that simple addition of exogenous IL-6 significantly aggravated radiation-induced cell apoptosis and cell cycle arrest in BRL-3A cells, and additional <em>Ccng1</em> knockdown alleviated this damage. <em>Ccng1</em> knockdown accelerated γH2AX degradation in BRL-3A cells after IR. In cells cultured in IL-6, <em>Ccng1</em> knockdown upregulated TP53.</div></div><div><h3>Conclusions</h3><div>Paracrine secretion of IL-6 by Kuppfer cells activates STAT3 in hepatocytes through classical signaling. Activated STAT3 increases <em>Ccng1</em> transcription. CCNG1 protein may promote TP53 degradation. When TP53 is downregulated, hepatocyte apoptosis increases significantly, resulting in atypical RILD.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 4","pages":"Article 102003"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Proton Therapy Implementation on Processes, Patient Satisfaction, and Technology Use in a Radiation Therapy Department","authors":"Luca Heising MSc ,&nbsp;Thijs Ackermans PhD ,&nbsp;Liesbeth Boersma MD, PhD ,&nbsp;Carol Ou PhD ,&nbsp;Geert Bosmans PhD ,&nbsp;Rachelle Swart PhD ,&nbsp;Andre Dekker PhD ,&nbsp;Maria Jacobs PhD","doi":"10.1016/j.adro.2025.101988","DOIUrl":"10.1016/j.adro.2025.101988","url":null,"abstract":"<div><h3>Purpose</h3><div>Because proton therapy (PT) can be regarded as a major radical innovation, its implementation in a radiation therapy (RT) department may have an adverse impact on processes. The current study aimed to investigate the effect of PT implementation on disruptions of clinical processes, patient satisfaction, and technology use.</div></div><div><h3>Materials and methods</h3><div>The study was performed in an independent Dutch RT institute, where PT was implemented in February 2019. Endpoints were (1) process disruptions, (2) patient satisfaction, and (3) technology use. Causal inference and Wilcoxon rank-sum tests in R and MATLAB were used for the analyses.</div></div><div><h3>Results</h3><div>After the implementation of PT, human-related errors and organizational culture-related errors in the photon therapy (PhT) process increased. Our empirical data showed more process disruptions associated with PT than with PhT. The implementation did not significantly affect patients’ satisfaction. Analysis of technology use showed a decrease in PT uptime, including treatment stagnations lasting ≥2 days. The organizational process of the entire clinic was affected in the first 13 months after PT implementation because of significantly more process disruptions in PT compared to PhT and an increase in some distinct PhT process disruptions. The decrease in PT machine uptime below 95% caused treatment stagnation with consequences for patients and staffing.</div></div><div><h3>Conclusions</h3><div>This study provides the first quantitative assessment of introducing PT in an ambidextrous, ambitious center that also runs PhT. Incident profiles shifted toward human-related errors in PhT and organizational issues in PT, with no lasting change in patient satisfaction. In conclusion, successful adoption requires stronger preparation and training, early patient engagement, and proactive planning for quality control, frequent updates, and lower initial uptime in partnership with vendors.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 4","pages":"Article 101988"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147385002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myeloablative Total Body Irradiation With Volumetric Modulated Arc Therapy for Children—a Single Center Experience","authors":"Hoong Hoong Ng MD ,&nbsp;Munira Mohd Rejab MSc ,&nbsp;David Lee MBBS ,&nbsp;Xin Yee Chiew MPaed ,&nbsp;Syaza Ab Rahman MBBS ,&nbsp;Ngie Min Ung PhD ,&nbsp;Zulaikha Jamalludin PhD ,&nbsp;Aik Hao Ng PhD ,&nbsp;Hany Ariffin PhD ,&nbsp;Nisha Shariff MBChB","doi":"10.1016/j.adro.2025.101991","DOIUrl":"10.1016/j.adro.2025.101991","url":null,"abstract":"<div><h3>Purpose</h3><div>Total body irradiation (TBI) is a critical component of conditioning therapy prior to allogeneic hematopoietic stem cell transplantation in pediatric acute lymphoblastic leukemia. Our institution implemented volumetric modulated arc therapy-TBI (VMAT-TBI) in 2023, aiming to improve target conformity and organ-at-risk sparing using standard linear accelerators. This study describes our initial 2-year institutional experience with VMAT-TBI, focusing on treatment planning and delivery metrics, as well as early clinical outcomes and acute toxicities in pediatric patients.</div></div><div><h3>Methods and Materials</h3><div>We conducted a review of 10 pediatric patients treated with VMAT-TBI at our institution from October 2023 to June 2025. All patients received myeloablative conditioning with 12 Gy in 6 fractions over 3 days, followed by intravenous etoposide preceding allogeneic hematopoietic stem cell transplantation. Data collected included treatment planning parameters, planning duration, delivery times, overall survival, relapse-free survival, and acute toxicities.</div></div><div><h3>Results</h3><div>Treatment plans achieved robust target coverage (<em>V</em>₁₀₀ &gt; 90%) and met organ-at-risk constraints, with mean lung, kidney, and lens doses of 8.8 Gy, 8.7 Gy, and 8.5 Gy, respectively. Mean beam-on time per fraction was 21.3 minutes, and in-room time was 77 minutes. Image guided verification showed that online translation was within 3 mm and &lt;1° rotation. The median follow-up was 19 months, with 1-year overall survival and relapse-free survival rates of 90%. Nonrelapse mortality at 1 year was 10%. The most common acute toxicity was mucositis, affecting 70% of patients (grades 2–3 in 40%), with a median onset of 2 days. Gastrointestinal toxicities, including vomiting (50%) and diarrhea (40%), occurred early, with a median onset of 2–3 days.</div></div><div><h3>Conclusions</h3><div>Our early institutional experience demonstrates that VMAT-TBI is safe, feasible, and effective in pediatric patients, achieving excellent target coverage and acceptable acute toxicity profiles. These findings support the viability of implementing VMAT-TBI even in resource-constrained settings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 4","pages":"Article 101991"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}