Durch das Medizinforschungsgesetz sind viele Aspekte auch im Genehmigungs- und Anzeigeverfahren für studienbedingte Strahlenanwendungen angepasst worden. Dieser Artikel soll einen Überblick über die neue Situation geben und den Forschenden, insbesondere im Bereich der Radioonkologie, als Wegweiser für die medizinisch-rechtliche Planung von Studienprojekten dienen.

Clinical backgroundCancer registry data are an essential resource for population-based oncology research and quality assurance in Germany. With the revision of the Federal Cancer Registry Data Act in 2021, for the first time, a legal basis was created for the development of a nationwide clinical cancer dataset. This registry offers new opportunities for research, particularly in radiation oncology.ObjectiveThis review aims to provide an overview of the current possibilities of and challenges to using German cancer registry data in radiation oncology, with a focus on data structure, missing data, access procedures, and methodological aspects for scientific research.MethodsWe examined legal frameworks, data access procedures, and the structure of the nationwide basic oncology dataset (oBDS), particularly the components relevant to radiotherapy (RT). The completeness and comprehensiveness of RT data across federal states were assessed using national registry data from the German Center for Cancer Registry Data (ZfKD) for the years 2020–2022.ResultsThe cancer registries provide structured data on RT through the oBDS, including treatment intent, technique, target area, and side effects. However, significant variability in terms of completeness and reporting standards persists among federal states. Missing data rates remain high in some regions, particularly for key RT parameters such as treatment technique, the relationship to surgery, and boost application. Methodological challenges for scientific use include handling missing data, confounding, immortal time bias, and exposure misclassification.ConclusionDespite existing limitations, cancer registry data in Germany represent a valuable resource for real-world research in radiation oncology. They allow for large-scale population-based studies beyond the constraints of clinical trials. With improved data harmonization, methodological rigor, and future data linkages (e.g., to health insurance data), registry-based studies can contribute significantly to evidence-based decision-making and quality improvement in radiation oncology.

BackgroundDose 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.Materials and methodsPlanning 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.ResultsPattern 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.ConclusionThis 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.

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.

BackgroundTotal 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.MethodsThe 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.ResultsThe 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.ConclusionThis 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.Supplementary InformationThe online version of this article (10.1007/s00066-025-02408-w) contains supplementary material, which is available to authorized users.

PurposeThe new Medical Licensing Regulations 2025 in Germany demand a longitudinal and interdisciplinary oncological curriculum for the future of medical education. Small disciplines like radiation oncology (RO) tend to be underrepresented in the general curriculum, which complicates attracting new residents and doctoral candidates to the field. To bridge this gap, our university successfully implemented a multidisciplinary training for preclinical semesters combining anatomical and RO knowledge. The following study addresses students’ perceptions of RO and learning success in the setting of a mandatory preclinical course.MethodsA quantitative single-center cross-sectional study with 106 students was conducted via online questionnaire before and after a 1-week semester course in anatomy and RO. The analysis was conceptualized using descriptive statistical methods and the expectancy–value model according to Eccles and Wigfield.ResultsOverall, 106 (73 female, 33 male) students with a mean age of 21.8 years took part in the first survey. Advanced courses during finals and gender had no effect on interest in RO. However, it could be shown that the understanding of RO (p < 0.0001), knowledge about patients who need to be referred to RO (p < 0.0001), and the interest in specialty training in RO (p < 0.0001) significantly increased during the course. The students’ perceptions of specialty training in RO remained stable before and after the course.ConclusionThis is the first study on the influence factors for students’ decisions to pursue a specialized training in RO. Students’ expectations regarding a good specialty training are well represented in RO, and the implementation of preclinical courses significantly increases the knowledge about RO and the level of interest regarding a specialty training in RO.

PurposeWe aimed to find predictive tumour characteristics as detected by interim positron-emission tomography/magnetic resonance imaging (PET/MRI) in cervical cancer patients. We also investigated the type of interim response. Furthermore, we compared the investigated parameters with disease-free (DFS) and overall survival (OS) outcomes.MethodsWe evaluated 108 patients treated between August 2015 and January 2023 with external-beam radiotherapy (EBRT) and image-guided adaptive brachytherapy (IGABT) who had undergone pretreatment staging, subsequent mid-treatment evaluation after completed EBRT and definitive restaging 3 months after completing the whole treatment using PET/MRI. Patients were then divided into two groups based on the RECIST and PERCIST criteria: responders (achieving complete metabolic response, CMR) and non-responders (non-CMR). These two groups were compared using selected parameters obtained at pre-PET/MRI and mid-PET/MRI. The early response to treatment as evaluated by mid-PET/MRI was categorized into three types: interim complete metabolic response, interim nodal response and interim nodal persistence.ResultsMid-TLG‑S (the sum of total lesion glycolysis for the primary tumour plus pelvic and para-aortic lymph nodes) parameter showed the best discriminatory ability for predicting non-CMR. The second factor with significant discriminatory ability was mid-MTV‑S (the sum of the metabolic tumour volume of the primary tumour plus pelvic and para-aortic lymph nodes). The strongest factor, mid-TLG‑S, showed a sensitivity of 40% and a specificity of 90% at a threshold value of 70. We found a statistically significant association of DFS and OS with the following parameters: number of chemotherapy cycles, early response type and CMR vs. non-CMR.ConclusionWe were able to identify thresholds for selected parameters that can be used to identify patients who are more likely to have worse DFS and OS. The type of early response during concurrent chemoradiotherapy (CCRT) was also significantly associated with DFS and OS. These aspects represent an important contribution to the possible stratification of patients for subsequent individualised adjuvant treatment.

Background and purposeBone 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.Material and methodsWe 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.ResultsOf 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.ConclusionOur 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.Supplementary InformationThe online version of this article (10.1007/s00066-025-02387-y) contains supplementary material, which is available to authorized users.