Sublobar resection, stereotactic body radiotherapy, and thermal ablation for early-stage non-small cell lung cancer: a systematic review and meta-analysis.

The role of stereotactic body radiotherapy in oligoprogressive breast cancer: A site-specific analysis of the prospective, phase-II RADIANT trial.

To identify dosimetric advantages of biaxially rotational dynamic radiation therapy (BROAD-RT) for stereotactic body radiation therapy (SBRT) with focal boost for non-metastatic prostate cancer (PCa), compared with coplanar volumetric-modulated arc therapy (co-VMAT). BROAD-RT is a unique beam delivery technique, which facilitates sequential non-coplanar beam delivery without the need to rotate the couch or reposition the patient. For 15 patients with non-metastatic PCa, two different plans (BROAD-RT and co-VMAT) were created, and these plans and dosimetric indices were compared. The prescribed dose was 35Gy in 5 fractions to the whole prostate gland, and that to the intra-prostatic dominant lesions (IPDLs) was increased up to 50Gy. Quality assurance (QA) was performed for BROAD-RT and co-VMAT plans from the 15 patients, and the calculated and measured dose distributions were evaluated according to global gamma analysis using ArcCHECK. The dose coverage of the target volumes and the high-dose exposure to organs at risk (rectum, bladder, and urethra) were not significantly different between BROAD-RT and co-VMAT plans. The normal tissue dose outside of the planning target volume (PTV) (maximum dose 2cm away from PTV [D2 cm], and 30%, 50%, or 70% isodose volume divided by the volume of PTV [R30, R50, and R70]) were significantly lower in the BROAD-RT plan (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). In QA, average (± standard deviation) passing rates were 98.2 ± 0.7% for BROAD-RT and 99.0 ± 1.0% for co-VMAT. Non-coplanar VMAT via BROAD-RT improved the dose distribution, mainly outside of the PTV and for some of the organs at risks, in prostate SBRT with focal boost compared with coplanar VMAT. Therefore, as BROAD-RT enables practical implementation of non-coplanar VMAT, it is considered a promising radiotherapy method of SBRT with focal boost for non-metastatic PCa.

Accurate assessment of liver function is essential for selecting patients with hepatocellular carcinoma (HCC) undergoing stereotactic body radiotherapy (SBRT). In this study, we examined whether the albumin-bilirubin (ALBI) grade and the Child-Pugh classification provide independent prognostic information when modeled concurrently. A retrospective analysis was conducted on 102 patients with HCC who received initial SBRT (2013-2020) and were classified as ALBI grades 1-2 and Child-Pugh classes A-B. Both classifications were entered simultaneously into a multivariable Cox proportional hazards model adjusted for age, sex, viral hepatitis status, time since HCC diagnosis, and prior local treatments. Model discrimination was evaluated using the concordance index (C-index) and the Akaike information criterion (AIC). The median follow-up was 52 months, and the median overall survival (OS) was 71 months. In the multivariable analysis, both ALBI grade 2 [hazard ratio (HR)=2.20; 95%confidence interval (CI)=1.07-4.51; p=0.032] and Child-Pugh class B (HR=3.70; 95%CI=1.77-7.72; p<0.001) were independently associated with poorer OS. The combined model incorporating both classifications showed improved discrimination compared with either classification alone (C-index, 0.7283 vs. 0.6976 and 0.7104; ΔAIC ≥2.85), indicating a complementary prognostic value. ALBI grade worsening at six months identified nonclassic radiation-induced liver disease in 21.5% of patients versus 7.5% identified by a ≥2-point increase in the Child-Pugh score, with 90% nonoverlap between criteria. ALBI grade 2 and Child-Pugh class B were independently associated with OS, with neither exhibiting clear superiority. Their combined use - ALBI grade for objective biochemical stratification and Child-Pugh for clinical assessment incorporating ascites and encephalopathy - may provide a more comprehensive evaluation than either system alone.

SBRT plus abiraterone acetate and ADT versus abiraterone acetate and ADT in oligometastatic castrate-resistant prostate cancer (ARTO): long-term, unplanned overall survival analysis of an open-label, randomised, phase 2 trial.

Outcomes of stereotactic body radiotherapy for supraclavicular lymph node metastasis among patients with metastatic prostate cancer.

Reirradiation for recurrent head and neck squamous cell carcinoma: international expert consensus recommendations endorsed by the Reirradiation Collaborative Group, the European Society for Radiotherapy and Oncology Reirradiation Focus Group, and the American Society for Radiation Oncology.

Accurate heterogeneity correction in high-precision radiotherapy relies on precise computed tomography (CT) number-to-density conversion via the Hounsfield unit look-up table (HLUT). While physical properties of tissue-equivalent materials are generally assumed consistent with manufacturer specifications, an independent audit identified clinically significant density discrepancies in commercially available lung-equivalent phantom inserts. This study evaluates the physical properties of nonconforming lung inserts through mass measurements and stoichiometric analysis, and assesses the clinical dosimetric impact of the associated density discrepancies. Five lung-inhale inserts manufactured in 2010, 2015, and 2024 (10A, 10B, 15A, 15B, and 24A) were analyzed. Mass and physical dimensions were measured in triplicate using a precision balance (1mg resolution) and vernier calipers. Stoichiometric analysis was conducted using reference materials to evaluate the tissue-equivalence of the inserts and quantify deviations from the theoretical baseline. A nonconforming table and a conforming reference table (RT) were established, derived from inserts 10A and 24A, respectively. For clinical impact assessment, volumetric modulated arc therapy (VMAT) plans for three clinical cases involving centrally located lung tumors (utilizing both inspiration breath-hold (IBH) and free-breathing) were optimized for stereotactic body radiotherapy (SBRT) and recalculated with the RT using the Acuros XB algorithm. Differences in gross tumor volume (GTV) mean dose and planning target volume (PTV) D95% were evaluated to quantify the dosimetric consequences. The 2010 inserts (10A and 10B) exhibited a 17.1% mass reduction and lower CT numbers compared to the reference 24A insert. Dimensional variations were negligible (≤ 0.2mm) across all samples. Clinical recalculation revealed maximum dose reductions of 2.1% for the GTV mean dose and 3.0% for the PTV D95% in the worst-case scenario. These errors exceed the 2% clinical tolerance, propagated by HLUT interpolation across the low-density range. Substantial inter-lot density variations in commercial calibration phantoms can lead to dosimetric errors that exceed established clinical limits, particularly for centrally located tumors treated with IBH. Medical physicists must not implicitly rely on nominal manufacturer values; independent audits and initial mass screening at acceptance are highly recommended for maintaining dose calculation accuracy.

Isolated retroperitoneal lymph-node (RPLN) recurrence after radical nephrectomy (RN) for renal cell carcinoma (RCC) is uncommon, and optimal management remains undefined. This study reports contemporary outcomes of retroperitoneal lymph-node dissection (RPLND) for isolated nodal recurrence, including in patients previously treated with stereotactic ablative body radiotherapy (SABR) or systemic therapy. A retrospective review was performed of all patients undergoing RPLND for isolated nodal recurrence of RCC between July 2023 and October 2024. Clinical, operative, and pathologic variables were collected, and postoperative complications were graded using the Clavien-Dindo system. Recurrence-free survival (RFS) was calculated from RPLND to recurrence or last follow-up. Eight patients met inclusion criteria. Median age at RPLND was 59.5years, and six were male. The median interval from RN to RPLND was 29 months. Median operative time was 255 min, estimated blood loss 300 mL, and hospital stay 6.5days. One patient experienced postoperative complication (Clavien-Dindo IIIa). All specimens confirmed malignancy with negative margins. After a median follow-up of 18 months, three patients (37.5%) recurred, with a mean RFS of 15.3months. RPLND is a safe and viable option for isolated nodal recurrence of RCC, offering complete resection and oncologic outcomes comparable to historical data, and may serve as an important component of multimodal management.

Local sinonasal and regional nodal effects of lymph node irradiation in a pilot study of dogs with naturally occurring sinonasal tumors.

Re: Ultra-hypofractionated Stereotactic Ablative Body Radiotherapy for Primary Renal Cell Carcinoma: 5-year Outcomes from a Pooled Analysis of the FASTRACK Trials.

To evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) in previously untreated primary mucosal head and neck cancer (HNC) patients unfit for conventional radiation therapy. Retrospective analysis of previously unirradiated primary SCC mucosal HNC patients treated with SBRT from 2011 to 2022. HN SBRT was prescribed to 74 patients (median age: 81 years [52-97]; 85% ECOG 2-3) with 77 primary tumors (62% oral cavity; 64% T3-4 disease). A five-fraction prescription ranging from 35 to 50 Gy (95% received ≥ 40 Gy, 59.7% received ≥ 45 Gy) was delivered twice weekly, with the majority (81%) completing treatment within 14 days and all patients completing treatment. Symptomatic relief was achieved by 84%, including 27.3% with complete symptomatic response. With a median follow-up of 7.3 months, 1-year outcomes were 81% local control, 16% regional recurrence rate, and 12% distant metastasis rate. Median progression-free and overall survival were 6.4 and 8 months, respectively. Acute Grade 3+ toxicity occurred in 36%, primarily mucositis (30%). Late Grade ≥ 3 toxicity was observed in 10% (n = 7), including osteoradionecrosis in 5 patients, with residual or concurrent disease present in 5% (n = 4). PTV > 159 cm3 was significantly correlated with late grade ≥ 3 toxicity (OR = 15.98; p = 0.0041). High-dose SBRT may deliver high rates of local control and palliation for primary mucosal HNC patients unfit for conventional radiation, but prospective, comparative, high-quality data are needed. A randomized trial (NCT06641791) comparing SBRT to conventional palliative RT in the elderly unfit HNC patient is underway.

Oligometastatic prostate cancer represents an intermediate disease state potentially amenable to metastasis-directed therapies such as stereotactic body radiotherapy (SBRT), aiming to delay disease progression and postpone systemic treatment. The aim of this study was to evaluate the real-world outcomes of SBRT in patients with hormone-sensitive oligometastatic prostate cancer. This single-center retrospective study included patients with hormone-sensitive oligometastatic prostate cancer staged with PSMA PET and treated with SBRT at a tertiary center between January 2022 and March 2024. The primary endpoint was hormone therapy-free survival (HTFS). Secondary endpoints included event-free survival (EFS), local control, overall survival (OS), and toxicity. A total of 34 patients were included, predominantly with low-volume disease (79.4% with a single metastasis). SBRT achieved significant biochemical responses (PSA50 in 69.7%; median PSA nadir 0.19 ng/mL). HTFS rates were 85.2% and 74.6% at 12 and 24 months, respectively, with the median not reached. Median EFS was 16.2 months. Local control was 84.2%, and 24-month OS was 87.8%. Toxicity was minimal, with no grade ≥ 3 adverse events. A PSA nadir ≤ 0.20 ng/mL and ISUP ≤ 2 were associated with improved outcomes. SBRT may delay systemic therapy without compromising disease control in oligometastatic prostate cancer. Its integration into personalized treatment strategies, guided by biological and biochemical factors, represents a promising therapeutic approach.

Why are clonal neoantigens paradoxically rare in established tumors? Why does tumor-associated antigen (TAA) burden inversely correlate with T-cell infiltration? Why do damage-associated molecular pattern (DAMP)/danger signal-inducing interventions (messenger RNA (mRNA) vaccines, stereotactic body radiotherapy (SBRT), immunogenic chemotherapy) enhance checkpoint blockade activity in "cold" tumors? We propose the "DEA Hypothesis" to resolve these paradoxes: durable antitumor immunity for established tumors requires three convergent signals-(1) Disinhibition of T cells through checkpoint blockade, (2) Enhanced recognition via the presentation of clonal neoantigens, and crucially, (3) Alerting the host through release of DAMPs/danger signal(s). We frame cancer as a subversion of an ancient "Guardian" system-the emergency hematopoietic response that evolved to orchestrate immune defense following epithelial breach or major trauma. Tumors hijack this system by promoting restorative hematopoiesis at the expense of immunity and masquerading as chronic wounds. This framework explains key observations: the paucity of clonal neoantigens reflects successful immunoediting over years of tumor evolution, not failed presentation. TAAs persist in cold tumors because insufficient DAMPs limit the "Decision to Attack"; and mRNA vaccines, recently SBRT, and immunogenic chemotherapy succeed in cold tumors by providing the missing Alert. For cold tumors, rational immunotherapy must extend beyond checkpoint blockade to reconstitute the Alert signal-not merely releasing the brakes but providing the ignition to reawaken the ancient Guardian.Graphic abstract: The DEA hypothesis proposes that effective cancer immunotherapy requires three convergent signals: Disinhibition (checkpoint blockade), Enhanced recognition (clonal neoantigens), and Alerting the host (DAMP release). Panel I depicts immune decision points in tumor-draining lymph nodes. Panel II shows mutation-driven DAMP generation via the Poly(ADP-Ribose) Polymerase 1 - High Mobility Group Box 1 (PARP1-HMGB1) axis. Panel III illustrates the three-signal model converging on type 1 conventional dendritic cells activation. Panel IV demonstrates how immunoediting shapes stage-specific therapeutic strategies for cold, warm, and hot tumors.

Renal cell carcinoma (RCC) is increasingly managed with a broad range of systemic and local therapies, creating new challenges for imaging-based response assessment in metastatic disease. While conventional size-based criteria such as RECIST v1.1 remain widely used, they incompletely capture the diverse morphologic and functional changes induced by modern treatment. Targeted therapies, including vascular endothelial growth factor receptor tyrosine kinase inhibitors and other pathway-directed agents, may produce necrosis, devascularisation, and prolonged disease stability without substantial tumour shrinkage. Immune checkpoint inhibitors introduce additional atypical response patterns, including pseudoprogression, mixed response, and rarely hyperprogression, which can complicate early interpretation of surveillance imaging. Combination regimens may demonstrate features of both targeted and immune-mediated response. In parallel, stereotactic body radiotherapy has emerged as an important treatment for oligometastatic and oligoprogressive RCC, with imaging appearances that may include lesion shrinkage, stability, or transient enlargement following treatment. This review summarises the current treatment landscape for metastatic RCC and the imaging manifestations of response across chemotherapy, targeted therapy, immunotherapy, combination systemic therapy, and stereotactic radiotherapy. It discusses the strengths and limitations of conventional and modified response criteria, including RECIST v1.1, iRECIST, attenuation-based CT criteria, and morphology-based approaches. The review also highlights the evolving role of functional and novel imaging techniques, including diffusion-weighted whole-body MRI, dual-energy and spectral CT, and PET/CT, as potential tools for improving response assessment beyond size alone. In addition, key imaging features of treatment-related toxicity are reviewed. Familiarity with these response patterns and complications is essential for radiologists involved in the care of patients with metastatic RCC, particularly as treatment strategies become increasingly multimodal and biologically complex.

Combination therapy involving radiotherapy and immune checkpoint inhibitors has become a cornerstone of modern oncology; however, its therapeutic efficacy is frequently compromised by radiation-induced lymphopenia, a phenomenon traditionally viewed as an unavoidable physical consequence of radiation exposure. Accumulating evidence suggests that RIL also reflects broader host-dependent biological dysregulation, extending beyond direct lymphocyte depletion. In this review, we introduce the microbiota-lymphocyte protective axis as a conceptual and integrative framework to recontextualize RIL as a biologically modulated state influenced by the gut microenvironment. We synthesize current mechanistic and clinical evidence indicating that microbial-derived signals may shape immune competence during radiotherapy by influencing hematopoietic lineage commitment within the bone marrow, cellular stress tolerance mechanisms such as DNA damage responses and mitochondrial quality control, as well as systemic neuroendocrine stress pathways. This framework supports a shift toward a dual-modulatory strategy that integrates lymphocyte-sparing radiotherapy approaches (e.g., stereotactic body radiotherapy) with microbiota-targeted interventions (e.g., postbiotics). While further validation is required, the MLPA model provides a biologically grounded perspective that may help refine personalized radio-immunotherapy strategies.

Stereotactic arrhythmia radioablation (STAR) is an emerging treatment for refractory or recurrent arrhythmias. Compared with conventional stereotactic body radiotherapy (SBRT), STAR involves greater complexity in target delineation, motion management, and organs at risk (OARs) protection, yet it lacks established consensus clinical guidelines, and workflow-specific risk analyses remain limited. To develop a C-arm linear accelerator (LINAC)-based STAR workflow and perform a failure modes and effects analysis (FMEA) with fault tree analysis (FTA), supplemented by an exploratory segment-based anatomical proximity analysis. A multidisciplinary team constructed a process map for C-arm LINAC-based STAR and identified potential failure modes across the workflow. Risks were scored using occurrence, severity, and detectability to calculate risk priority numbers (RPNs), and FTA was used to analyze causal pathways. In a predefined exploratory imaging subgroup of eight patients with ventricular tachycardia and simulation-acquired coronary computed tomography angiography (CCTA), we divided the left ventricle according to the 17-segment model and measured the minimum distances from each segment to adjacent OARs as an anatomical surrogate of exposure likelihood. Seventy-nine failure modes were identified, of which 17 were classified as high risk. The highest-risk failure modes were concentrated in target delineation and motion-related steps, including inaccurate multimodal image registration (RPN 432), improper motion evaluation/management (RPN 336), and diagnostic error of arrhythmia substrate definition (RPN 320). In the exploratory imaging subgroup (n = 8), segmental spatial patterns were moderately consistent across patients, with most standard deviations of minimum distance below 2.0cm, although variability remained for several segment-OAR relationships. Segments 4, 5, and 10 were each located within 2cm of both the stomach and esophagus, indicating relatively higher anatomical proximity-related risk. In this FMEA of C-arm LINAC-based STAR, the principal high-risk workflow steps were concentrated in substrate definition, image registration, and motion management. The segment-based analysis provides an exploratory anatomical risk-mapping framework for OAR awareness. Further multicenter studies are needed to refine workflow risk prioritization and evaluate the clinical relevance of the segment-based anatomical findings. Not applicable.

Stereotactic Body Radiation Therapy Combined With Immune Checkpoint Inhibitors in Unresectable Hepatocellular Carcinoma: A Comprehensive Single-Arm Meta-Analysis Approach.

This work aims to develop a digital twin (DT) framework for fast online adaptive proton therapy planning in prostate stereotactic body radiation therapy (SBRT) with dominant intraprostatic lesion (DIL) boost, achieving clinical-equivalent plan quality with significantly reduced reoptimization time compared to traditional clinical workflows.&#xD;Approach: The proposed DT framework integrates deep learning-based multi-atlas deformable image registration, daily patient anatomy updates, and knowledge-based plan quality evaluation to enable predictive and adaptive radiotherapy. Leveraging a database of 43 prior prostate SBRT cases, the framework forecasts potential interfractional anatomical variations for a new patient and pre-generates multiple probabilistic treatment plans. Upon acquiring daily cone-beam CT (CBCT) for the new patient, the framework facilitates rapid online plan reoptimization. Plan quality is assessed using the ProKnow scoring system, evaluating dose coverage to the DIL and clinical target volume (CTV), as well as sparing of organs at risk (OARs).&#xD;Main Results: The DT framework achieved an average reoptimization time of 5.52 ± 2.94 min, producing optimal DT-based plans with a mean plan quality score of 164.01 ± 8.03. These scores matched or exceeded those of the clinical plans, which required substantially longer reoptimization times (17.66 ± 7.93 min) to achieve comparable plan quality (161.23 ± 9.50). DT-based plans provided DIL V100 coverage of 99.27% ± 0.64% and CTV V100 of 99.95% ± 0.07%, with reduced OAR doses, including bladder V20.8Gy of 10.61 ± 2.64 cc, rectum V23Gy of 0.61±0.32 cc, and urethra D10 of 89.45%±1.07%, which were comparable to the clinical quality standard.&#xD;Significance: The proposed DT framework facilitates rapid, clinically comparable adaptive proton therapy planning, reducing reoptimization time while preserving or enhancing clinical plan quality. By addressing interfractional anatomical variations efficiently, it enhances treatment precision, reduces OAR toxicity, and supports online personalized radiotherapy, offering a transformative approach for prostate SBRT with DIL boost.

The impact of age on quality of life, 90-day mortality, adjuvant chemotherapy, and survival after treatment for localized pancreatic cancer: A nationwide analysis.