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Clinical Research in Radiation Oncology: Current Status and Future Directions
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Clinical Research in Radiation Oncology: Current Status and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (15 April 2026) | Viewed by 10370

Editor

Dr. Paolo Borghetti

E-Mail Website
Guest Editor
Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy
Interests: radiotherapy; cancer therapy; radiation therapy; radiology; lung cancer

Special Issue Information

Dear Colleagues,

Radiotherapy is a powerful weapon against cancer, alone or in combination with surgery or medical treatments. Much progress has been made in recent years, and new technologies have been shown to significantly increase the benefit/harm ratio, resulting in greater local control and limited toxicities. Despite this, many questions regarding the appropriateness of modern radiotherapy, the clinical management of patients, and biological issues still remain unanswered. This Special Issue of the Journal of Clinical Medicine, entitled "Clinical Research in Radiation Oncology: Current Status and Future Directions", aims to provide an opportunity for radiation oncologists and the entire oncology community to discuss current issues in radiotherapy and present original data, literature reviews, and consensuses that reflect research and clinical interests in radiotherapy.

Dr. Paolo Borghetti
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • radiation oncology
  • radiobiology
  • stereotactic body radiotherapy
  • multidisciplinary team
  • integrated treatment
  • predictive and prognostic biomarkers
  • cancer treatment

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Published Papers (4 papers)

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Research

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17 pages, 888 KB  
Article
Treatment Outcomes for Elderly Patients over the Age of 70 with Early-Stage Peripheral Non-Small Cell Lung Cancer Who Were Treated with Stereotactic Body Radiation Therapy (SBRT) at a Total Dose of 55 Gy in Four Fractions: A Single-Institution Retrospective Study
by Norio Mitsuhashi, Daichi Tominaga, Atsushi Motegi, Hajime Ikeda, Fumiya Shiina, Kazuhisa Kishimoto, Keiko Fukaya and Yoshitaka Nemoto
J. Clin. Med. 2026, 15(14), 5430; https://doi.org/10.3390/jcm15145430 - 10 Jul 2026
Abstract
Background/Objectives: Due to its rapidly aging population, lung cancer is expected to become the second most common and deadliest cancer in Japan. Although surgery is the primary treatment for early-stage non-small cell lung cancer (NSCLC), advances in radiation therapy technology mean that [...] Read more.
Background/Objectives: Due to its rapidly aging population, lung cancer is expected to become the second most common and deadliest cancer in Japan. Although surgery is the primary treatment for early-stage non-small cell lung cancer (NSCLC), advances in radiation therapy technology mean that stereotactic body radiation therapy (SBRT) is also a viable option for elderly patients with various underlying health conditions. Methods: We conducted a retrospective analysis to evaluate the outcomes of SBRT in 50 consecutive elderly patients (37 of whom were aged 80 and older) with early-stage peripheral NSCLC (Tis~T2aN0M0), who were treated with SBRT at our hospital and received a total dose of 55 Gy in four fractions. Results: The three-year overall, disease-free and cause-specific survival rates for all patients were 73.2%, 88.5% and 91.4%, respectively. For patients aged 80 years and older, these rates were 77.5%, 90.6% and 91.4%, respectively. There was no local recurrence. Hematogenous metastases were observed in four patients. However, hilar and subcarinal lymph node metastases developed in only one patient. Grade 2 pneumonitis and chest wall injuries (CWIs) were observed in two and five patients, respectively. Patients with larger tumors had a significantly higher incidence of chest wall injuries. Conclusions: SBRT at a total dose of 55 Gy in four fractions can achieve safe and satisfactory outcomes for early-stage peripheral NSCLC, even in patients aged 80 years and older. While CWIs were limited to Grade 2, attention to the chest wall dose is advisable when treating tumors adjacent to the chest wall. Full article
(This article belongs to the Special Issue Clinical Research in Radiation Oncology: Current Status and Future Directions)
13 pages, 702 KB  
Article
High-Risk Prostate Cancer Treated with Radiation Therapy: Favorable Outcomes in Men with PSA > 20 as the Sole High-Risk Factor
by Aoi Shimomura, Abed R. Kawakibi, Muzamil Arshad and Stanley L. Liauw
J. Clin. Med. 2026, 15(3), 1119; https://doi.org/10.3390/jcm15031119 - 30 Jan 2026
Viewed by 1169
Abstract
Background/Objectives: The National Comprehensive Cancer Network (NCCN) classifies prostate cancer with PSA > 20 ng/mL as high risk; however, outcomes within this group are heterogeneous. Emerging data suggest that men with PSA > 20 ng/mL as the sole high-risk feature may have more [...] Read more.
Background/Objectives: The National Comprehensive Cancer Network (NCCN) classifies prostate cancer with PSA > 20 ng/mL as high risk; however, outcomes within this group are heterogeneous. Emerging data suggest that men with PSA > 20 ng/mL as the sole high-risk feature may have more favorable disease biology. We evaluated outcomes of men with prostate cancer treated with definitive radiation therapy (RT), focusing on the prognostic significance of individual high-risk factors. Methods: We analyzed 742 men with prostatic adenocarcinoma treated with curative-intent RT between 2005 and 2021, including 282 meeting traditional NCCN high-risk criteria. Treatment consisted of dose-escalated RT (median 78 Gy), with androgen deprivation therapy (ADT) administered to 94% (median duration 28 months). Primary endpoints were freedom from biochemical failure (FFBF) and distant metastasis (FFDM). Outcomes were assessed using Kaplan–Meier methods and Cox proportional hazards modeling. Results: At 5 years, high-risk patients demonstrated FFBF of 83% and FFDM of 89%, with significantly worse outcomes among very high-risk subgroups. Men with PSA > 20 ng/mL as their only high-risk feature (n = 49) achieved superior outcomes compared with other high-risk patients (5-year FFBF 94% vs. 74%; FFDM 97% vs. 82%; both p = 0.05), comparable to intermediate-risk disease. On multivariable analysis, Gleason score and clinical T-stage independently predicted poorer outcomes, whereas PSA > 20 alone did not. Conclusions: PSA > 20 ng/mL as an isolated high-risk feature is associated with favorable outcomes following definitive RT and appears to be the weakest NCCN high-risk criterion. These findings support refined risk stratification and raise the possibility of treatment de-escalation in select patients. Full article
(This article belongs to the Special Issue Clinical Research in Radiation Oncology: Current Status and Future Directions)
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11 pages, 567 KB  
Article
Plan Quality Comparison at Five Years in Two Cohorts of Breast Cancer Patients Treated with Helical Tomotherapy
by Samantha Dicuonzo, Maria Alessia Zerella, Mattia Zaffaroni, Maria Giulia Vincini, Karl Amin, Giuseppe Ronci, Micol D’arcangelo, Damaris Patricia Rojas, Anna Morra, Marianna Alessandra Gerardi, Cristiana Fodor, Raffaella Cambria, Rosa Luraschi, Federica Cattani, Paolo Veronesi, Francesca De Lorenzi, Mario Rietjens, Roberto Orecchia, Maria Cristina Leonardi and Barbara Alicja Jereczek-Fossa
J. Clin. Med. 2025, 14(5), 1630; https://doi.org/10.3390/jcm14051630 - 27 Feb 2025
Viewed by 1897
Abstract
Objectives: this study aimed to evaluate the evolution of planned dose distribution quality in two groups of breast cancer patients treated with hypofractionated intensity-modulated radiotherapy (IMRT) using Helical TomoTherapy® at our institute 5 years apart. Methods: the analysis included two cohorts [...] Read more.
Objectives: this study aimed to evaluate the evolution of planned dose distribution quality in two groups of breast cancer patients treated with hypofractionated intensity-modulated radiotherapy (IMRT) using Helical TomoTherapy® at our institute 5 years apart. Methods: the analysis included two cohorts of patients who underwent implant-based immediate breast reconstruction (IBR) and received post-mastectomy IMRT to the chest wall and infra/supraclavicular lymph nodes, following a 15-fraction regimen (2.67 Gy per fraction). The first group was treated between 2012 and 2015, while the second received treatment between 2019 and 2020. Dosimetric indices derived from dose–volume histograms used in clinical practice were analyzed to assess dose distribution quality. A quantitative scoring system was applied retrospectively to compare the two groups in terms of target coverage and organ-at-risk (OAR) sparing. Additionally, capsular contracture (CC) incidence was examined in both cohorts. Results: A total of 240 patients were included in the study. The percentage of optimal treatment plans increased from 70.8% in the 2012–2015 cohort to 77.5% in the 2019–2020 cohort, while compromised plans decreased from 10.8% to 7.5%. Furthermore, the incidence of moderate-to-severe CC dropped from 54.8% in the earlier cohort to 43.5% in the later one. Conclusions: Helical Tomotherapy® has demonstrated the ability to achieve a high rate of optimal treatment plans concerning both PTV coverage and OAR sparing in a challenging population of postmastectomy patients with IBR. The learning curve showed that, after 5 years, the rate of optimal plans was increased, accompanied by a reduction in compromised plans and treatment-related toxicity. Full article
(This article belongs to the Special Issue Clinical Research in Radiation Oncology: Current Status and Future Directions)
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Review

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22 pages, 2265 KB  
Review
Lung Stereotactic Body Radiotherapy (SBRT): Challenging Scenarios and New Frontiers
by Serena Badellino, Francesco Cuccia, Marco Galaverni, Marianna Miele, Matteo Sepulcri, Maria Alessia Zerella, Ruggero Spoto, Emanuele Alì, Emanuela Olmetto, Luca Boldrini, Antonio Pontoriero and Paolo Borghetti
J. Clin. Med. 2025, 14(14), 4871; https://doi.org/10.3390/jcm14144871 - 9 Jul 2025
Cited by 2 | Viewed by 6356
Abstract
Stereotactic Body Radiotherapy (SBRT) has emerged as a pivotal treatment modality for early-stage non-small cell lung cancer (NSCLC), offering highly precise, high-dose radiation delivery. However, several clinical challenges remain, particularly in the treatment of central or ultracentral tumors, which are located near critical [...] Read more.
Stereotactic Body Radiotherapy (SBRT) has emerged as a pivotal treatment modality for early-stage non-small cell lung cancer (NSCLC), offering highly precise, high-dose radiation delivery. However, several clinical challenges remain, particularly in the treatment of central or ultracentral tumors, which are located near critical structures such as the heart, bronchi, and great vessels. The introduction of MRI-guided SBRT has significantly improved targeting precision, allowing for better assessment of tumor motion and adjacent organ structures. Additionally, SBRT has demonstrated efficacy in multifocal NSCLC, providing an effective option for patients with multiple primary tumors. Recent advances also highlight the role of SBRT in locally advanced NSCLC, where it is increasingly used as a complementary approach to concurrent chemotherapy or in cases where surgery is not feasible. Moreover, the combination of SBRT with immunotherapy has shown promising potential, enhancing tumor control and immunological responses. Furthermore, SBRTs application in SCLC is gaining momentum as a palliative and potentially curative option for selected patients. This narrative review explores these evolving clinical scenarios, the technical innovations supporting SBRT, and the integration of immunotherapy, providing an in-depth look at the new frontiers of SBRT in lung cancer treatment. Despite the challenges, the ongoing development of personalized approaches and technological advancements continues to push the boundaries of SBRTs clinical utility in lung cancer. Full article
(This article belongs to the Special Issue Clinical Research in Radiation Oncology: Current Status and Future Directions)
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