New Advances in Radiation Therapy

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 930

Special Issue Editors


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Guest Editor
Radiation Oncology Unit, Vito Fazzi Hospital, 73100 Lecce, Italy
Interests: lung cancer; head and neck cancer; soft tissue sarcomas; stereotactic radiotherapy

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Guest Editor
Radiation Oncology Unit, Oncology Department, Azienda USL Toscana Nord Ovest, S. Luca Hospital, 55100 Lucca, Italy
Interests: stereotactic radiotherapy; urology malignancies; radiobiology; image guidance; head and neck cancers; gynecology oncology; cancer immunity; tumor microenvironment

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Guest Editor Assistant
Radiation Oncology Unit, Vito Fazzi Hospital, 73100 Lecce, Italy
Interests: lung cancer; prostate cancer; stereotactic radiotherapy; image guidance

Special Issue Information

Dear Colleagues,

Radiation oncology continues to evolve as a discipline where technological advancement, biological insight, and therapeutic innovation converge. This Special Issue brings together a series of contributions that reflect some of the most dynamic and promising directions in contemporary clinical and translational research.

Central to this evolution is the increasing adoption of adaptive radiotherapy, which enables treatment adaptation in response to anatomical and functional changes, improving precision without compromising workflow feasibility. The spread of new hadrontherapy centers has made particle therapy available in an ever-increasing number of countries. In parallel, modern fractionation approaches—including hypofractionation and ultra-hypofractionation—are redefining therapeutic paradigms across multiple tumor sites, supported by growing clinical evidence and an improved understanding of radiobiological responses.

The integration of systemic agents, particularly immunotherapy and novel targeted drugs, in combination with radiotherapy or concurrent radiochemotherapy, is expanding treatment opportunities in both curative and metastatic settings. At the same time, radiomics and artificial intelligence are emerging as essential tools in decision support, risk stratification, and treatment personalization, offering a data-driven layer of refinement to existing protocols.

The articles in this collection reflect these trends, offering both technical depth and clinical relevance. By capturing the interplay between innovation and practical application, this Special Issue aims to contribute to the ongoing advancement in patient-centered, precision-based radiation oncology.

Dr. Angela Sardaro
Dr. Lilia Bardoscia
Guest Editors

Dr. Elisa Ciurlia
Guest Editor Assistant

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Keywords

  • adaptive radiotherapy
  • modern fractionations
  • image guidance
  • protontherapy
  • hadrontherapy
  • concurrent radiochemotherapy
  • immunotherapy
  • new drugs
  • radiomics
  • AI

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Published Papers (1 paper)

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Research

19 pages, 3276 KB  
Article
CBCT-Based Online Adaptive, Ultra-Hypofractionated Radiotherapy for Prostate Cancer: First Clinical Experiences
by Georg Wurschi, Alexander Voigt, Noreen Murr, Cora Riede, Michael Schwedas, Maximilian Römer, Sonia Drozdz and Klaus Pietschmann
Medicina 2025, 61(10), 1839; https://doi.org/10.3390/medicina61101839 - 14 Oct 2025
Viewed by 786
Abstract
Background and Objectives: Ultra-hypofractionated radiotherapy (uhRT) is increasingly used for low- and intermediate-risk localized prostate cancer, necessitating exceptional precision compared to conventional fractionation. CBCT-based online-adaptive uhRT may help mitigate pelvic organ motion but has not yet been established in clinical routine. We [...] Read more.
Background and Objectives: Ultra-hypofractionated radiotherapy (uhRT) is increasingly used for low- and intermediate-risk localized prostate cancer, necessitating exceptional precision compared to conventional fractionation. CBCT-based online-adaptive uhRT may help mitigate pelvic organ motion but has not yet been established in clinical routine. We report initial clinical experiences focusing on the feasibility and technical aspects of treatment delivery. Materials and Methods: Seven patients (35 fractions) with low- or intermediate-risk prostate cancer were treated with online-adaptive uhRT on the Varian Ethos® system within routine clinical care. The target included the prostate and proximal seminal vesicles (CTV1, 5 × 7.25 Gy), with an integrated boost to the prostate (CTV2, 5 × 8.00 Gy). For each fraction, dose–volume histogram (DVH) parameters for targets and organs at risk (OARs) were recorded retrospectively for both scheduled and adaptive plans, along with the plan selection decision. Plan quality was evaluated per clinical DVH constraints and target coverage. The treatment time was recorded. Results: Online-adaptive uhRT was successfully delivered every day in 5 patients and on alternate days in 2 patients. Mean treatment time was 30:17 (±05:49 SD) minutes per fraction. The median recorded change in target and OAR volumes was <10%. Adaptive plans resulted in a statistically significantly improved target coverage for CTV1 (V100%, p = 0.01), PTV1 (D98%, p < 0.001), PTV2 boost (D98%, p < 0.001) in Wilcoxon signed-rank tests. OAR dose reduction was limited, with a small improvement in bladder V40Gy (p = 0.02). Adaptive plans were applied in 32/35 fractions (91.4%). To encompass intra-fractional motion in 95% of fractions, positional adjustments up to 0.77 cm (longitudinal), 0.37 cm (lateral), and 0.59 cm (sagittal) were required. Conclusions: Online-adaptive uhRT appears feasible, leading to optimized target volume coverage. Considerable treatment times must be taken into account. A second CBCT is recommended to compensate for intra-fractional motion. Further research regarding patient-related endpoints and cost-effectiveness is highly needed. Full article
(This article belongs to the Special Issue New Advances in Radiation Therapy)
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