Radiation

Introduction: Radiotherapy (RT) plays a crucial role in the management of prostate cancer (PC). Artificial intelligence (AI) is reshaping cancer care by providing innovative tools for diagnosis, treatment optimization, and outcome prediction. This review provides an end-to-end synthesis of AI applications across the prostate RT workflow, critically evaluating their clinical maturity, level of evidence, and current barriers to real-world implementation. Methods: A literature review of PubMed/MEDLINE and Embase was conducted to investigate the impact of AI on prostate RT. Only original articles published up to 1 August 2025 were included. The 27 selected studies were categorized into the following clusters: adaptive radiotherapy, autocontouring, autoplanning, prediction, synthetic computed tomography (CT), quality assurance (QA), and tracking. Results: Autocontouring was the most represented cluster, followed by prediction, autoplanning, and adaptive RT. Fewer studies addressed tracking, QA, and synthetic CT. Conclusions: AI shows significant potential across multiple phases of the prostate RT workflow; however, most evidence is based on retrospective or technical validation studies. Further research is required to establish clinical benefit and support integration into personalized treatment strategies.

Background. Patients with malignant or benign central nervous system (CNS) tumours are evaluated for suitability of treatment modality based on multiple clinical and tumour-related factors. To obtain multidisciplinary consensus, a patient’s file and imaging are commonly reviewed by a tumour board (TB). There are three relevant weekly TB venues at our institute—gamma knife stereotactic radiosurgery (SRS) intake rounds, CNS rounds, and stereotactic body radiotherapy (SBRT) rounds—which are attended by non-overlapping clinician teams. We explored the clinical parameters prompting multiple TB reviews in patients with complex CNS tumours. Methods. Data were retrospectively obtained from electronic medical records. Patients referred for discussion at SRS rounds (November 2017–June 2020) were cross-referenced with those reviewed in CNS rounds and SBRT rounds. The cohort of interest included patients who underwent review at more than one TB for the same indication. Patient, tumour, and treatment factors were abstracted, and descriptive statistics were calculated. A sub-cohort of patients with pre-plans created for both SRS and conventionally fractionated external beam radiotherapy (EBRT) was identified. Dosimetric data were analyzed. Results. Of 1091 patients, 87 (8.0%) were discussed at more than one TB. 59/87 (67.8%) patients were reviewed at two TBs pertaining to the same CNS lesion and comprised the study cohort. The most common tumour type was meningioma (20/59), and the most common reason for multiple discussions was proximity to optic structures (19/59). After TB discussions, 25/59 patients were seen in consultation by one specialist, 29/59 by two, and 5/59 by none. Overall, the final treatment decisions were conventional EBRT in 21/59; SRS in 18/59; surveillance in 12/59; surgery in 3/59; systemic therapy in 3/59; proton referral in 1/59; and SBRT in 1/59. A total of 20/59 patients were treated with palliative intent. Among all patients who ultimately received radiotherapy, median interval between the first TB discussion and the first RT treatment was 56 days (IQR 7.5–65.5 d). The pre-plan sub-cohort consisted of four patients, all of whom were ultimately treated with conventional EBRT. Conclusions. Evidence to support optimal treatment for some complex CNS tumours can be limited. Multiple radiotherapy modalities may be equally favourable (or unfavourable) options. Proximity to the optic apparatus and previous CNS irradiation are common reasons for clinical equipoise. Tumour board review is an essential tool in formulating a multidisciplinary care plan; however, attention should be paid to ensuring that subsequent consultations and treatment initiation are not unduly delayed.

Background: Cancer patients receiving or having received radiotherapy (RT) represent a clinically vulnerable group during the COVID-19 pandemic. However, systematic data on their clinical course, comorbidities, and vaccination status are limited. The German National Pandemic Cohort Network (NAPKON), established to systematically collect comprehensive clinical data on COVID-19 patients nationwide, provides a unique opportunity to address this gap. This study aimed to describe radiation therapy patterns and COVID-19-related clinical characteristics among patients documented within the NAPKON Cross-Sectoral Platform (SUEP). Methods: This multicenter, descriptive analysis was conducted within the framework of the German National Pandemic Cohort Network (NAPKON). All patients with documented RT and confirmed SARS-CoV-2 infection were identified in the SUEP database. RT was classified relative to the documented infection date as occurring before, during, or after infection. Demographic, clinical, laboratory, imaging, and vaccination data were extracted and analyzed descriptively. Due to the small sample size, no correlation or multivariable analyses were performed. Results: A total of n = 90 patients were included in the analysis. The median age was 65 years (range 22–90), and 56% were male. Most patients (93%) received one course of RT, most frequently targeting specific organ systems (54%), while total body irradiation was performed in 4%. The median radiation dose was 45 Gy (IQR 30–60). Among 68 patients with evaluable timing information, RT had been administered before infection in 53 patients (77.9%), during infection in 3 patients (4.4%), and after infection in 12 patients (17.6%). At the time of SARS-CoV-2 detection, 76% of patients experienced a phase without complications, 19% a phase with complications, and 2% a critical phase. The majority of vaccinated individuals had received Comirnaty (BioNTech/Pfizer; 80%). COVID-19-typical findings were identified in 18% of chest X-rays and 27% of CT scans. Clinical and laboratory characteristics showed no substantial differences by hospital length of stay. Conclusions: Patients with documented RT and SARS-CoV-2 infection in the NAPKON registry predominantly experienced mild or moderate COVID-19 courses and showed a relatively high vaccination uptake. However, due to the descriptive study design and the absence of a control group, these findings should not be interpreted as being attributable to RT itself but rather as a characterization of this registry cohort. Importantly, the cohort mainly comprised patients with a history of RT before SARS-CoV-2 infection, whereas only a small minority received RT during infection. Although the analysis was descriptive and limited by missing data, it demonstrates the feasibility and scientific value of integrating oncologic subcohorts within national pandemic research networks. Continued longitudinal analyses will be essential to further characterize outcomes of patients with cancer and RT in future pandemics.