Concurrent chemoradiotherapy is an established treatment modality for several solid malignancies, whereas its role in breast cancer remains investigational. This study reports the five-year efficacy, safety, and survival outcomes of preoperative concurrent chemoradiotherapy (PCRT) in patients with HER2-positive and triple-negative breast cancer. This is a prospective single-center pilot study that includes 62 patients with non-metastatic HER2-positive or triple-negative breast cancer treated between 2018 and 2022. Patients received hypo-fractionated radiotherapy (40.5 Gy/15 fractions with a simultaneous integrated boost to 54 Gy to the macroscopic tumor using 18-FDG-PET-CT) delivered concurrently with subtype-specific systemic therapy, followed by surgery. Surgery was performed 4–6 weeks after PCRT. Primary endpoints included pathological complete response (pCR), toxicity, and long-term oncological outcomes. Between September 2018 and August 2022, 62 patients were enrolled (median age 53 years). Tumor subtypes were 28 TN (45

PURPOSE:Low-dose radiation therapy (LDRT) is a minimally invasive treatment option for pain management in selected patients with osteoarthritis (OA). However, standardized and internationally accepted target volume definitions are still lacking. METHODS AND MATERIALS:An international expert consortium of 15 institutions from Europe and the United States conducted a Delphi consensus process to define joint-specific target volumes based on the 3-dimensional (3D) concept of the clinical target volume (CTV). A standardized computed tomography data set ("homunculus") was used by all participants to ensure uniform anatomical reference for target volume delineation. RESULTS:Target volume definition includes inflammatory and OA-specific pathological features such as joint effusion, cysts, and subchondral sclerosis. The CTV encompasses the joint capsule and varies in its cranio-caudal extent among individual patients. Using joint-specific isocenter definitions-such as the midpoint between the femoral condyles for the knee joint-the 3D boundaries of the CTV can be determined. This approach enables anatomically precise delineation of the target volume, ensuring inclusion of inflammation-relevant structures while excluding uninvolved bone and soft tissue. CONCLUSIONS:This international consensus statement provides practical guidance for a standardized 3D target volume definition in the radiation therapy of OA. Accurate knowledge of joint anatomy and pathology, combined with precise target volume delineation and careful consideration of the clinical context, such as symptom distribution and the pattern of joint involvement, may support more consistent LDRT treatment planning for OA. These target volume definitions also provide a structured basis for future clinical studies and further clinical validation.

BACKGROUND: Radiotherapy is a technically precise yet deeply human medical specialty, often underrepresented in narrative depictions of oncology. Like modern superhero stories, radiotherapy practice blends idealism, responsibility, moral ambiguity, and human limitation. This work explores the professional behaviours, cultural identities, and interpersonal dynamics within radiotherapy departments through a satirical but recognisable framework. MATERIALS AND METHODS: We conducted a qualitative, narrative-based observational study informed by long-term clinical experience in radiotherapy practice. Using thematic synthesis, reflective ethnography, and humour as analytical tools, recurrent professional behaviours and attitudes were identified and distilled into archetypal personas representing common patterns within the radiotherapy workforce. RESULTS: Seven archetypal radiotherapy phenotypes emerged, each embodying characteristic strengths, flaws, and decision- making styles. These personas illustrate tensions between evidence and action, precision and pragmatism, idealism and compromise, as well as the balance between technical excellence and human factors. Collectively, they provide an accessible framework to describe the social and cognitive ecology of contemporary radiotherapy practice. CONCLUSIONS: This satirical taxonomy highlights the diversity, complexity, and humanity of professionals working in radiotherapy. By framing the specialty as a “multiverse” of flawed yet committed heroes, the study offers an engaging perspective on clinical culture, professional identity, and self-awareness. Ultimately, it argues that maintaining humour and humility may be as essential to radiotherapy practice as technical precision.

BACKGROUND AND OBJECTIVE:The management of metastatic cancer is shifting from a strict division between curative local therapy and palliative systemic treatment toward a biology-driven continuum. In this setting, stereotactic body radiotherapy (SBRT), or stereotactic ablative radiotherapy (SABR), has emerged as an effective consolidative approach for patients with limited metastatic burden. Its role is now being explored beyond the classical oligometastatic paradigm, including oligoprogressive and selected polymetastatic disease. This narrative review summarizes the evidence supporting SBRT/SABR in patients with metastatic burden exceeding the traditional definition (≤3-5 metastases), focusing on emerging clinical scenarios. METHODS:A structured PubMed/MEDLINE search identified studies published between January 2000 and December 2025 using MeSH and free-text terms related to stereotactic radiotherapy and metastatic disease states. Randomized trials, prospective cohorts, and retrospective studies evaluating SBRT/SABR in oligoprogressive and other non-classical settings were included. Reviews, case reports, and preclinical studies were excluded. Due to heterogeneity in definitions and study designs, findings were synthesized narratively. KEY CONTENT AND FINDINGS:Prospective and observational data show that SBRT/SABR achieves high local control with acceptable toxicity in oligometastatic disease and is increasingly investigated in patients with higher metastatic burden. The conventional cutoff of ≤3-5 metastases appears arbitrary, with ongoing trials assessing broader indications. Clinical benefit is strongly influenced by tumor biology, with more favorable outcomes in prostate and renal cell carcinoma than in other malignancies. SBRT/SABR is also used in oligoprogressive disease to prolong systemic therapy efficacy and for local symptom control. Patient-reported outcomes suggest disease progression, rather than treatment toxicity, is the main driver of quality-of-life decline. CONCLUSIONS:SBRT/SABR may extend beyond the oligometastatic paradigm, but lesion count alone is insufficient for patient selection. Optimal use requires individualized, biology-driven strategies. Future research should refine selection criteria, incorporate biomarkers, and clarify integration with systemic therapies.

This study aimed to investigate global practice patterns, barriers, and physician perspectives on implementing ultra-hypofractionated radiation therapy (UHF-RT) in breast cancer treatment. A 19-question online survey, distributed to radiation oncologists worldwide between February and August 2025, assessed UHF adoption, clinical use, barriers, training, and outlook. Chi-square tests compared adoption by institutional type, economic context, and physician experience (p < 0.05). 89 responses from 24 countries were analyzed. Moderate hypofractionation (MHF) predominated (70.8

Low dose radiotherapy (LDRT) is a radiation technique in the treatment of benign conditions to relieve symptoms and improve mobility and pain with minimal overall side effects. There are many reports describing the use of LDRT in the treatment of osteoarthritis (OA), tendinitis and hyperproliferative disorders. The targeted diseases are complex and multifactorial, characterized by inflammation, cellular alterations, and tissue degeneration, affecting millions of people worldwide with increasing prevalence due to aging populations. However, an understanding of the pathophysiological mechanisms as well as the underlying biological and physical mechanisms is important for the clinical-practical application, as a foundation for empirical clinical studies and state-of-the-art patient treatment. In this review, we provide an overview of the broad use of LDRT in the treatment of benign diseases with well-described and illustrated overviews of the pathomechanisms of OA, tendinitis, bursitis, benign fibromatoses and hyperproliferative diseases. The biological, physical, and molecular mechanisms behind it are also described. We further provide a broad overview of studies as well as current discussions of the therapy such as risk assessment, treatment frequency and dosage, along with future perspectives to improve clinical application overall. Taken together, this review illustrates the multifaceted application of (LD)RT, emphasizing that each disease requires a unique treatment approach due to the wide variation in pathology, biological mechanisms, target volumes, and organs at risk, but it also highlights the need for well-designed (placebo)-controlled studies in a range of indications.

Importance:Integration of molecular biomarker information into systemic therapy has become standard practice in breast cancer care. However, its implementation in guiding radiotherapy (RT) is slower. Although postoperative RT is recommended for most patients after breast-conserving surgery and, depending on risk factors, following mastectomy, emerging evidence has indicated that patients with low scores on gene expression signatures or selected clinical-pathological features may have very low local recurrence rates. This narrative review explored the potential of biomarker-directed personalized RT approaches, which may optimize treatment strategies and be associated with improved patient outcomes and experiences. Observations:Distinctions between prognostic and predictive biomarkers were highlighted, emphasizing the importance of analytical and clinical validity in biomarker-based studies. Findings from studies investigating the prognostic and predictive value of various genomic signatures and immunohistochemical markers for guiding breast RT were presented. These included the Adjuvant Radiotherapy Intensification Classifier and the Profile for the Omission of Local Adjuvant Radiation, which have shown potential in predicting RT benefits. The genomic-adjusted radiation dose and role of tumor-infiltrating lymphocytes were also discussed. Ongoing clinical trials exploring the use of biomarkers in ductal carcinoma in situ and invasive breast cancer to refine RT decision-making were illustrated. Conclusions and Relevance:The results of this narrative review suggest that evidence-based shared decision-making is crucial to optimize treatment according to the individual's predicted benefits and risks along with their personal preferences. Incorporation of biomarker-directed approaches in RT for breast cancer may hold promise for personalized treatment, potentially facilitating omission of RT for patients at low risk of recurrence, while identifying those who may benefit from intensified therapy. This personalized RT approach may be associated with improved clinical outcomes and quality of life and facilitate decision-making for people with breast cancer. However, there remains a need for robust clinical and analytical validation of biomarkers to ensure reliability and clinical utility for RT optimization.

SRS for the treatment of limited brain metastases (BM) is widely accepted, but there are still limitations in the management of numerous BM. Frameless single-isocenter multitarget SRS is a novel technique that allows for rapid treatment delivery to multiple BM. We report our preliminary clinical, dosimetric, and patient´s shifts outcomes with this technique. We have reviewed clinical and dosimetric outcomes of patients with intact BM treated with SRS using one isocenter either for single (1BM) or multiple (≥ 2BM) targets). Immobilization was based on an SRS stereotactic mask. Elements Multiple Brain Mets SRS (Brainlab AG, Munich, Germany) software was used for registration, image fusion, target contouring, and treatment planning. Exactrac Dynamic (Brainlab AG, Munich, Germany) and a 6 degree of freedom couch were used for monitoring, correcting the position and assessing and applying residual errors also when couch rotations. During dose delivery, the patient position was monitored and registered using surface tracking and stereoscopic X-rays. From May 2022 to December 2023, we treated 60 patients with a total of 255 BM. The 67

This study aimed to investigate the prevalence and characteristics of burnout among Radiation Oncology residents in Spain, focusing on its associated risk factors and implications for residency training. A cross-sectional online survey was conducted from June to September 2024, using the Maslach Burnout Inventory (MBI) to evaluate emotional exhaustion, depersonalization, and self-fulfillment. Residents from various Spanish regions completed an anonymous questionnaire covering workload and burnout. Fifty residents, predominantly in their third (38

Painful musculoskeletal disorders (PMDs) represent an increasing public health concern, particularly among aging populations. When conservative therapies prove insufficient, low-dose radiotherapy (LDRT) has emerged as a non-invasive and effective treatment alternative. Despite growing clinical evidence supporting its efficacy, LDRT remains underutilized due to persistent skepticism and the absence of standardized clinical guidelines. This review synthesizes current evidence on the use of LDRT for PMDs, focusing on its biological mechanisms, optimal dosing regimens, clinical efficacy, and safety profile. Attention is given to dose fractionation strategies, timing of re-irradiation, and technological advancements that enhance treatment precision. LDRT provides pain relief in 60–90

Background: Atypical fibroxanthoma is a rare cutaneous tumour of mesenchymal origin, often presenting as a rapidly growing, painless mass in sun-exposed areas. Although historically considered benign, it has an intermediate malignant potential with a risk of recurrence and, in rare cases, metastasis. Treatment primarily involves surgical excision, although recurrence rates can occur. Adjuvant superficial high-dose-rate (HDR) brachytherapy (plesiotherapy) is able to reduce recurrence risk, particularly after local tumour relapses and/or when complete excision with wide margins is unfeasible. It provides excellent local control, cosmetic outcomes and minimal toxicity, making it a promising option in selected cases. This report highlights the utility of customised-mold HDR plesiotherapy for a locally recurrent atypical fibroxanthoma.

PURPOSE:This study evaluated the feasibility and tolerability of SABR in patients with high- and very-high-risk prostate cancer. METHODS AND MATERIALS:A prospective study included patients with high-risk and N1 prostate cancer. SABR was delivered as 40 Gy in 8 Gy fractions, with optional elective nodal irradiation (26 Gy in 5.2 Gy fractions) and a 40 Gy nodal boost for N1 disease. The treatment protocol involved 24 to 36 months of androgen deprivation therapy, premedication with alpha-1 receptor antagonists, and dexamethasone (4 mg on treatment days). Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0, while quality of life was assessed using the EORTC QLQ-C30 and QLQ-PR25 questionnaires at the final check-up. RESULTS:The study included 96 patients (median age 77.2 years) with a median follow-up of 29.8 months. Elective nodal radiation therapy was delivered to 66.7% of patients, and 16.8% received a nodal boost. Acute grade 2 (G2) genitourinary and gastrointestinal (GI) events occurred in 5.2% and 7.3% of patients, respectively, with no grade ≥3 acute events. Late grade ≥2 genitourinary and GI events were observed in 7.8% and 15.7% of patients, respectively, including 1 grade 4 GI event. Common late symptoms included nocturia and rectal bleeding. Most patients (86.5%) reported no or minor difficulties posttreatment, though challenges with sexual activity, nocturia, and incontinence were noted. Physicians underestimated urgency and nocturia and overestimated rectal bleeding. CONCLUSIONS:SABR delivering 40 Gy in 5 fractions is feasible and well-tolerated for high-risk prostate cancer, with minimal additional toxicity from elective nodal irradiation and a boost to N1 disease. These findings support SABR as an effective treatment, warranting further long-term studies.

AIMS:Data on feasibility and safety of ultra-hypofractionated radiotherapy (UHF-RT) for ductal carcinoma in situ (DCIS) remain limited, particularly regarding its use with a simultaneous integrated boost (SIB). MATERIALS AND METHODS:This prospective cohort study included 100 women with histologically confirmed DCIS treated between April 2020 and May 2024. Ninety patients underwent breast-conserving surgery, and 10 received postmastectomy radiotherapy due to high-risk features. All patients received UHF-RT to 26 Gy in five fractions, with SIB to 29-32 Gy delivered using three-dimensional conformal radiotherapy or volumetric modulated arc therapy. Acute and late toxicities were assessed per Common Terminology Criteria for Adverse Events, version 5.0, and recurrence-free survival was analysed using Kaplan-Meier estimates. RESULTS:At a median follow-up of 44 months, all patients were alive and disease-free except one, who experienced in situ recurrence at 31 months and was successfully salvaged. The 48-month actuarial local control rate was 98.8%. Acute toxicity was mostly grade 1 dermatitis (57%) or oedema (10%). No grade ≥3 toxicity was observed. Fat necrosis occurred in 11% of patients, all asymptomatic. Late events included hyperpigmentation (9%), fibrosis (6%), and mild pain (28%). No clinical or dosimetric variables were significantly associated with toxicity. CONCLUSION:Ultra-hypofractionated whole-breast radiotherapy with SIB is feasible, safe, and well-tolerated in patients with DCIS, including those at high risk postmastectomy. These findings provide early evidence supporting its use, pending results from ongoing randomised trials.