Accurate prediction of inter-fractional tumor volume changes may improve the efficiency and personalization of magnetic resonance-guided adaptive radiotherapy in prostate cancer (PCa). This study investigates the feasibility of using machine learning algorithms to predict inter-fraction gross tumor volume (GTV) changes in PCa during adaptive radiotherapy (ART), aiming to identify the optimal similarity coefficient and model to improve ART decision-making. Retrospective magnetic resonance images from 22 PCa patients treated using the ViewRay MRIdian LINAC system were analyzed. The GTV of each patient was recorded before treatment (GTV0) and during five fractions (GTV1–5). Four different similarity coefficients—dice, Jaccard, Tanimoto, and Ochiai similarity coefficients (DSC, JSC, TSC, and OSC)—were calculated to evaluate inter-fractional GTV variations. Machine learning models—artificial neural networks (ANNs), extreme gradient boosting machine, random forests, classification and regression trees, and k-nearest neighbors—were trained with appropriate hyperparameters to predict tumor volume changes between fractions. Their predictive performances were compared to determine the most effective algorithm. The ANN model demonstrated superior performance in predicting GTV variations across treatment fractions. Among the similarity coefficients, DSC contributed most to predicting inter-fractional tumor volume changes, while OSC had the least impact. The ANN model achieved the highest predictive performance on the independent test dataset (R2 = 0.822). These findings indicate that ANN models can successfully predict inter-fractional GTV variations in PCa, thereby providing valuable support for ART decision-making. Incorporating DSC-based similarity analysis may facilitate ART planning and improve clinical outcomes. The study supports integrating AI-based methods into the ART workflow.

Magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) combines high-precision SBRT with superior soft tissue visualization and daily adaptive planning. While prospective studies suggest reduced toxicity compared to CT-based SBRT, data on oncologic outcomes and PSA kinetics in the MR-guided setting remain limited. We retrospectively reviewed 150 prostate cancer patients treated with MRgSBRT (ViewRay MRIdian) between September 2018 and April 2024. Patients received 36.25 Gy radiotherapy in 5 fractions with or without androgen deprivation therapy (ADT). Outcomes included biochemical recurrence free survival (bRFS), local progression free survival (LPFS), regional recurrence free survival (RRFS), distant metastases free survival (DMFS), event-free survival (EFS), PSA kinetics, and toxicity (CTCAE v5.0). The median follow-up was 27.2 months (range: 4–73 months). The estimated 5‑year bRFS, LPFS, RRFS, DMFS and EFS rates were 81.8

The optimal timing of radiotherapy (RT) in patients with WHO grade 2 meningiomas remains controversial, particularly following gross total resection (GTR). This multicenter study compared long-term outcomes of early RT versus late RT, focusing on progression-free survival (PFS), overall survival (OS), and tumor-related mortality. This retrospective multicenter cohort study included 263 adult patients with histopathologically confirmed WHO grade 2 meningiomas treated between 2005 and 2023. Patients were stratified by RT timing: early adjuvant RT after initial surgery versus late RT administered after radiologic or clinical progression. Outcomes were analyzed in the overall cohort and in a prespecified GTR subgroup. PFS and OS were estimated using the Kaplan–Meier method. Tumor-related mortality was assessed using cause-specific Cox and Fine–Gray competing-risk models. With a median follow-up exceeding 7 years, early RT was associated with a significant improvement in PFS compared with late RT. In the overall cohort, 10-year PFS was 84.8

Localized treatment of oligometastatic liver disease can improve both local control and survival. The liver is a frequent site of metastases from colorectal, breast, and lung cancers, but most patients are not eligible for surgical resection due to lesion number, location, or comorbidities. For these patients, non-surgical ablative methods such as radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) and increasingly microwave ablation (MWA) are used. RFA was used as the primary comparator in this review because it represents the most historically established and widely reported ablative modality in the comparative radiotherapy literature. While RFA has been the traditional approach, SBRT is emerging as a promising alternative, offering precise, non-invasive treatment. SBRT may be especially useful for larger lesions or tumors in locations where RFA is difficult to perform. However, high-quality evidence and large-scale trials are still needed to confirm its efficacy and define its role. This review compares the strengths and limitations of both methods and provides practical guidance for clinical decision-making in the treatment of patients with inoperable liver metastases.

PURPOSEThis study aimed to identify the concerns and needs of radiation oncology residents in Turkey regarding their efforts to stay current with advancements in this highly competitive discipline.MATERIALS AND METHODSA cross-sectional anonymous survey of 20 questions was designed by the Turkish Society for Radiation Oncology (TROD)-Young Radiation Oncologists Group (GROG) and distributed to radiation oncology residents across Turkey. Data were collected and analyzed using descriptive analyses to identify common themes and specific needs and stratified according to junior and senior residents. Statistical analysis was performed using the Statistical Package for Social Sciences Statistics 21.0 (SPSS Inc, Chicago, IL).RESULTSSixty-four residents participated in the survey, with an overall response rate of 20%. The majority of participants, 55 (85.9%), had a regular training program in their clinic. However, only 28 (51%) felt that this program was sufficient to stay up to date. Consequently, almost all participants (98.4%) reported making individual efforts to stay current, with 87.3% encountering difficulties. Notably, junior residents experienced a higher rate of difficulty than senior residents did (93.1% v 70%, respectively). All the participants expressed the need for a new platform to easily access the results of significant new studies.CONCLUSIONThe traditional radiation oncology curriculum needs to be updated to include modern methods of obtaining information in the current Internet era. In addition, new platforms should be provided to residents for easier access to information. As TROD/GROG, we have planned to address this issue with the GROG News project. Further efforts should be made to develop solutions to alleviate residents' concerns.

Stereotactic body radiotherapy (SBRT) is associated with good local control and symptom relief in the management of spinal metastases. Delivery of ablative doses and re-irradiation is challenged by spinal cord toxicity. We hypothesized that lower spinal cord doses as well as better target coverage could be yielded with stereotactic magnetic resonance-guided adaptive radiotherapy (SMART). Institutional records were reviewed to retrieve patients who received online MR-guided SBRT for spinal metastases. Each fraction was reviewed to determine the necessity of adaptive planning, to identify reasons for violations that required adaptive planning, and to assess the spinal cord dose. The study also evaluated how adaptive planning contributed to reducing spinal cord doses. A total of 34 patients with 61 lesions were included. The treatment intent was definitive for 47 (77.1

To determine recurrence patterns and prognostic factors in limited disease SCLC (LD-SCLC) and evaluate the effect of TNM classification on prognosis. We retrospectively evaluated 266 patients with LD-SCLC who underwent curative chemoradiotherapy ± prophylactic cranial irradiation (PCI) between 2003 and 2016. These patients were recruited from 10 centers and restaged using the 7th and 8th TNM staging systems. We assessed the impact of TNM stage, age, gender, and PCI on all survival outcomes through univariate and multivariate analyses. Survival rates were calculated using the Kaplan–Meier method. The median follow-up period was 42 months. In all cases, the 2- and 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 63.4–41.8

Aim This study explores the impact of age, malnutrition severity, and malnutrition risk on cancer treatment outcomes and their incidence based on cancer localization and stage, in geriatric and adult patients in Turkey. The study emphasizes the role of oral nutritional supplements (ONS) in improving nutritional status and treatment response in both age groups. Materials and methods This prospective observational cohort study involved 163 patients with solid tumors receiving radiotherapy (RT) or RT combined with chemotherapy. Malnutrition risk was assessed using the Nutritional Risk Screening (NRS) tool, and malnutrition severity was determined via body mass index (BMI). The significance of age, malnutrition severity, and risk on treatment outcomes and performance status were evaluated by the physician and the Eastern Cooperative Oncology Group Performance Status. Anthropometric measurements recorded before and after treatment were compared to evaluate ONS benefits across age and cancer groups. Results Of the patients, 50.9 % were aged ≥70 years. A majority had stage III cancer (57.4 %) and lung cancer (38.7 %). Weight and BMI scores significantly decreased from pre-to post-treatment (P < 0.001). Malnutrition risk was higher in stage III cancer (P = 0.039), and geriatric patients had higher baseline NRS scores than adults (P = 0.049). Pre-treatment weight loss and malnutrition risk negatively affected RT response (P < 0.007). Post-treatment malnutrition risk prevalence increased significantly in head and neck cancer patients (P = 0.016). Conclusions Nutritional therapy is crucial alongside cancer treatment, as pre-treatment weight loss and NRS≥3 negatively affect RT response. Maintaining a healthy nutritional status correlates with better outcomes, necessitating further research to optimize interventions stabilizing weight and BMI during RT.

To investigate the treatment outcomes of extracranial oligometastatic colorectal cancer (CRC) patients treated with stereotactic body radiotherapy (SBRT). The clinical data of 388 extra-cranial oligometastatic CRC (≤ 5 lesions) patients and 463 lesions treated with SBRT at 19 cancer institutions were retrospectively analyzed. The prognostic factors predicting overall survival (OS), progression-free survival (PFS), and local control (LC) were assessed in uni- and multivariable analyses. The median age was 62 years (range, 29–92 years). The majority of the patients (90.5

Aims: To present the preliminary results on the clinical utilisation of an online daily adaptive magnetic resonance-guided radiation therapy (MRgRT) for various gynaecological cancers. Materials and methods: Twelve patients treated between September 2018 and June 2022 were included. Six patients (50%) were treated with pelvic radiation therapy followed by MRgRT boost as brachytherapy boost was ineligible or unavailable, three patients (25%) were treated with pelvic MRgRT followed by high dose rate brachytherapy, two patients (16.7%) were treated with only MRgRT, one patient (8.3%) was treated with linear accelerator-based radiation therapy followed by MRgRT boost for bulky iliac lymph nodes. Results: The median age was 56.5 years (range 31-86 years). Eight patients (66.7%) had a complete response, three patients (25%) had a partial response and one patient (8.3%) died due to acute renal failure. The mean follow-up time was 11.2 months (range 3.1-42.6 months). The estimated 1-year overall survival was 88.9%. The median treatment time was 47 days (range 10-87 days). During external beam radiation therapy, 10 (83.3%) patients had concomitant chemoradiotherapy. Pelvic external beam radiation therapy doses for all cohorts were 45-50.4 Gy with a fraction dose of 1.8 Gy. The median magnetic resonance-guided boost dose was 32 Gy (range 20-50 Gy) and fraction doses ranged between 4 and 10 Gy. Three patients were treated with intracavitary high dose rate brachytherapy (26-28 Gy in four to five fractions). None of the patients had grade >3 late genitourinary toxicities. Conclusion: MRgRT is reliable and clinically feasible for treating patients with gynaecological cancers alone or in combination with brachytherapy with an acceptable toxicity and outcome. MRgRT boost could be an option when brachytherapy is not available or ineligible. (c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Purpose/Objective(s) Stereotactic body radiotherapy (SBRT) is an established treatment for most oligometastatic cancers. The challenge when treating oligometastatic GYN cancer (OGYNC) is metastases are commonly found near organs at risk (OAR). Therapeutic ratio may be improved using MR-guided radiation therapy (MRgRT) as it offers better soft tissue resolution and onboard adaptation, allowing for safe dose escalation on a mobile target or surrounded by mobile OARs. Few published prospective studies assess the role of Non-MRg SBRT in OGYNC. Reports of acute/late grade 2+ toxicity from the MITO retrospective cohorts range between 5% and 7%. Evidence for MRgRT in OGYNC is limited to small institutional series, and prospective outcomes using this technology have been reported only in a single institution stage I trial with 10 ovarian cancer patients. We report outcomes of the largest retrospective, multicenter cohort of MRgSBRT in patients with OGYNC. Materials/Methods We gathered data from 7 centers located in Miami, Dallas, Istanbul, London, and Munich, and included patients with OGYNC (≤ 5 metastases) treated by MRgSBRT w/wo online adaptation between January 2018 - July 2023. Primary endpoints were local control (LC) and Acute/late toxicities, recorded via version 5.0 of Common Terminology Criteria for Adverse Events (CTCAE). Secondary endpoints were progression free survival (PFS) defined as time from MRgSBRT to1st event: death, locoregional failure (using RECIST 1.1 criteria), or distant failure at 12 months, and overall survival (OS) at 12 months; both estimated using Kaplan-Meier method. Results We obtained data-sharing agreements and identified 81 patients (106 MRgSBRT courses) with a median follow-up of 15 months. Primary diagnoses were Ovary (n = 41), Vagina (n = 3), Uterine (n = 26), Cervix (n = 10). Sites treated included 28 RP lesions (26.4%), 15 intrabdominal (14.2%), 24 pelvic (22.6%), 10 vaginal (9.4%), 10 lung/mediastinal (9.4%), 17 liver/periportal lesions (16%), and 2 supraclavicular nodes (1.9%). Median GTV and PTV size was 8.14 cc (range = 0.5-274cc) and 16.6 cc (2-487cc) respectively. Median prescription dose was 40 Gy (18-60 Gy) in a median 5 (1-10) fractions, and median BED10 of 72 Gy (28-180Gy). Ninety-six MRgSBRT courses were adaptive (90%), of which 6.8% were due to motion management, 25.4% and 16.9% due to PTV or OAR violations respectively, and 32.2% due to violation of both. LC rate was 84.6%, of which 63.5% had complete response (Table 1). Estimated PFS and OS at 12 months were 48% (95% CI = 36-59) and 91% (95% CI = 81-96) respectively. Incidence of grade 2+ toxicity was 2.8% (2 grade 2 acute GI/GU events and 1 grade 3 vertebral fracture). Conclusion We provide the largest cohort to date of OGYNC treated with MRgSBRT, showing that dose escalation with this technology is feasible and well-tolerated with minimal toxicity and ∼85% local control.

Purpose/Objective(s) High stress levels and anxiety during cancer therapy may cause higher rates of side effects. Adaptive radiotherapy modalities in a closed bore MR Linac with significantly long treatment times may cause excessive stress in patients which calls for supportive measures. One of these measures is animal assisted activity support program. In the literature, results of therapy dog supportive programs are very limited. There is no study concerning therapy dog supported radiotherapy with MR Linacs. Materials/Methods During therapy dog visits, patients had time with the therapy dog for 15 minutes in a room prepared for this purpose, before their therapy sessions in MR-Linac device. In this study, Border Collie, Golden Retriever, French Bulldog, Labrador Retriever breeds dogs, carrying therapy dogs’ properties were used. Patients had activities with therapy dog such as playing games, walking together, or patting under supervision of the dog handler. Patients responded to the Profile of Mood States (POMS) questionnaire's Turkish version and Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F) questionnaire in the first day of radiotherapy before and after meeting the therapy dog. During 2 more radiotherapy sessions, the questionnaires were repeated after patient's time with therapy dog. In addition to behavioral and mood state evaluation, heart rate, respiratory rate and blood pressure of the patients were recorded before and after therapy dog visits. All test results and physiologic parameters before and after meeting the dog were compared accordingly. Results Eight (26.7 %) females with the median age of 59.5 (45-70) and 22 (73.3%) males with the median age of 61.0 (28-83) were included to this study. Vigor activity results were significantly (p = 0.0005) higher after therapy dog visits in all 3 sessions comparing to results before the visit. VAS energy scores were higher after dog visits comparing to scores before the visit (p = 0.03). Tension anxiety one of the negative parameters of POM's test were in highest level before therapy dog visit and gradually decreased after all 3 visits and the results were statistically significant (p = 0.0005). Depression-dejection, Anger-hostility, Confusion-bewilderment and Fatigue-inertia showed significant decrease after dog visits (p<0.05). VAS fatigue scores were significantly lower after interaction with the dogs (p<0.05). Overall POMS values were significantly better after each 3 visits comparing to pre visit values (p<0.05). Heart rates of patients found to be lower after dog visits (p<0.05). Diastolic blood pressure recorded significantly lower after 2nd and 3rd dog visits (p<0.05). Conclusion Our results support that animal-assisted activity in patients with cancer who are undergoing radiation therapy in MR Linac had positive impact on patients’ stress anxiety and depression also improved physiological parameters.

Stereotactic body radiotherapy is a highly effective form of radiation therapy for palliation of bone metastases, but it can also lead to rare but severe side effects, such as myonecrosis. According to the literature, the incidence of myonecrosis after stereotactic body radiotherapy is low and mostly dose dependent. It is crucial to consider the potential impact of immunotherapy and other systemic therapies in the assessment. The course of radiation myonecrosis can vary, and corticosteroids or vascular endothelial growth factor inhibitors may potentially play a role in its treatment. Herein, we report two patients presenting with myonecrosis after stereotactic body radiotherapy for bone metastasis.

Amaç: Çalışmamızın birincil amacı Küçük Hücreli Dışı Akciğer Kanseri (KHDAK) tanısıyla radikal amaçlı torasik Radyoterapi (TRT) uygulanan olgularda, torasik RT’nin yaşam kalitesi skorları üzerinde yaptığı değişiklikleri saptamak, ikincil amacı ise RT parametrelerinin yaşam kalitesi skorlarına etkisini araştırmaktır. Gereç ve Yöntem: Çalışmaya katılan 3 ayrı merkezde Temmuz 2018-Temmuz 2019 tarihleri arasında radikal torasik RT uygulanan Küçük Hücreli Dışı Akciğer Kanseri olguları çalışmaya dahil edilmiştir. RT öncesinde, RT sonunda ve RT’den 1 ay sonra genel (QLQC30) ve akciğer kanserine spesifik (QLQ-L13) yaşam kalitesi anket modülleri ile yaşam kalitesi verileri toplanmış ve bu parametrelerdeki değişimler değerlendirilmiştir. Ayrıca RT tekniği, total doz, planlanan hedef hacim, dozimetrik veriler ile yaşam kalitesi skorlarındaki oluşan değişiklikler arasındaki ilişkisi araştırılmıştır. Bulgular: Verileri analiz edilen olgu sayısı 124’tü. Ankete uyum oranı %88’di. Ortanca yaş 61 (54-65)’di. Olguların %90’ı erkek, %84’ü evre 3’tü. Olguların %46’sında 3 Boyutlu Konformal Radyoterapi, %54’ünde Yoğunluk Ayarlı RT tekniği uygulanmıştı. Eşzamanlı KT alan olgu sayısı 72 (%58)’ydi. Radikal torasik RT ile olguların genel yaşam kalitesi skorları değişmezken, RT bitiminde, RT öncesi ve sonrasında 1. aya göre; emosyonel fonksiyon azalmakta, disfaji, halsizlik, bulantı-kusma ve iştah kaybında anlamlı artış oluşmaktaydı. Hemoptizide ise anlamlı palyasyon RT sonrası 1. ayda sağlanmaktaydı. Klinik parametreler ve RT ilişkili parametreler ile yaşam kalitesi skorlarında oluşan değişiklikler arasında bir ilişki bulunamamıştır. Sonuç: Radikal torasik RT’nin bitiminde olguların genel yaşam kalitesi değişmezken, emosyonel fonksiyon düşmekte, disfaji, halsizlik, bulantı-kusma ve iştah kaybında anlamlı artış oluşmakta, hemoptizide ise anlamlı palyasyon sağlanmaktadır. RT ilişkili parametreler ile yaşam kalitesi skorlarında oluşan değişiklikler arasında bir ilişki bulunamamıştır.