The pandemic raised a discussion about the postponement of medical interventions for non-small cell lung cancer (NSCLC). We analyzed the characteristics of pretreatment diagnostic assessment in the pandemic and the influence of diagnostic assessment on outcomes. A total of 96 patients with stereotactic body radiation therapy (SBRT) for NSCLC were included. The number of patients increased from mean 0.9 (2012–2019) to 1.45 per month in the COVID era (p < 0.05). Pandemic-related factors (contact reduction, limited intensive care unit resources) might have influenced clinical decision making towards SBRT. The time from pretreatment assessment (multidisciplinary tumor board decision, bronchoscopy, planning CT) to SBRT was longer during the COVID period (p < 0.05). Reduced services, staff shortage, or appointment management to mitigate infection risks might explain this finding. Overall survival, progression-free survival, locoregional progression-free survival, and distant progression-free survival were superior in patients who received a PET/CT scan prior to SBRT (p < 0.05). This supports that SBRT guidelines advocate the acquisition of a PET/CT scan. A longer time from PET/CT scan/conventional staging to SBRT (<10 vs. ≥10 weeks) was associated with worse locoregional control (p < 0.05). The postponement of diagnostic or therapeutic measures in the pandemic should be discussed cautiously. Patient- and tumor-related features should be evaluated in detail.

Purpose: Financial toxicity (FT) associated with cancer and its treatment has become increasingly important. This study investigated factors associated with the development of FT during radiation therapy (RT). SOCOFIN was the first longitudinal prospective study to systematically evaluate FT in the context of RT. Methods: Financial toxicity was measured with the Comprehensive Score for Financial Toxicity (COST-12) at RT initiation, completion, and at 3 months afterwards. Secondary endpoints included socioeconomic factors, health-related quality of life (EORTC QLQ-C30), depression (PHQ-9), coping mechanisms, and sense of coherence. The data were collected digitally; missing data were estimated using multiple imputation with chained equations. Results: Between July 2023 and June 2024, 230 patients were recruited. Analyses were performed on 170 records. During RT, FT did not increase; a slight overall decrease was descriptively observed. Of seven tumor groups, the highest difference in FT at baseline was measured between prostate (median 33) and pelvic cancer patients (median 19), reaching statistical significance (Kruskal–Wallis test, p = 0.01). Nonetheless, tumor entity was not found to be a significant predictor of FT following RT in multivariate linear regression models. While factors associated with FT differed between timepoints, financial difficulties at baseline predicted the occurrence of FT most strongly ( p < 10 ⁻¹³ ) and persistently. Conclusion: Predictors of FT were predominantly socioeconomic, such as baseline financial difficulties, net income, employment stability, and sense of coherence, which superseded tumor- or treatment-specific variables. The findings of this study underscore the necessity of multifactorial, early screening before RT to mitigate FT among radiation oncology patients.

Diagnosis of brain metastases (BM) has traditionally marked a turning point in treatment goals and prognosis of patients with breast cancer (BC). However, new systemic treatment options have both prevented the development and improved the prognosis of BC patients with BM. Stereotactic radiotherapy techniques (SRT) have widely replaced whole brain radiotherapy (WBRT) in patients with limited BM, yielding impressive survival at modest toxicity rates. However, based on established prognostic scores, many patients will not profit from modern SRT treatment concepts and, therefore, remain candidates for WBRT or best supportive care (BSC). Here, treatment decisions may be challenging. This study aims to describe clinical outcomes and explore potential prognostic factors in a single-center cohort of BC patients treated with WBRT comprising patients across the prognosis continuum reflecting everyday work routine. We retrospectively analyzed 108 patients diagnosed with BM who received WBRT between 2008 and 2020. The cohort included patients with a broad range of prognostic factors (≥ 60 years old, Karnofsky Performance Status [KPS] ≤ 70, >3 BM and a Graded Prognostic Assessment [GPA] score < 1 [anticipated life expectancy of < 4 months]), who were either treated with palliative WBRT alone or in case of focal symptoms attributed to individual location of metastasis with surgery, SRT, or WBRT + focal dose escalation (“boost”). Survival rates were estimated using the Kaplan–Meier method, and factors potentially affecting outcome were statistically assessed by the log-rank test. Uni- and multivariable Cox regression was used in survival analysis to estimate hazard ratios and to evaluate the influence of various variables on survival time. For all statistical procedures SPSS software (v. 26) was used. Median survival after diagnosis of BM was 4 months (95% CI 3–5 months). The most relevant negative prognostic factor within the group of GPA-classifiers was KPS (≤ 70), followed by the number of BM (>3). Metastasectomy displayed significantly improved survival in univariable analysis (log rank p = 0.008; Cox-Regression p = 0.018), but did not elicit as predictive for OS in multivariable analysis ( p = 0.47). Furthermore, completion of the prescribed RT series had the strongest impact on OS in both univariable and multivariable Cox regression analyses ( p < 0.00001) while delivery of a radiation boost in addition to WBRT exerted no significant benefit (Cox regression p = 0.358). Despite the continuous development of effective treatment strategies for BM, BC patients who are ineligible for innovative treatment modalities show poor survival rates. Following prognostic assessment may help to make treatment decisions. KPS and number of BM may be most important in this context. In our retrospective cohort surgical removal of BM and completion of RT series were associated with improved prognosis, while focal radiation dose escalation in addition to WBRT was not.

The internal organ at risk volume (IRV) concept might improve toxicity profiles in stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC). We studied (1) clinical aspects in central vs. peripheral tumors, (2) the IRV concept in central tumors, (3) organ motion, and (4) associated normal tissue complication probabilities (NTCPs). We analyzed patients who received SBRT for NSCLC (clinical aspects, n = 78; motion management, n = 35). We found lower biologically effective doses, larger planning target volume sizes, higher lung doses, and worse locoregional control for central vs. peripheral tumors. Organ motion was greater in males and tall patients (bronchial tree), whereas volume changes were lower in patients with a high body mass index (BMI) (esophagus). Applying the IRV concept (retrospectively, without new optimization), we found an absolute increase of >10% in NTCPs for the bronchial tree in three patients. This study emphasizes the need to optimize methods to balance dose escalation with toxicities in central tumors. There is evidence that organ motion/volume changes could be more pronounced in males and tall patients, and less pronounced in patients with higher BMI. Since recent studies have made efforts to further subclassify central tumors to refine treatment, the IRV concept should be considered for optimal risk assessment.

Brain metastases and leptomeningeal carcinomatosis (LC) are complications of advanced-stage malignancies, associated with a poor prognosis. This study aimed to evaluate the role of prognostic factors and radiotherapy (RT) treatment approaches while taking toxicity into account. We performed a retrospective study and compared clinical characteristics, prognostic factors, toxicities and outcomes in patients with (1) parenchymal brain metastases (PM) (n = 275) vs. LC (n = 35) and (2) in patients with whole brain radiotherapy (WBRT) (n = 52) vs. WBRT + boost (n = 201). We found poorer survival (OS) of the LC group compared to PM patients in univariable analysis (not in multivariable analysis). LC patients predominantly underwent WBRT only, received surgical resection before RT less frequently and had more RT discontinuations than PM patients. OS was better in the WBRT + boost group than in the WBRT only group. In patients who received WBRT + boost, the primary tumor was more often controlled, and the number of PM was lower compared to the WBRT only group. WBRT + boost was associated with higher rates of alopecia than WBRT only. Patients with LC had a worse prognosis compared to patients with PM. WBRT + boost resulted in higher toxicity than WBRT only but resulted in better OS in the presented study. WBRT + boost patients had more favorable prognostic factors prior to RT, so OS improvement is not likely due to boost. Treating brain metastases requires a careful assessment of benefits and risks. Optimal RT planning should consider prognostic factors and potential side effects individually.

Background: Conventional image-guided radiotherapy (IGRT) typically relies on a computed tomography (CT)-based treatment planning process (planning CT, pCT) performed prior to the start of treatment. During this process, a patient-specific treatment plan is generated, which is then delivered to the patient with a linear accelerator on a daily basis, usually with image guidance to compensate for variations in patient setup. However, daily interfractional anatomical variations in target position, shape, and volume, as well as in surrounding organs at risk (OARs), can only be addressed indirectly by adding safety margins, resulting in larger irradiated volumes and potentially increased toxicity. Online adaptive radiotherapy (oART) is a promising and innovative technique to reduce such margins and, consequently, treatment-related toxicity. It uses daily imaging to generate a “plan of the day” that is aligned with the current patient anatomy, often supported by artificial intelligence (AI), while the patient remains on the treatment couch. Through daily image-guided re-optimization of the radiation treatment (RT) plan on the anatomy of the day, target coverage may also be improved. This approach is particularly attractive in the pelvic region, where high interfractional anatomical variability, for example due to peristalsis or changes in bladder and rectal filling, is frequently observed. Methods: This prospective registry-based cohort study will include patients with pelvic or thoracic tumors with an indication for RT treated with IGRT or oART using the Varian Ethos™ system. The primary endpoint is defined as a 10% reduction in the rate of acute RT related toxicity (≥Common Terminology Criteria for Adverse Events (CTCAE) II°, v5.0) using oART. Secondary endpoints encompass clinical outcomes including late toxicities, tumor control rates, and patient-reported outcomes (PROs), as well as technical factors such as target volume, coverage, dose to OARs and anatomical variability score. While the cohort study compares IGRT versus oART for primary and secondary clinical endpoints, it also evaluates the real oART scenario against two hypothetical control scenarios for technical endpoints. Discussion: The introduction of oART promises a reduction in toxicities and improved target volume coverage, potentially resulting in enhanced tumor control rates. It is poised to be a pioneering technology in the field of radiation oncology. Given the absence of a direct comparison between IGRT and oART thus far, the prospective registry-based cohort study PRoART aims to address this gap. Trial registration: Clinical trial number NCT06185062, Clinicaltrials.gov. Registered 12/14/2023. Last update 07/29/2026.