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JCM
Special Issues
Emerging Radiotherapy Technologies and Trends
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Emerging Radiotherapy Technologies and Trends

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 20 September 2026 | Viewed by 1123

Special Issue Editor

Dr. Michele Fiore

E-Mail Website
Guest Editor
1. Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
2. Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
Interests: gastrointestinal cancers; lung cancer; integrated therapies; adaptive radiotherapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Radiotherapy is undergoing a transformative evolution, driven by rapid advancements in imaging, treatment planning, artificial intelligence, and delivery techniques. Despite the fact that significant progress has been made, challenges remain, including tumour motion management, normal tissue toxicity, adaptive treatment, and real-time dose monitoring. This Special Issue is therefore both timely and essential, as we seek to explore radiotherapy technologies that could improve clinical outcomes and patient quality of life.

We aim to collate innovative research and comprehensive reviews that focus on technological breakthroughs such as MR-guided radiotherapy, FLASH therapy, AI-driven treatment optimisation, radiomics, proton and heavy ion therapy, and the integration of theragnostics. We also welcome the submission of studies focused on clinical implementation, as these contribute to the broader adoption of advanced radiotherapy techniques.

We invite researchers and clinicians to submit their original manuscripts exploring emerging methods or sharing clinical experiences. Your contributions will help to shape the future landscape of radiation oncology and accelerate the transition from innovation to clinical practice.

Dr. Michele Fiore
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • image-guided radiotherapy (IGRT)
  • 4D radiotherapy
  • SBRT
  • radiomics
  • FLASH therapy
  • MR-guided radiotherapy

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Published Papers (1 paper)

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Research

12 pages, 825 KB  
Article
Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy (PULSAR) for Patients with Lung Tumors and Severe Pulmonary Disease
by Kenneth D. Westover, Ruiqi Li, Stetler Tanner, Maureen Aliru, Mu-Han Lin, Bin Cai, David Parsons, Justin Visak, Yesenia Gonzalez, Anundip Gill, Yuanyuan Zhang, Shahed N. Badiyan, Puneeth Iyengar and Robert Timmerman
J. Clin. Med. 2026, 15(3), 1261; https://doi.org/10.3390/jcm15031261 - 5 Feb 2026
Viewed by 816
Abstract
Background/Objectives: Patients with early-stage non-small cell lung cancer (NSCLC) or limited lung metastases and compromised lung function, such as those with interstitial lung disease (ILD) or chronic obstructive pulmonary disease (COPD), or other factors rendering them high-risk for surgery or medically inoperable, face [...] Read more.
Background/Objectives: Patients with early-stage non-small cell lung cancer (NSCLC) or limited lung metastases and compromised lung function, such as those with interstitial lung disease (ILD) or chronic obstructive pulmonary disease (COPD), or other factors rendering them high-risk for surgery or medically inoperable, face increased risks of treatment-related toxicity from stereotactic ablative radiation therapy (SABR). This study evaluated a novel treatment approach to mitigate these risks. Methods: We investigated Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy (PULSAR), delivered as pulsed radiation every three weeks, in patients with <5 cm lung tumors and ILD, COPD, or prior therapy. Treatment occurred between 2022 and 2024. Online adaptive radiotherapy (o-ART) was employed in 20 patients (80%) to modify treatment plans when anatomical changes warranted replanning. Primary outcomes included volumetric tumor response, changes in dose to organs at risk (OARs) and acute events, while secondary outcomes included local and tumor control, and overall survival. Results: Twenty-three patients received PULSAR treatment at doses between 40 Gy and 60 Gy in 5 fractions and one patient received 54 Gy in 3 fractions, with a median follow-up time of 16.2 months. Approximately half of treated patients demonstrated volumetric tumor response, with median residual volume of 70% (range 36–100%) at maximal response. Among the 20 patients (80%) who underwent online adaptive replanning, significant reductions in OAR dosimetry were observed for all organs assessed including the Dmax for heart (p = 0.0053), bronchus (p = 0.0003), esophagus (p = 0.0005), spinal cord (p = 0.025), and the lung V20 Gy and V12.5 Gy (p < 0.0001). Treatment-related toxicity included two grade 1–2 adverse events and six grade 3 events consisting of pneumonitis, dyspnea or lung infection, with no grade 4 or 5 events. Median progression-free survival was 21.1 months, with 1-year overall survival of 74% and 1-year local control of 100%. Conclusions: PULSAR shows promise as a feasible treatment option for high-risk patients with NSCLC or lung metastases, demonstrating no grade 5 events and complete tumor control. Additional research is needed to fully evaluate the safety profile of PULSAR in the high-risk subgroups and whether PULSAR’s treatment intervals and adaptive planning advantages lead to improved long-term outcomes compared to conventional, uninterrupted SABR regimens. Full article
(This article belongs to the Special Issue Emerging Radiotherapy Technologies and Trends)
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