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To examine, if a shift in indications for radiotherapy is to be expected in the context of the COVID-19 pandemic, the database Pubmed was searched for multidisciplinary or surgical expert recommendations on the role of radiotherapy in modified treatment concepts. Increased use of radiotherapy or chemoradiation instead of surgical treatment was recommended for defined patient groups with head-and-neck cancer, lung cancer, cervix cancer, esophageal cancer and prostate cancer. Omission of radiotherapy was considered in elderly patients with low-risk breast cancer and in early-stage Hodgkin’s lymphoma. Only adjustments to the timing of radiotherapy were discussed for sarcoma and rectal cancer. Emerging recommendations on multidisciplinary cancer treatment concepts during the COVID-19 pandemic indicate a shift in radiotherapy indications and a potentially increased demand for radiotherapy.

Lung cancer is known for its high mortality; many patients already present with metastases at the time of diagnosis. The aim of this study is to assess the impact of new treatment strategies on the survival of primarily metastatic lung cancer patients and to analyze the differences in outcomes between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients. Population-based data, provided by the Robert-Koch Institute in Germany, was used and patients diagnosed between 2007 and 2018 were included in the study. We differentiated between NSCLC and SCLC patients and analyzed the survival over time for both sexes separately, using the Kaplan–Meier method. To evaluate survival advantages, we calculated multivariable hazard ratios. In total, 127,723 patients were considered for the study. We observed a moderate increase in survival over time. All patients showed an increased survival rate when undergoing chemotherapy. Minimal to no increase in survival was shown in NSCLC patients when receiving radiotherapy, whereas SCLC patients’ survival time did benefit from it. NSCLC patients receiving immunotherapy showed an increase in survival as well. It can be concluded that advancements in radiotherapy, the application of chemotherapy, and the introduction of immunotherapies lead to an increased survival time of both NSCLC and SCLC primarily metastatic lung cancer patients.

Background Anaplastic thyroid carcinoma has a very poor prognosis. We analyzed the effect of surgery, radiotherapy and chemotherapy on survival time and side effects in patients with ATC. Methods We retrospectively analyzed all patients (n = 63) with histologically confirmed ATC who presented at our clinic between 1989 and 2020. We analyzed the survival with Kaplan–Meier curves and cox proportional hazard models and acute toxicities with logistic regression models. Results Out of 63 patients, 62 received radiotherapy, 74% underwent surgery and 24% received combined chemotherapy. A median radiation dose of 49 Gy (range 4–66 Gy) was applied. In 32% of the cases opposing-field technique was used, in 18% 3D-conformal, in 27% a combination of opposing field and 3D-conformal technique and 21% obtained IMRT (intensity modulated radiotherapy) or VMAT (volumetric modulated arc radiotherapy). Median overall survival (OS) was 6 months. We identified five predictive factors relevant for survival: absence of distant metastases at the time of diagnosis (OS 8 months), surgery (OS 9.8 months), resection status R0 (OS 14 months), radiation dose of 50 Gy or higher (OS 13 months) and multimodal therapy (surgery, radiotherapy and chemotherapy) with a median OS of 9.7 months. Conclusion In spite of the dismal outcome, longer survival can be achieved in some patients with ATC using surgery and radiotherapy with a high radiation dose. Compared to our previous study, there are no significant advantages in overall survival. Trial registration Retrospectively registered.

Background: Accurate prognostication is essential for clinical decision-making in palliative radiotherapy (RT). The Palliative Performance Scale (PPS) is a validated tool for assessing functional status and estimating survival in palliative care, yet its prognostic value in patients receiving palliative RT for bone metastases remains insufficiently explored. This study aimed to evaluate the association between PPS and overall survival (OS) in a real-world cohort of cancer patients undergoing palliative RT. Methods: This retrospective, single-center study included 153 patients who received palliative RT for bone metastases between 2021 and 2025 at the Department of Radiation Oncology, University Hospital Halle (Saale), Germany. Clinical, demographic, and treatment data were extracted from institutional databases. The primary endpoint was OS, defined as the time from the end of RT to death. Univariable and multivariable Cox proportional hazards regression models were used to identify prognostic factors associated with OS, including PPS, sex, age, marital status, BMI, Charlson Comorbidity Index (CCI), and RT completion. Due to violation of the proportional hazards assumption, PPS (<60% vs. ≥60%) was used as a stratification factor in the final Cox model. Logistic regression was performed to explore predictors of discharge to home. Results: The median OS for the entire cohort was 108 days (3.6 months; 95% CI 78–143 days). Male sex (HR 1.61, 95% CI 1.06–2.46, p = 0.027) and older age (HR 0.98, 95% CI 0.96–1.00, p = 0.050) were associated with shorter survival, whereas completion of the prescribed RT course was strongly associated with improved OS (HR 0.06, 95% CI 0.03–0.12, p < 0.001). Patients with PPS ≥60% had significantly better survival compared to those with lower PPS (HR 0.62, 95% CI 0.41–0.93, p = 0.021). After stratification by PPS, no violation of the proportional hazards assumption was detected (global p = 0.55). The stratified model confirmed that male sex, age, and RT completion remained independent predictors of survival. No significant predictors were identified for discharge destination in logistic regression analysis. Conclusions: The PPS is a valuable prognostic tool for patients receiving palliative RT for bone metastases. A PPS of ≥60% was associated with prolonged survival, supporting its use in clinical prognostication and treatment planning. Completion of RT emerged as a strong independent predictor of survival, underscoring the importance of treatment adherence even in palliative settings. Stratification by PPS further improved model validity and prognostic accuracy.

Ionizing radiation induces amongst other the most critical type of DNA damage: double-strand breaks (DSBs). Efficient repair of such damage is crucial for cell survival and genomic stability. The analysis of DSB associated foci assays is often performed manually or with automatic systems. Manual evaluation is time consuming and subjective, while most automatic approaches are prone to changes in experimental conditions or to image artefacts. Here, we examined multiple machine learning models, namely a multi-layer perceptron classifier (MLP), linear support vector machine classifier (SVM), complement naive bayes classifier (cNB) and random forest classifier (RF), to correctly classify γH2AX foci in manually labeled images containing multiple types of artefacts. All models yielded reasonable agreements to the manual rating on the training images (Matthews correlation coefficient >0.4). Afterwards, the best performing models were applied on images obtained under different experimental conditions. Thereby, the MLP model produced the best results with an F1 Score >0.9. As a consequence, we have demonstrated that the used approach is sufficient to mimic manual counting and is robust against image artefacts and changes in experimental conditions.

IntroductionVideo-assisted thoracoscopic surgery (VATS) lobectomy is a commonly employed surgical technique for the management of operable early stage non-small cell lung cancer (NSCLC). This procedure, however, is dependent on the patient’s ability to tolerate surgery. In light of this, stereotactic ablative radiotherapy (SABR) has emerged as a viable alternative treatment strategy for patients who are inoperable or who refuse surgery. Considering the lack of randomised controlled trials and the increased risk of bias in observational cohort studies, this study protocol proposes an emulated target trial design to investigate the causal effect of SABR, in comparison to VATS, on overall survival in operable early stage NSCLC patients.Methods and analysisData on NSCLC patients will be collected from routinely collected university hospital records linked with German cancer registry data. This study protocol was developed using the target trial methodology outlined by Hernan et al. The protocol establishes specific parameters for key trial components in order to mitigate bias in the analysis of observational data and to facilitate the calculation of causal estimands. The target trial design that would be emulated is a multicentre open-label two-parallel arm superiority randomised trial. Mediators and confounding variables were determined through the use of a directed acyclic graph. The statistical analysis aims to measure the per-protocol and intention to treat effect of SABR versus VATS within 3 months of diagnosis, on survival, through the difference in restricted mean survival times, using weighted non-parametric Kaplan-Meier curves.Ethics and disseminationThe Ethics Committee of the Medical Faculty of Martin Luther University Halle-Wittenberg with an approved addendum with Dnr 2023–112 has approved this study. The study uses anonymised routinely collected hospital and cancer registry data in accordance with applicable data protection regulations. Results will be disseminated through peer-reviewed publications and presentations at scientific conferences.

ObjectiveTo assess the association of public health parameters with the regional variation in the initial treatment for prostate cancer.MethodsWe used data from German epidemiologic cancer registries for the years 2009–2013. Presence of a certified cancer center, a radiotherapy and/or urology institution, the district-specific GDP, and population density were used as predictors. Patients with indication for adjuvant treatment were excluded (T3b). Only districts with defined quality criteria were eligible. We used general linear mixed models (equivalent to logistic regression) with a covariance matrix weighted by the Euclidean distances between districts. Models were adjusted for age, grading, and TNM stage. We performed sensitivity analyses by imputing missing data with multiple imputation and considering extreme case scenarios. We applied inverse probability weighting to account for missing values.ResultsWhen radiotherapy/surgery is compared to neither treatment, the probability for the latter was higher in East than in West Germany (OR 1.7, 95% CI 1.43–2.02). The same was true for districts with both, a radiotherapy and urologic treatment facility (OR 1.43, 1.19–1.72). Analyzing radiotherapy vs. surgery, the probability for prostatectomy was inversely associated with the presence of a radiotherapy unit when compared to districts with neither treatment facility (OR 0.52, 95% CI 0.38–0.73). Patients treated in East Germany were more likely to receive a surgical treatment (OR 1.34, 95% CI 1.08–1.66). Sensitivity analyses revealed no relevant change of effect estimates.ConclusionTreatment differs between East and West Germany and is associated with the presence of a radiotherapy or urology clinic.

Introduction To identify potential risk factors for the development of jaw osteoradionecrosis (ORN) after 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) among patients with newly diagnosed head and neck cancer. Material and methods This study included 776 patients who underwent 3D-CRT or IMRT for head and neck cancer at the Department of Radiotherapy at the University Hospital Halle-Wittenberg between 2003 and 2013. Sex, dental status prior to radiotherapy, tumor site, bone surgery during tumor resection, concomitant chemotherapy, and the development of advanced ORN were documented for each patient. ORN was classified as grade 3, 4, or 5 according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer classification or grade 3 or 4 according to the late effects in normal tissues/subjective, objective, management, and analytic scale. The cumulative incidence of ORN was estimated. Cox regression analysis was used to identify prognostic risk factors for the development of ORN. Results Fifty-one patients developed advanced ORN (relative frequency 6.6 %, cumulative incidence 12.4 %). The highest risk was found in patients who had undergone primary bone surgery during tumor resection (hazard ratio [HR] = 5.87; 95 % confidence interval [CI]: 3.09–11.19) and in patients with tumors located in the oral cavity (HR = 4.69; 95 % CI: 1.33–16.52). Sex, dentition (dentulous vs. edentulous), and chemotherapy had no clinically relevant influence. Discussion and conclusion In contrast to most previous studies, we noted a low cumulative incidence of advanced ORN. Patients with tumors located in the oral cavity and those who undergo bone surgery during tumor resection prior to RT may be considered a high-risk group for the development of ORN.

Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. To assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients. We used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan-Meier and multivariate Cox regression (models adjusted for HPV-related cancer site). Temporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35-0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03). The advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery.

Background Lung cancer is the most frequent source of brain metastases (BMs), with 20-40% of patients with non-small cell lung cancer (NSCLC) developing BMs during the course of disease. The NSCLC-GPA (Graded Prognostic Assessment), developed by Sperduto et al., aims to estimate overall survival (OS) in lung cancer patients with BMs based on multiple prognostic factors. This study aimed to validate the applicability and prognostic relevance of the updated 2022 NSCLC-GPA in a German clinical cohort, with particular attention to programmed death-ligand 1 (PD-L1) expression and treatment-related outcomes. Methods We retrospectively analyzed patients with NSCLC and BMs treated between 2020 and 2022 at a German university hospital. GPA scores were calculated using established parameters: age, Karnofsky Performance Status (KPS), number of BMs, presence of extracranial metastases (ECM), EGFR and ALK mutation status, and PD-L1 expression. Due to the low number of non-adenocarcinoma (NAC) cases in our cohort, only patients with adenocarcinoma (AC) were included. Univariate and multivariate Cox regression models, log-rank tests, and Kaplan–Meier curves for illustrative purposes were used to evaluate associations between prognostic factors and OS. Results A total of 110 AC patients met the inclusion criteria. Median OS was 10 months (range: 6-11). Patients with GPA scores of 0-1 and 1.5-2 had significantly worse outcomes compared with the reference group (GPA 3.5-4; median OS: 36 months), with median OS times of 3 and 8 months, respectively (HR: 8.34, 95% CI: 2.53-27.5, p = 0.0005 and HR: 5.24, 95% CI: 1.584-17.33, p = 0.0067). Patients with a GPA of 2.5-3 had a median OS of 22.5 months (HR: 1.6, 95% CI: 0.469-5.45, p = 0.453), which was not statistically significant. Older age (≥ 70 years; HR: 1.95, 95% CI: 1.23-3.11, p = 0.0047), low KPS (KPS ≤ 70; HR: 3.88, 95% CI: 2.33-6.46, p  < 0.0001), a higher number of BMs (HR: 1.58, 95% CI: 1.03-2.41, p  = 0.035), and the presence of ECM (HR: 2.62, 95% CI: 1.66-4.13, p  < 0.0001) were all significantly associated with decreased OS. In the multivariate analysis, low KPS and ECM remained independently significant prognostic factors. PD-L1 expression showed no significant association with OS. Conclusion Despite shorter OS outcomes in our cohort, the 2022 NSCLC-GPA proved to be a valuable prognostic tool, with lower scores consistently associated with poorer outcomes. In addition, older age, low KPS, ECM, and a higher number of BMs were identified as prognostic factors, with low KPS and ECM remaining independent prognostic factors in the multivariate analysis.