{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T22:30:30Z","timestamp":1783549830195,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Brain metastases (BMs), among the most prevalent intracranial malignant tumors, frequently induce acute symptoms such as headaches and motor deficits due to elevated intracranial pressure. Although hippocampal\u2010avoidance whole brain radiotherapy (HA\u2010WBRT) has demonstrated superior preservation of cognitive function compared to standard WBRT\u2014despite comparable intracranial progression\u2010free survival and overall survival outcomes\u2014its clinical application remains restricted by the complexity and time\u2010intensive nature of conventional planning and delivery protocols. These limitations hinder its utility as an emergent intervention for patients requiring urgent symptom relief.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To address this challenge, we developed a novel HA\u2010WBRT\u2010specific all\u2010in\u2010one (AIO) radiotherapy integrated with online adaptive techniques, and systematically evaluated its operational feasibility, dosimetric precision, and therapeutic effectiveness for emergency HA\u2010WBRT in patients with BMs through preliminary clinical outcomes and related findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The HA\u2010WBRT\u2010specific AIO workflow featured by rapid auto\u2010segmentation of the target and hippocampal, HA\u2010constrained planning using volumetric modulated arc therapy (VMAT) with three coplanar lock\u2010field full arcs ache ensuring a high first\u2010pass success rate for treatment plans, and real\u2010time in vivo quality assurance (QA) enabling safe beam delivery without delay was applied to the eleven emergency patients with BMs receiving HA\u2010WBRT during their initial treatment fraction. Rotational setup errors in subsequent fractions were documented. For these fractions, online adaptive radiotherapy (ART) was implemented using the AIO\u2010generated plan as the baseline. Time requirements for each workflow step and in vivo 3D gamma passing rates were analyzed to evaluate efficiency and dosimetric accuracy. Dosimetric differences between the ART\u2010optimized plan (ART\u2010Plan) and the image\u2010guided radiotherapy plan (IGRT\u2010Plan) were compared to quantify the impact of rotational deviations on dose distribution. Cognitive function (via the Mini\u2010Mental State Examination [MMSE]) and functional independence (via the Basic Activities of Daily Living, BADL) were assessed before and after radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The average duration of the AIO radiotherapy was 24.3\u00a0\u00b1\u00a00.6 min. The majority of AIO\u2010Plan parameters satisfied RTOG 0933 criteria. For the AIO\u2010Plans, in vivo 3D \u03b3 pass rates exceeded 94% (3 mm\/3% gamma criteria with a 10% dose threshold). Recorded rotational errors in emergency patients exhibited irregular and substantial variations, highlighting the need for online adaptation. Notably, 94% of fractions required adaptation to meet the target coverage (TC) criteria specified by NRG CC001. All ART\u2010Plans demonstrated 3D \u03b3 pass rates exceeding 93% (3 mm\/3% gamma criteria with a 10% dose threshold). The average duration of ART was 22.9\u00a0\u00b1\u00a01.6 min. Post\u2010radiotherapy, both MMSE and BADL scores showed measurable improvements, while acute symptoms were effectively controlled and alleviated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The AIO workflow for managing emergency patients with BMs is feasible and safe, facilitating prompt initiation of highly efficient radiotherapy during the first treatment session, eliminating delays. Subsequent online ART effectively corrects rotational deviations, ensuring adequate prescription dose coverage of target volumes while optimizing dose distribution to normal tissues. HA\u2010WBRT incorporating the AIO workflow with online adaptation demonstrates potential for timely control and alleviation of acute symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70405","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T09:06:01Z","timestamp":1765530361000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["An all\u2010in\u2010one workflow for emergency hippocampal\u2010avoidance whole\u2010brain radiotherapy in brain metastases, with optional online adaptive extension"],"prefix":"10.1002","volume":"26","author":[{"given":"Haibo","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Oncology School of Clinical Medicine, and The First Affiliated Hospital of Chengdu Medical College  Chengdu Sichuan China"},{"name":"Clinical Key Speciality (Oncology Department) of Sichuan Province  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Oncology School of Clinical Medicine, and The First Affiliated Hospital of Chengdu Medical College  Chengdu Sichuan China"},{"name":"Radiology and Therapy Clinical Medical Research Center of Sichuan Province  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Cosmetic and Plastic Burn Surgery School of Clinical Medicine and The First Affiliated Hospital of Chengdu Medical College  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuegui","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of General Medicine School of Clinical Medicine and The First Affiliated Hospital of Chengdu Medical College  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningyue","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Oncology School of Clinical Medicine, and The First Affiliated Hospital of Chengdu Medical College  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Gao","sequence":"additional","affiliation":[{"name":"United Imaging Central Research Institute Co., Ltd  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lecheng","family":"Jia","sequence":"additional","affiliation":[{"name":"Radiotherapy Laboratory, Shenzhen United Imaging Research Institute of Innovative Medical Equipment  Shenzhen China"},{"name":"Zhejiang Engineering Research Center for Innovation and Application of Intelligent Radiotherapy Technology  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunyan","family":"Dai","sequence":"additional","affiliation":[{"name":"Shanghai United Imaging Healthcare Co., Ltd.  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