{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:06:11Z","timestamp":1787695571957,"version":"build-2784847793"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Jpn J Radiol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>External-beam radiation therapy is a treatment option for muscle-invasive bladder cancer (MIBC), which enables bladder preservation and is applicable to elderly or medically fragile patients. Since the accuracy of conventional intensity-modulated radiation therapy is vulnerable to even small daily changes, online adaptive radiation therapy (ART) may be a more appropriate option. This study aimed to evaluate the feasibility of cone-beam computed tomography (CBCT)-based online ART for MIBC in elderly or medically fragile patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We applied CBCT-based online ART to treat two elderly patients with dementia and N0 M0 MIBC, who were deemed poor candidates for surgery or systemic therapies. A cumulative dose of 55\u00a0Gy in 20 fractions over 4\u00a0weeks was prescribed. Online ART was administered using Ethos\u2122 Therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both patients were able to follow the prescribed protocols with assistance (e.g., bladder voiding or filling and maintaining the treatment position), although full adherence was hindered by dementia. Nonetheless, they successfully completed the entire treatment regimen with manageable acute toxicities. The median treatment session duration was 23 (range 14\u201350, interquartile range 19\u201330) min. The median volume receiving at least 90% of the prescribed dose (V\n                      <jats:sub>90%<\/jats:sub>\n                      ) of the bowels was 1.25 (range 0.01\u20136.77) cm\n                      <jats:sup>3<\/jats:sup>\n                      in the adapted plans and 24.78 (range 6.80\u201390.72) cm\n                      <jats:sup>3<\/jats:sup>\n                      in the scheduled plan (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) in the first patient, and 0.13 (range 0.00\u20132.96) cm\n                      <jats:sup>3<\/jats:sup>\n                      in the adapted plans and 9.60 (range 4.65\u201318.62) cm\n                      <jats:sup>3<\/jats:sup>\n                      in the scheduled plan (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) in the second patient, respectively. A significant volume of the bowels was spared from receiving high doses in the adapted plans without compromising the target dose coverage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CBCT-based online ART was considered a feasible therapeutic option for elderly or medically fragile patients with MIBC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11604-025-01885-4","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T03:20:40Z","timestamp":1760066440000},"page":"432-438","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Online adaptive radiation therapy for muscle-invasive bladder cancer: short-course and high-precision definitive treatment for elderly or medically fragile patients"],"prefix":"10.1007","volume":"44","author":[{"given":"Peter J. 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Takashi Kobayashi holds leadership positions in the Japan Society of Clinical Oncology and the Japan Society of Urologic Oncology. Takashi Mizowaki has been involved in both commissioned and collaborative research projects sponsored by Varian Medical Systems, a collaborative research project with Hitachi, Ltd., and a commissioned research project funded by Brainlab AG. He has also received honoraria from Varian Medical Systems, Hitachi, Ltd., Elekta, and Brainlab AG. In addition, he holds leadership roles in the Japanese Society for Radiation Oncology, the Japan Radiological Society, the Japan Society of Clinical Oncology, and the Japan Society of Urologic Oncology. All other authors declare no conflicts of interest relevant to the subject matter of this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Clinical trial registration number: R1048-3.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical statement"}},{"value":"All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants"}},{"value":"Informed consent was obtained from all participants included in the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}