{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:08:26Z","timestamp":1779451706772,"version":"3.53.1"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"1182","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Adaptive radiotherapy (ART) is increasingly recognized for its potential to optimize treatment accuracy by adjusting to anatomical changes during therapy. In children, who are particularly sensitive to radiation-induced toxicities and experience rapid anatomical changes, ART could be especially beneficial. We conducted an online survey to assess the current state of ART in children across Europe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 21-question survey regarding ART implementation, techniques, indications, and technical infrastructure was distributed online to SIOP-Europe affiliated centres.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty responses from 18 European countries were received. ART was available for children in 68% of centres. Most frequent sites for implementation were pelvis, abdomen, and head-and-neck, with an average of 20% of respondents using ART for &amp;gt;75% of these cases. Higher-volume centres were more likely to implement ART (r\u2009=\u20090.34, P\u2009=\u2009.048). Fifteen percent performed daily adaptation, while 75% applied it only for major anatomical changes. Half of the centres used offline and 24% online ART. Specific infrastructure included Ethos (21%), MR-LINAC (5%), and Tomotherapy (13%). Automatic contouring was mostly used for OARs (57%). Barriers to implementation included a need for more evidence (50%), specialized equipment (52%) and guidelines (39%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ART use in paediatric patients is highly variable and remains limited. Only a subset of centres reported routine use of ART, with notable variation in frequency and criteria for adaptation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>This is the first Europe-wide survey to comprehensively map ART practices in paediatric oncology, revealing substantial heterogeneity and identifying key barriers to wider adoption, representing a base to guide standardization and future clinical validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqag059","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T07:01:27Z","timestamp":1773212487000},"page":"1092-1100","source":"Crossref","is-referenced-by-count":0,"title":["Adaptive radiotherapy in paediatric patients: a SIOP Europe ROWG survey on practice patterns across 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