{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:16:42Z","timestamp":1770877002896,"version":"3.50.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Adaptive radiotherapy (ART) enables daily plan modification based on anatomy and may improve outcomes in muscle-invasive bladder cancer (MIBC) treated with bladder-preserving chemoradiation. This retrospective study evaluated the dosimetric and clinical outcomes of daily ART.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between March 2021 and August 2024, 37 patients with T2\u2013T4a MIBC received 55 Gy in 20 fractions with or without chemotherapy. Patients were stratified by margin strategy: small-margin (SM, n=26) adaptive versus scheduled plans, and small-margin adaptive versus large-margin (SM-LM, n=11) scheduled plans. Daily cone beam CT\u2013guided ART with AI-assisted contouring, physician review, and plan selection was performed. Planning target volumes (PTVs) were generated by expanding the clinical target volume (CTV) by 0.5\u20131.0 cm in SM plans; 1.0\u20131.5 cm in LM plans. Toxicity was graded using CTCAE v5.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 740 fractions, adaptive plans were chosen in 96.9%. ART improved coverage in both cohorts. In SM patients, mean PTV V95 increased from 92.9% to 99.3% and CTV V98 from 96.7% to 99.8% (p &amp;lt; 0.01). In SM-LM comparison, PTV V95 improved from 95.5% to 99.8% (p &amp;lt; 0.01), with rectum and bowel dose reductions up to 91.9% and 57.8% (rectum V100%, bowel V100% respectively, both p &amp;lt; 0.01). At 12 months, cystectomy-free, progression-free, and overall survival were 95.8%, 82.7%, and 92.8%. No grade \u22653 acute toxicities occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Daily ART improves target coverage, reduces organ-at-risk exposure, and enables margin reduction in bladder-preserving radiotherapy. This represents one of the largest series of daily online ART for MIBC, demonstrating that margin-reduced ART is feasible and improves dosimetry compared with non-adaptive workflows.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1729810","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T05:23:04Z","timestamp":1770873784000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Daily artificial intelligence-assisted adaptive small margin radiotherapy during trimodal therapy of muscle-invasive bladder cancer"],"prefix":"10.3389","volume":"16","author":[{"given":"Philip","family":"Blumenfeld","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yair","family":"Hillman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Salhab","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ofer N.","family":"Gofrit","sequence":"additional","affiliation":[{"name":"Department of Urology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aron","family":"Popovtzer","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Wygoda","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Hebrew University Hospital","place":["Jerusalem, Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.12.104","article-title":"Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results","volume":"20","author":"R\u00f6del","year":"2002","journal-title":"J Clin Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2014.09.014","article-title":"Radical cystectomy vs. chemoradiation in T2-4aN0M0 bladder cancer: a case-control study","volume":"33","author":"Gofrit","year":"2015","journal-title":"Urol Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.06.047","article-title":"Interfraction bladder variability during radiotherapy for bladder cancer: a prospective study using cone beam computed tomography","volume":"81","author":"Foroudi","year":"2011","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2003.10.039","article-title":"Impact of changes in bladder and rectal filling volume on organ motion and dose distribution of the bladder in radiotherapy for urinary bladder cancer","volume":"59","author":"Fokdal","year":"2004","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)04158-5","article-title":"Influence of bladder and rectal volume on spatial variability of a bladder tumor during radical radiotherapy","volume":"55","author":"Pos","year":"2003","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2012.06.012","article-title":"Bladder cancer radiotherapy margins: a comparison of daily alignment using skin, bone or soft tissue","volume":"24","author":"Foroudi","year":"2012","journal-title":"Clin Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/42\/1\/008","article-title":"Adaptive radiation therapy","volume":"42","author":"Yan","year":"1997","journal-title":"Phys Med Biol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.3390\/cancers16061206","article-title":"Adaptive radiotherapy: next-generation radiotherapy","volume":"16","author":"Dona Lemus","year":"2024","journal-title":"Cancers (Basel)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1016\/j.ijrobp.2017.04.023","article-title":"Online adaptive radiation therapy","volume":"99","author":"Lim-Reinders","year":"2017","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.10.011","article-title":"Individualized nonadaptive and online-adaptive intensity-modulated radiotherapy treatment strategies for cervical cancer patients based on pretreatment acquired variable bladder filling computed tomography scans","volume":"83","author":"Bondar","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B11","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/s0167-8140(03)00246-9","article-title":"Organ motion, set-up variation and treatment margins in radical radiotherapy of urinary bladder cancer","volume":"69","author":"Muren","year":"2003","journal-title":"Radiother Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20150644","article-title":"Critical appraisal of treatment margins for pelvic tumors","volume":"89","author":"Palorini","year":"2016","journal-title":"Br J Radiol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2025.105677","article-title":"Bladder surface-based analysis proves the advantages of online adaptive radiotherapy over plan of the day","volume":"140","author":"Sapignoli","year":"2025","journal-title":"Phys Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s13014-025-02710-y","article-title":"CBCT-based online adaptive radiotherapy of the bladder - geometrical and dosimetrical considerations compared to conventional IGRT","volume":"20","author":"Fischer","year":"2025","journal-title":"Radiat Oncol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s13014-024-02484-9","article-title":"Adaptive radiotherapy for muscle invasive bladder cancer: a retrospective audit of two bladder filling protocols","volume":"19","author":"Guel","year":"2024","journal-title":"Radiat Oncol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.radonc.2022.03.014","article-title":"Online adaptive radiotherapy of urinary bladder cancer with full re-optimization to the anatomy of the day: Initial experience and dosimetric benefits","volume":"171","author":"\u00c5str\u00f6m","year":"2022","journal-title":"Radiother Oncol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e041005","DOI":"10.1136\/bmjopen-2020-041005","article-title":"Protocol for tumour-focused dose-escalated adaptive radiotherapy for the radical treatment of bladder cancer in a multicentre phase II randomised controlled trial (RAIDER): radiotherapy planning and delivery guidance","volume":"10","author":"Hafeez","year":"2020","journal-title":"BMJ Open"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.09.045","article-title":"Clinical implementation of \u201cPlan of the day\u201d Strategy in definitive radiation therapy of cervical cancer: online adaptation to address the challenge of organ filling reproducibility","volume":"118","author":"Ghosh","year":"2024","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2021.03.023","article-title":"Image-guided adaptive radiotherapy for bladder cancer","author":"Kong","year":"2021","journal-title":"Clin Oncol (R Coll Radiol)"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2025.03.018","article-title":"Online adaptive radiotherapy for bladder preservation: transitioning to hypofractionation","volume":"122","author":"Krishnan","year":"2025","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B21","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s13014-024-02436-3","article-title":"Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer","volume":"19","author":"Blumenfeld","year":"2024","journal-title":"Radiat Oncol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.11.068","article-title":"Clinical outcomes of a randomized trial of adaptive plan-of-the-day treatment in patients receiving ultra-hypofractionated weekly radiation therapy for bladder cancer","volume":"110","author":"Huddart","year":"2021","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B23","doi-asserted-by":"publisher","first-page":"100596","DOI":"10.1016\/j.ctro.2023.100596","article-title":"Implementing cone-beam computed tomography-guided online adaptive radiotherapy in cervical cancer","volume":"40","author":"Shelley","year":"2023","journal-title":"Clin Transl Radiat Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.03.022","article-title":"Cone beam CT imaging analysis of interfractional variations in bladder volume and position during radiotherapy for bladder cancer","volume":"76","author":"Yee","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.09.010","article-title":"Clinical outcomes with dose-escalated adaptive radiation therapy for urinary bladder cancer: A prospective study","volume":"94","author":"Murthy","year":"2016","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1106106","article-title":"Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer","author":"James","year":"2012","journal-title":"N Engl J Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.2799","article-title":"Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience","author":"Efstathiou","year":"2013","journal-title":"Cancer"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1729810\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T05:23:04Z","timestamp":1770873784000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1729810\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":27,"alternative-id":["10.3389\/fonc.2026.1729810"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1729810","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"article-number":"1729810"}}