{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T04:54:57Z","timestamp":1781499297612,"version":"3.54.1"},"reference-count":6,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"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>Background<\/jats:title>\n                    <jats:p>There are currently no effective treatment options for large, inoperable, centrally located thoracic lesions with poor or suboptimal response to immunotherapy. The use of SBRT for tumors larger than 5\u00a0cm in this location is limited by toxicity. Therefore, new and innovative treatment strategies are a major unmet medical need. Adaptive radiotherapy (ART) guided by MR-Linac systems, enables real-time adjustment of the treatment plan according to daily anatomical changes and tumor response. This approach is particularly beneficial in thoracic oncology, where tumor shrinkage and respiratory motion can significantly affect dose delivery. Moreover, ART may enhance the therapeutic synergy between radiotherapy and immunotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report the case of a 65-year-old woman diagnosed with stage IV non-small cell lung cancer (NSCLC) of mixed squamous and adenocarcinoma histology. The patient initially presented with seizures, and an MRI revealed 10 intracranial metastases alongside a 55\u00a0mm tumor in the left lung. Following stereotactic brain radiotherapy and the initiation of nivolumab plus ipilimumab, the treatment was continued with nivolumab monotherapy due to grade 3 pulmonary toxicity. Imaging demonstrated a tumor progression limited to the lung. She was then qualified for MR-guided adaptive stereotactic radiotherapy (3 \u00d7 10 Gy), delivered at 10-day intervals. Significant tumor regression required redefinition of the GTV before fractions 2 and 3. No acute or late toxicity was observed. A 6-month follow-up PET-CT revealed marked regression in tumor size (from 79\u00a0mm to 17\u00a0mm) and metabolic activity (SUVmax reduced from 33.1 to 5.13). Comparative imaging showed less extensive post-radiation lung changes than typically observed after conventional radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates the potential of MR-guided adaptive radiotherapy to enhance treatment precision, reduce toxicity, and enable immune-radiotherapy synergy. Integration of the PULSAR concept\u2014with spaced fractions and immunotherapy\u2014may improve tumor response. Further clinical trials are required to confirm these benefits on larger patient populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1791499","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T04:27:57Z","timestamp":1781497677000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intensified MR-guided pulsed adaptive cancer treatment- a potential new treatment option for large(&gt;5cm) central non-small cell lung cancer, a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Maciej","family":"Blok","sequence":"first","affiliation":[{"name":"Department of Neurooncology and Radiosurgery, Franciszek Lukaszczyk Memorial Oncology Center","place":["Bydgoszcz, Poland"]},{"name":"Department of Clinical Medicine, Jan and Jedrzej Sniadecki University of Science and Technology","place":["Bydgoszcz, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Wisniewski","sequence":"additional","affiliation":[{"name":"Department of Neurooncology and Radiosurgery, Franciszek Lukaszczyk Memorial Oncology Center","place":["Bydgoszcz, Poland"]},{"name":"Department of Oncology and Brachytherapy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum","place":["Bydgoszcz, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izabela","family":"Wiatrowska","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, Franciszek Lukaszczyk Memorial Oncology Center","place":["Bydgoszcz, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Harat","sequence":"additional","affiliation":[{"name":"Department of Neurooncology and Radiosurgery, Franciszek Lukaszczyk Memorial Oncology Center","place":["Bydgoszcz, Poland"]},{"name":"Department of Clinical Medicine, Jan and Jedrzej Sniadecki University of Science and Technology","place":["Bydgoszcz, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.zemedi.2018.03.001","article-title":"Adaptive radiation therapy","volume":"42","author":"Yan","year":"1997","journal-title":"Phys Med Biol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(15)00007-8","article-title":"Radiation and checkpoint blockade immunotherapy: Radiosensitization and potential mechanisms of synergy","volume":"16","author":"Sharabi","year":"2015","journal-title":"Lancet Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.07.5937","article-title":"Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer","volume":"24","author":"Timmerman","year":"2006","journal-title":"J Clin Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.00622","article-title":"Safety and efficacy of a five-fraction stereotactic body radiotherapy schedule for centrally located non-small-cell lung cancer: NRG Oncology\/RTOG 0813 Trial","volume":"37","author":"Bezjak","year":"2019","journal-title":"J Clin Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.66877","article-title":"Use of personalized ultra-fractionated stereotactic adaptive radiotherapy for oligometastatic lung adenocarcinoma: Leveraging CT-guided online adaptive radiotherapy","volume":"16","author":"Eustace","year":"2024","journal-title":"Cureus"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.03.047","article-title":"Personalized ultrafractionated stereotactic adaptive radiotherapy (PULSAR) in preclinical models enhances single-agent immune checkpoint blockade","volume":"110","author":"Moore","year":"2021","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1791499\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T04:28:00Z","timestamp":1781497680000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1791499\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":6,"alternative-id":["10.3389\/fonc.2026.1791499"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1791499","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]},"article-number":"1791499"}}