S3046
Invited Speaker
ESTRO 2026
5455 Adaptive radiotherapy: From offline to real-time Lotte Wilke Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland Adaptive radiotherapy has evolved from an offline concept addressing systematic anatomical changes after multiple days of treatment to an online strategy responding to day-to-day variability. And it has the potential to develop to a real-time strategy in the
How should thymic tumors be treated with radiotherapy? Modern radiation therapy techniques have greatly improved our ability to precisely target tumors and postoperative tumor beds while minimizing acute, intermediate and long-term side effects. Highly conformal radiation therapy techniques such as IMRT, VMAT and proton therapy are now widely available and should be used in this patient population with comparably good outcomes and prognosis. Even larger fields such as the pleura or reirradiation - when necessary - can now be safely delivered in many patients. References: Omasa et al.; Cancer 2015 Vol. 121 Issue 7 Pages 1008- 16 Chun et al.; JAMA Oncol 2023 Vol. 9 Issue 7 Pages 971- 980 Rimner et al.; J Thorac Oncol 2016 Vol. 11 Issue 10 Pages 1785-92 Rimner et al.; J Thorac Oncol 2024 Vol. 19 Issue 4 Pages 626-635 Raoof et al.; JTO Clinical and Research Reports (2026), https://doi.org/10.1016/j.jtocrr.2026.100970. 5499 One standard, many nations: Building harmony for better clinical training Barbara A Jereczek-Fossa Radiation Oncology, European Institute of Oncology IEO IRCCS, Milan, Italy. Oncology and Hemato- oncology, University of Milan, Milan, Italy Clinical training in radiation oncology varies considerably across Europe and beyond, reflecting differences in national regulations, resources, and educational systems. While this diversity can foster innovation, it may also lead to disparities in competencies, professional mobility, and ultimately in the quality of patient care. This teaching lecture will provide an overview of current variability in radiation oncology training across European and selected extra-European countries, focusing on differences in curricula, clinical exposure, access to advanced technologies, and assessment methods. In a rapidly evolving field, such variability poses important challenges for ensuring consistent standards of practice. The lecture will then explore strategies to promote greater harmonization, including competency-based education, shared core curricula, structured mentorship, and international training opportunities. Key barriers—such as regulatory constraints, resource limitations, and cultural differences—will also be addressed, emphasizing the need for realistic and adaptable approaches.
future. I will outline the history of adaptive radiotherapy and give and outlook on future developments form a physicists perspective.
5456 Radiotherapy for thymic malignancies: What, when, and how? Andreas Rimner Radiation Oncology, University of Freiburg, Freiburg, Germany Radiation therapy for thymic malignancies has greatly evolved in the last few years. Significant progress has been made through large database analyses and some smaller prospective clinical trials on these rare tumors providing more robust data on the indications and oncologic outcomes for radiation therapy. Ongoing randomized data will bolster the insights for when and how to use radiation therapy. What should be treated by radiation therapy? In cases of neoadjuvant or unresectable tumors the gross tumor itself with a safety margin is the target volume for radiation therapy. In the postoperative setting the tumor bed, areas of concern about sufficient margins and intraoperative findings will guide the target volumes. These must be closely coordinated with the thoracic surgery and pathology team. Pleural lesions and metastases can be treated with various radiation techniques as well. When should patients be treated with radiation therapy? This answer to this question continues to evolve, especially for resectable tumors. Most currently available data show a benefit of postoperative radiation therapy (PORT) for completely resected stage II and III thymomas and locally advanced thymic carcinomas. The role of PORT in earlier stages is less clearly defined, and oncologic effects have to be carefully weighed against potential long-term effects of radiation therapy. There is an indication for PORT in incompletely resected patients based on oncologic principles as well as data pointing towards a benefit of PORT. Pleural lesions and metastases can be targeted if they present in an oligometastatic or oligoprogressive pattern or require palliation.
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