Normal-tissue sparing with ultrahigh dose-rate radiotherapy remains conditional and cannot replace conformal dosimetry, organ-at-risk constraints, or rigorous quality assurance.
Semi-automated trajectory planning reduced workflow time and needle use while maintaining clinically acceptable target coverage and organ-at-risk doses.
Risk-adapted esophagus-sparing radiotherapy maintained target coverage, with grade 3 esophagitis in only 1.25% of high-risk patients.
Bone marrow-sparing planning reduced pelvic marrow dose, but heterogeneous evidence did not confirm a consistent reduction in hematologic toxicity.