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Practical Radiation Oncology

First Implementation of an All-in-One Fully Automatic Workflow for Rectal Cancer on an Integrated CT-linac

This single-center prospective pilot study first implemented and evaluated a fully automatic All-in-One radiotherapy workflow on an integrated CT-linac in 20 patients with rectal cancer, sequentially completing CT simulation, AI-based autosegmentation, autoplanning, online verification, and beam delivery on one platform without patient repositioning; the workflow was completed in all patients, mean total treatment time was 37.5 ± 6.9 minutes, Dice similarity coefficients ranged from 0.83 to 0.95, three-dimensional gamma pass rates exceeded 95% in all patients, leukopenia occurred in 55.0%, and at follow-up 19 of 20 patients underwent surgery with 1 clinical complete response, an overall complete response rate of 15.0% and tumor regression grade 0-1 in 68.4% of surgical patients.