Thanks to the rapidly evolving integration of LLMs into decision-support tools, a significant transformation is happening across large-scale systems. Like other medical fields, the use of LLMs such as GPT-4 is gaining increasing interest in radiation oncology as well. An attempt to assess GPT-4's performance in radiation oncology was made via a dedicated 100-question examination on the highly specialized topic of radiation oncology physics, revealing GPT-4's superiority over other LLMs. GPT-4's performance on a broader field of clinical radiation oncology is further benchmarked by the ACR Radiation Oncology In-Training (TXIT) exam where GPT-4 achieved a high accuracy of 74.57%. Its performance on re-labelling structure names in accordance with the AAPM TG-263 report has also been benchmarked, achieving above 96% accuracies. Such studies shed light on the potential of LLMs in radiation oncology. As interest in the potential and constraints of LLMs in general healthcare applications continues to rise5, the capabilities and limitations of LLMs in radiation oncology decision support have not yet been fully explored.
Mathematical oncology is an interdisciplinary research field where the mathematical sciences meet cancer research. Being situated at the intersection of these two fields makes mathematical oncology highly dynamic, as practicing researchers are incentivised to quickly adapt to both technical and medical research advances. Determining the scope of mathematical oncology is therefore not straightforward; however, it is important for purposes related to funding allocation, education, scientific communication, and community organisation. To address this issue, we here conduct a bibliometric analysis of mathematical oncology. We compare our results to the broader field of mathematical biology, and position our findings within theoretical science of science frameworks. Based on article metadata and citation flows, our results provide evidence that mathematical oncology has undergone a significant evolution since the 1960s marked by increased interactions with other disciplines, geographical expansion, larger research teams, and greater diversity in studied topics. The latter finding contributes to the greater discussion on which models different research communities consider to be valuable
Traditional health authority approval for oncology drugs is based on a clinical benefit endpoint, or a valid surrogate. In 1992 the FDA created the Accelerated Approval pathway to allow for earlier approval of therapies in serious conditions with an unmet medical need. This is accomplished typically by granting accelerated approval based on a surrogate endpoint that can be measured earlier than a traditional approval endpoint. Minimal residual disease (MRD) is a sensitive measure of residual cancer cells in hematology oncology after treatment, and is increasingly considered as a secondary or exploratory endpoint due to its prognostic potential for traditional clinical trial endpoints such as progression-free survival (PFS) and overall survival (OS). This work aims to evaluate MRD's surrogacy potential across several hematologic cancer indications while keeping the focus on follicular lymphoma (FL), using data from published studies. We examine individual-level and trial-level correlations extracted from previously published studies to elucidate the potential role of MRD in accelerating the drug approval process in hematology oncology trials.
In the past year, there has been a growing trend in applying Large Language Models (LLMs) to the field of medicine, particularly with the advent of advanced language models such as ChatGPT developed by OpenAI. However, there is limited research on LLMs specifically addressing oncology-related queries. The primary aim of this research was to develop a specialized language model that demonstrates improved accuracy in providing advice related to oncology. We performed an extensive data collection of online question-answer interactions centered around oncology, sourced from reputable doctor-patient platforms. Following data cleaning and anonymization, a dataset comprising over 180K+ oncology-related conversations was established. The conversations were categorized and meticulously reviewed by field specialists and clinicians to ensure precision. Employing the LLaMA model and other selected open-source datasets, we conducted iterative fine-tuning to enhance the model's proficiency in basic medical conversation and specialized oncology knowledge. We observed a substantial enhancement in the model's understanding of genuine patient inquiries and its reliability in offering oncology-relate
Turbulence holds immense importance across various scientific and engineering disciplines. The direct numerical simulation (DNS) of turbulence proposed by Orszag in 1970 is a milestone in fluid mechanics, which began an era of numerical experiment for turbulence. Many researchers have reported that turbulence should be chaotic, since spatiotemporal trajectories are very sensitive to small disturbance. Thus, due to the famous butterfly-effect of chaos, unavoidable numerical noises of DNS might have great influence on spatiotemporal trajectories of turbulence. This is indeed true for a two-dimensional (2D) Kolmogorov turbulent flow, as currently revealed by a much more accurate algorithm than DNS, namely the ``clean numerical simulation'' (CNS). Different from DNS, CNS can greatly reduce both of truncation error and round-off error to any required small level so that numerical noise can be rigorously negligible throughout a time interval long enough for calculating statistics. However, In physics, 3D turbulent flow is more important than 2D turbulence. Thus, for the first time, we solve a 3D turbulent Kolmogorov flow by means of CNS in this paper, and compare our CNS result with that
Recent advances in large language models (LLMs) and their extension to vision-language models (VLMs) have made it easier to combine text and images for tasks such as report generation. Existing VLMs in medicine typically focus on 2D images (chest X-rays), and their extension to 3D imaging has been difficult because of the lack of paired 3D imaging-text data. Thus, we introduce a new method for creating a 3D image-text dataset for brain oncology using 3D MRI scans of glioma and meningioma cases. We use a cooperative system in which several LLMs work together to generate and check reports, ensuring that they are accurate and clear. By leveraging the new 3D MRI-text dataset, we further build a VLM that converts MRI scans into tokens and aligns them with text instructions. Our VLM performed better in report generation and visual question answering tasks than other 2D and 3D methods. Our method not only improves the quality of reports but also helps with better diagnosis and treatment in brain oncology.
Personalized oncology aims to tailor treatment strategies to the unique molecular and clinical profiles of individual patients, moving beyond the traditional paradigm of treating the disease not the patient. Achieving this vision requires the integration and interpretation of vast, heterogeneous biomedical data within a meaningful scientific framework. Knowledge graphs, structured according to biomedical ontologies, offer a powerful approach to contextualize and interconnect diverse datasets, enabling more precise and informed clinical decision-making. We present ECKO (Explainable Clinical Knowledge for Oncology), a comprehensive knowledge graph that integrates 33 biomedical ontologies and aggregates data from multiple studies to create a unified resource optimized for data-driven clinical applications in oncology. Designed to support personalized drug recommendations, ECKO facilitates the identification of optimal therapeutic options by linking patient-specific molecular data to relevant pharmacological knowledge. It provides transparent, interpretable explanations for drug recommendations, fostering greater trust and understanding among clinicians and researchers. This resource r
Background: The radiation oncology clinical practice involves many steps relying on the dynamic interplay of abundant text data. Large language models have displayed remarkable capabilities in processing complex text information. But their direct applications in specific fields like radiation oncology remain underexplored. Purpose: This study aims to investigate whether fine-tuning LLMs with domain knowledge can improve the performance on Task (1) treatment regimen generation, Task (2) treatment modality selection (photon, proton, electron, or brachytherapy), and Task (3) ICD-10 code prediction in radiation oncology. Methods: Data for 15,724 patient cases were extracted. Cases where patients had a single diagnostic record, and a clearly identifiable primary treatment plan were selected for preprocessing and manual annotation to have 7,903 cases of the patient diagnosis, treatment plan, treatment modality, and ICD-10 code. Each case was used to construct a pair consisting of patient diagnostics details and an answer (treatment regimen, treatment modality, or ICD-10 code respectively) for the supervised fine-tuning of these three tasks. Open source LLaMA2-7B and Mistral-7B models wer
Unstructured notes within the electronic health record (EHR) contain rich clinical information vital for cancer treatment decision making and research, yet reliably extracting structured oncology data remains challenging due to extensive variability, specialized terminology, and inconsistent document formats. Manual abstraction, although accurate, is prohibitively costly and unscalable. Existing automated approaches typically address narrow scenarios - either using synthetic datasets, restricting focus to document-level extraction, or isolating specific clinical variables (e.g., staging, biomarkers, histology) - and do not adequately handle patient-level synthesis across the large number of clinical documents containing contradictory information. In this study, we propose an agentic framework that systematically decomposes complex oncology data extraction into modular, adaptive tasks. Specifically, we use large language models (LLMs) as reasoning agents, equipped with context-sensitive retrieval and iterative synthesis capabilities, to exhaustively and comprehensively extract structured clinical variables from real-world oncology notes. Evaluated on a large-scale dataset of over 40
Accurate trend forecasting in healthcare time series is essential for planning and resource allocation. This paper proposes a Bayesian framework for predicting oncology demand trends, modeling weekly appointments as a Poisson process with a Gamma prior to the demand rate. To enhance adaptability and capture persistent directional patterns, we incorporate a residual-based boosting mechanism grounded in a Gamma-Log-Normal conjugate structure. This boosting approach allows the model to track both short- and long-term trend shifts while maintaining the analytical tractability of conjugate Bayesian updating. The methodology was evaluated on real oncology service data from Cariri, Ceara, Brazil, and compared against established baselines, including linear regression, ARIMA, naive forecasting, LSTM neural networks, and XGBoost. Results showed that the proposed model outperforms competing methods in trend detection accuracy, with gains in terms of percentage of correct direction of 38.25% in relation to the second best approach in some cases.
The application of AI in oncology has been limited by its reliance on large, annotated datasets and the need for retraining models for domain-specific diagnostic tasks. Taking heed of these limitations, we investigated in-context learning as a pragmatic alternative to model retraining by allowing models to adapt to new diagnostic tasks using only a few labeled examples at inference, without the need for retraining. Using four vision-language models (VLMs)-Paligemma, CLIP, ALIGN and GPT-4o, we evaluated the performance across three oncology datasets: MHIST, PatchCamelyon and HAM10000. To the best of our knowledge, this is the first study to compare the performance of multiple VLMs on different oncology classification tasks. Without any parameter updates, all models showed significant gains with few-shot prompting, with GPT-4o reaching an F1 score of 0.81 in binary classification and 0.60 in multi-class classification settings. While these results remain below the ceiling of fully fine-tuned systems, they highlight the potential of ICL to approximate task-specific behavior using only a handful of examples, reflecting how clinicians often reason from prior cases. Notably, open-source
In oncology, access to patient-level data is often restricted. Synthetic data provides an alternative for analyzing treatment effectiveness, but existing methods for synthetic data generation fail to preserve the causal relationships between covariates, treatments, and outcomes, thereby leading to biased estimates of treatment effects. Here, we introduce OncoSynth, a generative, causally-aware machine learning framework designed to produce synthetic cohorts that enable accurate estimation of population- and patient-level treatment effects. OncoSynth uses a diffusion-based sequential approach to model how covariates influence treatment assignment and how treatment affects survival. We evaluate OncoSynth using large lung (N = 37,128) and breast cancer (N = 17,046) cohorts. Our results show that OncoSynth generates high-fidelity synthetic patient cohorts that preserve real-world patient, treatment, and outcome distributions. Notably, OncoSynth improves treatment effect estimation over existing approaches, by reducing population-level treatment effect error by up to 66%, and patient-level treatment effect error by up to 58%. Thereby, OncoSynth supports reliable evidence generation for
Clinical oncology generates vast, unstructured data that often contain inconsistencies, missing information, and ambiguities, making it difficult to extract reliable insights for data-driven decision-making. General-purpose large language models (LLMs) struggle with these challenges due to their lack of domain-specific reasoning, including specialized clinical terminology, context-dependent interpretations, and multi-modal data integration. We address these issues with an oncology-specialized, efficient, and adaptable NLP framework that combines instruction tuning, retrieval-augmented generation (RAG), and graph-based knowledge integration. Our lightweight models prove effective at oncology-specific tasks, such as named entity recognition (e.g., identifying cancer diagnoses), entity linking (e.g., linking entities to standardized ontologies), TNM staging, document classification (e.g., cancer subtype classification from pathology reports), and treatment response prediction. Our framework emphasizes adaptability and resource efficiency. We include minimal German instructions, collected at the University Hospital Zurich (USZ), to test whether small amounts of non-English language dat
Randomized discontinuation design (RDD) is an enrichment strategy commonly used to address limitations of traditional placebo-controlled trials, particularly the ethical concern of prolonged placebo exposure. RDD consists of two phases: an initial open-label phase in which all eligible patients receive the investigational medicinal product (IMP), followed by a double-blind phase in which responders are randomized to continue with the IMP or switch to placebo. This design tests whether the IMP provides benefit beyond the placebo effect. The estimand framework introduced in ICH E9(R1) strengthens the dialogue among clinical research stakeholders by clarifying trial objectives and aligning them with appropriate statistical analyses. However, its application in oncology trials using RDD remains unclear. This manuscript uses the phase III JAVELIN Gastric 100 trial and the phase II trial of sorafenib (BAY 43-9006) as case studies to propose an estimand framework tailored for oncology trials employing RDD in phase III and phase II settings, respectively. We highlight some similarities and differences between RDDs and traditional randomized controlled trials in the context of ICH E9(R1). T
In this paper, we give characterization of quadratic $\varepsilon-$canonical number system ($\varepsilon-$CNS) polynomials for all values $\varepsilon \in\lbrack0,1)$. Our characterization provides a unified view of the well-known characterizations of the classical quadratic CNS polynomials ($\varepsilon=0$) and quadratic SCNS polynomials ($\varepsilon=1/2$). This result is a consequence of our new characterization results of $\varepsilon -$shift radix systems ($\varepsilon-$SRS) in the two-dimensional case and their relation to quadratic $\varepsilon-$CNS polynomials.
Introduction: Large language models (LLM) have shown great potential in clinical decision support. GPT-5 is a novel LLM system that has been specifically marketed towards oncology use. Methods: Performance was assessed using two complementary benchmarks: (i) the ACR Radiation Oncology In-Training Examination (TXIT, 2021), comprising 300 multiple-choice items, and (ii) a curated set of 60 authentic radiation oncologic vignettes representing diverse disease sites and treatment indications. For the vignette evaluation, GPT-5 was instructed to generate concise therapeutic plans. Four board-certified radiation oncologists rated correctness, comprehensiveness, and hallucinations. Inter-rater reliability was quantified using Fleiss' \k{appa}. Results: On the TXIT benchmark, GPT-5 achieved a mean accuracy of 92.8%, outperforming GPT-4 (78.8%) and GPT-3.5 (62.1%). Domain-specific gains were most pronounced in Dose and Diagnosis. In the vignette evaluation, GPT-5's treatment recommendations were rated highly for correctness (mean 3.24/4, 95% CI: 3.11-3.38) and comprehensiveness (3.59/4, 95% CI: 3.49-3.69). Hallucinations were rare with no case reaching majority consensus for their presence.
Multimodal clinical reasoning in the field of gastrointestinal (GI) oncology necessitates the integrated interpretation of endoscopic imagery, radiological data, and biochemical markers. Despite the evident potential exhibited by Multimodal Large Language Models (MLLMs), they frequently encounter challenges such as context dilution and hallucination when confronted with intricate, heterogeneous medical histories. In order to address these limitations, a hierarchical Multi-Agent Framework is proposed, which emulates the collaborative workflow of a human Multidisciplinary Team (MDT). The system attained a composite expert evaluation score of 4.60/5.00, thereby demonstrating a substantial improvement over the monolithic baseline. It is noteworthy that the agent-based architecture yielded the most substantial enhancements in reasoning logic and medical accuracy. The findings indicate that mimetic, agent-based collaboration provides a scalable, interpretable, and clinically robust paradigm for automated decision support in oncology.
Background: Lung cancer ranks as the leading cause of cancer-related mortality worldwide. The complexity of tumor delineation, crucial for radiation therapy, requires expertise often unavailable in resource-limited settings. Artificial Intelligence(AI), particularly with advancements in deep learning (DL) and natural language processing (NLP), offers potential solutions yet is challenged by high false positive rates. Purpose: The Oncology Contouring Copilot (OCC) system is developed to leverage oncologist expertise for precise tumor contouring using textual descriptions, aiming to increase the efficiency of oncological workflows by combining the strengths of AI with human oversight. Methods: Our OCC system initially identifies nodule candidates from CT scans. Employing Language Vision Models (LVMs) like GPT-4V, OCC then effectively reduces false positives with clinical descriptive texts, merging textual and visual data to automate tumor delineation, designed to elevate the quality of oncology care by incorporating knowledge from experienced domain experts. Results: Deployments of the OCC system resulted in a significant reduction in the false discovery rate by 35.0%, a 72.4% decrea
We present the Radiation Oncology NLP Database (ROND), the first dedicated Natural Language Processing (NLP) dataset for radiation oncology, an important medical specialty that has received limited attention from the NLP community in the past. With the advent of Artificial General Intelligence (AGI), there is an increasing need for specialized datasets and benchmarks to facilitate research and development. ROND is specifically designed to address this gap in the domain of radiation oncology, a field that offers many opportunities for NLP exploration. It encompasses various NLP tasks including Logic Reasoning, Text Classification, Named Entity Recognition (NER), Question Answering (QA), Text Summarization, and Patient-Clinician Conversations, each with a distinct focus on radiation oncology concepts and application cases. In addition, we have developed an instruction-tuning dataset consisting of over 20k instruction pairs (based on ROND) and trained a large language model, CancerChat. This serves to demonstrate the potential of instruction-tuning large language models within a highly-specialized medical domain. The evaluation results in this study could serve as baseline results for
Purpose To evaluate the reasoning capabilities of large language models (LLMs) in performing root cause analysis (RCA) of radiation oncology incidents using narrative reports from the Radiation Oncology Incident Learning System (RO-ILS), and to assess their potential utility in supporting patient safety efforts. Methods and Materials Four LLMs, Gemini 2.5 Pro, GPT-4o, o3, and Grok 3, were prompted with the 'Background and Incident Overview' sections of 19 public RO-ILS cases. Using a standardized prompt based on AAPM RCA guidelines, each model was instructed to identify root causes, lessons learned, and suggested actions. Outputs were assessed using semantic similarity metrics (cosine similarity via Sentence Transformers), semi-subjective evaluations (precision, recall, F1-score, accuracy, hallucination rate, and four performance criteria: relevance, comprehensiveness, justification, and solution quality), and subjective expert ratings (reasoning quality and overall performance) from five board-certified medical physicists. Results LLMs showed promising performance. GPT-4o had the highest cosine similarity (0.831), while Gemini 2.5 Pro had the highest recall (0.799) and accuracy (0