onc brain

2026-05-19

digest generated 2026-05-20

SF-SABR (n=1687): LC 90-93% at 2yr, G3+ 2.9%; single-fraction SABR efficacy and safety now benchmarked at scale for primary NSCLC and pulmonary oligomets.
TL;DR
Thoracic and prostate carried the day's most actionable data: SF-SABR (n=1687) reaches institutional scale with LC 90-93% and G3+ toxicity 2.9%, and PSMA PET NPV ~96% challenges routine ePLND in intermediate-risk prostate. Spanish MIBC TMT cohort (n=369) anchors real-world CLR benchmarks at 63.7%.

Bladder

Real-world Spanish multicenter TMT cohort fills a gap: 5-FU CRT and portal imaging frequency now have ORs to cite in multidisciplinary bladder-preservation discussion.

Bladder-preserving TMT for MIBC — prognostic factors for recurrence and survival (ESTRO 2026)

Sourced from @URONCOR

ForMIBC cT2-T4aN0M0, median age 76, selected for bladder preservation, TMT-eligible

Multicenter Spanish TMT cohort (n=369 MIBC): CLR 63.7%; 5-FU-based CRT and image-guided RT predict response.

Bladder-preserving TMT for MIBC — prognostic factors for recurrence and survival (ESTRO 2026)
  • 📊 CLR 63.7%; disease progression 28.8% (local 10.1%, systemic 10.7%, combined 8.7%); salvage cystectomy 9.7%
  • 🔍 Multicenter retrospective cohort, Spain 2010-2022; 369 pts (median age 76, 85.1% male); cT2-T4aN0M0 treated with TURBT + concurrent chemoradiotherapy
  • 📐 Weekly portal imaging associated with lower CLR: OR 0.35 (95% CI 0.20-0.60), p<0.001
  • 📐 5-FU-based CRT associated with higher CLR: OR 4.9 (95% CI 1.1-22.1), p=0.038
  • 📊 VMAT showed trend toward favorable outcomes (not statistically significant)
  • ⚠️ Retrospective design; multicenter heterogeneity in CRT regimen, imaging, and era (2010-2022) limits internal validity
  • ⚠️ Primary endpoint CLR is a surrogate; OS and CSS data not quantified in source beyond qualitative comparison to international benchmarks
  • ⚠️ No randomised comparator vs radical cystectomy; selection bias for TMT candidates expected
📚 Sources · 🐦 1 tweet
vs leading data
  • Authors report survival outcomes comparable to international series; supports TMT as standard alternative to RC in selected pts
Open questions
  • Optimal CRT regimen (5-FU vs cisplatin-based) for CLR in real-world TMT
  • Role of IGRT quality standards in harmonizing outcomes across centers

Thoracic / Lung

SF-SABR reaches pooled scale; LC and toxicity data now sufficient to inform institutional single-fraction protocol decisions.

Single-fraction SABR for primary NSCLC and lung oligometastases (pooled, n=1687)

Sourced from @_ShankarSiva

ForPrimary NSCLC (early-stage, SABR candidate) or pulmonary oligomets, multi-instit

SF-SABR pooled analysis (n=1687): LC 90-93% at 2yr, G3+ AEs 2.9%, mOS 3.5yr (primary NSCLC) and >4yr (oligomets).

Single-fraction SABR for primary NSCLC and lung oligometastases (pooled, n=1687)
Cohort1-yr OS2-yr OSMedian OS (mo)
Primary NSCLC84% (95% CI 82-86)67% (95% CI 64-69)40 (36-43)
Pulmonary oligomets90% (95% CI 86-92)75% (95% CI 71-79)51 (42-58)
  • 🔍 Pooled 3-institution retrospective: Peter Mac, Cleveland Clinic, Roswell Park; 1200 primary NSCLC + 487 pulmonary oligomets treated with single-fraction SABR
  • 📊 Local control 90-93% at 2 years across both cohorts; isolated local/locoregional failure very uncommon
  • 📊 Overall survival by cohort
  • 📊 Primary NSCLC: mPFS 30 mo; pulmonary oligomets: mPFS 11 mo
  • 📐 AE data available for NSCLC cohort only (n=789; no AE data from Roswell Park)
  • ⚠️ G3+ AEs 2.9% (23/789); G2+ 15.7% (124/789); any AE 27% (215/789)
  • 📊 Most common AEs (primary NSCLC, n=789)
    • Chest wall pain: 114 (14%) total, grade 3+ rare
    • Pleural effusion: 71 (9%)
    • Pneumonitis: 52 (7%)
    • Dyspnea: 29 (4%)
    • Lung infection: 8 (1%)
  • ⚠️ Retrospective pooled design; no randomised comparator vs multifraction SBRT (3-5fx); institutional selection bias for single-fraction candidates
  • ⚠️ AE data missing for Roswell Park (401 pts), likely underestimates true toxicity denominator
📚 Sources · 🐦 1 tweet
vs leading data
  • Consistent with SAFRON II (single-arm, 5fx vs 1fx SABR for early NSCLC) and CHISEL trial LC benchmarks; SF-SABR LC here aligns with 5fx data
Open questions
  • Randomised comparison of SF-SABR vs 3-5fx SABR for primary NSCLC still lacking
  • Optimal pt selection criteria for single-fraction (tumor size, location, histology)
  • Long-term LC and OS beyond 5yr for oligomets cohort

Prostate

PSMA PET NPV ~96% reframes ePLND as a morbidity question, not a staging one.

ePLND vs PSMA PET staging for prostate cancer (AUA 2026)

Sourced from @RomanCarvajal

ForNewly diagnosed intermediate-to-high-risk prostate cancer, RP planned

AUA 2026 review: PSMA PET NPV ~96% may safely guide ePLND omission in intermediate-risk prostate; ePLND therapeutic benefit unproven in RCTs.

1253 men, primary staging Ga-PSMA PET/CT; 47.7% of LN metastases outside ePLND template (Yaxley et al, BJUI 2019)
1253 men, primary staging Ga-PSMA PET/CT; 47.7% of LN metastases outside ePLND template (Yaxley et al, BJUI 2019)
  • 📊 PSMA PET/CT NPV ~96% for pelvic LN involvement at primary staging
  • 📊 47.7% of LN metastases outside ePLND anatomical template (N=1253; Yaxley et al, BJUI 2019)
  • 🔍 Risk-stratified AUA 2026 conclusions
    • Intermediate risk: PLND may safely be omitted if PSMA PET negative for LNI
    • GG3: nomograms add value alongside PSMA PET findings
    • High-risk: individual decision; discuss adjuvant/salvage pelvic RT as PLND alternative
  • ⚠️ Absent Level 1 evidence for oncological benefit from ePLND; RCTs show no consistent BCR improvement
  • ⚠️ ePLND morbidity (Clinckaert et al systematic review)
    • 0-14% lower limb lymphedema after RP + PLND
    • 19-29% after PLND + salvage pelvic nodal RT; 2-22% also develop genital lymphedema
    • 6-10x increased DVT/PE risk with LND (Tyritzis et al, J Urol 2015, N=3544)
  • ⚠️ ePLND template limitation: nearly half of LN mets missed even when performed
📚 Sources · 🐦 1 tweet
vs leading data
  • PSMA PET-guided post-op pelvic nodal RT may replace routine ePLND, limiting lymphedema morbidity (Roberts et al, PCAN 2024)
Open questions
  • PSMA PET NPV threshold to safely defer PLND in high-risk disease
  • Role of targeted/radioguided LND incorporating PSMA PET
  • Optimal sequencing: PSMA PET staging to selective post-op pelvic RT vs routine ePLND