onc brain

Prospective nationwide population-based cohort across 6 Danish RT centres, N=4541, 2007-2014. Not randomized: IMNI allocated by tumour laterality per national guideline; ITT right vs left. Median follow-up 13.7y.

Macrometastatic node-positive breast cancer, all with ALND, mastectomy or BCS. Excluded neoadjuvant systemic therapy, bilateral BC, prior malignancy, recurrence before RT. Median age 59; 68.3% had 1-3 positive nodes.

EC x3 then docetaxel x3 when chemo indicated; AI postmenopausal, tamoxifen premenopausal; trastuzumab concurrent for HER2+. 96.2% of chemo pts received taxanes.

48 Gy/24 Fx before Jan 2009, 50 Gy/25 Fx after. IMN target ICS 1-4 with 3D conformal wide tangents, free breathing, plus level II-III, interpectoral and level IV in all pts.

Primary: OS. Secondary: breast cancer mortality and distant metastasis, with non-breast-cancer death as competing event.

15y death from ischemic or valvular heart disease 0.2% right vs 0.7% left. 15y secondary lung cancer death 1.8% vs 2.2%. No smoking or baseline cardiac data.

OS HR 0.85 sits with the EBCTCG regional RT RR 0.90 (0.84-0.96) and underpowered KROG 08-06 HR 0.87 (0.57-1.31). Magnitude matches DBCG IMN1, which treated pts before taxanes and 3D planning.

Left-sided controls got incidental IMN dose (median CTV V90% 20.4%) and 10.1% received IMNI, compressing separation. 1-3 node analysis was post hoc; no correction for multiple testing across subgroups.

Newer systemic therapy did not erase the IMNI gain. The medial/central ≥4 node HR 0.98 and ER-/HER2+ HR 1.49 are exploratory signals, not omission criteria; authors found no subgroup for safe omission.

Large prospective multicentre cohort, primary endpoint met with 13.7y f/u, but laterality allocation is not randomization. Aligns with EBCTCG and DBCG IMN1.

Phase 2, open-label, randomised (1:1) trial at 21 hospitals in Australia, Belgium, Italy, Norway, Spain, Switzerland. Minimisation stratified by PET tracer (choline vs PSMA) and MDT type (sLND vs SBRT/SIB). Median follow-up 50 mo (IQR 42-58).

Biochemical relapse after RP, postoperative RT or definitive RT, with ≤5 PET-detected pelvic nodes up to the aortic bifurcation. Excluded: bone/visceral mets, nodes above the bifurcation, testosterone <50 ng/dL. Median PSA 1.00 vs 0.85 ng/mL; 81% and 83% PSMA-staged.

ENRT: 45 Gy/25 fx whole pelvis + 65 Gy SIB to PET+ nodes, IMRT/VMAT mandatory. MDT: SBRT 30 Gy/3 fx every other day, 3 mm PTV margin, or extended sLND. Prostate bed RT ≥66 Gy/33 fx suggested for high-risk RP features in both arms, with benchmark-case QA.

6 mo LHRH agonist or antagonist in both arms, started no later than the first fraction. ADT was not to be restarted without clinical progression.

Primary: MFS (any M1 on PET or death). Secondary: bRFS, locoregional RFS, ADT-free survival, late G2+ GU/GI toxicity. OS, PCSS and time to castration resistance had too few events to report.

4yr cumulative G2+ GU 28% vs 31% (p=0.73) and GI 7% vs 9% (p=0.93), MDT vs ENRT. One ENRT pt had a recto-urethral fistula needing surgery. No treatment-related deaths.

First randomised comparison of MDT vs ENRT for nodal oligorecurrence. The single-arm GETUG-P07-OLIGOPELVIS reported 3yr bRFS 45% with ENRT, in a higher-PSA, choline-staged cohort. POINTER-PC (phase 3) and GETUG-P12-OLIGOPELVIS 2 are the confirmatory tests.

Prostate bed RT was unevenly used (25% vs 41%) and linked to both local control and GI toxicity, which muddies attribution to the pelvic field. No central PET review, and the PSA and nodal-level subgroups are post hoc.

The MFS gain is mostly prevention of further nodal (M1a) spread, consistent with PSMA PET under-staging microscopic pelvic disease. It does not settle whether the benefit holds at higher PSA or with choline staging, or whether it reaches survival.

Randomised phase 2 hit its MFS primary at 50 mo median f/u, but was powered at α 0.20 with 80% CIs; authors call for phase 3 confirmation (POINTER-PC).