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About · curated by Nick Boehling, MD · @nb2276

    2026-06-04 ASCO Annual Meeting 2026

    digest generated 2026-07-19

    AREST: adjuvant RT cuts 3-yr loco-regional failure in resected intermediate-risk oral SCC — LRFS 89.2% vs 80.9%, HR 0.52 (0.30-0.91), p=0.02; no OS/DFS gain.
    TL;DR
    Head/neck carried the day: AREST is the first randomized evidence that adjuvant RT (60Gy/30fx) improves loco-regional control in resected pN0 intermediate-risk oral SCC, though the LC gain doesn't reach OS/DFS. Prostate news is a practice gap: an MROQC registry finds just 67% of definitive-RT high-risk pts get guideline-concordant ADT, ARPI intensification only 23%.

    Prostate

    A practice-pattern registry, not a trial: how often high-risk pts on definitive RT actually get guideline-concordant ADT and STAMPEDE-era ARPI intensification.

    Confirmatory

    MROQC ADT Practice Patterns

    ForHigh-risk M0/N0-1 prostate on definitive RT, GG4-5 predominant

    TL;DRGuideline-concordant ADT (≥18mo) recommended in 67.0% of high-risk pts on definitive RT; ARPI intensification just 23.2% of STAMPEDE-eligible.

    Why it mattersRadiation oncology

    The RT prescriber's read is the adoption gap, not a treatment effect: even in a quality consortium, only 67.0% of high-risk pts on definitive RT are recommended ≥18mo ADT, and just 23.2% of STAMPEDE-eligible get ARPI intensification. Facility-level variability persists on multivariable analysis (P<.0001), so where a man is treated, not only his risk, sets his ADT. Prompts an audit of your own duration and intensification practice.

    8 details
    Design

    Prospective practice-pattern study within the Michigan Radiation Oncology Quality Consortium (MROQC), a statewide RT registry. 553 pts across 26 centers, Jun 2020–Nov 2024. Facility modeled as a random intercept (mixed-effects).

    Population & inclusion

    Intact, high-risk M0/N0-1 prostate cancer on definitive RT. GG4-5 75.0%, PSA ≥20 40.0%, cN1 19.9%, cT3/4 13.3%. 27.9% met STAMPEDE M0 intensification criteria.

    Endpoints

    Primary: intended guideline-concordant ADT (≥18mo). Also assessed: ARPI adoption before vs after STAMPEDE M0 publication, facility-level variability, and multivariable predictors of concordance.

    Results

    91.3% recommended any ADT, 67.0% guideline-concordant. ARPI intensification among STAMPEDE-eligible rose 0% → 23.2% post-publication. Facility variability persisted on MVA (P<.0001).

    FactorOR (GC-ADT)95% CI
    cN12.941.44-5.99
    GG46.232.85-13.62
    GG59.454.46-20.06
    PSA ≥403.641.22-10.87
    vs leading data

    Benchmarks real practice against the 2022 AUA/ASTRO guideline (18-36mo ADT) and STAMPEDE M0 (ARPI for high-burden high-risk). Documents a persistent adoption gap, not a treatment effect.

    Applies to
    high-risk M0/N0-1 prostate treated with definitive RT within a quality consortium
    Does not represent low/intermediate-risk disease, national non-consortium practice, or delivered (vs intended) treatment.
    Limitations

    Captures intended ADT duration and recommendations, not delivered therapy or adherence. Single-state consortium limits generalizability, and there is no efficacy or outcome endpoint.

    Rationale

    Descriptive practice-pattern audit (no efficacy endpoint); reinforces AUA/ASTRO ADT guideline and STAMPEDE M0 as benchmark, documenting under-adoption rather than testing a new effect.

    Monday clinic

    In high-risk men (GG4-5, cN1, PSA ≥40, or ≥2 STAMPEDE factors) starting definitive RT, this supports benchmarking ADT to ≥18mo and weighing ARPI intensification when STAMPEDE-eligible; it does not extend to low/intermediate-risk disease or ADT-omission decisions.

    Open questions
    • Does intended guideline-concordant ADT translate to delivered treatment and adherence?
    • What interventions reduce facility-level variability in ADT recommendations?
    • Do Michigan consortium patterns generalize to national practice?

    Sourced from Dykstra, Michael P. et al.

    📚 Sources · 📄 1 paper
    📄 PAPER Dykstra, Michael P.; Regan, Samuel N.; Yin, Huiying (Maggie) et al. · JCO Oncology Practice (2025-09)
    Androgen Deprivation Therapy Practice Patterns in High-Risk Prostate Cancer Treated With Definitive Radiotherapy: Prospective Results From a Statewide Quality Consortium
    doi
    Abstract
    PURPOSE The 2022 AUA/ASTRO guidelines recommend 18-36 months of androgen deprivation therapy (ADT) with definitive radiotherapy for localized, high-risk prostate cancer. The STAMPEDE M0 trial supports intensification with androgen receptor pathway inhibitors (ARPIs) for patients with ≥2 cT3/T4, Grade Group [GG] 4-5, prostate-specific antigen (PSA) ≥40 ng/mL, or cN1. Given advances in imaging, risk stratification, and treatment delivery, we characterized contemporary practice patterns using prospective data from the Michigan Radiation Oncology Quality Consortium (MROQC). METHODS Patients enrolled in MROQC with intact, high-risk M0/N0-1 prostate cancer were included. Clinical information, including intended ADT duration and ARPI use, was prospectively collected. The primary outcome was intended guideline-concordant ADT (GC-ADT, ≥18 months). Multivariable analyses (MVA) assessed associations between clinical factors and GC-ADT recommendations. We compared the adoption of ARPI with standard therapies before and after the publication of STAMPEDE M0. Facility-level variability was evaluated using a mixed-effects model, with the treatment site as a random intercept. RESULTS Between June 2020 and November 2024, 553 patients across 26 centers were included: cT3/4 (13.3%), cN1 (19.9%), GG 4-5 (75.0%), and PSA ≥20 ng/mL (40.0%). Overall, 91.3% were recommended ADT, with 67.0% being guideline-concordant. On MVA, GC-ADT was significantly associated with cN1 (odds ratio [OR], 2.94 [95% CI, 1.44 to 5.99]), GG (GG4 OR, 6.23 [95% CI, 2.85 to 13.62]; GG5 OR, 9.45 [95% CI, 4.46 to 20.06]), and PSA ≥40 (OR, 3.64 [95% CI, 1.22–10.87]). Facility-level variability persisted in the MVA ( P &lt; .0001). Among the 27.9% who met meeting STAMPEDE criteria, ARPI recommendations increased from 0% prepublication to 23.2% afterward. CONCLUSION Within a statewide quality consortium, guideline-concordant ADT recommendations occurred in two thirds of patients, with ARPI intensification in under 25% among STAMPEDE-eligible patients. These findings highlight the need for individualized ADT strategies and collaborative efforts to standardize high-quality care.

    Systemic Curative Real-world evidence Confirmatory ASCO Annual Meeting 2026

    Head & Neck

    First randomized test of adjuvant RT in the resected pN0 intermediate-risk oral-cavity setting, where prior evidence was only retrospective.

    Confirmatory

    AREST

    ForAdequately resected pT1-2N0 oral SCC with ≥1 intermediate-risk feature

    Loco-regional recurrence-free survival local control

    HR 0.52

    3-yr LRFS 89.2% vs 80.9%, 95% CI 0.30-0.91, p=0.02 (ITT)

    TL;DR3-yr LRFS 89.2% vs 80.9%, HR 0.52 (0.30-0.91) p=0.02 favoring adjuvant RT in resected intermediate-risk pT1-2N0 oral SCC; no OS/DFS gain.

    Why it mattersRadiation oncology

    The move is observe-vs-treat in adequately resected pT1-2N0 OSCC with one adverse feature: 60Gy/30fx to tumor bed plus at-risk neck cut 3-yr loco-regional failure (HR 0.52), strongest in oral tongue over buccal mucosa (exploratory). The gain is loco-regional only, so weigh it against RT morbidity when baseline LRR risk is low.

    AREST
    Arm3-yr LRFSHR (95% CI)p
    Adjuvant RT89.2% (84.3-93.3)0.52 (0.30-0.91)0.02
    Observation80.9% (74.6-86.1)ref—
    8 details 2 trials watching
    Design

    Phase 3, open-label, multicenter RCT (India); 1:1 to adjuvant RT vs observation, N=392 (191 RT, 201 observation), stratified by subsite, PNI/LVE, differentiation. Median follow-up 47.2 months.

    Population & inclusion

    pT1-2 pN0 OSCC with ≥1 intermediate-risk feature (DOI 5-10mm, PNI, LVE, or poor differentiation), after adequate surgery: margins ≥5mm and ipsilateral level I-III neck dissection with ≥16 nodes.

    Radiotherapy

    60Gy in 30 fractions over 6 weeks to the resected tumor bed and at-risk neck nodal region.

    Endpoints

    Primary: 3-yr loco-regional recurrence-free survival (LRFS), KM with log-rank. Secondary: DFS, OS, and cumulative incidence of loco-regional failure (competing-risk).

    Results

    Per-protocol LRFS 91.1% vs 80.9%, HR 0.43 (0.23-0.80), p=0.01. DFS and OS not significantly different between arms.

    AnalysisAdjuvant RTObservationHR (95% CI), p
    ITT10.6% (6.1-15.1)18.9% (13.3-24.6)0.52 (0.30-0.91), p=0.021
    Per-protocol8.7% (4.3-13.1)18.9% (13.3-24.6)0.43 (0.23-0.79), p=0.007
    vs leading data

    Prior evidence for adjuvant RT in this pN0 intermediate-risk setting was retrospective (per the abstract); AREST is the first randomized confirmation.

    Applies to
    adequately resected pT1-2 pN0 oral SCC (margins ≥5mm, ≥16-node neck dissection) with one intermediate-risk feature
    Does not represent node-positive disease, positive/close margins, or inadequately staged necks.
    Limitations

    Open-label, abstract-only; benefit is loco-regional control only, no OS/DFS at 47.2-mo median. Observation LRFS (80.9%) exceeded the 70% powering assumption, so the absolute LRFS gain is modest.

    Rationale

    First randomized backing for the guideline-listed retrospective signal that RT cuts LRR in adverse-feature pN0 OSCC; loco-regional benefit only, no OS/DFS, open-label abstract.

    Monday clinic

    In an adequately resected pT1-2N0 oral tongue SCC with a single intermediate-risk feature, this supports adjuvant RT for loco-regional control but not survival, and it does not extend to buccal mucosa (weaker signal) or node-positive disease.

    Open questions

    Sourced from @DrRishabhOnco, Nair, Sudhir Vasudevan et al.

    📚 Sources · 🐦 1 tweet · 📄 1 paper
    📄 PAPER Nair, Sudhir Vasudevan; Gupta, Tejpal; Rane, Swapnil Ulhas et al. · Journal of Clinical Oncology (2026-06)
    Adjuvant radiotherapy versus observation following curative surgery for early-stage oral squamous cell carcinoma (AREST; CTRI/2017/07/009114).
    doi article →
    Abstract
    6000 Background: The role of adjuvant radiotherapy (RT) in early-stage, node-negative oral squamous cell carcinoma (OSCC) with one or more intermediate risk factors - such as depth of invasion (DOI) ≥5 to ≤10mm, perineural invasion (PNI), lymphovascular emboli (LVE), or poor differentiation - remains debatable and is largely based on retrospective data. This multicenter, open-label, phase III randomized controlled trial was designed to assess the impact of post-operative adjuvant RT in this setting. Methods: Patients with early-stage (pT1-T2), node-negative (pN0) OSCC undergoing adequate surgery (defined as clear margins ≥5mm and at least ipsilateral level I-III neck dissection with ≥16 nodes) with presence of one or more intermediate risk factors were screened. Eligible patients underwent stratified randomization (oral cavity subsite, PNI/LVE, and differentiation) in 1:1 ratio to either observation or adjuvant RT (60Gy in 30 fractions over 6-weeks) to the resected tumor-bed and at-risk neck nodal region after written informed consent. Primary endpoint was loco-regional recurrence-free survival (LRFS) measured from randomization to first documented event of local and/or regional recurrence from index cancer. All time-to-event outcomes were computed using Kaplan-Meier (KM) method with log-rank test for comparison and expressed as 3-year point estimates with 95% confidence intervals (CI). The planned sample size (N=392) provided 80% power at an α of 0.05 to detect a Hazard Ratio (HR) of 0.6256, assuming 3-year LRFS of 70% in the observation arm. Results: Following curative surgery, a total of 392 patients were randomized (191 to adjuvant RT; 201 to observation). Baseline characteristics were balanced between the two arms. At a median follow-up of 47.2 months (inter-quartile range=30-59.4 months), 3-year KM estimate of LRFS was 89.2% in adjuvant RT arm vs 80.9% in observation arm (HR=0.52, 95%CI=0.30-0.91; p=0.02) in the intention-to-treat (ITT) population and 91.1% vs 80.9% (HR=0.43, 95%CI=0.23-0.80; p=0.01) on per-protocol (PP) analyses. Cumulative incidence of loco-regional failure with death as competing event was 10.6% (95%CI=6.1%-15.1%) with adjuvant RT and 18.9% (95%CI=13.3%-24.6%) with observation (HR=0.52, 95%CI=0.30-0.91; p=0.021) in the ITT population and 8.7% (95%CI=4.3%-13.1%) vs 18.9% (95%CI=13.3%-24.6%) (HR=0.43, 95%CI=0.23-0.79; p=0.007) on PP analyses. Disease-free and overall survival were not significantly different between the two arms. Subgroup analysis identified oral tongue deriving higher benefit of adjuvant RT compared to buccal mucosa. Conclusions: Adjuvant RT significantly reduces risk of loco-regional recurrence for early-stage, node-negative adequately resected OSCC, particularly oral tongue. However, such reduction in loco-regional failure does not translate into significant survival benefit. Clinical trial information: CTRI/2017/07/009114.
    📝 https://ascopubs.org/doi/10.1200/JCO.2026.44.16_suppl.6000

    Radiation Curative Phase 3 RCT Confirmatory ASCO Annual Meeting 2026