ASCO Annual Meeting 2026

Prostate

Practice-pattern data, not an efficacy signal: what high-risk pts are actually offered at consult.

Unclear

MROQC ADT Practice Patterns

ForIntact high-risk M0/N0-1 prostate ca planned for definitive RT

TL;DR67.0% of 553 high-risk pts got guideline-concordant ADT (≥18mo); ARPI use 23.2% among STAMPEDE-eligible post-publication.

Why it mattersRadiation oncology

The deviation is concentrated where the guideline is weakest-anchored: cN1 (OR 2.94) and GG4-5 (OR 6.23 / 9.45) drove ≥18mo recommendations, so the third of pts NOT getting guideline-concordant ADT are largely single-factor high-risk. Facility remained a predictor after case-mix adjustment (P<.0001), which points at practice culture, not patient selection.

Monday clinic

For a man with single-factor high-risk localized disease (GG4-5 or PSA ≥20 alone) heading to definitive RT, this frames how much of the ≥18mo ADT recommendation is guideline versus local habit; it does not address post-prostatectomy salvage or M1 disease.

The longer read

9 details

Design

Prospective observational analysis within the Michigan Radiation Oncology Quality Consortium (MROQC), a statewide quality collaborative. 26 centers, accrual June 2020 to November 2024, N=553. Intended ADT duration and ARPI use were collected prospectively at the treatment decision, not abstracted retrospectively.

Population & inclusion

Intact (non-postoperative) high-risk M0/N0-1 prostate cancer planned for definitive radiotherapy. Risk features: cT3/4 13.3%, cN1 19.9%, GG 4-5 75.0%, PSA ≥20 ng/mL 40.0%.

Endpoints

Primary outcome was intended guideline-concordant ADT (GC-ADT, ≥18 months) per the 2022 AUA/ASTRO recommendation of 18-36 months. Secondary analyses covered multivariable predictors of GC-ADT, ARPI adoption before versus after STAMPEDE M0 publication, and facility-level variability via a mixed-effects model with treatment site as random intercept.

Results

91.3% were recommended ADT and 67.0% were guideline-concordant. Among the 27.9% meeting STAMPEDE M0 eligibility, ARPI recommendation went from 0% pre-publication to 23.2% after. Site-level variability remained significant on multivariable analysis (P<.0001).

Factor	OR (95% CI)
cN1	2.94 (1.44 to 5.99)
GG4	6.23 (2.85 to 13.62)
GG5	9.45 (4.46 to 20.06)
PSA ≥40	3.64 (1.22 to 10.87)

vs leading data

The 2022 AUA/ASTRO guideline sets 18-36 months, and STAMPEDE M0 supports ARPI intensification for ≥2 of cT3/T4, GG 4-5, PSA ≥40, or cN1. Both benchmarks are met by a minority here, echoing the long-standing gap between the long-course ADT durations tested in EORTC 22863 and RTOG 9202 era trials and what is actually intended in practice.

Applies to

intact high-risk M0/N0-1 prostate cancer treated with definitive RT inside a statewide quality consortium

Does not represent post-prostatectomy salvage, node-positive M1 disease, or practices outside a participating quality collaborative.

Limitations

Intended duration is a proxy for delivered duration, so the true concordance rate could fall further with early discontinuation. STAMPEDE M0 eligibility was applied to a cohort accrued partly before that trial reported, so the 23.2% post-publication figure reflects an adoption curve still in motion rather than a steady state.

Discussion

The finding that facility explains variance after adjusting for cN1, grade group, and PSA is the load-bearing result: with case mix accounted for, where a man is treated still moves how long he is recommended ADT. That is a quality-improvement target rather than an evidence gap, and it is the kind of signal a consortium is uniquely built to detect and act on.

Rationale

Prospective practice-pattern survey of intended treatment, no efficacy endpoint. Documents a care-delivery gap rather than testing whether the guideline duration is right.

Open questions

Does intended ADT duration match delivered duration?
Which facility-level factors drive the residual variability?
Optimal ADT duration for single-factor high-risk disease

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 < .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.

Combined Curative Real-world evidence Unclear ASCO Annual Meeting 2026

Head & Neck

First randomised look at whether intermediate risk factors alone justify adjuvant RT after an adequate oral cavity resection.

Confirmatory

AREST

ForpT1-2N0 oral SCC post adequate resection, ≥1 intermediate-risk feature

Loco-regional recurrence-free survival local control

HR 0.52

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

TL;DR3yr LRFS 89.2% vs 80.9% with adjuvant RT after adequate resection of intermediate-risk pT1-2N0 OSCC; HR 0.52, no OS gain.

Why it mattersRadiation oncology

Transfer hinges on the surgery: benefit was shown only after margins ≥5mm and a ≥16-node level I-III dissection, so a lesser neck operation is not the population studied. Per-protocol the effect strengthens (HR 0.43, 91.1% vs 80.9%), and competing-risk LRF ran 10.6% vs 18.9%. Dose was 60Gy/30fx to bed plus at-risk nodes.

Monday clinic

In an intermediate-risk pT1-2N0 oral tongue resection, this is the first randomised evidence supporting adjuvant RT for loco-regional control, with no survival gain shown; buccal mucosa benefit looked smaller and stays exploratory, and node-positive or close-margin disease sits outside the trial.

The longer read

AREST — Arm 3yr LRFS (95% CI) HR (95% CI) p

Adjuvant RT 89.2% (84.3-93.3) 0.52 (0.30-0.91) 0.02
Observation 80.9% (74.6-86.1) reference n/a

Arm	3yr LRFS (95% CI)	HR (95% CI)	p
Adjuvant RT	89.2% (84.3-93.3)	0.52 (0.30-0.91)	0.02
Observation	80.9% (74.6-86.1)	reference	n/a

8 details 3 trials watching

Design

Multicentre open-label phase III RCT from India, 1:1 randomisation, N=392 (191 adjuvant RT, 201 observation), stratified by oral cavity subsite, PNI/LVE and differentiation. Median follow-up 47.2 months (IQR 30-59.4).

Population & inclusion

pT1-2, pN0 OSCC after adequate surgery, defined as clear margins ≥5mm plus at least ipsilateral level I-III neck dissection yielding ≥16 nodes. At least one intermediate risk factor required: DOI ≥5 to ≤10mm, PNI, LVE, or poor differentiation. Baseline characteristics reported as balanced.

Radiotherapy

60Gy in 30 fractions over 6 weeks to the resected tumour bed and the at-risk neck nodal region. Technique, target volume detail and dose constraints are not reported in the source.

Endpoints

Primary: loco-regional recurrence-free survival, from randomisation to first documented local and/or regional recurrence of the index cancer. Kaplan-Meier 3-year point estimates with log-rank comparison; DFS and OS secondary.

Results

Primary endpoint met on both ITT and per-protocol analysis, and reproduced in the competing-risk analysis. DFS and OS did not differ between arms.

Analysis	Adjuvant RT	Observation	HR (95% CI), p
3yr LRFS, per-protocol	91.1%	80.9%	0.43 (0.23-0.80), p=0.01
Cumulative LRF, ITT	10.6%	18.9%	0.52 (0.30-0.91), p=0.021
Cumulative LRF, per-protocol	8.7%	18.9%	0.43 (0.23-0.79), p=0.007

vs leading data

The randomised adjuvant evidence in resected head and neck cancer (EORTC 22931, RTOG 9501) tested chemoradiation against radiation in high-risk disease defined by positive margins and extranodal extension, leaving the intermediate-risk indication to retrospective series, which the abstract itself names as the basis for the debate. This is the first randomised test of that indication in an adequately resected node-negative cohort.

Applies to

pT1-2 pN0 oral squamous cell carcinoma resected with clear margins ≥5mm and a ≥16-node ipsilateral level I-III dissection, carrying at least one intermediate risk factor

Does not represent node-positive disease, positive or close margins, DOI above 10mm, or a neck staged below that dissection standard.

Limitations

The observation arm reached 80.9% 3-year LRFS against the 70% the sample size assumed, so the trial ran event-poor and the DFS and OS comparisons are underpowered rather than reassuring. No toxicity, xerostomia or quality-of-life data appear in the source, so the price of the local control gain is unquantified. The subsite effect is exploratory.

Discussion

The whole content of the result is loco-regional control at a median 47.2 months, with no survival separation, so the decision turns on how the reader values preventing a recurrence in a cohort whose failures are visible and often salvageable. The exploratory oral tongue over buccal mucosa split, if it replicates, would narrow the indication rather than extend adjuvant RT to every intermediate-risk resection.

Enrolment

CONSORT flow

Randomized 392

↓

Adjuvant RT

allocated 191

3yr LRFS 89.2%

Observation

allocated 201

3yr LRFS 80.9%

Rationale

First randomised test of an indication previously grounded in retrospective data; primary endpoint met, but open-label and the gain is loco-regional only, no DFS or OS.

Open questions

Does the oral tongue vs buccal mucosa subsite effect replicate?

recruiting A Study of Radiation Therapy After Surgery in People With Oral Tongue Squamous Cell Carcinoma Phase 2

n=24 · primary completion 2027-06 · pT1-2 pN0-2b oral tongue only, post-op IMRT
Toxicity and QoL cost of the loco-regional control gain

recruiting A Study of Radiation Therapy After Surgery in People With Oral Tongue Squamous Cell Carcinoma Phase 2

n=24 · primary completion 2027-06 · post-op IMRT sparing tongue site; QoL questionnaires

not yet A Study Evaluating the Contribution of Non-Coplanar Beam Arrangement in Reducing Toxicity in Radiotherapy for Upper Aerodigestive Tract Cancers Phase NA

n=70 · primary completion 2028-02 · non-coplanar vs coplanar EBRT, OAR dose + xerostomia
Whether longer follow-up reveals any survival difference

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

📚 Sources · 🐦 1 tweet · 📄 1 paper

#ASCO26

🗣️ The AREST trial tackles one of the biggest gray zones in oral cavity cancer.

After adequate surgery in pT1-2N0 OSCC with intermediate-risk features:

✅ Adjuvant RT improved loco-regional control
❌ No OS benefit observed

3-year LRFS:
🔹 89.2% vs 80.9%
🔹 HR 0.52… https://t.co/qsALPFX032 pic.twitter.com/F4XzTMETih
— Dr Rishabh Jain (@DrRishabhOnco) May 27, 2026

📄 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

onc brain

2026-06-04 ASCO Annual Meeting 2026

Prostate

MROQC ADT Practice Patterns

Head & Neck

AREST

🌰 Prostate

MROQC ADT Practice Patterns

👄 Head & Neck

AREST

Prostate

Head & Neck