onc brain

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).

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.

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.

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.

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.

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.

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.

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.

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.

Multicentre phase 3 RCT, 2:1 randomisation to IMPT vs IMRT, 205 pts recruited. Stratified by T-stage, N-stage, p16 status and smoking history. This ESTRO 2026 presentation reports the longitudinal HR-QoL analysis only.

Oropharyngeal SCC requiring concurrent chemo-radiotherapy including bilateral neck treatment. p16 status was a stratification factor, not an exclusion, so both HPV-driven and HPV-negative disease are represented.

70 Gy / 56 Gy in 33 fractions over 6.5 weeks in both arms, IMPT vs IMRT. Same dose, same schedule, same constraints, so delivery technique is the only variable.

Concurrent cisplatin 100mg/m2 on D1 and D22, identical in both arms. The systemic backbone is fixed, so nothing here reads on regimen choice.

Co-primary (clinician): CTCAE grade 3 weight loss (≥20% decrease from baseline) or gastrostomy dependence at 12 months post RT. Co-primary (patient): UW-QoL physical composite of saliva, taste, chewing, swallowing, appearance and speech at 12 months post CRT.

No difference in mean UW-QoL physical composite between arms at 3, 12 and 24 months post RT, with similar trajectories from week 6 post CRT and similar results across multiple PRO instruments. Scores fell at end of treatment then recovered, most stabilising from 12 months. No effect sizes given in source.

Non-randomised proton series in oropharynx have reported lower gastrostomy dependence and xerostomia than photon comparators, and that expectation is what this trial was built to test. The randomised patient-reported comparison does not reproduce a separation. No cross-trial numbers are in the source.

A composite of six domains dilutes a benefit confined to one, xerostomia being the obvious candidate. 90% CIs and no stated non-inferiority margin mean this is an absence of difference, not demonstrated equivalence. The commentary point that UK proton centres are early on the learning curve is untestable from the source.

The clean part of this design, matched dose and matched constraints, is also what bounds the answer: IMPT was planned to objectives written for photons, so the trial measures what protons deliver under photon rules rather than what they can achieve when pushed. It supports selecting patients by individual sparing benefit rather than referring bilateral-neck OPSCC to protons as a class.

Randomised phase 3 PRO co-primary shows no arm difference, supporting IMRT as standard. Clinician-reported co-primary and effect sizes absent from source.