Consensus / guideline

ESTRO Prostate SBRT Consensus Recommendations

TL;DR15-expert ESTRO Delphi consensus on optimising primary prostate SBRT: patient selection, contouring, dose/fractionation, follow-up, and delivery technique.

Trials discussed

HYPO-RT-PCPACE-B

Why it mattersRadiation oncology

For a department standardising primary prostate SBRT, this is the implementation reference: an ESTRO Delphi panel settles the controversy points (patient selection, contouring, dose, fractionation, follow-up, delivery technique). Planning is anchored to the PACE-B protocol (Fig 1, isodose 8 to 46 Gy).

4 details 5 trials watching

Design

ESTRO clinical practice consensus, 15-expert panel, Delphi process answering a 10-item questionnaire on areas of controversy. Covers selection, contouring, dose, fractionation, follow-up, and minimal-vs-optimal delivery technique for primary prostate SBRT.

Applies to

departments initiating or optimising primary prostate SBRT

Does not represent post-prostatectomy salvage, nodal, or metastasis-directed SBRT.

Open questions

Optimal dose and fractionation for prostate SBRT

active Prostate Radiotherapy Comparing Moderate and Extreme Hypo-fractionation (PRIME Trial) Phase NA

n=526 · primary completion 2024-09 · extreme vs moderate hypofx, non-inferiority

recruiting Two-fraction Versus Five-fraction Stereotactic Radiotherapy for Localized Prostate Cancer Phase NA

n=562 · primary completion 2027-12 · 2-fraction vs 5-fraction SBRT, localized
Role of focal ablative microboost

active Hypofractionated Focal Lesion Ablative Microboost in prostatE Cancer 2.0 Phase 2

n=124 · primary completion 2022-06 · SBRT focal ablative microboost, hypo-FLAME 2.0

recruiting Image-guided Focal Dose Escalation- Primary pc Treated With Primary External Beam Hypofract.Stereotactic rt Phase NA

n=374 · primary completion 2025-08 · randomized focal dose escalation vs no boost

active Standard Moderately Hypofractionated RT vs. Ultra-hypofractionated Focal Lesion Ablative Microboost in Prostate Cancer Phase NA

n=484 · primary completion 2032-01 · randomized standard RT vs focal microboost

📚 Sources · 📄 1 paper

📄 PAPER Draulans, Cédric; Tree, Alison; Zilli, Thomas et al. · Radiotherapy and Oncology (2026-07)

How to optimise prostate SBRT: ESTRO clinical practice consensus recommendations

doi

Radiation Curative Consensus / guideline

EANO Consensus Statement on Radiation Necrosis

TL;DRDelphi consensus (20 experts): 53/57 statements reached ≥80% agreement; perfusion MRI + amino-acid PET to distinguish RN from recurrence, bevacizumab for steroid-refractory RN.

Why it mattersRadiation oncology

The RT-actionable core is the recurrence-vs-necrosis call: perfusion MRI (DSC/DCE) plus amino-acid PET (FET/DOPA/MET) over standard MRI, with histopathology still gold standard. For symptomatic RN, bevacizumab (5-10 mg/kg q2-3wk) is recommended for steroid-refractory cases and noted effective even at low doses.

8 details 5 trials watching

Design

Three-round Delphi among 20 EANO experts; consensus set at ≥80% agreement on a 5-point Likert scale. Reached consensus on 53 of 57 statements.

Results

RN occurs in 4-30% after focal RT, typically 6-24 mo post-treatment. Perfusion MRI (DSC/DCE) plus amino-acid PET (FET/DOPA/MET) preferred for the RN-vs-recurrence call; histopathology remains gold standard.

Discussion

Symptomatic RN: dexamethasone (e.g. 8mg, rapid taper), then bevacizumab (5-10 mg/kg q2-3wk) for steroid-refractory/dependent disease (>4wk); surgery preferred when feasible, LITT an option. Bevacizumab noted effective even at low doses.

Limitations

No Level 1 evidence; expert opinion only. Panel explicitly flags the need for prospective randomized trials in symptomatic RN.

Monday clinic

In a brain-tumor pt 6-24 mo post-RT with a new or enlarging enhancing lesion, this supports advanced imaging (perfusion MRI + amino-acid PET) before calling recurrence; it does not apply to asymptomatic necrosis beyond serial observation.

Open questions

Prospective randomized trials for symptomatic radiation necrosis

not yet TENS of Auricular Vagal Nerve for Radiation Necrosis Phase NA

n=40 · primary completion 2029-08 · randomized taVNS vs sham for RN cerebral edema
Optimal bevacizumab dose and duration for RN

recruiting Bevacizumab Versus Corticosteroids as First-line Treatment in Patients With Symptomatic Cerebral Radiation Necrosis After Radiation for High-grade Glioma or Brain Metastases Phase 3

n=408 · primary completion 2028-07 · phase 3 bevacizumab vs steroids first-line for sCRN

recruiting Corticodependent or Corticoresistant Brain Radionecrosis After Radiotherapy for Brain Metastases Phase 3

n=84 · primary completion 2028-08 · phase 3 bev vs placebo, steroid-refractory RN
Standardizing perfusion MRI and amino-acid PET thresholds

recruiting Diagnostic Assessment of Amino Acid PET/MRI in the Evaluation of Glioma and Brain Metastases

n=160 · primary completion 2025-12 · amino-acid PET/MRI to separate RN from tumor

not yet Performance of Amino Acid Positons Emission Tomography in Brain Metastases

n=80 · primary completion 2026-09 · amino-acid PET, RN vs progression in brain mets

📚 Sources · 📄 1 paper

📄 PAPER Duerinck, Johnny; Van Den Bent, Martin; Brandal, Petter et al. · Neuro-Oncology (2026-07)

The European Association for Neuro-oncology (EANO) Consensus Statement on Radiation Necrosis

doi

Abstract

Abstract Introduction Radiation necrosis (RN) complicates neuro-oncological care, mimicking tumor recurrence and lacking high-level evidence for standardized management. Methods A European Association for Neuro-Oncology (EANO) expert panel utilized a three-round Delphi process to create a comprehensive expert opinion document based on the available current scientific evidence. A series of statements, derived from the published literature were created by the experts in each field. Consensus was defined as ≥ 80% agreement using a 5-point Likert scale. Results After three rounds among 20 experts that included adaptation of statements, the Delphi process reached a consensus (≥80% agreement) on 53 statements out of 57. RN occurs in 4% to 30% of patients, typically appearing 6 to 24 months after radiotherapy for primary (glial) or metastatic brain tumors. Experts identified perfusion MRI and amino acid PET as the most suitable imaging modalities for differentiation from tumor recurrence. While histopathology remains the gold standard, identifying viable tumor cells in irradiated gliomas is challenging due to overlapping cytological features with reactive glia. For symptomatic management, corticosteroids may be tried, and bevacizumab is recommended for corticosteroid-refractory cases, with evidence suggesting profound efficacy even at low doses. Surgery is considered effective for rapid symptom relief and definitive diagnosis in accessible lesions. Laser Interstitial Thermal Therapy (LITT) can be considered an additional treatment option for symptomatic RN. Conclusions Despite the absence of Level 1 evidence, these Delphi-survey-formulated recommendations provide actionable guidance for clinical practice. There is a need for prospective randomized trials focusing on symptomatic RN.

Supportive Consensus / guideline

ESTRO Oral Cavity CTV Delineation Guidelines

TL;DRNew consensus recipe for post-op CTV: recreate pre-op GTV-P +10mm composited with surgical defect/flap +5mm; standardizes OCSCC delineation at EQD2 60 Gy.

Trials discussed

DAHANCA

Why it mattersRadiation oncology

The recipe is asymmetric: 10mm around the recreated pre-op GTV-P but only 5mm around the surgical defect/flap, composited. Recreating the GTV-P pre-op (not relying on the defect alone) is the load-bearing step; one buccal case would have missed the infratemporal fossa otherwise. Standardizes OCSCC post-op contouring at EQD2 60 Gy.

7 details

Design

Consensus clinical guideline from an ESTRO multidisciplinary expert panel; proposals drafted, then validated by a second tier of international HNSCC experts across many countries for worldwide applicability. Not a trial, no outcome data.

Population & inclusion

Post-operative oral cavity SCC (OCSCC) requiring PORT. Fills a gap: no prior systematic consensus for post-op primary + nodal CTV in mucosal HNSCC, a source of wide institutional variation.

Radiotherapy

CTV-P post-op = (GTV-P pre-op + 10mm) composited with (surgical defect/flap + 5mm), edited for air/bone/teeth/fascial planes. Surrogate GTV-P/N recreated on the planning scan via MRI/CT registration or anatomical landmarks. Nodal CTV-N1 = GTV-N + involved level, CTV-N2 covers prophylactic at-risk levels, with uni- vs bilateral neck guidance. Example dose EQD2 60 Gy (2 Gy/fx).

vs leading data

Extends the 2018 primary-setting CTV guidelines (5mm + 5mm geometric expansion) into the post-op setting. DAHANCA data showed geometric margins give more conformal CTVs than anatomical ones, and a protocol switch correlated with lower late dysphagia in an unplanned post-hoc analysis.

Applies to

resected oral cavity SCC receiving post-operative radiotherapy

Does not represent definitive (non-operative) RT or other head and neck subsites (larynx, oropharynx, hypopharynx, nasopharynx).

Limitations

Expert consensus, not outcome-validated. The benefit is standardization (reduced inter-institutional variation, enabling RTQA and multi-institutional trials), not a demonstrated survival or toxicity endpoint.

Monday clinic

In resected oral cavity SCC referred for PORT, this defines a standardized post-op CTV recipe; it does not extend to definitive (non-operative) RT or to other head/neck subsites (larynx, oropharynx, hypopharynx), which await their own guidelines.

Open questions

Whether standardized CTV margins reduce marginal recurrence vs current practice
Extension to other head/neck subsites beyond oral cavity

📚 Sources · 📄 1 paper

📄 PAPER Evans, Mererid; Bonomo, Pierluigi; Chan, Po Chung et al. · Radiotherapy and Oncology (2025-11)

Delineation of the post-operative primary tumour and nodal clinical target volumes in oral cavity squamous cell carcinoma: European Society for Radiotherapy and Oncology (ESTRO) clinical guidelines

doi

Radiation Curative Consensus / guideline

American Radium Society AUC: Intraprostatic Recurrence After RT

TL;DRPSMA PET + mpMRI plus mandatory pre-salvage biopsy, then reirradiation (≤6 fx) over ADT alone, for radiorecurrent intraprostatic disease.

Trials discussed

RTOG 9408FORECAST

Why it mattersRadiation oncology

The RT-actionable read is workup discipline: mandatory biopsy before salvage (radiographic recurrence is often just treatment effect) and PSMA PET + mpMRI to exclude nodal/distant disease first. Preferred salvage is reirradiation in ≤6 fx over ADT alone, with short-course classic ADT (not ARSIs) for radiosensitization.

8 details 5 trials watching

Design

ARS Genitourinary Appropriate Use Criteria consensus. PubMed + Embase across four topics (staging, biopsy, salvage modality, hormone therapy); evidence tables by 3 authors, panel voting via modified Delphi with RAND disagreement methodology.

Discussion

Workup: PSMA PET + mpMRI to exclude metastatic disease and map local extent; biopsy mandatory before salvage to avoid treating radiographic changes that are only treatment effect. Salvage reirradiation preferred over noncurative ADT alone, most regimens ≤6 fractions; focal salvage when focal recurrence is confirmed, though whole-gland toxicity called very tolerable.

Limitations

Evidence limited to pts initially treated with conventionally fractionated EBRT and worked up before the PSMA PET era; no randomized salvage trials, so recommendations rest on retrospective series and expert consensus.

Results

Modality	Sensitivity (95% CI)	Specificity (95% CI)
mpMRI (n=155)	94% (88-98%)	18% (7-35%)
MRI-targeted biopsy (n=87)	92% (83-97%)	75% (45-92%)

Monday clinic

In a man with biopsy-confirmed isolated intraprostatic recurrence after definitive RT (mets excluded on PSMA PET/mpMRI), this supports curative-intent local salvage over ADT alone; it does not extend to nodal or distant failure.

Open questions

Optimal salvage reirradiation modality and dose/fractionation

not yet Prostate Reirradiation Toxicity Outcomes Feasibility Study Phase NA

n=60 · primary completion 2024-11 · randomises salvage EBRT vs HDR brachytherapy

recruiting Stereotactic Re-irradiation of Local Recurrences of Prostate Cancer After Radiotherapy Phase 2

n=55 · primary completion 2029-12 · phase 2 focal SBRT reirradiation, GU/GI toxicity
Focal vs whole-gland salvage for intraprostatic radiorecurrence

recruiting Salvage HDR for Locally Recurrent Prostate Cancer Phase NA

n=50 · primary completion 2025-03 · focal salvage HDR brachy after definitive RT

recruiting Partial Prostate Salvage High Dose Rate Brachytherapy Phase NA

n=30 · primary completion 2032-01 · partial-gland (focal) salvage HDR after EBRT/LDR
Salvage outcomes in the PSMA PET era

recruiting Trial Evaluating the Safety and Efficacy Of MR-Linac-Guided Radiotherapy as Salvage Treatment After External Beam Radiotherapy Recurrence (TUMORNATOR II) Phase NA

n=28 · primary completion 2028-08 · PSMA/PET MR-Linac salvage SBRT, radiorecurrent

📚 Sources · 📄 1 paper

📄 PAPER Valle, Luca F.; Jiang, Tommy; Rosenbloom, Ashton et al. · European Urology Oncology (2025-06)

American Radium Society Appropriate Use Criteria for the Workup and Treatment of Local Intraprostatic Recurrence of Prostate Cancer Following Definitive Radiotherapy

doi

Radiation Curative Consensus / guideline

ReCOG/ESTRO/ASTRO HNSCC Reirradiation Consensus

TL;DRExpert consensus on reRT for recurrent/2nd-primary HNSCC in previously irradiated fields; 17-panel vote, guidance on selection, delineation, dose accumulation, toxicity.

Why it mattersRadiation oncology

The dose-accumulation and target-delineation domains are the real value: reRT toxicity is gated by cumulative OAR dose from the first course, and this is the first multi-society attempt to standardize how you sum the two plans and draw the reRT target. It sequences salvage surgery first, then postoperative or definitive reRT, so it shapes selection, not a dose prescription.

8 details 4 trials watching

Design

Policy Review / expert-consensus statement. A 10-member core (6 radiation oncologists, 3 physicists, 1 research fellow) drafted, then an international panel of 17 radiation oncologists cast a single formal vote. Consensus predefined as high ≥85%, moderate 70-84%, low <70%, with no-opinion kept in the denominator.

Population & inclusion

Recurrent or second-primary HNSCC within a previously irradiated region, a setting with scarce options. Background: 15-50% of HNSCC pts recur or develop a second primary.

Radiotherapy

Covers definitive and postoperative reRT with modern conformal technique (IMRT, VMAT, proton, SBRT). Guidance spans patient selection, imaging, target delineation, treatment planning, dose accumulation, and toxicity management; salvage surgery preferred when feasible.

Applies to

recurrent or second-primary HNSCC arising in a previously irradiated region

Does not represent nasopharyngeal carcinoma, rare histologies, or first-course HNSCC.

Limitations

Evidence base is low-level (much at Oxford level 3-4, retrospective / expert consensus); single voting round with no reconciliation, and a radiation-oncologist-only panel.

Monday clinic

In a pt with an in-field HNSCC recurrence or second primary (non-nasopharyngeal) being weighed for reRT, this frames selection, dose accumulation, and delineation; it does not extend to first-course or nasopharyngeal disease.

Open questions

Role of modern reRT (IMRT/proton/SBRT) undefined absent randomised trials

active SBRT +/- Pembrolizumab in Patients With Local-Regionally Recurrent or Second Primary Head and Neck Carcinoma Phase 2

n=86 · primary completion 2027-07 · phase 2 SBRT reRT +/- pembrolizumab

recruiting Prospective Evaluation of Pencil Beam Scanning Proton Therapy for Previously Irradiated Tumors Phase NA

n=1800 · primary completion 2028-01 · prospective PBS proton reRT, prior-irradiated

recruiting Carbon Ion Re-Radiotherapy in Patients With Recurrent or Progressive Locally Advanced Head-and-Neck Cancer Phase NA

n=72 · primary completion 2030-07 · randomised carbon ion vs photon reRT

recruiting Re-Radiochemotherapy and Pembrolizumab vs. Immuno(Chemo)Therapy for Locoregionally Recurrent PD-L1 Positive (CPS≥1) HNSCC Phase 3

n=214 · primary completion 2032-12 · phase 3 randomised reRCT vs pembrolizumab
Optimal dose accumulation method across two RT courses
Selection for definitive vs postoperative reRT

📚 Sources · 📄 1 paper

📄 PAPER Julian Biau; Arnaud Beddok; Manju Sharma et al. · The Lancet Oncology (2026-07)

Reirradiation for recurrent head and neck squamous cell carcinoma: international expert consensus recommendations endorsed by the Reirradiation Collaborative Group, the European Society for Radiotherapy and Oncology Reirradiation Focus Group, and the American Society for Radiation Oncology

Radiation Curative Consensus / guideline

ARS Appropriate Use Criteria for Locoregionally Recurrent Rectal Cancer

TL;DRGuideline update, 116 studies: margin-negative (R0) resection determines survival; preop systemic ± RT/reirradiation enables downsizing, no major practice change.

Why it mattersRadiation oncology

Reirradiation and preop (chemo)RT are framed as R0-enabling downsizing tools in the previously-irradiated pelvis, not definitive therapy: the guideline holds that margin-negative resection, not RT dose or intensity, is the survival and local-control lever. Moves the reirradiate-to-downstage-before-salvage-surgery decision.

8 details 5 trials watching

Methods

🔍 Systematic review with RAND/UCLA modified Delphi consensus; PICOTS + PRISMA; 116 references, Jan 2013-Jul 2025
🔍 Evidence base skews retrospective (116 refs total)
- 10 well-designed (phase 2 randomized / phase 3)
- 29 moderately designed (matched cohort / phase 2)
- 76 retrospective (design limitations)
- 1 meta-analysis
💊 Preop systemic therapy, RT, or both facilitate tumor downsizing → improve likelihood of R0 resection
🔍 Five PICO questions: surgery, preop/periop therapy, nonoperative management, RT/reirradiation, systemic therapy
🔍 High-res pelvic MRI preferred to map resectability (sidewall, sacral, nerve involvement)
🔍 FDG-PET/CT separates postoperative fibrosis from active recurrent tumor

Results

📊 Margin-negative (R0) resection is the ultimate determinant of survival and local control

Critique

⚠️ Updates 2012 ACR AUC; does not suggest major practice change, reaffirms combined-modality therapy

Open questions

Optimal reirradiation dose and technique for previously-irradiated LRRC

recruiting Pencil Beam Proton Therapy for Pelvic Recurrences in Rectal Cancer Patients Previously Treated With Radiotherapy Phase 2

n=65 · primary completion 2025-10 · proton reirradiation for previously-RT rectal recur

not yet Re-irradiation Therapy of Locally Recurrent Rectal Cancer With Carbon Ion Phase 2

n=31 · primary completion 2025-12 · carbon-ion reirradiation, unresectable LRRC
Role of ctDNA in detecting and monitoring LRRC

active Application of Polygenic Methylation Markers in Postoperative Recurrence Monitoring of Colorectal Cancer

n=800 · primary completion 2026-06 · ctDNA methylation for postop CRC recurrence monitoring

recruiting RESPONSE: Colorectal Cancer Survivors' Follow-up Care - Now Digital and Need-based Phase NA

n=400 · primary completion 2028-03 · ctDNA recurrence surveillance in CRC follow-up
Role of immunotherapy in LRRC management

recruiting SBRT + PD-1 Antibody in Unresectable Locally Recurrent Rectal Cancer（SPARKLE） Phase 2

n=31 · primary completion 2026-11 · SBRT + PD-1 in unresectable LRRC

📚 Sources · 📄 1 paper

📄 PAPER Miller, Eric D.; Jethwa, Krishan R.; Dozois, Eric et al. · Cancer (2026-06)

Executive summary of American Radium Society Appropriate Use Criteria for the treatment of locoregionally recurrent rectal cancer

doi

Abstract

Abstract This literature‐based systematic review and associated guidelines provide evidence‐based paradigms for the management of locoregionally recurrent rectal cancer (LRRC). This multispecialty committee included gastrointestinal radiation and medical oncology, gastroenterology, radiology, and colorectal surgery. As is the standard, the previously described American Radium Society Appropriate Use Criteria methodology for this project was followed rigorously, with the Population, Intervention, Comparator, Outcome, Timing, and Study Design framework and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses methodology to assess the evidence. RAND/University of California Los Angeles consensus methodology (modified Delphi) was used to rate the appropriateness of treatment options. Published between January 1, 2013, and July 16, 2025, 116 peer‐reviewed trials provided the evidence: 10 were well‐designed randomized phase 2/3 trials, 29 were moderately well designed trials that accounted for most common biases (matched cohort and phase 2), 76 trials had design limitations (retrospective), and one was a meta‐analysis. Clinical cases were created as examples to illustrate current acceptable management of LRRC. Treatment and prognosis are influenced by prior therapy and the site(s) and extent of LRRC. The ability to achieve a margin‐negative surgical resection is the ultimate determinant of survival and local control. Preoperative systemic therapy, radiation therapy, or a combination of the two can facilitate tumor downsizing and improve the likelihood of a margin‐negative resection. An individualized multidisciplinary approach is required to ensure the best outcome. Although this review does not suggest a major alteration of current practice, it provides reassuring evidence of the importance of combined‐modality therapy.

📝 https://doi.org/10.1002/cncr.70464

Combined Curative Consensus / guideline

GEC-ESTRO APBI Patient Selection Recommendations

TL;DRExpanded APBI eligibility: now unifocal/multifocal ≤2cm, pTis/T1-2 ≤30mm, pN0/pN1mi, all histologies; BRCA1-2, TNBC, ≥pN1a, age <40 contraindicated.

Why it mattersRadiation oncology

The expansion is the actionable read: pN1mi, multifocal ≤2cm, DCIS (pTis), and all histologies now qualify as good APBI candidates, widening who you can offer partial-breast over whole-breast RT. BRCA1-2 carriers, TNBC, ≥pN1a nodes, and age <40 stay hard contraindications.

5 details 5 trials watching

Design

Systematic review with consensus recommendations. PubMed/Medline/Scopus/Cochrane searched 2010-2024; 618 articles screened to 10 prospective RCTs and 7 retrospective comparative studies (median follow-up ≥5 yr), then supplemented with expert opinion.

Applies to

early breast cancer pts considered for partial-breast irradiation after breast-conserving surgery

Does not represent pts requiring whole-breast or regional nodal irradiation.

Limitations

Consensus, not a comparative trial: the eligibility expansion blends RCT evidence with expert opinion, with no randomized test of expanded vs restrictive criteria. Patient selection only, no APBI dose, fractionation, or modality specified.

Results

Criterion	Low-risk (good APBI candidate)	High-risk (contraindicated)
Age	>40 yr	<40 yr
Tumor	Unifocal/multifocal ≤2cm; pTis, T1-2 ≤30mm	Multicentric or >30mm
Nodal	pN0 or pN1mi	≥pN1a, or pNx (unknown status)
Histology	All types	Triple-negative
Margins	Negative (≥2mm for DCIS)	Positive (<2mm for DCIS)
EIC / LVI	Absent	EIC+ or extensive LVI
BRCA1-2	Non-carrier	Mutation carrier

Monday clinic

In a woman >40 with T1-2 ≤30mm, pN0/pN1mi, margin-negative breast cancer of any histology, this supports offering APBI over whole-breast RT; it does not extend to BRCA carriers, TNBC, ≥pN1a disease, or age <40.

Open questions

Long-term outcomes in newly eligible groups (pN1mi, multifocal, DCIS)

active Accelerated Partial Breast Irradiation Study Phase NA

n=139 · primary completion 2025-12 · 10y local/regional recurrence registry, incl DCIS

recruiting Single-Fraction Very Accelerated Partial Breast Irradiation (sfVAPBI) Phase NA

n=250 · primary completion 2027-07 · enrolls pN1mi; clinical outcomes + late toxicity

recruiting Single-fraction APBI for Early-stage Breast Cancer With Favorable Histological Subtypes (Breast-1F) Phase NA

n=311 · primary completion 2029-06 · single-fraction non-inferiority RCT incl pTis/DCIS
Optimal APBI modality and dose for expanded-eligibility patients

active Accelerated Partial Breast Irradiation Following Lumpectomy for Breast Cancer Phase NA

n=121 · primary completion 2029-03 · head-to-head IORT/brachy/3D-CRT/SBRT APBI

active PBI for Breast in Situ Carcinoma of Intermediate Low Risk As Local Adjuvant Treatment Phase NA

n=150 · primary completion 2029-12 · EBRT vs brachytherapy for low/intermed DCIS

📚 Sources · 📄 1 paper

📄 PAPER Polgár; Gutierrez-Miguelez; Ivanov et al. · Clinical and translational radiation oncology (2026-07)

Patient selection for accelerated partial breast irradiation (APBI) after breast-conserving surgery: Updated evidence-based recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) Breast Cancer Working Group.

PMID 42058323 → doi full text (PMC) article →

Abstract

PURPOSE: To update recommendations on patient selection criteria for accelerated partial breast irradiation (APBI) based on available clinical evidence supplemented by expert opinions. METHODS AND MATERIALS: Between 2010 and 2024, a systematic search of the PubMed, Medline, Scopus and Cochrane database identified 618 articles using the keywords "accelerated partial breast irradiation" and "APBI". This search was complemented by reviewing the reference lists of articles and manual reviewing of relevant conference abstracts and book chapters. Of these, ten prospective randomized clinical trials and seven retrospective comparative studies with a minimum median follow-up time of five years were identified. The authors reviewed the clinical evidence published on APBI, supplemented it with relevant clinical and pathological studies on breast-conserving therapy, and then formulated the recommendations presented in this manuscript. RESULTS: Based on published new clinical evidence, the GEC-ESTRO Breast Cancer Working Group recommends two categories as guidelines for selecting patients eligible for APBI: (1) low-risk group representing good candidates for APBI including patients ageing > 40 years with unifocal or multifocal within 2 cm, pTis,T1-2 (≤30 mm) pN0 or pN1mi, all histology types of breast cancer without the presence of an extensive intraductal component (EIC), without extensive lympho-vascular invasion (LVI) and with negative surgical margins for invasive tumors (≥2 mm for DCIS), (2) high-risk group, for whom APBI is considered contraindicated including patients with BRCA 1-2 mutations or ageing < 40 years; having positive margins for invasive tumor (<2 mm for DCIS), and/or multicentric or large (>30 mm), and/or triple negative tumours, and/or EIC positive, and/or extensive lympho-vascular invasion (LVI) or macrometastatic positive lymph nodes (≥pN1a) or unknown axillary status (pNx). CONCLUSIONS: Based on emerging clinical evidence, the 2010 GEC-ESTRO APBI patient selection criteria can be significantly expanded, meaning that in the future, more patients may receive APBI as a part of routine clinical practice.

📝 https://pmc.ncbi.nlm.nih.gov/articles/PMC13122701/

Radiation Curative Consensus / guideline

EORTC Cutaneous Lymphoma RT Recommendations

TL;DRLow-dose RT (8-12 Gy) recommended for indolent cutaneous lymphomas; MF 1-yr local control ≥92%, but no RCT defines a standard dose per entity.

Why it mattersRadiation oncology

The actionable read is the dose floor: 4 Gy (1-2 fx) underperformed vs 8-12 Gy, so 8-12 Gy stays the low-dose local standard for MF, 24 Gy reserved for large/refractory lesions or pre-autoSCT remission. Low-dose TSEBT trades durability for repeatability and lower toxicity, moving the de-escalation decision in indolent CTCL.

7 details 4 trials watching

Design

EORTC cutaneous lymphoma tumour group expert-opinion / consensus recommendations, synthesizing retrospective case series and limited prospective registries. Proposes a treatment algorithm to standardize radiation dose across EORTC centres.

Radiotherapy

Modalities span electrons, photons, kilovoltage X-ray, brachytherapy. Low-dose regimens favored for low toxicity and repeatability on relapse; higher-dose TSEBT reserved for remission induction before autologous SCT.

Applies to

indolent primary cutaneous lymphomas (MF, pcALCL, CD4+ small/medium T-cell LPD, cutaneous B-cell)

Does not represent aggressive CTCL variants (SPTCL, gamma/delta, CD8+ epidermotropic, NK/T-cell), where low-dose RT has a limited role.

Limitations

No completed RCTs define the standard dose per entity; recommendations rest on retrospective series and expert consensus. Authors call a prospective trial urgently needed.

Results

Entity / setting	RT dose
MF plaque/tumour (local)	8-12 Gy / 2-3 fx
Low-dose TSEBT (palliative)	8-12 Gy
TSEBT pre-autoSCT	up to 24 Gy
Cutaneous DLBCL, leg type	16-45 Gy (4 Gy/wk to ≤40 Gy)

Monday clinic

In indolent cutaneous lymphoma (MF plaque/tumour, pcALCL, cutaneous B-cell), this supports low-dose RT (8-12 Gy) as effective skin-directed treatment; it does not set a dose for aggressive CTCL variants, where low-dose RT has a limited role.

Open questions

Optimal radiation dose per cutaneous lymphoma entity

active Low Dose Radiotherapy in Primary Indolent Cutaneous B-cell Lymphoma

n=52 · primary completion 2025-12 · 4 Gy low-dose RT in cutaneous B-cell lymphoma

recruiting Ultra Low Dose Radiation Therapy in Treating Patients With Mycosis Fungoides Phase 2

n=50 · primary completion 2027-12 · phase 2 ultra-low-dose RT vs higher-dose in MF
Durability of low-dose TSEBT vs higher-dose regimens

not yet TOtal Skin Electron Beam Therapy (Low-dose) for Tumor Clone Eradication in Early-stage Mycosis Fungoides Phase 3

n=78 · primary completion 2027-02 · phase 3 low-dose TSEBT, clone-eradication EP
TSEBT combined with immunotherapy in Sézary syndrome

recruiting Mogamulizumab + Low-Dose Total Skin Electron Beam Tx in Mycosis Fungoides & Sézary Syndrome Phase 2

n=30 · primary completion 2026-12 · LD-TSEBT + mogamulizumab in MF/SS

📚 Sources · 📄 1 paper

📄 PAPER Khaled Elsayad; Emmanuella Guenova; Chalid Assaf et al. · European Journal of Cancer (2024)

Radiotherapy in cutaneous lymphomas: Recommendations from the EORTC cutaneous lymphoma tumour group

doi

Radiation Consensus / guideline