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IPD meta-analysis of randomised phase 3 trials of PORT with or without hormone therapy, MARCAP consortium, PROSPERO CRD42019134376. One-stage framework, univariable Cox stratified by trial, intention-to-treat. Six randomised comparisons, 6057 pts, median follow-up 9·0 years.

Post-radical-prostatectomy pts receiving prostate-bed radiotherapy, adjuvant or salvage. Median pre-PORT PSA 0·3 ng/mL overall (0·5 in the long-term cohort). Positive margins in 57–60%, Gleason 7 in about two-thirds, seminal vesicle invasion 16–17%. Race and ethnicity data were not available.

Short-term arm was 4–6 months, predominantly GnRH agonist. Long-term was 24 months, GnRH agonist in 425 (86%) of 492 RADICALS three-way pts, with RTOG 9601 contributing bicalutamide monotherapy rather than castration.

PORT to the prostate bed with or without pelvic nodes, per each contributing trial. Dose, fractionation and nodal-volume detail are not reported in the source text, so the RT technique is not standardised across the six randomisations.

Primary: overall survival. Secondary MFS, event-free survival, biochemical recurrence (Fine–Gray). Prespecified interaction testing on pre-PORT PSA and hormone therapy duration, plus 10-year restricted mean survival time and NNT.

The primary endpoint was not met. The signal sits entirely in the PSA interaction and in MFS, both shown in the detail tables.

RTOG 9601 remains the only contributing trial to show an OS benefit, and it enrolled late salvage at higher PSA with bicalutamide, exactly the high-PSA stratum where benefit persists here. The contrast with intact-prostate radiotherapy, where the same consortium's 2022 Lancet Oncology analysis found an OS benefit for added ADT, is the point: the postoperative setting does not inherit it.

The short-term and long-term comparisons draw on different trial populations, and the long-term cohort carried higher PSA and worse pathology, so the duration read is not a clean randomised contrast outside the 1523-pt RADICALS exploratory analysis. Spline thresholds of 1·6 and 2·0 ng/mL sit at the sparse tail of a cohort with median PSA 0·3.

MFS improved while OS did not, and the authors show the MFS effect never clears the ICECaP 0·81 threshold, so the divergence is not simply immature follow-up. What the analysis cannot settle is whether hormone therapy is inert at low PSA or whether its cancer-specific benefit is cancelled by other-cause mortality in pts with indolent disease.

IPD meta-analysis of six randomised trials, prespecified PSA interaction, 9-yr follow-up. Contradicts routine hormone therapy with PORT at low PSA. Duration contrast is exploratory.

Individual patient-level meta-analysis pooling 248 patients from 7 international institutions, all retrospective except one prospective trial. Median follow-up 67.1 months (range 2.13-178). PFS was the primary outcome, analyzed by Kaplan-Meier, Cox MVA, and IPTW propensity weighting.

High-risk meningioma per RTOG 0539: newly diagnosed WHO grade 2 after STR/biopsy, any recurrent grade 2, or any grade 3. 188 (75.8%) were grade 2, 103 (41.5%) recurrent, and 182 (75.2%) had Simpson grade 4/STR. Median age 60; 55 (22.2%) had prior RT.

DE-RT was defined by biologically effective dose ≥79.2 Gy (equivalent to 66 Gy in 33 fractions) or receipt of a carbon-ion boost; anything below that threshold counted as SD-RT. Photon DE-RT used a sequential or simultaneous integrated boost with a 0.5 to 2 mm PTV margin, versus 1-2 cm CTV margins in the SD-RT arm. Carbon DE-RT boosted 16 Gy/8 fx after 50 Gy/25 fx photons with a 6 mm CTV margin.

Whole-cohort 3- and 5-yr PFS were 62.8% and 45.0%. DE-RT improved 3-yr (86.4% vs 55.6%) and 5-yr PFS (65.8% vs 38.8%), P = .0022, holding on stratified Cox by grade (HR 0.40, 0.22-0.73) and after IPTW (3-yr 84.7% vs 55.8%). OS was not improved on MVA or IPTW.

Any-grade radionecrosis was 33.9% with DE-RT vs 13.2% with SD-RT (P = .001), but grade ≥3 RN did not differ (5.1% vs 3.2%, P = .47). All 3 grade ≥3 events in the DE-RT arm occurred in the mixed carbon-photon cohort; the photon-alone DE-RT cohort had none, and its any-grade RN rate was not significantly higher than SD-RT (P = .41). One grade 5 event occurred in each arm.

Published series anchored on RTOG 0539 report 5-yr PFS of roughly 40% to 60% with 60 Gy/30 fx, which is what the SD-RT arm reproduces (45.0% overall). The escalation signal draws on MARCIE (carbon boost) and the Zeng et al. photon series, both contributors to this pool, so the comparison is partly internal rather than independent.

DE-RT was delivered at only 2 of 7 institutions, one carbon-only and one photon-only, so treatment arm is nearly collinear with center, and unmeasured practice differences (DOTATATE PET planning, response assessment, supportive care) travel with it. Molecular classification was unavailable, and P values were not adjusted for multiple testing across the subgroup analyses.

The Simpson 1-3 subgroup showed absolute separation as large as Simpson 4-5 (5-yr PFS 70.0% vs 40.0%) without reaching significance (P = .08 on MVA), which the authors attribute to a smaller GTR subset and fewer events rather than an absent effect. Whether escalation belongs in fully resected disease is the open question, and the PFS-only benefit means the case rests on avoiding local progression and its neurologic morbidity, not on survival.

Retrospective IPD pooling, DE-RT confined to 2 centers, no randomization; IPTW cannot remove selection. Direction consistent across every sensitivity analysis, but prospective randomization still needed.

Systematic review of EBRT publications meeting prespecified HCC technical standards (search date December 15, 2022), with corresponding authors invited to contribute individual patient data. Kaplan-Meier OS and RMST stratified by BCLC stage and treatment status; random-effects Cox for covariates. No comparator arm.

4,913 pts treated with EBRT, median follow-up 5.0 years, multinational. Analyses split by BCLC stage and by treatment-naive vs treatment-experienced; the headline read sits in BCLC-0 and BCLC-A.

EBRT delivered per each contributing series, gated by the prespecified technical standards rather than one protocol. Ablative dose was associated with a reduced risk of death; specific dose levels, fractionation, and modality mix are not given in the source abstract.

Overall survival by Kaplan-Meier and restricted mean survival time, stratified by BCLC stage and treatment status. Covariate associations from multivariable random-effects Cox modeling.

Median OS 6.8 y (95% CI 5.7-8.7) for BCLC-0 and 4.6 y (95% CI 4.1-5.1) for BCLC-A. Treatment-naive: not reached (95% CI 8.6-NR) for BCLC-0, 5.4 y (95% CI 4.5-6.7) for BCLC-A.

The authors frame these medians as comparable with resection, thermal ablation, and other ablative locoregional therapies, a cross-study benchmark rather than a randomised comparison. EBRT's exclusion from BCLC has rested on the absence of OS evidence, which is the gap this cohort is built to fill.

IPD came only from authors who published and agreed to share, so contributing centers are self-selected and unmeasured selection at the patient level (who was routed to EBRT rather than resection) is unrecoverable. More recent year of treatment predicting survival mixes technique gains with stage migration and modern systemic salvage over a multi-decade accrual window.

The claim is an allocation claim, not an efficacy claim: EBRT belongs in the BCLC decision tree as an option to be weighed. It does not settle sequencing against ablation in a pt eligible for both, and the ablative-dose signal makes the quality of the RT, not its mere availability, the operative variable.

Largest EBRT IPD cohort argues for a BCLC allocation change, but it is pooled non-randomised data with no head-to-head comparator against resection or ablation.