Radiation
FIRESTORM
ForHigh-risk meningioma (WHO grade 2 or recurrent), post-resection (mostly subtotal
TL;DR5-yr PFS 65.8% vs 38.8%, HR 0.40 favoring dose-escalated RT in high-risk meningioma; retrospective IPD meta-analysis.
8 details 3 trials watching
Methods
- π IPD meta-analysis, 7 institutions, N=248 (59 DE-RT, 189 SD-RT); DE-RT = BED β₯79.2 Gy (β‘66 Gy/33 fr)
- π 75.8% WHO grade 2; 41.5% recurrent; 75.2% subtotal resection
Results
- π 5-yr PFS: DE-RT 65.8% vs SD-RT 38.8%; 3-yr PFS 86.4% vs 55.6% (log-rank P=.0022)
- π MVA: HR 0.40 (95% CI 0.24-0.69), P=.001; IPTW-adjusted HR 0.45 (95% CI 0.24-0.83), P=.01
Critique
- β οΈ Radionecrosis higher with DE-RT
- Any grade RN: 33.9% DE-RT vs 13.2% SD-RT, P=.001
- Grade 3+ RN: 5.1% vs 3.2% (not significant)
- β οΈ Retrospective non-randomized design; selection bias in who received dose escalation not fully eliminated by IPTW
- β οΈ DE-RT arm small (N=59); 3:1 imbalance limits subgroup stability
- β οΈ No OS endpoint reported in source
Open questions
- Does OS benefit accompany the PFS gain with dose-escalated RT?
- Does a prospective RCT confirm superiority of dose-escalated RT? n=90 Β· primary completion 2028-12 Β· prospective proton dose escalation, 5y RFS endpointrecruiting Somatostatin Receptor PET Imaging to Guide Radiotherapy Dose Escalation in High Risk Meningiomas. Phase NAn=53 Β· primary completion 2037-12 Β· prospective dose escalation guided by SSTR-PET in high-risk
- Which pts carry highest radionecrosis risk from dose escalation? recruiting Somatostatin Receptor PET Imaging to Guide Radiotherapy Dose Escalation in High Risk Meningiomas. Phase NAn=53 Β· primary completion 2037-12 Β· SSTR-PET-guided contouring to limit OAR dose escalation risk
π Sources Β· π 1 paper
Improved Progression-Free Survival Following Dose-Escalated Versus Standard-Dose Postoperative Radiation Therapy for High-Risk Meningiomas: An International Multicenter Individual PatientβLevel Meta-Analysis (FIRESTORM)
Abstract
Purpose: We performed an individual patientβlevel meta-analysis of high-risk meningiomas to compare the outcomes of dose-escalated radiation therapy (DE-RT) versus standard-dose postoperative radiation therapy (SD-RT).<br/>Methods and Materials: A total of 7 institutions participated. DE-RT was defined as treatment with a biologically effective dose of β₯79.2 Gy (equivalent of 66 Gy in 33 fractions). We compared progression-free survival (PFS) with DE-RT versus SD-RT via Kaplan-Meier analysis and log-rank t tests, a Cox proportional hazards multivariable model, and propensity score analyses with inverse probability of treatment weighting (IPTW). We also compared incidences of central nervous system radionecrosis (RN) with DE-RT versus SD-RT.<br/>Results: The analysis included 248 patients with high-risk meningioma (59 received DE-RT and 189 received SD-RT). One hundred and eighty-eight cases (75.8%) were World Health Organization grade 2, and 103 cases (41.5%) were recurrent meningiomas. Extent of resection was subtotal resection in 182 of 248 (75.2%). Three- and 5-year PFS rates were 62.8% (95% CI, 55.8%-69.0%) and 45.0% (95% CI, 37.3%-52.3%), respectively. DE-RT was associated with superior PFS rates (P = .0022), with 3-year (86.4% vs 55.6%) and 5-year (65.8% vs 38.8%) PFS rates favoring DE-RT. On multivariable analysis, DE-RT was associated with superior PFS (hazard ratio, 0.40; 95% CI, 0.24-0.69; P = .001). On IPTW, DE-RT continued to be associated with superior PFS (hazard ratio, 0.45; 95% CI, 0.24-0.83; P = .01). A greater incidence of any grade RN was observed following DE-RT (20 of 59; 33.9%) versus SD-RT (25 of 189; 13.2%) (P = .001) but with similar grade 3 or greater RN events (DE-RT 5.1% vs SD-RT 3.2%).<br/>Conclusions: DE-RT resulted in superior PFS for patients with high-risk meningiomas over SD-RT without an increase in severe toxicities.
NRG Oncology RTOG 0539 NCT00895622
ForWHO grade 1-3 meningioma, post-resection (GTR or STR), newly-diagnosed or recurr
TL;DR10-yr PFS 85.2%, 72.2%, 42.5% for low/intermediate/high-risk meningioma with risk-adapted observation or RT (median f/u ~12yr).
vs leading data
- Long-term benchmarks for future trials; ROAM/EORTC-1308 is ongoing randomised RT vs obs for grade 2
7 details 3 trials watching
Methods
- π Prospective phase 2, N=165 eligible (244 consented); risk-stratified by WHO grade, resection extent, recurrence status
- π Low: grade 1 GTR/STR β obs; intermediate: recurrent grade 1 or new grade 2 post-GTR β 54 Gy; high: new grade 2 post-STR, grade 3, or recurrent grade 2/3 β 60 Gy
- π Median PFS not reached in low- and intermediate-risk cohorts
Results
- π 10-yr outcomes by risk group
Risk Group Rx n 10-yr PFS 10-yr OS 10-yr prog. incidence Low Observation 60 85.2% 94.1% 8.9% (3.2β18.2%) Intermediate 54 Gy/30fx 52 72.2% 84.7% 21.2% (10.8β33.9%) High 60 Gy/30fx 53 42.5% 51.1% 39.3% (25.8β52.5%)
Critique
- β οΈ G3+ RT-attributed toxicity
- Intermediate-risk: 9.6% (5/52 pts)
- High-risk: 15.1% (8/53 pts)
- β οΈ Non-randomized: risk allocation deterministic, not randomised; no RT vs obs head-to-head for intermediate group
- β οΈ WHO 2021 molecular criteria not applied; risk stratification reflects histologic grading (WHO 2007/2016)
Open questions
- RT vs observation for intermediate-risk meningioma: no randomised data recruiting Observation or Radiation Therapy in Treating Patients With Newly Diagnosed Grade II Meningioma That Has Been Completely Removed by Surgery Phase 3n=163 Β· primary completion 2027-06 Β· phase 3 RCT: adjuvant RT vs obs, resected grade II
- Optimal RT dose for WHO grade 3 meningioma beyond 60 Gy n=90 Β· primary completion 2028-12 Β· proton escalation 60/68/72 Gy(RBE), grade II/IIIrecruiting Somatostatin Receptor PET Imaging to Guide Radiotherapy Dose Escalation in High Risk Meningiomas. Phase NAn=53 Β· primary completion 2037-12 Β· SSTR-PET guided dose escalation, grade III/recurrent II
- Role of WHO 2021 molecular grading in meningioma risk stratification
π Sources Β· π 1 paper
Long-Term Analysis of NRG Oncology RTOG 0539: A Phase II Trial of Observation for Low-Risk Meningioma and Radiotherapy for Intermediate- and High-Risk Meningioma
Abstract
NRG Oncology RTOG 0539 was a prospective phase II trial of risk-adapted radiotherapy for patients with WHO grade 1-3 meningioma. Low-risk (group 1, n = 60) was defined as a grade 1 tumor after gross total resection or subtotal resection (GTR/STR) and prospectively monitored. Intermediate-risk (group 2, n = 52) was defined as recurrent grade 1 or newly diagnosed grade 2 tumor after GTR and treated with radiotherapy (54 Gy). High-risk (group 3, n = 53) included a newly diagnosed grade 2 tumor after STR, newly diagnosed grade 3 tumor, or recurrent grade 2 or 3 tumor and treated with radiotherapy (60 Gy). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The median follow-up times for the low-, intermediate-, and high-risk cohorts were 12.1, 12.0, and 11.1 years, respectively. The 10-year PFS and OS rates for the low-, intermediate-, and high-risk cohorts were 85.2% and 94.1%, 72.2% and 84.7%, and 42.5% and 51.1%, respectively. Five patients (9.6%) and eight patients (15.1%) had a grade 3+ toxicity attributed to radiotherapy in the intermediate- and high-risk cohorts, respectively. The long-term outcomes using this risk-adapted approach support observation for low-risk patients, inform radiotherapy patient selection and practice standards for intermediate- and high-risk patients, and provide comparative benchmarks for future trials.
RAPCHEM (BOOG 2010-03)
ForBreast cancer cT<5cm cN1-3, receiving NAC prior to BCS or mastectomy
TL;DR10-yr locoregional recurrence 2.9% overall with risk-stratified RT de-escalation after NAC + surgery in cN1 breast cancer.
vs leading data
- NSABP RCT (NCT01872975) directly tests RT omission post-NAC in ypN0; results expected ~3 years from EBCC15 presentation
7 details 3 trials watching
Methods
- π Prospective single-arm, N=848, 17 centers (Netherlands), enrolled 2011-2015
- π Eligibility: cT<5cm, cN1-3 at diagnosis; risk tier assigned by ypN status post-NAC + surgery
- π RT allocation by risk tier
- ypN0 (low): BCS β breast RT; mastectomy β RT omitted
- ypN1-3 (intermediate): breast/chest wall RT; regional nodal RT withheld
- ypN4+ (high): breast/chest wall + regional nodal RT
Results
- π 10-yr locoregional recurrence by risk tier
- Low (ypN0): 7/291 (2.4%)
- Intermediate (ypN1-3): 12/370 (3.2%)
- High (ypN4+): 5/177 (2.8%)
- π Overall: 24/838 (2.9%) locoregional events at 10 yr
Critique
- β οΈ No randomized comparator arm; low LRR rates may reflect patient selection or favorable NAC biology, not de-escalation effect per se
- β οΈ Most pts had ALND β less common in current practice; generalizability to sentinel node biopsy era uncertain
Open questions
- OS impact of RT omission in ypN0 after mastectomy vs. locoregional control alone?
- Applicability to sentinel node biopsy era without ALND? n=2012 Β· primary completion 2026-01 Β· ph3 RCT: ALND vs nodal RT post-NAC in cT1-3N1recruiting ALND vs ART in Positive Sentinel Node After Neoadjuvant Therapy in Breast Cancer Phase NAn=820 Β· primary completion 2026-06 Β· ALND vs axillary RT in ypSLN+ post-NAT cN1 ptsrecruiting Axillary Management in Breast Cancer Patients With Needle Biopsy Proven Nodal Metastases After Neoadjuvant Chemotherapy Phase NAn=1900 Β· primary completion 2030-02 Β· ALND+ART omission in cN1βypN0 on SLNB, DFS endpoint
- Does risk-stratified RT de-escalation hold in randomized comparison?
π Sources Β· π 1 paper
Breast Cancer Recurrence Remains LowβEven After 10 YearsβWith Radiotherapy Tailored to Patientβs Individual Risk
Abstract
βThe results of our study show that tailoring the extent of radiotherapy according to how well the chemotherapy has worked to treat cancer in the lymph nodes leads to very low and reassuring recurrenc...
π Breast Cancer Recurrence Remains Low Even After 10 Years With Radiotherapy Tailored to Patientβs Individual Risk - The ASCO Post
AREST
ForpT1-2 pN0 OSCC, intermediate-risk (DOI/PNI/LVE/poor diff), post-curative surgery
TL;DR3-yr LRFS 89.2% vs 80.9%, HR 0.52 (p=0.02) favoring adj RT in pT1-2 pN0 OSCC with intermediate-risk features; DFS/OS NS.
8 details
Methods
- π Phase III open-label RCT, N=392; 1:1 stratified by subsite, PNI/LVE, differentiation
- π Eligibility: pT1-2 pN0 OSCC, β₯1 intermediate-risk factor (DOI 5-10mm, PNI, LVE, poor diff); margins β₯5mm, β₯16 nodes dissected
- π Adj RT: 60Gy/30fr to tumor-bed + at-risk neck nodes; median f/u 47.2mo (IQR 30-59)
CONSORT flow
Randomized 392
β
Adjuvant RT
allocated 191
Observation
allocated 201
Results
- π 1Β° EP LRFS ITT: 3-yr 89.2% RT vs 80.9% obs, HR 0.52 (95%CI 0.30-0.91), p=0.02
- π Competing-risk cumulative LR failure: 10.6% RT vs 18.9% obs, HR 0.52, p=0.021
- π PP analysis: HR 0.43 (0.23-0.80), p=0.01
- π Subgroup: oral tongue derives greater LRFS benefit than buccal mucosa
Critique
- β οΈ DFS and OS not significantly different; LRC benefit does not translate to survival gain at 47mo
Open questions
- Does LRC benefit translate to OS with longer follow-up?
- Should adj RT selection favor oral tongue over buccal mucosa?
- Does benefit differ by number of risk factors (1 vs β₯2)?
π Sources Β· π 1 paper
Adjuvant radiotherapy versus observation following curative surgery for early-stage oral squamous cell carcinoma (AREST; CTRI/2017/07/009114).
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) β₯5 to β€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 β₯5mm and at least ipsilateral level I-III neck dissection with β₯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 Ξ± 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.
π https://ascopubs.org/doi/10.1200/JCO.2026.44.16_suppl.6000
ES-SCLC Concurrent TRT + Chemoimmunotherapy (LBA8005)
ForES-SCLC, treatment-naΓ―ve, ECOG 0-1, measurable thoracic lesion
TL;DRmOS 10.0 vs 11.8mo, HR 1.14, p=0.40: concurrent TRT adds no OS benefit to chemoIO in ES-SCLC.
vs leading data
- vs CREST (Lancet 2015): TRT 30 Gy/10 fr post-induction improved 1yr OS in pre-IO ES-SCLC; not replicated here in IO era
| Arm | Median OS | 95% CI | HR (95% CI) | p |
|---|---|---|---|---|
| ChemoIO + TRT | 10.0 mo | 8.3-11.7 | 1.14 (0.84-1.56) | 0.40 |
| ChemoIO | 11.8 mo | 10.0-13.6 | ref | n/a |
+3 more figures
| Arm | Median PFS | 95% CI | HR (95% CI) | p |
|---|---|---|---|---|
| ChemoIO + TRT | 5.1 mo | 4.7-5.4 | 1.10 (0.84-1.45) | 0.49 |
| ChemoIO | 5.0 mo | 4.6-5.4 | ref | n/a |
| Subgroup | ChemoIO+TRT median OS | ChemoIO median OS | HR (95% CI) | p |
|---|---|---|---|---|
| Completed all 4 cycles | 11.9 mo | 12.1 mo | 1.02 (0.72-1.44) | 0.92 |
| No brain/liver mets | 11.9 mo | 13.2 mo | 1.10 (0.65-1.87) | 0.72 |
6 details
Methods
- π Phase III RCT, N=228 (115 vs 113); TRT 30 Gy/10 fr concurrent from day 21-28 of cycle 1
- π Eligibility: stage IV SCLC or stage III ineligible for curative CRT, ECOG 0-1, measurable thoracic lesion required
- π PCI 25-30 Gy optional for responders per local routine; durvalumab 1500 mg Q4W maintenance until PD
CONSORT flow
Randomized 228
β
ChemoIO + TRT
allocated 115
ChemoIO
allocated 113
Critique
- β οΈ Control arm mOS (11.8mo) consistent with CASPIAN durvalumab arm (~12.9mo); TRT arm numerically inferior at 10.0mo
- β οΈ Pre-specified OS subgroups (completed all 4 cycles, no brain/liver mets) both null, consistent with ITT
- β οΈ PCI optional per local routine; differential PCI use between arms unreported, potential survival confound
Open questions
- Whether consolidative rather than concurrent TRT sequencing improves outcomes
- Role of PCI in IO-era ES-SCLC given uncontrolled differential use in this trial
- Optimal ES-SCLC subpopulation (if any) for TRT in the IO era
π Sources Β· π¦ 1 tweet
π¨ #ASCO26 | #οΈβ£LBA8005β°β’οΈ Concurrent thoracic radiotherapy + chemoimmunotherapy in ES-SCLC
— Masahiro TORASAWA, MD. PhD. (@M_Torasawa) June 2, 2026
π₯ ES-SCLCβ°Durvalumab + platinum/etoposideβ°Β± concurrent thoracic radiotherapyβ°TRT: 30 Gy / 10 fractions, starting day 21β28
π Randomized phase IIIβ°ChemoIO + TRT: n=115β°ChemoIOβ¦ pic.twitter.com/TDA5amz59e
COMPPARE
ForDe novo localized prostate cancer, excluding very high risk and metastatic
TL;DRNo sig difference (bowel urgency 5.7% vs 6%, p=0.28; 3-yr BCF 98.0% vs 97.9%) between proton and IMRT in de novo localized prostate.
vs leading data
- vs PARTIQoL RCT: also null for bowel toxicity at 2yr in randomized proton vs IMRT; COMPPARE extends to larger N but non-randomized
| Outcome | IMRT (actual) | PT (actual) | p |
|---|---|---|---|
| Bowel urgency (EPIC) | 6% | 5.7% | 0.28 |
| Bowel frequency (EPIC) | 4% | 3.5% | 0.43 |
| β₯G2 GI toxicity (CTCAEv5) | 5.6% | 5.2% | 0.60 |
| 3-yr freedom from progression | 97.9% | 98.0% | 0.90 |
+2 more figures
| Group | 2-yr β₯G2 GI toxicity (95% CI) |
|---|---|
| IMRT, no spacer | 7.2% (5.0-9.9%) |
| Proton, no spacer | 8.7% (5.0-14%) |
| IMRT, spacer | 4.4% (2.8-6.4%) |
| Proton, spacer | 4.7% (3.6-6.0%) |
6 details
Methods
- π Prospective non-randomized comparative effectiveness study, N=2524, 51 PT + IMRT centers, Jul 2018-Oct 2022
- π De novo localized prostate cancer; very high risk and metastatic excluded; proton cohort 1500, photon 1000
Results
- π All 4 primary endpoints non-significant (p range 0.28-0.90); both modalities performed substantially better than hypothesized event rates
- π Rectal spacers significantly reduced 2-yr β₯G2 GI toxicity regardless of modality (p=0.009, Gray's Test); spacer benefit exceeded modality effect
Critique
- β οΈ Severely underpowered: hypothesized bowel urgency 15% (IMRT) vs actual 6%; study cannot establish equivalence at these event rates
- β οΈ Non-randomized design; selection into proton vs IMRT may confound any toxicity signal
Open questions
- Whether underpowering masks a real late toxicity advantage for proton therapy
- Role of rectal spacers in abrogating any modality-specific GI difference
- Long-term BCR and MFS as follow-up matures
π Sources Β· π¦ 1 tweet
#COMPPARE early results: in localized #ProstateCancer, #proton therapy vs #IMRT showed no sig difference in pt-reported bowel urgency/frequency,Β β₯G2 GI toxicity, or 3-year biochemical control. Longer follow-up needed for late toxicity/long term outcomes #ASCO2026 pic.twitter.com/yli4l8nEOY
— QianJanieQin (@QianJanieQin) May 31, 2026
NRG Clinico-Transcriptomic Risk Stratification (Abstract 5000)
ForNCCN β₯ high-risk localized prostate cancer, RT+ADT candidates
TL;DR22-gene GC independently predicts MFS, DM, and OS; combined NRG score reclassifies ~25% discordant NCCN high-risk pts for AAP intensification.
vs leading data
- STAMPEDE MO calibration anchor (Attard, Lancet 2022): HRMFS 0.53 (95% CI 0.44-0.64), HROS 0.60 (0.48-0.73), both p < 0.0001 for AAP intensification
+1 more figure
| GC High | GC Low | |
|---|---|---|
| Clinical High | 49% | 15% |
| Clinical Low | 9% | 27% |
5 details
Methods
- π Combined clinico-transcriptomic (CT) score: NCCN points + GC points
- NCCN HR = 1 pt; NCCN VHR = 2 pts
- GC <HR = 0 pt; GC HR = 1 pt; GC VHR = 2 pts
- CT HR (β€2 pts) β RT+ADT; CT VHR (β₯3 pts) β RT+ADT+AAP
Results
- π 22-gene GC independently predicts MFS, DM, and OS beyond clinical variables alone (p < 0.001 for each endpoint)
- π ~25% of NCCN β₯HR pts have discordant clinical vs. GC risk, warranting the combined approach
Critique
- β οΈ Framework developed on existing NRG trial data; no prospective RCT validating CT-score-guided treatment allocation reported
- β οΈ Design not fully specified in source; likely secondary correlative analysis; GC cutoffs extend Spratt et al. (JCO 2018) prior work
Open questions
- Prospective RCT: does CT-score-guided allocation improve outcomes vs. clinical risk alone?
- Generalizability to modern ARSI-backbone ADT regimens
- GC threshold stability across contemporary cohorts
π Sources Β· π¦ 2 tweets
#ASCO26 GU Oncology Spotlight π¨
— Dra. MarΓa Natalia Gandur Quiroga (@nataliagandur) May 30, 2026
π¬ Abstract 5000 | High-risk prostate cancer
Clinico-transcriptomic risk stratification to guide abiraterone intensification
Presented by Krishnan R. Patel, MD, MHS@Krishnan_Patel@OncoAlert@ASCO
In high-risk localized prostate cancer,β¦ pic.twitter.com/pZSCiTyGB8
#ASCO26 Dr. Patel presented a clinically practical framework integrating NCCN clinical risk + a 22-gene genomic classifier to guide treatment intensification in high-risk localized prostate cancer.
— Julian Chavarriaga (@chavarriagaj) May 30, 2026
Key findings:
πΉ The genomic classifier independently improved prognosticβ¦ pic.twitter.com/fRcdTmfBec
ROADS
ForResected brain mets >2cm
TL;DRSurg bed recurrence 1% (GT) vs 12% (SRS); 2yr OS 62% vs 36% favoring GammaTile in resected brain mets >2cm.
vs leading data
- vs Alliance N107C: established SRS as post-resection standard; ROADS directly randomizes vs GammaTile for the first time
| Endpoint | GammaTile | SRS |
|---|---|---|
| Time to surg bed recurrence | NR | 17 mo |
| Surg bed recurrence-FS | NR | 11 mo |
| 2-yr OS | 62% | 36% |
6 details
Methods
- π Randomized, N=230, resected brain mets >2cm; GammaTile brachytherapy vs post-op SRS
Results
- π Surg bed recurrence 1% GammaTile vs 12% SRS β primary EP
- π Radiation necrosis similar: 8% GammaTile vs 7% SRS
Critique
- β οΈ LMD 10% GammaTile vs 3% SRS β leptomeningeal spread higher with brachytherapy
- β οΈ OS 62% vs 36% is a secondary endpoint; trial powered for cavity control, not OS confirmation
- β οΈ Trial phase not stated in source; primary EPs both NR suggests follow-up still maturing for OS
Open questions
- Does LMD increase with GammaTile translate to OS detriment at longer follow-up?
- Benefit extend to resected mets <2cm?
- Optimal GammaTile activity prescription for cavity control
π Sources Β· π¦ 1 tweet
π¨π¨ ASCO 2026 Final Results Randomized trial resected brain met Brachytherapy vs Post-Op SRSπ¨
— PDBrown (@PDBrownOnc) May 30, 2026
- Incredible Surg Bed Control with Brachy (ββOS as well)
- Surg bed recurrence 12% SRS vs 1% GammaTile pic.twitter.com/PCTsCluyUd
SPIN Score (Celiac Plexus SRS) NCT03323489
ForPancreatic cancer, intractable retroperitoneal pain, planned celiac plexus SRS
TL;DR89% pain response in SPIN-2 pts (baseline pain >6 + no prior neurotoxic chemo) vs 32% SPIN-0 after celiac SRS.
| SPIN score | Response rate | n |
|---|---|---|
| 0 | 32% | 31 |
| 1 | 53% | 40 |
| 2 | 89% | 19 |
8 details
Methods
- π Post-hoc analysis of 90 evaluable pts from pivotal ph2 (NCT03323489; Lancet Oncol 2024:25:1070-79)
Results
- π Pain response by SPIN score
- π Pivotal ph2 overall response: 53% (95% CI 42-64%)
- π Multivariate predictors: no prior neurotoxic chemo (OR 5.1, p=0.009); baseline pain >6 (OR 1.8, p=0.003)
- π Optimism-corrected AUC 0.714 (bootstrap 500 iterations)
- π Pain threshold dose-response: >6 optimal (65.8%); >7 (83.3%); >8 (85.7%)
Critique
- β οΈ Post-hoc design; internal validation only; external validation required before clinical use
- β οΈ SPIN-2 subgroup N=19; response estimate imprecise
Open questions
- External validation before clinical implementation
- Applicability to non-pancreatic retroperitoneal malignancies
- How early before neurotoxic chemo should SRS be offered?
π Sources Β· π¦ 1 tweet
Celiac SRS = convenient, effective tx for intractable pain, but who benefits most?
— Dr. Nina Niu Sanford (@NiuSanford) May 30, 2026
Post-hoc Ph2 analysis identified 2 response predictors (SPIN score): severe baseline pain & no prior neurotoxic chemo.
Supports earlier use before potential chemo neuropathy. #ASCO26 @OncoAlert pic.twitter.com/3qFYU6N1iD
Wait or Treat β NCT05236946 (Upfront vs Delayed Brain RT in Oncogene-mutated NSCLC) NCT05236946
ForMetastatic NSCLC, EGFR or ALK mutant, completely asymptomatic BM, ECOG 0-2
TL;DRUpfront brain RT halves icPD (HR 0.35, p<0.001) but OS numerically favors delayed (HR 1.45, 2yr 60% vs 48%) in EGFR/ALK+ mNSCLC.
vs leading data
- First RCT on this question; supports emerging TKI-first approach (osimertinib/alectinib CNS penetration)
| Upfront RT (n=105) | Delayed RT (n=103) | |
|---|---|---|
| Events | 20 | 47 |
| 1-yr cumulative icPD | 8.7% (2.9%, 14.5%) | 25.7% (16.8%, 34.7%) |
| 2-yr cumulative icPD | 21.7% (12.6%, 30.8%) | 50% (39.2%, 60.9%) |
| Sub-HR (95% CI) | 0.35 (0.21, 0.59) | ref |
| p-value | <0.001 | β |
+1 more figure
7 details
Methods
- π Phase III open-label RCT, N=208; EGFR/ALK+ mNSCLC, completely asymptomatic BM, ECOG 0-2
- π Both arms: TKIs + chemotherapy; delayed arm: RT at intracranial PD or patient request
- π Stratification: GPA score (0-2 vs >2); synchronous vs metachronous BM
CONSORT flow
Randomized 208
β
Upfront Cranial RT
allocated 105
Delayed Cranial RT
allocated 103
Results
- π OS HR 1.45 favoring delayed; 2yr OS 48% upfront vs 60% delayed (secondary endpoint)
Critique
- β οΈ Radiation necrosis: 6% upfront vs 0% delayed
- β οΈ OS HR p-value not reported in source; trial takeaway: 'timing of RT does not affect survival'
- β οΈ TKI + chemo backbone may not reflect current osimertinib or alectinib monotherapy practice
Open questions
- Does icPD reduction with upfront RT translate to QoL or neurocognitive benefit?
- SRS vs WBRT in upfront arm: impact on radiation necrosis rate?
- Which pts (high GPA, many lesions) benefit most from upfront cranial RT?
π Sources Β· π¦ 3 tweets
#ASCO26 | Wait or Treat? Brain RT in EGFR/ALK+ NSCLC
— OncLive.com (@OncLive) May 29, 2026
Presented by Dr Anil Ramakant Tibdewal.
A landmark Phase III randomized trial from @TataMemorial addressed a long-standing question: should asymptomatic brain metastases in oncogene-driven NSCLC receive upfront cranial RT or⦠pic.twitter.com/lRy9CfyQ8r
Should asymptomatic brain mets await systemic response in front line within EGFR/ALK context? I think yes. Despite reducing icPD, delayed brain RT OS looked better and radiation necrosis didnβt occur vs 6% #ASCO26 pic.twitter.com/O6d7GrvtU4
— Dr Riyaz Shah (@DrRiyazShah) May 29, 2026
No improvement in survival with up front radiation. OS favored delayed radiation with 2y OS 48% with early radiation vs 60% in late (OS HR 1.45). Also, radiation necrosis less common and less severe in delayed arm. Each case unique but delayed approach appealing #ASCO26 pic.twitter.com/wIhjqxhSaq
— Stephen V Liu, MD (@StephenVLiu) May 29, 2026
EORTC Cutaneous Lymphoma RT Recommendations
TL;DREORTC expert consensus formalizes low-dose RT recommendations across all primary cutaneous lymphoma entities; no RCT dose-comparison data exist.
vs leading data
- Low-dose rationale: characteristic radiosensitivity of cutaneous lymphoma lesions enables high efficacy with low toxicity and repeatable treatment
5 details
Methods
- π Expert opinion + systematic literature review; no randomized dose-comparison trials completed for any cutaneous lymphoma entity
- π Low-dose RT endorsed for T-cell (MF, SΓ©zary) and B-cell entities (PCMZL, PCFCL, PCDLBCL-leg type)
- π TSEBT for advanced-stage MF addressed; limited prospective registry data recently published
Critique
- β οΈ Underlying evidence base largely retrospective case series; controlled trials defining standard dose per entity not yet completed
- β οΈ Recommendations aim to reduce individualized decision-making variation until prospective trial data mature
Open questions
- RCT defining optimal radiation dose per cutaneous lymphoma entity
- Factors influencing pt outcomes across dose levels
π Sources Β· π 1 paper
Radiotherapy in cutaneous lymphomas: Recommendations from the EORTC cutaneous lymphoma tumour group
Abstract
The number of primary cutaneous lymphoma patients receiving low-dose radiotherapy is increasing, though controlled clinical trials defining the standard radiation dose for each specific entity have not yet been completed. Radiation oncologists are left with making highly individualized decisions that would be better enriched by additional clinical evidence. In this expert opinion, we aim to provide a clear recommendation to improve the current practice of radiation oncology. In addition, existing literature has been reviewed to develop recommendations for all types of primary cutaneous lymphoma. A prospective trial is urgently needed to identify the factors influencing patient outcomes following different radiation doses.
PEACE VβSTORM NCT03569241
ForPelvic nodal oligorecurrence (β€5 PET+ nodes), prostate, post-radical tx, PS 0-1
TL;DR4-yr MFS 76% (ENRT) vs 63% (MDT), HR 0.62 favoring elective nodal RT for PET+ pelvic nodal prostate oligorecurrence.
vs leading data
- First RCT comparing MDT vs ENRT for PET-detected pelvic nodal prostate recurrence
9 details
Methods
- π Phase 2 open-label RCT, N=196 randomized 1:1, 21 hospitals across 6 countries
- π MDT arm: SLND or SBRT 30 Gy/3 fx every other day + 6 mo ADT
- π ENRT arm: 45 Gy/25 fx to pelvis + SIB 65 Gy to PET+ nodes (or SLND) + 6 mo ADT
- π Eligibility: PET+ pelvic nodal oligorecurrence β€5 nodes post-radical local treatment, PS 0-1
CONSORT flow
Assessed / enrolled 198
β 2 excluded
Randomized 196
β
MDT
allocated 99
analyzed 97
ENRT
allocated 97
analyzed 93
Results
- π 1Β° EP: 4-yr metastasis-free survival
Arm 4-yr MFS 80% CI ENRT 76% 69-81% MDT 63% 56-69% - π HR 0.62 (80% CI 0.44-0.86), p=0.063; median f/u 50 mo (IQR 42-58)
- π G3 AEs
- Urinary incontinence: 6% MDT vs 10% ENRT
- Diarrhea: 1% MDT vs 2% ENRT
- No treatment-related deaths
Critique
- β οΈ 80% CI threshold (not 95%); p=0.063 at conventional alpha; prespecified phase 2 go/no-go design
- β οΈ Open-label; heterogeneous MDT arm (SLND vs SBRT); PSMA + choline PET tracers mixed
Open questions
- Phase 3 confirmation needed before ENRT replaces MDT as SOC
- ENRT benefit differential by PET tracer type (PSMA vs choline)
- Optimal ADT duration in combination with ENRT
π Sources Β· π 1 paper
Salvage metastasis-directed therapy versus elective nodal radiotherapy for oligorecurrent nodal prostate cancer metastases (PEACE VβSTORM): a phase 2, open-label, randomised controlled trial
Abstract
Background Various locoregional treatments exist for PETβCT-detected pelvic nodal oligorecurrences in patients with prostate cancer. We aimed to assess whether elective nodal radiotherapy (ENRT) to the pelvis would be superior to metastasis-directed therapy (MDT).<br/>Methods PEACE VβSTORM is a phase 2, open-label, randomised, controlled trial conducted in 21 hospitals in Australia, Belgium, Italy, Norway, Spain, and Switzerland. Eligible participants were aged 18 years or older, with WHO performance status 0β1 and a histologically confirmed initial diagnosis of adenocarcinoma of the prostate, with a PET-detected pelvic nodal oligorecurrence (up to five nodes) following radical local treatment. Patients were randomly assigned (1:1) to MDT or ENRT. Randomisation was done online by minimisation with randomisation factor 0Β·80 and was stratified by type of PET tracer (choline vs prostate-specific membrane antigen) and type of MDT used (salvage lymph node dissection vs stereotactic body radiotherapy or simultaneous integrated boost). Participants and researchers were not masked to treatment assignment. Patients in the MDT group had salvage lymph node dissection or stereotactic body radiotherapy (30 Gy in three fractions every other day), with 6 months of androgen deprivation therapy. Patients in the ENRT group received a 45 Gy dose in 25 fractions to the pelvis with a simultaneous integrated boost of 65 Gy to the PET-positive nodes or salvage lymph node dissection, with 6 months of androgen deprivation therapy. The primary endpoint was metastasis-free survival, defined as the time between randomisation and the appearance of a metastatic recurrence (any M1) on PET imaging or death due to any cause, and was analysed per modified intention to treat. This study is registered with ClinicalTrials.gov, NCT03569241, and the Swiss National Clinical Trials Portal, SNCTP000002947, and is active, not recruiting.<br/>Findings Between June 11, 2018, and April 30, 2021, 198 patients were screened for eligibility, 196 of whom were randomly assigned to MDT (n=99) or ENRT (n=97), with 190 evaluable patients (MDT n=97 and ENRT n=93). All patients were male. Data on race and ethnicity were not collected. Median follow-up was 50 months (IQR 42β58). 4-year metastasis-free survival was 63% (80% CI 56β69) in the MDT group and 76% (69β81) in the ENRT group (HR 0Β·62 [80% CI 0Β·44β0Β·86]; p=0Β·063). The most common grade 3 adverse events were urinary incontinence (six [6%] of 97 in the MDT group vs nine [10%] in the ENRT group) and diarrhoea (one [1%] in the MDT group vs two [2%] in the ENRT group). No treatment-related deaths occurred.<br/>Interpretation To our knowledge, this is the first randomised trial for metachronous PET-detected nodal recurrences comparing two local treatment approaches (MDT and ENRT) in combination with 6 months of androgen deprivation therapy. By showing an improved metastasis-free survival with ENRT, this trial establishes ENRT as a potential standard treatment approach, awaiting a phase 3 trial confirming these results.<br/>Funding Movember Foundation, Kom Op Tegen Kanker, Stichting tegen Kanker.
DBCG IMN2 NCT06549920
ForNode-positive breast cancer, adjuvant RT, taxane/trastuzumab/AI systemic therapy
TL;DR15-yr OS 65.0% vs 60.8%, HR 0.85 (0.76-0.94), p=0.0016 favoring IMNI in node-positive breast cancer with modern systemic therapy, N=4541.
vs leading data
- vs DBCG IMN1 (N=3089, 2003-07): OS gain 4.7% at 14.8-yr f/u; confirms benefit persists in modern era
- vs KROG 06-08 (negative Korean study, 3D-RT + newer agents): IMN2 contradicts null result
8 details
Methods
- π Prospective nationwide cohort, N=4541, Jan 2007-May 2014; median f/u 13.7 yr
- π Allocation: right-sided β IMNI, left-sided β no IMNI; 6 RT centres, 3D-based RT
- π Systemic: taxane-based chemo, AIs, trastuzumab
Results
- π Primary EP OS: 15-yr 65.0% (IMNI) vs 60.8% (no IMNI)
- π All endpoints favor IMNI (adjusted HRs)
Endpoint HR (95% CI) p OS 0.85 (0.76-0.94) 0.0016 Breast cancer mortality 0.84 (0.74-0.95) 0.0077 Distant metastasis 0.87 (0.78-0.98) 0.026
Critique
- β οΈ Cohort design, not RCT; laterality-based allocation; baseline characteristics balanced but not randomized
- β οΈ No subgroup identified favoring IMNI omission, including 1-3 positive axillary nodes
Notes
- Cardiac: 15-yr ischemic/valvular HD death
- 0.2% (95% CI 0.0-0.5) right-sided / IMNI
- 0.7% (95% CI 0.4-1.2) left-sided / no IMNI
- Gap likely reflects left breast cardiac dose, not IMNI-specific toxicity
Open questions
- Benefit with post-2014 systemic agents (CDK4/6i, T-DM1) not established
- Optimal IMNI technique to minimize cardiac exposure in left-sided pts
- Whether cohort evidence sufficient to shift 1-3 node guidelines broadly
π Sources Β· π 1 paper
Internal mammary node irradiation in 4541 node-positive breast cancer patients treated with newer systemic therapies and 3D-based radiotherapy (DBCG IMN2): a prospective, nationwide, population-based cohort study
Abstract
Background Internal mammary node irradiation (IMNI) improves overall survival (OS) in node-positive breast cancer patients. However, the effect is not documented in breast cancer patients treated with newer systemic therapies and 3D-based radiotherapy (RT). Therefore, the Danish Breast Cancer Group (DBCG) IMN2 study aimed to investigate the effect of IMNI in node-positive breast cancer patients treated with newer systemic therapies and 3D-based RT.<br/>Methods DBCG IMN2 was a nationwide population-based cohort study prospectively allocating node-positive breast cancer patients with right-sided tumours to IMNI and patients with left-sided tumours to no IMNI in six RT centres. Exclusion criteria were prior malignancies, bilateral breast cancer, neoadjuvant systemic therapy, recurrence before RT, or non-standard RT. Systemic treatment included taxane-based chemotherapy, aromatase inhibitors, and trastuzumab. The primary end-point was OS. Secondary endpoints were breast cancer mortality and distant metastasis. Cox regression analyses were used for adjusted hazard ratios (HR). Clinicaltrial.gov ID: NCT06549920.<br/>Findings In the period January 2007βMay 2014, a total of 4541 patients were included. Patient characteristics were distributed evenly between right- and left-sided patients. Median follow-up was 13.7 years for OS. Survival rates at 15 years were 65.0% in patients with IMNI and 60.8% without leading to an adjusted HR of 0.85 (95% CI, 0.76β0.94; p = 0.0016) for OS. Corresponding HRs were 0.84 (95% CI, 0.74β0.95; p = 0.0077) for breast cancer mortality and HR 0.87 (95% CI, 0.78β0.98; p = 0.026) for distant metastasis. No subgroups were identified for the omission of IMNI. The 15-year cumulative incidence of death from ischemic or valvular heart disease was 0.2% (95% CI, 0.0β0.5) in right-sided and 0.7% (95% CI, 0.4β1.2) in left-sided patients.<br/>Interpretation IMNI reduced distant metastasis and breast cancer mortality and improved OS in node-positive breast cancer patients, despite treatment with newer systemic therapies and 3D-based RT.
Bladder Adjuvant Radiotherapy
ForHigh-risk urothelial MIBC post-RC (pT3-4, pN+, margin+, or β€10 nodes), periopera
TL;DR2-yr LRFS 87.1% vs 76.0% (HR 0.43, p=0.04) favoring adj pelvic IMRT post-cystectomy in high-risk MIBC; DFS/OS NS.
vs leading data
- Adj RT + IO interaction unstudied; generalizability to current practice uncertain
6 details
Methods
- π Phase III RCT, N=153 (RT=77, Obs=76); stratified by nodal involvement and chemo timing
- π Eligibility: any of pT3-4, pN1-3, margin+, or β€10 nodes dissected; 62% pT3-T4, 41% pN+
- π Stoma-sparing IG-IMRT 50.4Gy/28fx to cystectomy bed and pelvic nodes
CONSORT flow
Randomized 153
β
Adjuvant RT
allocated 77
Observation
allocated 76
Results
- π RT vs observation outcomes, median f/u 47mo
Endpoint RT Obs HR (95% CI) p 2-yr LRFS (1Β°) 87.1% 76.0% 0.43 (0.20-0.96) 0.04 DFS 71.6% 58.7% 0.62 (0.36-1.05) β BCSS 79.6% 65.0% 0.59 (0.33-1.10) β OS 70.4% 57.4% 0.78 (0.49-1.26) β
Critique
- β οΈ Small N (153); underpowered for OS; CI crosses 1.0 on all secondary endpoints
- β οΈ None received immunotherapy; cohort predates nivolumab post-cystectomy standard (CheckMate 274)
Open questions
- OS benefit with longer follow-up?
- Safety and efficacy of adj RT combined with IO (nivolumab) post-RC
- Optimal selection: does pN+ subgroup derive greatest locoregional benefit?
π Sources Β· π 1 paper
Bladder Adjuvant Radiotherapy: Phase III Multicenter Randomized Controlled Trial of Adjuvant Radiotherapy or Observation for Postcystectomy Muscle-Invasive Bladder Cancer.
Abstract
PURPOSE: To report the primary analysis of a multicenter, phase III randomized trial of adjuvant radiotherapy (RT) after chemotherapy and radical cystectomy (RC) in patients with high-risk muscle-invasive bladder cancer (MIBC).<br/><br/>METHODS: Patients with nonmetastatic urothelial MIBC at high risk after RC (any one of: T3-4, N1-3, margin positive, ≤10 nodes dissected) were randomly assigned 1:1 to adjuvant RT or observation (Obs), stratified by nodal involvement (yes/no) and chemotherapy (neoadjuvant/adjuvant/none). Stoma-sparing IG-IMRT 50.4Gy in 28 fractions was prescribed to the cystectomy bed and pelvic nodes. The primary end point was 2-year locoregional recurrence-free survival (LRFS), and the secondary end points were disease-free survival (DFS), bladder cancer-specific survival (BCSS), and overall survival (OS).<br/><br/>RESULTS: From June 2016 to May 2024, 153 patients were randomly assigned (Obs = 76, RT = 77), with 62% and 41% of patients having pT3-T4 and pN+ stages, respectively. Over 90% of the patients received systemic chemotherapy (71% neoadjuvant and 20% adjuvant), and none received immunotherapy. After a median follow-up of 47 months, the 2-year LRFS was significantly higher with adjuvant RT versus observation (87.1% v 76.0%, hazard ratio [HR], 0.43 [95% CI, 0.20 to 0.96], P = .04). The DFS was 71.6% versus 58.7% (HR, 0.62 [95% CI, 0.36 to 1.05]), BCSS was 79.6% versus 65.0% (HR, 0.59 [95% CI, 0.33 to 1.10]), and OS was 70.4% versus 57.4% (HR, 0.78 [95% CI, 0.49 to 1.26]) for RT and Obs, respectively.<br/><br/>CONCLUSION: Adjuvant pelvic IMRT after radical cystectomy and perioperative chemotherapy suggests an improvement in locoregional control in patients with high risk urothelial MIBC with no additional severe toxicity.
EORTC 22922/10925
ForStage I-III breast, node-positive or central/medial tumor, median age 54, post-s
TL;DR20yr OS HR 1.00 (null): BC mortality reduced HR 0.82 but non-BC deaths increased HR 1.26, offsetting benefit.
vs leading data
- vs EORTC 22922 10yr data (NEJM 2015): DFS and BC mortality benefit seen at 10yr did not translate to OS by 20yr; competing-cause mortality dominant
6 details
Methods
- π Phase 3 RCT, N=4004 randomized 1996-2004, median f/u 22.2yr; prespecified 20yr final analysis
- π Eligible: women β€75yr, stage I-III, node-positive OR central/medial tumor; post-mastectomy or BCS + ALND
Results
- π Outcomes at 20 years (IM-MS-RT vs control)
Endpoint Control IM-MS-RT HR p OS (20yr rate) 61.8% 61.0% 1.00 .967 DFS (20yr rate) 49.0% 48.2% 0.97 .515 DMFS (20yr rate) 59.8% 58.9% 0.97 .578 BC mortality (20yr rate) 22.4% 18.6% 0.82 .006 Non-BC deaths (20yr rate) 15.8% 20.4% 1.26 .002
Critique
- β οΈ Non-BC death excess emerged after 15yr, driven by cardiac and pulmonary morbidity from IM-MS-RT
- β οΈ Late RT morbidity (IM-MS-RT vs control)
- Lung fibrosis: 6.3% vs 3.2%
- Cardiac fibrosis: 2.7% vs 1.7%
- Cardiac diseases: 15.2% vs 11.7%
- Severe cardiac G3-4: 1.9% vs 1.7%
- Severe lung G3-4: 0.3% vs 0.0%
- β οΈ 2D RT planning era (enrolled 1996-2004); modern cardiac-sparing techniques may attenuate the non-BC mortality signal
Open questions
- Does modern cardiac-sparing IM-RT eliminate the non-BC death excess?
- Which subgroups (high nodal burden, HER2+, TNBC) derive net OS benefit?
- Impact of contemporary systemic therapy on IM-MS-RT benefit/harm ratio
π Sources Β· π 1 paper
Twentyβyear results of the randomized European Organization for Research and Treatment of Cancer trial 22922/10925 evaluating internal mammary chain and medial supraclavicular lymph node irradiation in stage IβIII breast cancer
Abstract
Abstract European Organization for Research and Treatment of Cancer trial EORTC 22922/10925 evaluated internal mammary and medial supraclavicular (IMβMS) lymph node irradiation (IMβMSβRT) in patients with stage IβIII breast cancer. Eligible patients had involved axillary nodes and/or centrally/medially located tumors regardless of nodal involvement. The primary end point was overall survival, secondary end points were diseaseβfree survival, distant metastasesβfree survival, breast cancer mortality, and any breast recurrence. Between 1996 and 2004, 4004 patients were randomized. The median patient age was 54 years. At a median followβup of 22.2 years, 1550 (38.7%) patients died, of whom 796 (51.4%) died from breast cancer. At 20 years, the overall survival rate was 61.8% in the control group versus 61.0% in the IMβMSβRT group (hazard ratio [HR], 1.00; p = .967); the diseaseβfree survival rate was 49.0% versus 48.2%, respectively (HR, 0.97; p = .515); and the distant metastasesβfree survival rate was 59.8% versus 58.9%, respectively (HR, 0.97; p = .578). The breast cancer mortality rate was 22.4% in the control group and 18.6% in the IMβMSβRT group (HR, 0.82; p = .006), whereas the rate of deaths not from breast cancer or from unknown causes was 15.8% versus 20.4%, respectively (HR, 1.26; p = .002). Lung fibrosis, cardiac fibrosis, and cardiac diseases were more frequent after IMβMSβRT versus no IMβMSβRT (6.3% vs. 3.2%, 2.7% vs. 1.7%. and 15.2% vs. 11.7%, respectively); and the rates of severe cardiac and lung morbidities (scores of 3 or 4) were 1.9% versus 1.7% and 0.3% versus 0.0%, respectively. Breast cancer mortality at 20 years was statistically significantly lower after IMβMSβRT, but deaths not from breast cancer increased after 15 years, resulting in no longβterm benefit of IMβMSβRT on overall survival. Therefore, the authors strongly call for very longβterm followβup of treatments for prognostically favorable cancers such as breast cancer.
SWOG S1007 RNI analysis
ForHR+/HER2-, Oncotype DX β€25, N1 (1-3 nodes) breast cancer, adjuvant
TL;DR5-yr LRR <1% with or without RNI in HR+/HER2-, Oncotype β€25, N1 breast; IDFS not associated with RNI receipt.
vs leading data
- vs MA.20/EORTC 22922 (RNI benefit in N+ disease broadly): S1007 population (Oncotype β€25) is a biologically favorable subgroup potentially below the threshold for RNI benefit
7 details
Methods
- π Secondary analysis of S1007 phase 3 RCT (chemo vs ET); N=4871 with prospective RT data; median f/u 6.1 yrs
- π RT practice patterns
- 81% received any RT
- 59% of RT recipients received RNI (supraclavicular region minimum)
- Practice divided on RNI use in this biologically favorable N1 setting
- π Low LRR also observed in pts randomized to ET alone without chemo
Results
- π 5-yr cumulative LRR by locoregional treatment
Treatment 5-yr LRR BCS + RT + RNI 0.85% BCS + RT, no RNI 0.55% Mastectomy + PMRT 0.11% Mastectomy, no RT 1.7% - π IDFS by RNI receipt (observational; RNI not randomized)
Menopausal status HR (95% CI) p Premenopausal 1.03 (0.74-1.43) 0.87 Postmenopausal 0.85 (0.68-1.07) 0.16
Critique
- β οΈ RNI not randomized: confounding by indication likely (lower-risk pts selected for omission by treating physicians)
- β οΈ Survival analyses landmarked at 1 yr; RT data recorded only in first year post-randomization
Open questions
- Dedicated RCT of RNI omission in Oncotype β€25 N1 disease needed to confirm safety
- Does chemo vs ET assignment (original randomization) modify RNI benefit?
- Durability of low LRR beyond 6 yrs in this favorable-biology population?
π Sources Β· π 1 paper
Radiotherapy Use and Incidence of Locoregional Recurrence in Patients With Favorable-Risk, Node-Positive Breast Cancer Enrolled in the SWOG S1007 Trial.
Abstract
IMPORTANCE: Little is known about regional nodal irradiation (RNI) practice patterns or rates of locoregional recurrence (LRR) with and without RNI in patients with limited nodal disease and favorable biology treated with modern surgical and systemic therapy, including approaches that de-escalate those latter treatments.<br/><br/>OBJECTIVE: To investigate how often patients with low-recurrence score breast cancer with 1 to 3 nodes involved receive RNI, incidence and predictors of LRR, and associations between locoregional therapy and disease-free survival.<br/><br/>DESIGN, SETTING, AND PARTICIPANTS: In this secondary analysis of the SWOG S1007 trial, patients with hormone receptor-positive, ERBB2-negative breast cancer, and a Oncotype DX 21-gene Breast Recurrence Score assay result of no more than 25, were randomized to endocrine therapy alone vs chemotherapy then endocrine therapy. Prospectively collected radiotherapy information was collected from 4871 patients treated in diverse settings. Data were analyzed June 2022 to April 2023.<br/><br/>EXPOSURE: Receipt of RNI (targeting at least the supraclavicular region).<br/><br/>MAIN OUTCOME(S) AND MEASURE(S): Cumulative incidence of LRR was calculated by locoregional treatment received. Analyses were assessed for associations between invasive disease-free survival (IDFS) and locoregional therapy, adjusted for menopausal status, treatment group, recurrence score, tumor size, nodes involved, and axillary surgery. Radiotherapy information was recorded in the first year after randomization, so survival analyses were landmarked as starting at 1 year among those still at risk.<br/><br/>RESULTS: Of 4871 female patients (median [range] age, 57 [18-87] years) with radiotherapy forms, 3947 (81.0%) reported radiotherapy receipt. Of 3852 patients who received radiotherapy and had complete information on targets, 2274 (59.0%) received RNI. With a median follow-up of 6.1 years, the cumulative incidence of LRR by 5 years was 0.85% among patients who received breast-conserving surgery and radiotherapy with RNI; 0.55% after breast-conserving surgery with radiotherapy without RNI; 0.11% after mastectomy with postmastectomy radiotherapy; and 1.7% after mastectomy without radiotherapy. Similarly low LRR was observed within the group assigned to endocrine therapy without chemotherapy. The rate of IDFS did not differ by RNI receipt (premenopausal: hazard ratio [HR], 1.03; 95% CI, 0.74-1.43; P = .87; postmenopausal: HR, 0.85; 95% CI, 0.68-1.07; P = .16).<br/><br/>CONCLUSIONS AND RELEVANCE: In this secondary analysis of a clinical trial, RNI use was divided in the setting of biologically favorable N1 disease, and rates of LRR were low even in patients who did not receive RNI. Disease-free survival was not associated with RNI receipt; omission of chemotherapy among patients similar to those enrolled in the S1007 trial is not an independent indication for use of RNI.
LS-SCLC 54 Gy Hyperfractionated RT NCT03214003
ForLS-SCLC, ECOG 0β1, age 18β70, chemo-naive or β€1 prior platinum-etoposide cycle
TL;DRmOS 60.7 vs 39.5mo (HR 0.55, p=0.003) favoring 54 Gy hyperfractionated RT in LS-SCLC; no added toxicity.
vs leading data
- vs CONVERT trial (Lancet Oncol 2017): CONVERT also BID 45 Gy SIB to 66 Gy failed to show OS benefit over 45 Gy β this trial's positive result contrasts CONVERT's null, likely due to SIB technique differences and PTV homogeneity approach
9 details
Methods
- π Phase 3 open-label RCT; N=224; 16 centers in China; 1:1 randomization; median f/u 46mo
- π 54 Gy SIB to GTV in 30 BID fractions vs 45 Gy in 30 BID fractions; both arms VMAT; PTV 45 Gy both arms
- π Chemo-naive or β€1 prior cisplatin/carboplatin+etoposide cycle; ECOG 0β1; age 18β70
- π Concurrent chemotherapy + PCI (25 Gy/10 fx) for responders in both arms
CONSORT flow
Assessed / enrolled 224
β
Randomized 224
β
54 Gy SIB
allocated 108
analyzed 108
45 Gy
allocated 116
analyzed 116
Results
- π 1Β° EP (OS): mOS 60.7mo (95% CI 49.2β62.0) vs 39.5mo (27.5β51.4), HR 0.55 (0.37β0.72), p=0.003
Critique
- β οΈ G3β4 RT toxicity by type
- Oesophagitis: 13% (54 Gy) vs 12% (45 Gy), p=0.84
- Pneumonitis: 5% (54 Gy) vs 6% (45 Gy), p=0.663
- 1 treatment-related death in 54 Gy arm (MI)
- β οΈ Trial stopped early by DSMB (April 2021) on clinical benefit grounds; early termination inflates effect estimates
- β οΈ Single-country (China), age-capped at 70, open-label; generalizability to Western populations uncertain
- β οΈ 45 Gy BID (not OD) control β aligns with historical standard but not universally practiced globally
Open questions
- Confirmatory data needed in non-Asian populations
- Optimal dose escalation with modern immunotherapy combinations
- Late cardiac/pulmonary toxicity beyond 46mo median f/u
π Sources Β· π 1 paper
High-dose hyperfractionated simultaneous integrated boost radiotherapy versus standard-dose radiotherapy for limited-stage small-cell lung cancer in China: a multicentre, open-label, randomised, phase 3 trial
Abstract
Background For the past 20 years, twice-daily thoracic radiotherapy with concurrent chemotherapy has been the treatment of choice for limited-stage small-cell lung cancer (LS-SCLC), which has a poor prognosis. We aimed to assess the efficacy and safety of high-dose, accelerated, hyperfractionated, twice-daily thoracic radiotherapy (54 Gy in 30 fractions) versus standard-dose radiotherapy (45 Gy in 30 fractions) as a first-line treatment for LS-SCLC.<br/>Methods This open-label, randomised, phase 3 trial was performed at 16 public hospitals in China. The key inclusion criteria were patients aged 18β70 years, with histologically or cytologically confirmed LS-SCLC, who had an Eastern Cooperative Oncology Group (ECOG) performance status of 0β1, and who were previously untreated or had received one course of cisplatin or carboplatin and etoposide. Eligible patients were randomly assigned (1:1) to receive volumetric-modulated arc radiotherapy (VMAT) of 45 Gy in 30 fractions to the gross tumour volume or VMAT with a simultaneous integrated boost of 54 Gy in 30 fractions to the gross tumour volume starting 0β42 days after the first chemotherapy course. Both groups received 10 fractions of twice-daily thoracic radiotherapy per week. The planning target volume was 45 Gy in 30 fractions in both groups. Patients with responsive disease received prophylactic cranial radiotherapy (25 Gy in 10 fractions). Randomisation was performed using a centralised interactive web response system, stratified by ECOG performance status, disease stage, previous chemotherapy course, and chemotherapy choice. The primary outcome was overall survival in the intention-to-treat population. Safety was analysed in the as-treated population. This study was registered at ClinicalTrials.gov, NCT03214003.<br/>Findings From June 30, 2017, to April 6, 2021, 224 patients (102 [46%] females and 122 [54%] males; median age 64 years [IQR 58β68]) were enrolled and randomly assigned to the 54 Gy group (n=108) or 45 Gy (n=116) group. The median follow-up was 46 months (IQR 33β56). The median overall survival was significantly longer in the 54 Gy group (60Β·7 months [95% CI 49Β·2β62Β·0]) than in the 45 Gy group (39Β·5 months [27Β·5β51Β·4]; hazard ratio 0Β·55 [95% CI 0Β·37β0Β·72]; p=0Β·003). Treatment was tolerable, and the chemotherapy-related and radiotherapy-related toxicities were similar between the groups. The grade 3β4 radiotherapy toxicities were oesophagitis (14 [13%] of 108 patients in the 54 Gy group vs 14 [12%] of 116 patients in the 45 Gy group; p=0Β·84) and pneumonitis (five [5%] of 108 patients vs seven [6%] of 116 patients; p=0Β·663). Only one treatment-related death occurred in the 54 Gy group (myocardial infarction). The study was prematurely terminated by an independent data safety monitoring board on April 30, 2021, based on evidence of sufficient clinical benefit.<br/>Interpretation Compared with standard-dose thoracic radiotherapy (45 Gy), high-dose radiotherapy (54 Gy) improved overall survival without increasing toxicity in a cohort of patients aged 18β70 years with LS-SCLC. Our results support the use of twice-daily accelerated thoracic radiotherapy (54 Gy) with concurrent chemotherapy as an alternative first-line LS-SCLC treatment option.
Proton vs Photon PMRT Capsular Contracture (Zerey et al.)
ForPost-mastectomy breast cancer, subpectoral TE/I or DTI reconstruction, PMRT cand
TL;DRMVA HR 1.76 (P=0.083) proton vs photon CC, non-significant; proton+DTI 2yr CC 50% vs photon+DTI 35%.
vs leading data
- Proton PMRT improves cardiac/pulmonary dosimetry vs photon; this CC signal is the risk to weigh in reconstruction planning
8 details
Methods
- π Retrospective, 2 centers/single institution, N=175 (89 proton, 86 photon), Jan 2017-Dec 2023; median f/u 42 vs 47 mo
Results
- π 2-year CC rates by modality and reconstruction type
Reconstruction Proton Photon DTI 50% 35% TE/I 23% 12% - π MVA HR 1.76 (95% CI 0.93-3.32), P=0.083 for proton vs photon
- π Univariate HR 2.3 (95% CI 1.26-4.30), P=0.007 for proton vs photon
- π DTI vs TE/I in MVA: HR 3.0 (95% CI 1.7-5.5), P<.001
Critique
- β οΈ Groups unbalanced for reconstruction type (TE/I vs DTI, P<.001); this is the dominant confounder and MVA adjustment may be insufficient
- β οΈ Groups also unbalanced for tumor laterality (P<.001); uncontrolled institutional practice patterns, not randomization
- β οΈ MVA primary result is P=0.083, below conventional significance; framed as a trend, not a confirmed signal
Open questions
- Does proton-CC signal replicate in a prospective matched or randomized cohort?
- Optimal reconstruction type (TE/I vs DTI) when proton PMRT is indicated for cardiac/pulmonary dosimetry reasons?
π Sources Β· π 2 papers
Does Pencil Beam Scanning Proton Therapy Impart a Higher Risk of Capsular Contracture Compared With Intensity Modulated Photon Radiation Therapy in the Postmastectomy Reconstruction Setting?
Abstract
BACKGROUND: Postmastectomy radiation therapy (PMRT) may cause adverse events in the reconstruction setting. Proton-based PMRT is increasingly used and has been shown to improve cardiac and pulmonary dosimetry. Data on the risk of capsular contracture (CC) with proton versus photon PMRT remain scarce. We compared the CC rate of the largest cohort of patients undergoing reconstruction after pencil beam scanning proton PMRT reported to date with an intensity modulated radiation therapy photon cohort, hypothesizing that the proton cohort would have a higher rate of CC.<br/><br/>METHODS AND MATERIALS: An institutional review board -approved retrospective study was conducted on patients with breast cancer who underwent subpectoral 2-stage tissue expander/implant (TE/I) or direct-to-implant (DTI) breast reconstruction and received either pencil beam scanning proton or intensity modulated radiation therapy photon PMRT between January 2017 and December 2023 at 2 centers within a single institution. All patients undergoing TE/I had the TE irradiated. CC rates were estimated using the Kaplan-Meier method. Cox proportional hazards analysis, denoted as hazard ratios (HRs) with 95% CIs, was used to assess variables potentially associated with the outcome, and a binary logistic regression model was used to verify the results.<br/><br/>RESULTS: The study cohort comprised 175 patients (89 proton; 86 photon). The median age was 49 years (range, 24-78), 63% were Hispanic. Patient demographics were well balanced between the groups, except in tumor laterality (P < .001) and reconstruction type (TE/I vs DTI; P < .001). The median follow-up was 42 and 47 months for the proton and photon groups, respectively. In a multivariable analysis, DTI patients had a significantly higher risk of CC compared with TE/I patients (HR, 3.0; 95% CI, 1.7-5.5; P < .001). Proton patients had a higher risk of developing CC compared with the photon group in univariate analysis (HR, 2.3; 95% CI, 1.26-4.30; P = .007), although this effect did not reach statistical significance in the multivariable model (HR, 1.76; 95% CI, 0.93-3.32; P = .083). The 2-year CC rate for patients treated with protons and DTI (n = 36), photons and DTI (n = 15), protons and TE/I (n = 53), and photons and TE/I (n = 71) was 50%, 35%, 23%, 12%, respectively (P < .001). No other factors were significantly associated with CC development.<br/><br/>CONCLUSION: In this contemporary large proton versus photon PMRT cohort, patients treated with proton showed a trend toward an increased risk of CC. Patients undergoing DTI who were treated with protons had the highest risk of CC (50%). Careful consideration of reconstruction and radiation therapy modalities, assessing CC risk, and also involving patient input, is important for treatment selection.
Single-fraction SABR for primary NSCLC and pulmonary oligometastases (pooled analysis, n=1687)
ForInoperable primary NSCLC or pulmonary oligomets, multi-institution pooled cohort
TL;DR2yr LC 90-93%, G3+ AEs 2.9% across 1687 pts treated with SF-SABR at 3 institutions.
vs leading data
- SAFRON-II (phase 2 RCT, Peter Mac) showed SF-SABR non-inferior vs multi-fraction for peripheral NSCLC; this series extends to central tumors and oligomets across 3 institutions
| Endpoint | Primary NSCLC (n=1200) | Oligomets (n=487) |
|---|---|---|
| 1-yr OS | 84% (95% CI 82, 86) | 90% (95% CI 86, 92) |
| 2-yr OS | 67% (95% CI 64, 69) | 75% (95% CI 71, 79) |
| Median OS (mo) | 40 (95% CI 36, 43) | 51 (95% CI 42, 58) |
+2 more figures
7 details
Methods
- π Three-institution pooled retrospective: Peter Mac, Cleveland Clinic, Roswell Park
- π N=1687: 1200 primary NSCLC + 487 pulmonary oligomets
Results
- π LC 90-93% at 2yr across both cohorts; isolated local/locoregional failure very uncommon
- π Median PFS
- Primary NSCLC: 30mo
- Pulmonary oligomets: 11mo
- π AEs (primary NSCLC, n=789)
- G3+: 23/789 (2.9%)
- G2+: 124/789 (15.7%)
- Any AE: 215/789 (27%)
Critique
- β οΈ AE data excludes Roswell Park β toxicity rates incomplete for the full 1687-pt cohort
- β οΈ Single-arm pooled retrospective; no randomised comparator vs conventional multi-fraction SBRT
Open questions
- Non-inferiority vs multi-fraction SBRT in a phase 3 RCT?
- Optimal pt selection for SF-SABR (tumor size, location, histology)?
- Long-term LC durability beyond 5 years?
π Sources Β· π¦ 1 tweet
ππ½ππ½ππ½@neildwallaceie at #ESTRO26 - 1687 patients receiving single fraction SABR for #lungcancer and pulmonary oligomets, @PeterMacRadOnc / @ClevelandClinic / @RoswellPark. Fantastic local control, and low adverse rates. Should we be using βone stopβ SABR more often #radonc ? pic.twitter.com/w2IlGKRU5o
— Shankar Siva (@_ShankarSiva) May 18, 2026
PEACE 2
ForVHR localized prostate (β₯2: Gleason β₯8, T3-T4, PSA β₯20), N0M0 on conventional im
TL;DRPelvic RT did not improve cPFS vs prostate-only RT in VHR localized prostate cancer (HR 0.81, p=0.088).
vs leading data
- Contrasts with POP-RT, which showed bPFS and MFS benefit from pelvic RT in high-risk CaP; population definitions and staging modalities differ
| Prostate-only RT | Pelvic RT | |
|---|---|---|
| 7-yr cPFS | 62.9% [57.4; 68.1] | 67.1% [61.6; 72.2] |
| HR (95% CI) | ref | 0.81 [0.63; 1.03] |
| p | 0.088 |
+1 more figure
8 details
Methods
- π Phase III, 4-arm: ADT Γ 3 yrs + prostate RT Β± cabazitaxel Γ 4 cycles; pelvic vs prostate-only RT comparison
- π VHR eligibility: β₯2 of Gleason β₯8, T3-T4, PSA β₯20 ng/mL; N0M0 on conventional imaging or choline PET/CT
- π Side effects minimal with modern RT techniques; no quantitative toxicity figures reported in source
CONSORT flow
Randomized 761
β
Prostate-only RT (A+C pooled)
allocated 380
Pelvic RT (B+D pooled)
allocated 381
Results
- π 1Β° EP cPFS: HR 0.81 (95% CI 0.63-1.03), p=0.088 β non-significant
- π 7-yr cPFS: 67.1% pelvic RT vs 62.9% prostate-only RT
- π No improvement on secondary endpoints: MFS, PCSS, OS (effect sizes not reported in source)
Critique
- β οΈ Staged with conventional imaging/choline PET, not PSMA-PET; PSMA-era cohort may carry different nodal risk profile
- β οΈ Presenter conclusion: pelvic RT cannot be considered SOC even in pts at high nodal extension risk without detectable disease on imaging
Open questions
- Does PSMA-PET staging identify a nodal subgroup that benefits from pelvic RT?
- How to reconcile with POP-RT (different risk definitions, staging modalities)?
- Does cabazitaxel interaction modify pelvic RT benefit in the 4-arm design?
π Sources Β· π¦ 1 tweet
Yesterday, I presented the @GETUG_Unicancer PEACE 2 trial at #ESTRO26 on the role of pelvic RT in very high risk #prostatecancer pts (staged with conventional imaging).
— Pierre Blanchard, MD (@PBlanchardMD) May 18, 2026
Twittorial below
Key conclusion: pelvic RT did not improve clinical outcomes (cPFS, MFS, PCSS, OS)...
1/n pic.twitter.com/ZKRt2QZzt1
HEAT Trial NCT01794403
ForLow-intermediate risk localized PCa, IPSS <12, ADT-eligible
TL;DRSBRT 5 fx non-inferior to EHRT for BF (7% vs 7.4%, p-noninferiority=0.007 at 4.25y) in low-int risk PCa; interim data.
vs leading data
- Prior AHRT RCTs (HYPO-RT-PC, PACE-B, NRG-GU005) excluded ADT or used heterogeneous controls; HEAT is first head-to-head with modern IMRT + ADT permitted in both arms
| Endpoint | AHRT | EHRT | p-noninferiority |
|---|---|---|---|
| Biochemical failure (Phoenix) at 4.25y | 7% | 7.4% | 0.007 |
+1 more figure
9 details
Methods
- π AHRT: 36.25 Gy in 5 fx (7.25 Gy/fx, GTV SIB to 40 Gy); EHRT: 70.2 Gy in 26 fx using IMRT
- π Low-intermediate risk PCa; IPSS <12; ADT permitted (β€6 months) in both arms; 28% received ADT
- π Median FU 59.7 months; 82.4% intermediate-risk; n=156 randomized, n=142 analyzed (interim)
Results
- π 1Β° EP (biochemical failure, Phoenix def): 7% AHRT vs 7.4% EHRT at 4.25y, p-noninferiority = 0.007
- π Acute G2+ GI toxicity lower with AHRT; no absolute rates reported in source
- π Late G2+ GI and acute/late G2+ GU toxicities comparable between arms
Critique
- β οΈ Interim analysis only; accrual goal n=456 (420 evaluable planned); non-inferiority not yet confirmed at final analysis
- β οΈ Non-inferiority margin 12% is wide relative to observed BF rates of 7-7.4%
- β οΈ Clinician-reported toxicity; laxative/psyllium use scored as G2 GI event
Open questions
- Non-inferiority confirmed at final analysis (n=456 accrual goal)?
- Late toxicity differences beyond 5yr follow-up?
- Does short-course ADT differentially affect BCF rates by fractionation arm?
π Sources Β· π¦ 2 tweets
Day FOUR of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 18, 2026
Results of a Randomized Non-Inferiority Trial of Hypofractionation via Extended versus Accelerated Therapy (HEAT) for Prostate Cancer Presented by Matthew C. AbramowitzπΊπΈ #RadOnc β’οΈ #ProstateCancer
HEAT is an international phase⦠pic.twitter.com/IkSTgQHwXK
The HEAT trial is another randomized demonstration of the safety & efficacy of SBRT compared to hypofractionted RT in #prostatecancer at #ESTRO26 pic.twitter.com/c9sNb3KOqo
— Pierre Blanchard, MD (@PBlanchardMD) May 18, 2026
TORPEdO (CRUK/18/010)
ForOropharyngeal SCC requiring definitive concurrent CRT with bilateral neck treatm
TL;DRIMPT showed no HR-QoL benefit vs IMRT at 12 months in OPSCC; UW-QoL scores similar across arms to 24 months.
vs leading data
- Lancet 2026 (McBride et al.): concurrent proton vs photon analysis in OPSCC
+1 more figure
7 details
Methods
- π Phase 3 RCT; N=205; 2:1 IMPT vs IMRT; cisplatin 100mg/mΒ² D1+D22; 70/56 Gy in 33 fractions over 6.5 weeks
- π HR-QoL declines at end of treatment then recovers; most pts stabilize by 12 months post-CRT
Results
- π Patient-reported co-primary: UW-QoL physical composite (saliva, taste, chewing, swallowing, appearance, speech) at 12 months post-CRT
- π No differences in UW-QoL scores between arms at 3, 12, or 24 months post-RT
- π Clinician-reported co-primary (CTCAE G3 weight loss or gastrostomy dependence at 12 months): not reported in this presentation
Critique
- β οΈ Meaningful HR-QoL deterioration persists in some pts up to 2 years in both arms
- β οΈ Commentary: identical planning constraints and novice UK proton centers likely attenuated any IMPT advantage; high-experience centers may still see clinical benefit
Open questions
- Does proton center experience modify HR-QoL or late-toxicity outcomes?
- Will clinician-reported co-primary (G3 weight loss/gastrostomy) diverge from HR-QoL?
- Late-effect differentiation at 5-year follow-up
π Sources Β· π¦ 2 tweets Β· π 1 paper
Day FOUR of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 18, 2026
Health-related quality of life in the phase III trial of Toxicity Reduction using Proton Beam Therapy for Oropharyngeal Cancer (TORPEdO;CRUK/18/010) Presented by Matthew Tylerπ¬π§ #RadOnc β’οΈ
TORPEdO, a multicentre phase 3β¦ pic.twitter.com/ZP6yK7RThL
TORPEdO. Misma planificaciΓ³n + constraints idΓ©nticas y centros UK noveles probablemente limitaron el potencial de #IMPT.
— Amadeo Wals (@AmadeoWals) May 18, 2026
Centros con alta experiencia se siguen viendo ventajas clΓnicas . La QA rigurosa del UK es una fortaleza, pero no maximiza la diferencia.#ESTRO26 #HNCSM https://t.co/rASp3QDIk1
Proton versus photon therapy for oropharyngeal cancer.
π McBride SM, Riaz N, Sherman EJ, Tsai CJ, Mell LK. Proton versus photon therapy for oropharyngeal cancer. Lancet. 2026 May 16;407(10542):1917.
INRT-AIR & DARTBOARD (ENI omission, HNSCC)
ForHNSCC oropharynx/larynx/hypopharynx, stage I-IVB, definitive CRT candidates
TL;DR5-yr solitary ENI recurrence 0% in 117 HNSCC pts on AI-assisted INRT omitting elective nodal fields.
8 details
Methods
- π INRT: AI-assisted identification of suspicious lymph nodes, ENI fields entirely omitted
- π Eligibility
- Sites: oropharynx, larynx, hypopharynx
- Stage I-IVB (excl T1-2N0 larynx)
- PET/CT + neck CT required for staging
Results
- π 5-yr risk of solitary elective nodal recurrence: 0% (N=117, median f/u 3.4yr)
- π 5-yr OS 87%, 5-yr PFS 74%
- π 3-yr LR 9.5%, regional recurrence 4.3%, DM 11%
- π MDADI composite 84.9 at 12mo (no significant post-treatment decline)
Critique
- β οΈ No randomized comparator; toxicity reduction vs standard ENI-CRT unconfirmed
- β οΈ N=117 pooled from 2 trials; cross-trial heterogeneity in eligibility and AI model not reported
Open questions
- RCT comparing INRT vs standard ENI-CRT needed before non-trial adoption
- Late toxicity reduction and QoL benefit beyond 12 months
- Generalizability of AI-assisted nodal staging to community practice
π Sources Β· π¦ 1 tweet
Day FOUR of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 18, 2026
Omission of elective nodal irradiation in HNSCC: long-term results and patient-level pooled analysis from 2 prospective trials (INRT-AIR & DARTBOARD)
Presenter Sympascho Young πΊπΈ
A patient-level pooled analysis of 117 patients⦠pic.twitter.com/KaaT70nSNH
OPERA Trial (5-year, rectal preservation)
ForLocally advanced rectal cancer, post-neoadjuvant therapy
TL;DR76% good response at W14 by clinical exam; 5yr OP 81% cCR vs 77% nCR; W14 assessment safely identifies W&W candidates.
| Arm A | Arm B | p | |
|---|---|---|---|
| W14 good response (cCR+nCR) | 65% | 88% | 0.004 |
| 5yr OP | 75% | 83% | 0.24 |
+1 more figure
7 details
Methods
- π OPERA primary: tumor response assessed at W24 via DRE + rectoscopy + MRI triad
- π Post-hoc tests W14 CTRE (DRE + rectoscopy) as earlier OP decision gate, ~1mo after NAT end
- π nCR reflects RT-induced tissue change, not incomplete clearance; should not trigger radical surgery
Results
- π W14 CTRE in 122/141 pts (87%): 76% good response (cCR+nCR), 24% PR
- π MRI concordance at W14: TRG1-2 in 98% (80/82) of CR pts
- π 5yr OP by response depth: cCR 81% vs nCR 77%
Critique
- β οΈ Post-hoc analysis of OPERA RCT; W14 timing not pre-specified as the primary assessment endpoint
Open questions
- Can W14 assessment replace W24, or is it additive?
- Management of nCR pts at W14 who may convert to cCR by W24?
- MRI TRG added value vs clinical exam alone at W14?
π Sources Β· π¦ 1 tweet
Day FOUR of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 18, 2026
Five-year Results of the OPERA Trial: When and How to Assess Tumor Response to Guide Rectal Preservation Presented by Syrine Ben Dhia π«π· #RadOnc β’οΈ
This post-hoc analysis of the OPERA trial evaluated early tumor response⦠pic.twitter.com/KUanFTxeFh
HCC EBRT Multinational IPD Cohort
ForHCC BCLC-0 or BCLC-A, treatment-naΓ―ve or previously treated
TL;DRBCLC-A mOS 4.6yr, BCLC-0 6.8yr in 4,913-pt IPD cohort; OS comparable to resection and ablation.
vs leading data
- Authors conclude OS comparable to resection, thermal ablation, and other ablative locoregional therapies for BCLC-0/A
7 details
Methods
- π Systematic review + IPD meta-analysis; 4,913 HCC pts treated with EBRT; median f/u 5.0yr; multinational institutions
Results
- π OS by BCLC stage (all pts)
Stage Median OS 95% CI BCLC-0 6.8yr 5.7-8.7 BCLC-A 4.6yr 4.1-5.1 - π OS in treatment-naΓ―ve pts
Stage Median OS 95% CI BCLC-0 NR 8.6yr-NR BCLC-A 5.4yr 4.5-6.7 - π Multivariable: ablative RT dose and more recent treatment year both associated with reduced mortality risk
- π Higher BCLC stage, greater tumor burden, worse PS, Child-Pugh B/C associated with higher mortality risk
Critique
- β οΈ No randomized comparator vs resection or ablation; historical cross-study comparison subject to selection bias
- β οΈ Dose heterogeneity across contributing institutions; ablative and non-ablative RT pooled together
Open questions
- Randomized comparison vs resection or thermal ablation still absent
- Optimal fractionation and ablative dose threshold for OS benefit
- Applicability to Child-Pugh B/C pts given worse prognosis in this cohort
π Sources Β· π 1 paper
Overall Survival Among Patients With Hepatocellular Carcinoma Treated With External Beam Radiation Therapy: Individual Patient Data Outcomes From a Multinational Cohort.
Abstract
PURPOSE: External beam radiation therapy (EBRT) has gained delayed acceptance as a recommended first-line treatment modality for patients with hepatocellular carcinoma (HCC), given limited evidence that it improves overall survival (OS). We analyzed individual patient data (IPD) from an international cohort to assess OS among patients with HCC treated with EBRT.<br/><br/>METHODS: We performed a systematic review of publications that assessed EBRT, met prespecified technical standards for HCC, and reported OS (search date December 15, 2022). Corresponding authors were invited to submit IPD for the study. We performed Kaplan-Meier survival analyses to determine OS and restricted mean survival time (RMST) stratified by Barcelona Clinic Liver Cancer (BCLC) stage and treatment status (ie, treatment-naïve and experienced). We performed random effects Cox proportional hazards modeling to assess clinical characteristics associated with OS.<br/><br/>RESULTS: Data were provided on 4,913 patients treated with EBRT with a median follow-up time of 5.0 years. The median OS was 6.8 years (95% CI, 5.7 to 8.7) for BCLC-0 and 4.6 years (95% CI, 4.1 to 5.1) for BCLC-A. Among treatment-naïve patients, the median OS was not reached (95% CI, 8.6 to not reached) for BCLC-0 and was 5.4 years (95% CI, 4.5 to 6.7) for BCLC-A. In multivariable models, more advanced BCLC stage, higher tumor burden, worse performance status, and Child-Pugh class B or C were associated with a higher risk of mortality. Ablative radiation dose and more recent year of treatment were associated with a reduced risk of death.<br/><br/>CONCLUSION: To our knowledge, this study represents the largest multinational cohort of patients with HCC treated with EBRT. OS outcomes with EBRT for very early- and early-stage HCC appear to be comparable with resection, thermal ablation, and other ablative locoregional therapies. These data support the inclusion of EBRT in the BCLC HCC clinical decision-making process.
π Moon AM, Yanagihara TK, Dawson LA, Yu JI, Lawrence TS, Kim TH, Yan M, Iwata H, Nabavizadeh N, Apisarnthanarax S, Dunne EM, Lock MI, Chuong MD, Chiang CL, Scorsetti M, Katoh N, Sioshansi S, Numata K, Liu HY, Iwamoto H, Wakatsuki M, Chen Y, Pollom EL, Gkika E, Jabbour SK, Munoz-Schuffenegger P, Dutta D, Hajj C, Ueno M, Hallemeier CL, Feldman AM, MΓ©ndΓ¨z Romero A, Tan X, Molla M, Tepper JE, Torres F, Reig M; EBRT Collaboration Group. Overall Survival Among Patients With Hepatocellular Carcinoma Treated With External Beam Radiation Therapy: Individual Patient Data Outcomes From a Multinational Cohort. J Clin Oncol. 2026 May 15:JCO2502399.
EXTEND Trial
ForOligometastatic solid tumors, 1-5 mets, 6 histology baskets
TL;DRPFS HR 0.54 (95% CI 0.41-0.72, p<0.001) favoring MDT+SOC across histologies in phase II oligometastatic basket RCT; basket-specific signals identified.
vs leading data
- Consistent with SABR-COMET (Lancet 2019), STOMP (JCO 2018), ORIOLE (JAMA Oncol 2020); extends MDT evidence across 6 histology groups
7 details
Methods
- π Multicenter randomized phase II, 6-basket design (breast, pancreas, kidney, 2 prostate, Other); 1-5 mets; N=334 per-protocol (MDT+SOC n=166, SOC n=168)
- π MDT was RT in 98% of treated mets (370/379)
- π Exploratory ctDNA findings
- Detectable ctDNA at enrollment correlated with shorter PFS + survival
- ctDNA clearance at 3mo post-enrollment correlated with improved survival
Results
- π 1Β° EP PFS: HR 0.54 (95% CI 0.41-0.72), p<0.001, MDT+SOC vs SOC; median f/u 53 mo
- π Excluding prostate baskets: PFS HR 0.60 (95% CI 0.40-0.89)
- π Basket-level PFS superiority
- Superiority demonstrated: pancreas, prostate, Other baskets
- Inconclusive: breast, kidney baskets
Critique
- β οΈ Phase 2 only; overall HR may not apply uniformly across histologies given basket heterogeneity
Open questions
- Which histologies warrant dedicated phase 3 MDT trials?
- Can ctDNA clearance predict MDT benefit for patient selection?
- Optimal MDT modality beyond SBRT in basket-specific settings?
π Sources Β· π 1 paper
Addition of Metastasis-Directed Therapy to Standard of Care for Oligometastatic Solid Tumors: Primary Analysis of All Tumor-Histology Baskets of the Phase II Randomized EXTEND Trial.
Abstract
PURPOSE: We tested the hypothesis that adding metastasis-directed therapy (MDT) to standard of care (SOC) systemic therapy improves progression-free survival (PFS) among patients with oligometastatic disease.<br/><br/>METHODS: EXTEND was a multicenter randomized phase II trial. Patients with 1-5 metastases were randomized to MDT+SOC vs SOC in 1 of 6 baskets (breast, pancreas, kidney, two prostate baskets, and an "Other" basket) with basket-specific stratification and powering. PFS, the primary endpoint, was pre-specified in the per-protocol set within each basket, across all baskets, and across all baskets excluding the prostate baskets. Exploratory endpoints included circulating tumor DNA (ctDNA) and immune profiling.<br/><br/>RESULTS: From 2018 through 2023, 521 patients were screened, 350 were randomized, and 334 were analyzed per protocol (MDT+SOC, n=166; SOC, n=168). Radiotherapy was used as MDT for 98% of metastases (370/379). Overall, after median follow-up of 53 months, PFS was improved with MDT+SOC (HR 0.54, 95% CI 0.41 to 0.72, p < 0.001). Similarly, PFS was improved when excluding the prostate baskets (HR, 0.60; 95% CI: 0.40 to 0.89). Within each basket, PFS superiority was identified for the pancreas, prostate, and "Other" baskets, whereas the breast and kidney baskets were inconclusive. At enrollment, detectable ctDNA correlated with shorter PFS and survival; by contrast, ctDNA clearance 3-months post-enrollment correlated with improved survival. MDT+SOC-induced systemic immune activation was most pronounced among baskets demonstrating PFS superiority.<br/><br/>CONCLUSION: The phase II EXTEND trial supports the addition of MDT to SOC for oligometastatic disease. Histology-specific efficacy signals were identified for phase III testing. Translational insights suggest the potential for optimizing the definition of oligometastasis using ctDNA, and point to systemic immune responses as a possible mechanism of benefit from MDT.
π Sherry AD, Haymaker C, Wang S, Liu S, Bathala TK, Medina-Rosales MN, Seo A, Hara K, Reddy J, Chun SG, Mayo LL, Walker G, Pant S, Zhao D, Kovitz CA, Ramirez D, Ha CS, Smith BD, Gomez D, Cohen L, Koong AC, Reuben A, Tannir N, Corn PG, Tran PT, Siddiqui BA, Subudhi SK, Msaouel P, Ludmir EB, Tang C. Addition of Metastasis-Directed Therapy to Standard of Care for Oligometastatic Solid Tumors: Primary Analysis of All Tumor-Histology Baskets of the Phase II Randomized EXTEND Trial. J Clin Oncol. 2026 May 16:101200JCO2502856.
FASTRACK II (TROG 15.03) NCT02613819
ForInoperable/surgery-declining primary RCC, T1b-dominant, median age 77
TL;DR100% LC at 84 months in primary RCC (N=70) treated with SABR; G3 AE 10%, no grade 4 events or cancer deaths.
vs leading data
- Thermal ablation (cryo/RFA) LC decreases for T1b+ tumours; SABR's 100% LC in this T1b-dominant cohort addresses where ablation underperforms
9 details
Methods
- π Non-randomised phase 2, N=70 (71 enrolled, 1 withdrew consent), 8 sites (AU/NL); median f/u 62 months (IQR 60-72)
- π Eligibility: medically inoperable, high-risk, or surgery-declining; ECOG β€2; tumour β€10cm; N0-N1
- π SABR dose: 26 Gy Γ 1 for tumour β€4cm; 42 Gy/3fx at 48h intervals for >4cm
- π Median age 77 (IQR 70-82); 70% male; T1b dominant (56%); median tumour 46mm (IQR 37-55)
Results
- π 1Β° EP: 100% freedom from local progression at 36, 60, and 84 months
- π No G4 events, no treatment-related deaths, no new long-term safety signals at 62-month median f/u
Critique
- β οΈ G3 AEs within 9 months: 7 pts (10%)
- Abdominal/flank/tumour pain: 4 (6%)
- Nausea/vomiting: 3 (4%)
- Colonic obstruction: 2 (3%)
- Diarrhoea: 1 (1%)
- β οΈ Single-arm, all inoperable/surgery-declining; no randomised comparator vs partial nephrectomy or ablation β LC durability not generalisable to operable candidates
- β οΈ Varian-funded (RT equipment manufacturer); sponsor interest aligned with positive SABR outcome
Open questions
- Randomised comparison vs thermal ablation or partial nephrectomy in operable candidates
- OS benefit vs active surveillance in truly inoperable primary RCC
- Durability beyond 84 months for T2a/T3a subset (small N)
π Sources Β· π 1 paper
Long-term outcomes of stereotactic ablative body radiotherapy for primary kidney cancer (TROG 15.03 FASTRACK II): a multicentre, non-randomised, phase 2 study.
Abstract
BACKGROUND: Stereotactic ablative body radiotherapy (SABR) is an emerging, non-invasive alternative for primary renal cell carcinoma. We aimed to provide the final long-term trial outcomes of TransTasman Radiation Oncology Group (TROG) 15.03 FASTRACK II, the first phase 2 trial investigating SABR for primary renal cell carcinoma to our knowledge.<br/><br/>METHODS: FASTRACK II was a non-randomised, phase 2 study conducted in eight hospitals in Australia and the Netherlands by TROG and the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group. Here, we report the final pre-planned follow-up results. Adult patients (aged ≥18 years) with histologically confirmed primary renal cell carcinoma, who were medically inoperable, high risk, or declined surgery, had an Eastern Cooperative Oncology Group performance status of 2 or less, had tumours 10 cm or less in size, and had N0-N1 disease were included. Patients underwent either a single fraction SABR of 26 Gy for tumours 4 cm or less in maximum diameter, or 42 Gy in three fractions delivered 48 h apart for tumours more than 4 cm in maximum diameter. The primary outcome was freedom from local progression to assess local control after SABR evaluated with the Response Evaluation Criteria in Solid Tumours. The primary endpoint and safety were evaluated in the intention-to-treat population. A patient representative was involved in the study design and conduct. The trial was registered with ClinicalTrials.gov (NCT02613819) and is closed to enrolment.<br/><br/>FINDINGS: Between July 28, 2016, and Feb 27, 2020, 71 patients were enrolled and one withdrew consent before treatment. Median follow-up was 62 months (IQR 60-72), median age was 77 years (70-82). 49 (70%) of 70 patients were male and 21 (30%) were female. Race and ethnicity data were not collected. The median tumour size was 46 mm (37-55), with 24 (34%) patients with T1a disease, 39 (56%) with T1b disease, six (9%) with T2a disease, and one (1%) with T3a disease. One patient (1%) had nodal involvement (N1). SABR resulted in 100% local control at 36 months, 60 months, and 84 months. Seven (10%) patients had at least one grade 3 adverse event within 9 months of SABR that was designated possibly, probably, or definitely related to treatment: nausea and vomiting (three [4%] events); abdominal, flank, or tumour pain (four [6%]); colonic obstruction (two [3%]); and diarrhoea (one [1%]). No new long-term safety signals, grade 4 events, or treatment-related deaths were noted.<br/><br/>INTERPRETATION: Long-term follow-up supports the safety and local control of SABR for non-surgical patients with renal cell carcinoma, with no observed local recurrences or cancer-related deaths in this cohort, which had predominantly T1b disease or higher.<br/><br/>FUNDING: The Cancer Australia Priority-driven Collaborative Cancer Research Scheme and Varian.
π Siva S, Pryor D, Martin J, Hardcastle N, Moon D, Kron T, Higgs B, Foroudi F, Ruben J, Sridharan S, Montgomery R, Davey R, Lin C, Shaw M, Lawrentschuk N, Appu S, Vanneste BGL, Hofman MS, Murphy DG, De Abreu Lourenco R, Mancuso P, Brook NR, Raman A, Wong LM, Sidhom M, Wood S, Ali M, Bressel M. Long-term outcomes of stereotactic ablative body radiotherapy for primary kidney cancer (TROG 15.03 FASTRACK II): a multicentre, non-randomised, phase 2 study. Lancet Oncol. 2026 May 17:S1470-2045(26)00091-4.
NRG/RTOG 1005 NCT01349322
ForPost-lumpectomy high-risk early breast: grade 3, ER-neg, LVI, or close margins
TL;DR7-yr IBR 2.6% vs 2.2%, HR 1.31 (90% CI 0.84-2.04); concurrent boost noninferior, reducing treatment to 15 fractions.
vs leading data
- vs EORTC 22881-10882 (Bartelink): addresses delivery timing, not boost vs no boost; landmark context only
9 details
Methods
- π Phase III unblinded RCT, N=2,255 analyzed; 278 sites, North America + 6 countries; median f/u 7.3 yr
- π High-risk post-lumpectomy: grade 3 (52.7%), ER-neg (29.6%), LVI (16.7%), close margins (16.7%), chemo (61.8%)
- π Concurrent arm: WBI 40 Gy/15F + simultaneous boost 0.53 Gy/fx (15 total fractions)
- π Sequential arm: WBI 50 Gy/25F or 42.7 Gy/16F + boost 12-14 Gy/6-7F after (22-32 total fractions)
Results
- π 1Β° EP (IBR noninferiority): HR 1.31 (90% CI 0.84-2.04), p=0.037; upper bound 2.04 < NI margin 2.12
- π 7-yr IBR: 2.6% concurrent vs 2.2% sequential; 5-yr: 1.9% vs 2.1%; 56 total events
- π No significant differences in DFS, DDFS, OS, or RNR between arms; 7-yr RNR 1.2% overall
- π Cosmesis at 3yr: NI met by both measures
- Physician-rated excellent/good: 82.4% concurrent vs 85.9% sequential, p=0.34
- Central digital photo review excellent/good: 72.0% vs 64.2%, p=0.11
- BCTOS mean change from baseline: 0.18 concurrent vs 0.16 sequential (NI met)
Critique
- β οΈ G3-4 AEs similar between arms (p=0.81); radiation dermatitis, fatigue, breast pain most prevalent
Open questions
- Long-term cosmesis and fibrosis beyond 3-yr QoL endpoint
- Applicability to pts on hormonal therapy without chemo (lower baseline risk)
- Integration with APBI or partial-breast techniques
π Sources Β· π 1 paper
Concurrent Versus Sequential Radiation Dose Escalation to the Surgical Cavity for Conservative Treatment of High-Risk Early Breast Cancer: NRG/RTOG 1005 Phase III Trial.
Abstract
PURPOSE: For patients with breast cancer undergoing breast conservation, escalating the dose (boost) of radiation to the lumpectomy cavity after whole-breast irradiation (WBI) reduces ipsilateral breast recurrence (IBR) but extends treatment duration. This phase III trial investigated whether boost delivery during WBI versus after WBI provides noninferior IBR and preserves cosmetic appearance.<br/><br/>METHODS: NRG/RTOG 1005 randomly assigned patients at higher risk for IBR after lumpectomy and axillary surgery to either a sequential boost of 12 Gy in six fractions(F) or 14 Gy in 7F after WBI of 50 Gy in 25F or 42.7 Gy in 16F (sequential arm) or a concurrent boost of 8 Gy in 15F of 0.53 Gy per day with WBI of 40 Gy in 15F (concurrent arm) using 3-dimensional conformal radiation therapy (RT) or intensity-modulated RT. Based on 1.59% 5-year IBR for the sequential arm, defining the noninferiority margin as a hazard ratio upper limit on the 90% CI of 2.12, 2,312 patients provide 80% power for noninferiority of IBR as first recurrence for the concurrent arm. Secondary end points included disease-free survival and overall survival, adverse events (AEs), and cosmetic outcomes.<br/><br/>RESULTS: Between May 24, 2011, and June 20, 2014, 2,354 patients were randomly assigned, with 2,255 eligible for analysis (sequential arm, n = 1,118; concurrent arm, n = 1,137). With median follow-up of 7.3 years, there were 56 IBR events; 5- and 7-year IBR were 2.1% and 2.2% on the sequential arm and 1.9% and 2.6% on the concurrent arm, respectively. The noninferiority criterion was met: HR (90% CI): 1.31 (0.84 to 2.04), P = .037. No differences were observed in AEs, cosmetic outcomes, or survival between arms.<br/><br/>CONCLUSION: Concurrent boost during WBI results in noninferior IBR compared with sequential boost without worsening toxicity or cosmetic outcomes and reduces overall treatment time.
π Vicini FA, Winter K, Freedman GM, Arthur DW, Rosenstein BS, Bentzen SM, Li XA, Halyard MY, Woodward WA, Bleicher RJ, Taghian A, Lyons J, Tomberlin JK, Seaward SA, Cheston SB, Hoover AC, Anderson BM, Perera FE, Poppe MM, Petersen IA, Jhawar S, Hijal T, Moughan J, Movsas B, White JR. Concurrent Versus Sequential Radiation Dose Escalation to the Surgical Cavity for Conservative Treatment of High-Risk Early Breast Cancer: NRG/RTOG 1005 Phase III Trial. J Clin Oncol. 2026 May 11:JCO2502465. ; PMCID: PMC13166090.
APBI-IMRT Florence NCT02104895
ForEarly BC post-BCS, pT <25mm, FSM β₯5mm, age >40
TL;DR15-yr IBTR 7.7% vs 4.2% (HR 1.57, p=0.17); no locoregional control, BCSS, or OS difference confirms APBI de-escalation.
vs leading data
- Consistent with RAPID (phase III, similar local recurrence rates); supports guideline-listed APBI indications
| Endpoint | APBI (15-yr) | WBI (15-yr) | p |
|---|---|---|---|
| IBTR | 20 (7.7%) | 11 (4.2%) | 0.14 |
| IBTR HR | 1.57 (0.82-3.04) | β | 0.17 |
| Local relapse | 5 (2.1%) | 4 (1.6%) | 0.75 |
| New ipsilateral primary | 15 (5.9%) | 7 (2.7%) | 0.09 |
+2 more figures
7 details
Methods
- π Phase III equivalence trial, N=520, 1:1 randomization, enrolled 2005-2013
- π APBI: IMRT 30Gy/5 fractions; WBI: 50Gy/25# + 10Gy tumor bed boost
- π Eligible: BCS, pT <25mm, FSM β₯5mm, age >40; ITT for survival, per-protocol for toxicity/cosmesis
CONSORT flow
Randomized 520
β
PBI IMRT (30Gy/5#)
allocated 260
WBI (50Gy/25# + 10Gy TBB)
allocated 260
Results
- π Secondary oncological outcomes at 15 years
Critique
- β οΈ IBTR excess in APBI driven by new ipsilateral primaries, not true local recurrence
- β οΈ Equivalence powered for 5-yr IBTR Ξ5%; underpowered to exclude small absolute OS differences at 15 years
- β οΈ 2005-2013 enrollment; applicability with contemporary genomic risk stratification uncertain
Open questions
- Whether IBTR signal from new primaries reflects inadequate coverage or independent field biology
- Applicability with contemporary genomic risk stratification and wider APBI eligibility criteria
- Long-term cosmesis and toxicity outcomes in per-protocol population
π Sources Β· π¦ 1 tweet
π Fifteen-year outcomes of the randomised APBI-IMRT Florence phase Ill trial of partial versus whole-breast irradiation in early breast cancer β¨
— Elisabetta Bonzano MD, PhD (@to_be_elizabeth) May 17, 2026
Excellent presentation led by @CarlottaB ππ»#ESTRO26 @Icro_Meattini @ESTRO_RT @OncoAlert #OncoAlertAF pic.twitter.com/1j4bIA2nyC
OLIGOMA NCT04495309
ForMetastatic breast, β€5 mets, any systemic therapy line
TL;DRmPFS 35.8 vs 20.4 mo, HR 0.48; first RCT positive for MDT in oligometastatic breast cancer.
vs leading data
- Claimed first RCT positive for MDT PFS specifically in oligomet breast; confirmatory trials ongoing (TAORMINA, STEREO-SEIN, LARA, CLEAR)
+2 more figures
5 details
Methods
- π Randomised; metastatic breast any line, β€5 lesions; systemic Β± ablative RT to all mets
- π >80% had 1-3 mets; 2/3 of lesions bone mets; majority ER/PR+, HER2- in 1st-line
CONSORT flow
Randomized 87
β
Systemic + ablative RT
allocated 43
Systemic alone
allocated 44
Results
- π QoL 12-wk co-primary met: QLQ-C30 diff -2.1 (-9.2 to 5.1), NI margin -10 pts (n=64)
Critique
- β οΈ Stopped early: enrolled <20% of initial, <40% of amended target; N=87 total
- β οΈ HR CI very wide (0.25-0.91); no OS data reported
Open questions
- Which subgroups benefit most (therapy line, met burden, histology subtype)?
- OS benefit not yet demonstrated; durability of PFS gain uncertain
- Will confirmatory data from ongoing breast-specific MDT RCTs align?
π Sources Β· π¦ 3 tweets
π Metastases-directed treatment in Patients with Oligometastatic Breast Cancer: Results from the OLIGOMA-trial (ARO-2021-09, NCT04495309) @DavidKrugMD ππ» #ESTRO26 @ESTRO_RT @OncoAlert #OncoAlertAF pic.twitter.com/YDMef0fXRm
— Elisabetta Bonzano MD, PhD (@to_be_elizabeth) May 17, 2026
βοΈ The OLIGOMA trial results just dropped at #ESTRO26 and they are massive. A 15-month improvement in median PFS for OMD breast cancer (HR = 0.48). This adds to the growing mountain of evidence that MDT (Metastasis-Directed Therapy) works. Letsβs go 𧡠1/n pic.twitter.com/5uiEVSYtdH
— NonsparseOncologist (@5_utr) May 17, 2026
Here are some details!
— Jeff Ryckman (@jryckman3) May 17, 2026
On OLIGOMA, nearly 3/4 were first line endocrine or chemotherapy. #ESTRO26 #OncTwitter@CJTsaiMDPhD pic.twitter.com/r3kJzNNsyK
DBCG HYPO
ForNode-negative early breast cancer or DCIS, adjuvant whole-breast RT
TL;DR10-yr G2-3 induration HR 0.76 (19.5% vs 24.7%) favoring 40Gy/15fr; OS and locoregional outcomes equivalent at 12.8yr median f/u.
vs leading data
- Consistent with START B and FAST-FORWARD: extends long-term safety/efficacy evidence for moderate hypofractionation beyond 5yr
| Endpoint | 50 Gy/25fr | 40 Gy/15fr | HR (95% CI) | p |
|---|---|---|---|---|
| 10-yr G2-3 induration | 24.7% | 19.5% | 0.76 (0.62-0.92) | 0.005 |
| 10-yr OS | 92.1% | 93.0% | 0.81 (0.63-1.04) | 0.10 |
+1 more figure
4 details
Methods
- π Phase III non-inferiority RCT (1:1), N=1,882, node-negative BC or DCIS, Denmark/Norway/Germany, 2009-2014
CONSORT flow
Randomized 1882
β
50 Gy/25fr
allocated 949
analyzed 936
40 Gy/15fr
allocated 933
analyzed 917
Results
- π No significant differences in locoregional recurrence, distant failure, or breast cancer mortality at 10 yrs
Critique
- β οΈ Original 1Β° EP was 3-yr grade β₯2 induration; 10-yr toxicity, recurrence, and survival analyses were prespecified
- β οΈ Trial not powered for 10-yr OS as 1Β° endpoint; HR 0.81 (p=0.10) non-significant and should not be over-interpreted
Open questions
- Whether 10-yr induration benefit extends to pts receiving regional nodal RT
- Long-term comparison with ultra-hypofractionation (FAST-FORWARD 26Gy/5fr)
π Sources Β· π¦ 1 tweet
Day TWO of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 17, 2026
10-year Follow-Up of the DBCG HYPO Trial: Breast Induration, Recurrence and Survival After Hypofractionated Whole Breast Irradiation Presented by Hanna Forsberg π©π° @BOffersen #RadOnc β’οΈ #BreastCancer
The DBCG HYPO trial reports⦠pic.twitter.com/4qf9R3HZwT
IMPORT HIGH
ForInvasive early BC (pT1-3, pN0-N3a, M0) post-BCS requiring tumour bed boost RT
TL;DR48Gy SIB: 10-yr IBTR 3.7% vs 3.5% sequential boost, non-inferior; further escalation to 53Gy not beneficial (5.5%).
vs leading data
- 5-yr non-inferiority of 48Gy SIB published Lancet 2023 (401:2124-37); 10-yr results confirm durable local control
| Arm | 10-yr IBTR (95% CI) |
|---|---|
| 40Gy/15F + 16Gy/8F | 3.5% (2.4, 5.0) |
| 48Gy/15F (3.2Gy/F) | 3.7% (2.6, 5.3) |
| 53Gy/15F (3.5Gy/F) | 5.5% (4.1, 7.3) |
+1 more figure
| Arm | 5-yr IBTR (95% CI) |
|---|---|
| 40Gy/15F + 16Gy/8F | 1.9% (1.2, 3.1) |
| 48Gy/15F (3.2Gy/F) | 2.0% (1.2, 3.2) |
| 53Gy/15F (3.5Gy/F) | 3.2% (2.2, 4.7) |
6 details
Methods
- π Phase 3 RCT, N=2617 (1:1:1), 76 UK hospitals, 2009-2015; pT1-3 pN0-N3a M0 invasive BC post-BCS requiring tumour bed boost
- π SIB delivers boost in 15 fractions (3 weeks) vs 23 total for sequential 40+16Gy; reduced pt visits
CONSORT flow
Randomized 2617
β
40Gy/15F + 16Gy/8F (sequential)
allocated 871
48Gy/15F SIB (3.2Gy/F)
allocated 874
53Gy/15F SIB (3.5Gy/F)
allocated 872
Results
- π 10-yr OS absolute difference vs 40+16Gy (both NS)
- 48Gy/15F: -0.5% (-3.0, 2.8)
- 53Gy/15F: +1.5% (-1.4, 5.1)
Critique
- β οΈ 53Gy/15F: numerically higher 10-yr IBTR than control; dose escalation beyond 48Gy adds no benefit
- β οΈ Moderate/marked late AEs at 10yr (all arms)
- Breast distortion/shrinkage: <18%
- Induration: <10%
- Telangiectasia: <2%
- Breast oedema: <2%
- β οΈ 10-yr IBTR in both boost groups remains below the 5% control estimate used in original sample size calculations
Open questions
- Any subgroup that benefits from 53Gy escalation
- Very long-term (>10yr) toxicity trajectory
- Applicability to post-mastectomy or regional nodal RT settings
π Sources Β· π¦ 1 tweet
Day THREE of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 17, 2026
Ten-year results of the IMPORT HIGH trial (ISRCTN47437448): Dose escalated simultaneous integrated boost radiotherapy in early breast cancer Presented by Charlotte Coles π¬π§ #RadOnc β’οΈ
Ten-year IMPORT HIGH trial data show that a⦠pic.twitter.com/7RqVy2SrQm
EORTC IM-MS (22922/10925)
ForStage I-III BC, node-positive or pN0, adjuvant IM-MS RT decision
TL;DR20-yr OS null (HR 1.00, p=0.967); BCM benefit offset by non-BCM excess; pN0: no benefit.
vs leading data
- DBCG IMN2 (Lancet Reg Health Eur 2024): modern IM-MS RT (MHD 1.2 Gy right / 2.3 Gy left) showed BCM + DM + OS benefit at 15yr in node-positive pts
| Arm | 20-yr OS | HR (95% CI) | p |
|---|---|---|---|
| +IM-MS RT | 61.0% | 1.00 (0.90-1.10) | 0.967 |
| -IM-MS RT | 61.8% | β | β |
+3 more figures
| Endpoint (15yr) | +IM-MS | -IM-MS | HR (95% CI) | p |
|---|---|---|---|---|
| BCM | 18.6% | 22.4% | 0.82 (0.72-0.95) | 0.006 |
| non-BCM | 20.4% | 15.8% | 1.26 (1.09-1.46) | 0.002 |
| Late AE (absolute rate) | +IM-MS | -IM-MS |
|---|---|---|
| Lung fibrosis | 6.3% | 3.2% |
| Cardiac fibrosis | 2.7% | 1.7% |
| Cardiac diseases | 15.2% | 11.7% |
| Endpoint (20yr, pN0) | +IM-MS | -IM-MS | HR (95% CI) | p |
|---|---|---|---|---|
| DFS | 53.9% | 53.6% | 0.93 (0.81-1.07) | 0.318 |
| DMFS | 67.2% | 67.4% | 0.93 (0.78-1.10) | 0.397 |
4 details
Methods
- π Phase III RCT, N=4004, stage I-III BC; IM + medial supraclavicular RT vs no IM-MS RT; 20-yr follow-up
CONSORT flow
Randomized 4004
β
+IM-MS RT
allocated 2002
-IM-MS RT
allocated 2002
Results
- π BCM reduction (HR 0.82, p=0.006 at 15yr) fully offset by non-BCM excess (HR 1.26, p=0.002); net OS nullified at 20yr
Critique
- β οΈ pN0 subgroup: no DFS or DMFS benefit at 20yr; IM-MS benefit restricted to node-positive disease
- β οΈ EORTC era heart doses 4-9x higher than DBCG IMN2; late cardiac mortality likely drives the non-BCM excess at 20yr
Open questions
- Whether modern low-dose cardiac RT (DBCG IMN2) restores net OS benefit at 20yr
- Which node-positive subgroup (pN1 vs pN2-3) retains net BCM benefit over late cardiotox
- Should pN0 be excluded from IM-MS RT indications given consistently null data
π Sources Β· π¦ 2 tweets
π Internal Mammary and Medial Supraclavicular irradiation in stage I-III breast cancer: 20 years results of the randomised EORTC trial 22922/10925, including in pNo patients
— Elisabetta Bonzano MD, PhD (@to_be_elizabeth) May 17, 2026
Special Joint Presentation Led by Prof. Philip Poortmans and Orit Kaidar-Person ⨠at #ESTRO26 @ESTRO_RT⦠pic.twitter.com/KIoJtdhEzp
20-year outcomes of @EORTC internal mammary #radiotherapy trial.
— Shankar Siva (@_ShankarSiva) May 17, 2026
β‘οΈinternal mammary improved control
β‘οΈ survival counterbalanced by late adverse events #radiotherapy #bcsm
Great to see the long term data at #ESTRO26, and discussing Charlotte Cole suggests with modern RT, long⦠pic.twitter.com/yPtlfrLcri
DBCG RT Natural
Forβ₯60y, pT1N0, ER+ β₯10%, HER2-normal, grade 1-2, unifocal post-lumpectomy
TL;DR9.8% 4-yr LR without PBI vs 1.5% with PBI in pT1N0 low-risk elderly breast conservation; stopped early per pre-specified threshold.
vs leading data
- PRIME II (Lancet Oncol 2015): ~10% 10-yr LR without RT in β₯65y low-risk ER+; RT benefit durable
| Arm | Events/Total | CIF % (95% CI) |
|---|---|---|
| +RT | 2/236 | 1.5 (0.3-5.1%) |
| -RT | 19/272 | 9.8 (5.9-14.9%) |
| S-RT | 18/278 | 8.2 (4.5-13.3%) |
+1 more figure
4 details
Methods
- π Phase III RCT; β₯60y, pT1N0, ER+ β₯10%, HER2-normal, grade 1-2, unifocal, non-lobular, margin β₯2mm, breast conservation
- π RT arm: PBI 40Gy/15fr; ET per DBCG guideline (recommended pT1c and/or grade 2); stratified by institution + ET yes/no
CONSORT flow
Randomized 508
β
PBI 40Gy/15fr
allocated 236
No PBI
allocated 272
Critique
- β οΈ Median FU 4 yrs; primary endpoint is 5-yr invasive LR; stopped early per pre-specified 4% max-LR threshold
- β οΈ Suboptimal ET adherence per presenter; -ET groups drive high LR in the -RT arm; adherence confounds the no-treatment effect
Open questions
- Whether WBRT (vs PBI) changes the RT-omission picture in this population
- Which molecular low-risk subset, if any, can safely defer all adjuvant therapy
- Duration of ET benefit when combined with PBI in β₯60y low-risk pts
π Sources Β· π¦ 2 tweets
Another trial showing even for lR optimal local control with RT and ET and suboptimal adherence to ET. In era of 5 fraction decision making is easier # Estro2026 pic.twitter.com/nkvYl3iuTn
— Sushil (@Sushilberiwal) May 17, 2026
Danish #breastcancer partial breast #radiotherapy βnaturalβ trial.
— Shankar Siva (@_ShankarSiva) May 17, 2026
β‘οΈ No postoperative treatment had highest risk of recurrence
β‘οΈeither tamoxifen or #radonc reduced recurrence
β‘οΈcombined tamoxifen + RT had no recurrences
In context of EUROPA trial, RT has best QoL vs endocrine⦠pic.twitter.com/bDVmbDKRNb
HypoG-01
ForEarly-stage breast cancer, adjuvant hypofractionated RT
TL;DRLRR 16% of 118 events; failure patterns comparable between 40 Gy/15fx and 50 Gy/25fx; most in-volume per ESTRO guidelines.
vs leading data
- Patterns of failure not obviously different between 3-week and 5-week arms
- ESTRO-guided contouring adequately covers LRR sites
| Event type | n | % |
|---|---|---|
| Isolated distant recurrence | 61 | 51% |
| Second malignancy | 37 | 31% |
| LRR (iLRR + cLRR) | 20 | 16% |
+1 more figure
6 details
Methods
- π Pre-planned secondary analysis of HypoG-01 phase III RCT (ITT); N=1260, median f/u 4.8 years
- π 40 Gy/15fx vs 50 Gy/25fx + tumor-bed boost; endpoint: first oncological event (LRR, DR, or second malignancy)
Results
- π 118 first oncological events total; LRR lowest-frequency event (20/118, 16%)
- π First events by type (N=118)
- Isolated distant recurrence: 61 (51%)
- Second malignancy: 37 (31%)
- LRR (isolated + concomitant): 20 (16%)
- π Of LRR sites assessed: 20/30 in-volume (67%) per ESTRO contouring; 19/30 were nodal (mainly L1 & L2)
Critique
- β οΈ Secondary analysis not powered for arm-vs-arm failure subtype comparisons; no formal statistical testing of between-arm pattern differences reported
Open questions
- Longer f/u needed to assess late second malignancy differences between arms
- Whether ESTRO contouring adequacy extends to higher-risk subgroups (node-positive, TNBC)
π Sources Β· π¦ 1 tweet
Day TWO of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 16, 2026
Patterns of locoregional and distant recurrence and dosimetric analysis in the HypoG-01 phase III trial Presented by Louis Munschi π«π· #RadOnc β’οΈ
In the HypoG-01 phase III trial (1260 patients, median follow-up 4.8 years), 118β¦ pic.twitter.com/ogARInu0fB
Dutch BCRG Breast Boost (Modern Systemic Era)
ForEarly-stage breast cancer, BCT + WBRT, modern systemic therapy era, stratified b
TL;DR10-yr IBTR 1.2% with or without boost in 0-2 risk-factor BCT pts; boost omission appears safe in modern systemic era.
vs leading data
- vs EORTC 22881/10882 (Bartelink, Lancet Oncol 2015): boost reduced IBTR ~50% in pre-modern-systemic era; absolute benefit appears negligible for 0-2 rf pts now
| Risk factors | 5yr IBTR (no boost) | 5yr IBTR (boost) | 10yr IBTR (no boost) | 10yr IBTR (boost) |
|---|---|---|---|---|
| 0-2 (N=15,085/13,845) | 0.6% | 0.7% | 1.2% | 1.2% |
| β₯3 (N=149/733) | 1.3% | 2.9% | 2.7% | 3.3% |
| Uncertain (N=592/944) | 0.8% | 3.3% | 1.4% | 3.6% |
+1 more figure
5 details
Methods
- π Dutch registry retrospective cohort, BCT pts 2012-2016; boost vs no-boost allocation was clinical, non-randomized
- π Five risk factors scored: age β€40, grade 3, TNBC, inadequate guideline-directed systemic therapy, no pCR post-NACT in TNBC/HER2+
- 0-2 rf: large majority (n=15,085 no boost, n=13,845 boost)
- β₯3 rf: small high-risk minority (n=149 no boost, n=733 boost)
Results
- π Assisi decision thresholds: boost omissible if 10yr IBTR <3% (boosted cohort) or <6% (no-boost); only boosted β₯3-rf pts exceeded threshold at 10yr (3.3%)
Critique
- β οΈ Non-randomized; no-boost selection reflects clinician risk stratification, not random allocation; confounding by indication expected
- β οΈ No-boost arm for β₯3 rf pts very small (n=149); insufficient to characterize boost omission in high-risk subgroup
Open questions
- RCT needed to confirm boost omission equivalence in 0-2 risk-factor pts
- Optimal RT boost strategy for β₯3 risk-factor pts where boosted 10yr IBTR still exceeds Assisi threshold
π Sources Β· π¦ 1 tweet
Day TWO of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 16, 2026
Is a boost to the tumour bed still indicated after breast-conserving surgery and whole-breast radiotherapy in the era of modern systemic therapy? Presented by Femke Froklage π³π± #RadOnc β’οΈ
We aimed to identify a subgroup of breast⦠pic.twitter.com/RqK5r9XPqW
RAPCHEM
ForNode-positive breast cancer achieving pathological nodal response after neoadjuv
TL;DR10yr locoregional recurrence <3% with nodal-response-guided RT de-escalation after neoadjuvant in breast cancer.
vs leading data
- Complete RT omission remains separately under validation via B-51 and other prospective studies
3 details
Methods
- π De-escalation strategy: locoregional RT field/dose reduced based on nodal pathological response after neoadjuvant chemotherapy
Results
- π Locoregional recurrence <3% at 10yr with pathological nodal response-guided RT de-escalation post-neoadjuvant
Critique
- β οΈ No CI, HR, or comparator arm outcome reported in source; design not confirmed as randomized
Open questions
- Can RT be safely omitted (not just de-escalated) after pathological nodal response?
- Will B-51 confirm safety of complete locoregional RT omission post-neoadjuvant?
π Sources Β· π¦ 1 tweet
A 10 aΓ±os de RAPCHEM son muy buenos y tranquilizadores: desescalar RT locorregional segΓΊn respuesta nodal tras neoadyuvante da tasas de recurrencia <3%. Sin embargo, la omisiΓ³n completa de RT sigue en proceso de validaciΓ³n (estudios prospectivos + B-51). #RadOnc#ESTRO26 https://t.co/dlpH8joIGA
— Amadeo Wals (@AmadeoWals) May 17, 2026
OligoCare
ForOligometastatic solid tumors, multiple histologies, 1-5 mets, SABR-eligible
TL;DR88.6% local control at 3yrs across 2447 pts; CRC shows worst local control despite highest delivered dose.
vs leading data
- Adds real-world multi-institutional scale to phase II RCT signals (SABR-COMET, STOMP, ORIOLE); direction consistent
| Tumor type | 1-yr local failure | 3-yr local failure |
|---|---|---|
| CRC | 9.3% | 19.6% |
| Breast | 4.1% | 11.3% |
| NSCLC | 6.0% | 9.8% |
| Prostate | 2.7% | 8.1% |
+2 more figures
7 details
Methods
- π Prospective multi-institutional EORTC registry (OligoCare), 57 sites; interim analysis
- π 2447 pts, 3533 lesions; median age 69 (range 28-94), 69% male; median f/u 31 months
Results
- π 88.6% local control at 3yrs
- π Minimum PTV dose: most critical technical factor for local control
Critique
- β οΈ De novo OMD better LC than repeat OMD (attributed to higher delivered dose in de novo setting)
- β οΈ CRC worst LC despite highest median dose per fraction; relative radioresistance; combination treatment or dose escalation strategies may be needed
- β οΈ Single-arm interim registry; no comparator; histology mix and 6-yr enrollment window limit subgroup inference
Open questions
- Optimal approach for CRC oligomets (combination treatment, dose escalation?)
- Minimum PTV dose thresholds for adequate LC across histologies
- Whether LC advantage for de novo vs repeat OMD reflects dose, biology, or selection
π Sources Β· π¦ 1 tweet
π£ #ESTRO26 - @UmbertoRicardo e2irradiate @EORTC prospective OLIGOCARE registry of SABR for oligomets. ~2500 patients, ~3500 mets.
— Shankar Siva (@_ShankarSiva) May 17, 2026
β‘οΈ local failure 5% at 1 year and 11% at 3 years
β‘οΈ Colorectal cancer has higher risk of progression
β‘οΈ minimum PTV dose correlated with outcomeβ¦ pic.twitter.com/cx4zERqHhK
EXTEND
ForOligometastatic solid tumors, multiple histologies, all disease sites, systemic
TL;DRPhase II RCT of MDT added to SOC for oligometastatic solid tumors, all histology baskets; no effect size in source tweet.
vs leading data
- Broadens prior oligometastatic MDT RCT signal (STOMP, ORIOLE, SINDAS) to multi-histology population with prospective design
5 details
Methods
- π Phase II randomized, multi-histology basket design; all solid tumor histologies eligible
- π MDT + SOC vs SOC alone; metastasis-directed therapy (radiation-based ablation) added to ongoing systemic SOC
- π ctDNA correlatives presented at ESTRO26 synchronously with primary JCO publication
Results
- π Primary aggregated analysis across all tumor histology baskets; no effect size reported in source tweet
Critique
- β οΈ Basket aggregation across histologies: pooled primary estimate may obscure site-specific heterogeneity in MDT benefit
Open questions
- Which histology baskets drove the primary endpoint signal?
- Do ctDNA dynamics at baseline or on-treatment predict MDT benefit?
- Does Phase III confirmation across histologies follow?
π Sources Β· π¦ 1 tweet
1/ Tremendous thanks to the patients, coauthors and all who made the EXTEND trial possible. The primary aggregated analysis is now available online @JCO_ASCO with ctDNA correlatives presented synchronously at @ESTRO_RT #ESTRO26 pic.twitter.com/Zoy8DGRWbW
— Alexander Sherry (@AlexSherryMD) May 17, 2026
PRIME NCT03561961
ForHigh-risk, very high-risk, or node-positive non-metastatic prostate cancer
TL;DRSBRT 5fx with pelvic RT: G3+ toxicity <1%, comparable early BFFS to moderate hypo (N~434); mature 4-5yr endpoint pending.
vs leading data
- vs HYPO-RT-PC (10-yr mature, HR 0.84, CI 0.69-1.03): non-inferior but node-negative, no ADT, no pelvic RT
| Toxicity | SBRT 5fx | Moderate Hypo 25fx |
|---|---|---|
| Acute GU G2+ | ~5.4% | ~4.0% |
| Acute GI G2+ | ~2.2% | ~3.7% |
| Acute G3+ GU/GI | <1% | <1% |
| Late GU G2+ (1-2yr) | ~10-12% | ~9-11% |
| Late GI G2+ (1-2yr) | ~5-7% | ~4-6% |
| Late G3+ GU/GI | <1% | <1% |
+1 more figure
7 details
Methods
- π Phase III open-label non-inferiority, N ~434; Tata Memorial + collaborating centers, India
- π High-risk, very high-risk, and/or node-positive non-metastatic prostate cancer; ECOG 0-2; PSMA PET/CT staging allowed
- π Both arms: prostate + whole-pelvis RT + long-course ADT (~2yr); SIB to positive nodes in SBRT arm
- π Fractionation
- Arm A (SBRT): 36.25 Gy/5fx (7.25 Gy/fx), every other day
- Arm B (moderate hypo): ~68 Gy/25fx (2.7 Gy/fx), 5fx/wk
Results
- π 1Β° EP: BFFS (Phoenix nadir +2 ng/mL); interim only, mature 4-5yr data pending
- π Early BFFS, MFS, OS: no significant differences; no inferiority signal for SBRT at interim
Critique
- β οΈ Interim analysis (1-2yr f/u) only; 4-5yr primary endpoint not yet reached; non-inferiority pending
Open questions
- Mature BFFS/MFS/OS at 4-5yr follow-up to confirm non-inferiority
- Long-term late toxicity (>2yr) profile with 5-fraction pelvic SBRT
- Impact of PSMA PET/CT staging on outcomes vs conventional imaging cohorts
π Sources Β· π¦ 1 tweet
PRIME trial
— Rohit Malde (@roxboxfix) May 18, 2026
Can we safely deliver ultra-short SBRT including pelvic nodal irradiation in biologically aggressive disease treated with ADT?
With Pelvic RT
Moderate hypofractionation:
~68 Gy/25#/5w
Vs
Extreme hypofractionation/SBRT:
36.25 Gy / 5 # /1-2w
Compare HYPO RT PC pic.twitter.com/7NABknLsD5
PIVOTALboost
ForHigh-risk localised prostate cancer, moderately fractionated 20-fraction RT
TL;DRLate G2+ bowel 6.5-8.7%, bladder 16.5-24.1% at 2yr, no increase with focal boost or pelvic node RT vs prostate-only (N=1465).
vs leading data
- vs FLAME (JCO 2021): focal boost improved 5yr bFFS in high-risk prostate with no significant late GI/GU toxicity increase; PIVOTALboost 2yr safety consistent, but FLAME used conventional fractionation (39fr)
| Arm | Bowel G2+ | Bladder G2+ |
|---|---|---|
| Prostate (n=281) | 8.2% (5.7-11.7) | 19.5% (15.5-24.4) |
| Prostate+Boost (n=345) | 8.7% (6.3-12.1) | 24.1% (20.2-28.7) |
| Prostate+Nodes+Boost (n=347) | 6.5% (4.5-9.5) | 16.5% (13.1-20.6) |
+1 more figure
5 details
Methods
- π Phase 3 RCT, N=1465, 39 UK centres; 3 arms (prostate, prostate+boost, prostate+pelvic+boost); 20-fraction moderately hypofractionated RT
- π High-risk localised prostate cancer; 1Β° EP biochemical/clinical failure β efficacy data not reported here; secondary toxicity endpoints presented
Results
- π Early bowel side effects increased with pelvic node RT; resolved by 18 weeks post-RT
- π No significant differences in G2+ bowel or bladder toxicity at 2 years across arms (973 pts, 74% with β₯2yr f/u)
Critique
- β οΈ 2-year late toxicity is preliminary for prostate RT; G3+ late effects can emerge at 5+ years
Open questions
- Primary efficacy (biochemical/clinical failure) not yet reported
- Late toxicity beyond 2 years needed to confirm durability
π Sources Β· π¦ 1 tweet
Day THREE of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 17, 2026
Moderately fractionated prostate radiotherapy with a focal boost: acute and preliminary late side effects from the phase 3 PIVOTALboost trial Presented by Isabel Syndikus π¬π§ #RadOnc β’οΈ
In the PIVOTALboost trial, we treated 1314β¦ pic.twitter.com/cGuR1j2Qos
PACE-NODES
ForHigh-risk localised prostate (T3a-T4, Gleason 8-10, or PSA >20), planned ADT 12-
TL;DRPPN-SBRT increases Gβ₯2 GI toxicity (28% vs 21%) vs prostate-only SBRT; symptoms resolved by 12wk; GU toxicity equivalent; efficacy endpoint pending.
vs leading data
- POP-RT (NEJM 2021): nodal RT improved bFFS with moderate hypofractionation in high-risk pts; PEACE-2 showed no nodal RT benefit (conventional fractionation); PACE-NODES tests the same hypothesis with SBRT fractionation for nodes
| Endpoint | PPN-SBRT | P-SBRT |
|---|---|---|
| Gβ₯2 GI toxicity (12wk) | 28% | 21% |
+1 more figure
8 details
Methods
- π Phase 3 RCT, 1:1; high-risk localised prostate (T3a-T4, Gleason 8-10, or PSA >20), planned ADT 12-36mo; target N=1128, 1166 randomised
- π P-SBRT: 36.25Gy/5f (prostate); PPN-SBRT: 36.25Gy/5f (prostate) + 25Gy/5f (nodes), alternate days
Results
- π Gβ₯2 GI toxicity over 12wk: 28% PPN-SBRT vs 21% P-SBRT
- π GI symptoms resolved; no difference between arms at 12 weeks
- π EPIC-26 bowel domain worse at 4 weeks in PPN-SBRT arm
- π No difference in acute GU toxicity (CTCAE or patient-reported)
Critique
- β οΈ 11% PPN-SBRT vs 4% P-SBRT did not receive allocated treatment, mostly due to planning constraints not being met
- β οΈ Primary endpoint (time to biochemical/clinical failure) not yet mature; this is an acute toxicity interim report only
Open questions
- Does nodal SBRT improve bFFS/cFFS vs prostate-only SBRT (primary endpoint pending)?
- Late GI/GU toxicity profile with extended follow-up
- Whether SBRT nodal fractionation recapitulates bFFS benefit seen with POP-RT moderate hypofractionation
π Sources Β· π¦ 1 tweet
Day THREE of #ESTRO26 Coverage by OncoAlert π¨
— OncoAlert (@OncoAlert) May 17, 2026
Acute toxicity in PACE-NODES: A randomised trial of 5 fraction (f) prostate stereotactic body radiotherapy (SBRT) vs 5f prostate and pelvic nodal SBRT
Presented by Angela Pathmanathan π¬π§ #RadOnc β’οΈ #ProstateCancer
PACE-NODES is a⦠pic.twitter.com/z9bAOiKSIy
PEACE-2
ForVery high-risk localized prostate Ca (β₯2 of Gleason β₯8, T3-T4, PSA β₯20), N0M0
TL;DRPelvic RT adds no significant cPFS benefit over prostate-only RT in very high-risk PCa with 3yr ADT (HR 0.81, p=0.088) at interim analysis.
vs leading data
- POP-RT (2yr ADT, conventional imaging, 74-76 Gy EQD2) showed significant pelvic RT benefit across bFFS, cFFS, MFS
| Arm | 7-yr cPFS | HR (95% CI) | p |
|---|---|---|---|
| Pelvic RT | 67.1% [61.6; 72.2] | 0.81 [0.63; 1.03] | 0.088 |
| Prostate-only RT | 62.9% [57.4; 68.1] | reference | β |
+1 more figure
| Endpoint | POP-RT HR (95% CI) | POP-RT p | PEACE-2 HR (95% CI) | PEACE-2 p |
|---|---|---|---|---|
| bFFS/bPFS | 0.50 (0.42-0.61) | <0.001 | 0.97 (0.81-1.16) | 0.73 |
| cFFS/cPFS | 0.74 (0.61-0.90) | 0.002 | 0.81 (0.63-1.03) | 0.09 |
| MFS | 0.72 (0.58-0.89) | 0.002 | 0.93 (0.74-1.17) | 0.54 |
7 details
Methods
- π Trial design
- Phase III 2Γ2 factorial (pelvic vs prostate-only RT Γ Β± cabazitaxel Γ4)
- Very high-risk PCa: N0M0, β₯2 of Gleason β₯8, T3-T4, PSA β₯20
- ADT 3yr + 78 Gy EQD2 dose-escalated IMRT; PSMA PET/CT staging; accrual 2018-2023
CONSORT flow
Randomized 761
β
Pelvic RT
allocated 381
Prostate-only RT
allocated 380
Results
- π All secondary endpoints (bPFS, MFS, CSS, OS) also non-significant with pelvic RT
Critique
- β οΈ Interim analysis at ESTRO 2026 (median f/u ~5.5yr); final prespecified primary analysis pending
- β οΈ PSMA PET/CT may exclude occult metastatic pts who drove pelvic RT benefit in the conventional-imaging era
- β οΈ Longer ADT (3yr vs 2yr) + dose escalation may reduce incremental pelvic RT gain
- β οΈ No added toxicity: comparable Gβ₯2 GU rates in both arms
- β οΈ Blanchard: <1 in 10 dying from PCa at 10yr challenges the 'very high-risk' label in modern-imaged pts
Open questions
- Will final analysis confirm null benefit of pelvic RT with modern staging and 3yr ADT?
- Does PSMA PET/CT staging explain divergence from POP-RT by excluding occult metastatic pts?
- Which pts still benefit from elective pelvic RT in the contemporary dose-escalated ADT era?
π Sources Β· π¦ 2 tweets
π£@PBlanchardMD shows #ESTRO26 that pelvic #radiotherapy in high risk #prostatecancer does not have a large improve in outcomes.
— Shankar Siva (@_ShankarSiva) May 17, 2026
- With only 1 in 10 dying of prostate cancer in 10 years, are these patients truly βhigh riskβ? #pcsm #radonc pic.twitter.com/D0XrGD6iNX
POP RT Vs PEACE II
— Rohit Malde (@roxboxfix) May 18, 2026
2 years ADT + WPRT
Vs 3 years ADT + Prostate Only RT
Tough to choose or you already have a choice ?? pic.twitter.com/42kdSKQYKW
RCC SBRT 5-year LC
TL;DR100% 5-yr local control for RCC treated with SBRT; no additional endpoints in source.
vs leading data
- consistent with FASTRACK II (single-arm phase 2, primary inoperable RCC, high LC at 62-mo median f/u)
3 details
Results
- π 5-yr LC: 100% (per π― emoji in source tweet; no numeric table provided)
Critique
- β οΈ N, fractionation, eligibility, and survival endpoints absent from source
- β οΈ design not specified; likely single-arm phase 2 β no comparator arm
Open questions
- OS/RFS benefit vs partial nephrectomy or thermal ablation
- Optimal fractionation by tumor size and collecting system proximity
π Sources Β· π¦ 1 tweet
These results are so impressive!! π― local control at 5 years for RCC treated with SBRT@DrRanaMcKay @AdityaBagrodia @DrTylerStewart @DrYukselUrun @OncoAlert https://t.co/fUB3airM5g
— Tyler Seibert MD PhD (@TylerSbrt) May 17, 2026
DIREKHT
ForPost-operative HNSCC, low contralateral nodal risk subgroup
TL;DRPost-op RT de-intensification in HNSCC: contralateral neck sparing and/or primary CTV dose reduction to 56 Gy; no effect size reported in source tweet.
vs leading data
- De-escalation context: ECOG-ACRIN 3311 (HPV+ oropharynx) and NRG HN002 established dose/volume reduction as feasible; DIREKHT extends this logic to post-op setting with anatomic field reduction
5 details
Methods
- π Post-operative RT de-intensification trial in HNSCC
- π Two strategies evaluated: contralateral neck sparing in selected pts and/or primary CTV dose reduction to 56 Gy (vs standard 60-66 Gy)
Results
- π No effect size, HR, or primary endpoint result reported in source tweet (content truncated)
Critique
- β οΈ De-intensification trials in post-op HNSCC carry risk of local-regional relapse if patient selection criteria are not tightly specified; contralateral neck failure rates in similar series run 3-8%
Notes
- β Whether contralateral neck sparing and dose reduction are evaluated as independent arms or a composite de-intensification strategy is unclear from source
Open questions
- Local-regional control rates with contralateral neck sparing vs elective nodal irradiation
- Which patient subgroup (HPV+, N stage, margin status) benefits from 56 Gy de-escalation
- Whether both de-intensification strategies are independently randomized or combined
π Sources Β· π¦ 1 tweet
There are tremendous opportunities to improve post-operative radiotherapy in HNSCC. The DIREKHT trial is an excellent example of such work, in which they spared the contralateral neck in a specified group of patients and/or reduced the primary CTV dose to 56 Gy.
— David Sher (@DavidSherMD) May 16, 2026
The details⦠https://t.co/7W84LYIofR