30-Second Takeaway
- Single-fraction lung SBRT remains rarely used but shows survival comparable to multifraction at high-volume centers.
- Durvalumab after stage III NSCLC chemoradiation retains benefit even when started later than PACIFIC timelines.
- Postoperative RT after neoadjuvant immunochemotherapy improves DFS in non-pCR esophageal squamous cell carcinoma with acceptable toxicity.
- Systemic and imaging biomarkers are emerging to refine organ preservation and risk-adapted RT strategies.
- Adjuvant RT for DCIS improves survival without increasing long-term ischemic heart disease risk in a large national cohort.
Week ending December 13, 2025
Radiation oncology decision-points across thoracic, GI, gyn, head and neck, and breast cancer
Single-fraction SBRT for stage I NSCLC is increasing slowly, with survival similar to multifraction regimens
Among 83,377 stage I NSCLC patients in the National Cancer Database, only 1.1% received single-fraction SBRT (SF-SBRT). SF-SBRT utilization rose from 0% in 2006 to 1.6% in 2021, concentrated in high-volume and academic centers. Common SF-SBRT prescriptions were 34 Gy, 27 Gy, and 30 Gy in one fraction, versus 10 Gy × 5, 18 Gy × 3, and 12 Gy × 4 for multifraction SBRT. Overall survival did not differ between SF-SBRT and multifraction SBRT, despite clear practice-level variation in adoption. Smaller tumors (≤2 cm) and treatment at higher-volume centers were independently associated with SF-SBRT use.
Durvalumab after stage III NSCLC chemoradiation shows survival benefit even when started beyond 6 weeks
In a nationwide electronic health record cohort of 854 stage III NSCLC patients, durvalumab after concurrent chemoradiation improved overall survival versus no durvalumab. The adjusted hazard ratio for death with durvalumab, regardless of timing, was 0.44, indicating substantial real-world benefit. Median durvalumab start time was 5.6 weeks after chemoradiation, with no loss of benefit when initiation occurred after week 6. When timing was modeled, survival benefit was not statistically significant for initiation on or before week 4. The survival advantage became significant from week 5 onward, and treatment duration did not differ meaningfully by start time.
Postoperative RT after neoadjuvant immunochemotherapy improves DFS in non-pCR esophageal squamous carcinoma
This retrospective cohort included 204 locally advanced esophageal squamous cell carcinoma patients with non-pCR after neoadjuvant immunochemotherapy. Fifty patients received postoperative radiotherapy (PORT), while 154 did not, with a median follow-up of 27 months. After propensity score matching, PORT significantly improved disease-free survival, with a hazard ratio of 0.26. High-risk subgroups, including ypN+, ypT3-4, stage III-IVA, poor tumor regression grade, and non-downstaging patients, derived notable DFS benefit. Toxicities with PORT were mainly grade 1–2, dominated by radiation esophagitis and myelosuppression, suggesting acceptable tolerability. Without PORT, mediastinal and supraclavicular nodal metastases were the predominant failure sites, supporting comprehensive regional targeting.
References
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Additional Reads
Optional additional studies from this edition.