Radiation Oncology

SBRT alone provides substantial systemic therapy–free survival with low severe toxicity in oligometastatic cancer

This systematic review and meta-analysis included 29 studies with 2074 patients receiving metastasis-directed SBRT without upfront systemic therapy for ≤5 metastases. Among 13 studies (984 patients) in the meta-analysis, pooled 1- to 2-year systemic therapy–free survival was 69.7% (95% CI, 57.4%-80.9%). Renal cell and prostate cancers showed the highest systemic therapy–free survival, 87.0% and 78.1% respectively, with lower rates in other histologies. Across 20 studies, grade ≥3 toxicity was absent in most; observed severe event rates ranged from 1.9% to 8.8%. 1

Postoperative SBRT to the surgical bed is well tolerated with high 2-year control in early oral/oropharyngeal SCC

This national phase 2 trial delivered postoperative SBRT, 36 Gy in 6 fractions over 2 weeks, to the primary bed in pT1–T2 OCSCC/OPSCC with high-risk margins. Among 90 patients, the 2-year rate of grade ≥3 late toxicity was 2.2%, while 14.6% experienced at least one grade ≥3 late event over 2 years. Late severe events were mainly soft-tissue necrosis and osteoradionecrosis and were often transient; acute grade ≥3 toxicity was mostly mucositis (28.9%). Two-year local control was 92.0% (95% CI, 84.6%-96.4%), with median follow-up of 25 months. 2

PORT lowers locoregional recurrence and may benefit selected pN2 NSCLC without ENE

This retrospective single-institution cohort included 231 pN2 NSCLC patients treated with resection and adjuvant chemotherapy, comparing those who did versus did not receive PORT. In 99 propensity-matched pairs, PORT did not significantly improve overall or disease-free survival but significantly reduced locoregional recurrence (p=0.011). Distant metastasis rates were similar between groups, underscoring systemic failure as the dominant relapse pattern. Subgroup analyses showed PORT was associated with improved overall survival in patients with 1–3 positive N2 nodes and better disease-free survival in those without ENE or lymphatic invasion. 3

Clinically integrated prior-authorization software cuts denials and speeds radiation treatment approval

This quality-improvement study implemented real-time prior-authorization software in three radiation centers, with four centers as controls, spanning 6551 cases. Software use was associated with a 65.4% reduction in denials, from 7.6% (314/4148) to 2.6% (63/2403) across all payers (P<.001). Payer-specific denial decreases ranged from 45.7% to 88.6%, with 97.4% alignment between payer decisions and practitioner prescriptions at intervention sites. Median authorization time dropped by 33.9%, from 4.2 to 2.8 business days, with about a 1-week reduction at the 90th percentile. 4