Radiation Oncology

Early RT with First-Line Chemo-Immunotherapy Improves Outcomes in ES-SCLC

In this five-center cohort of 771 ES-SCLC patients, adding early radiotherapy to first-line chemo-immunotherapy improved PFS and OS versus no RT (p<0.001). Benefits were seen with both thoracic and extrathoracic RT and persisted after propensity score matching, suggesting a robust association. Within thoracic RT, consolidative treatment yielded better PFS and OS than fully concurrent RT with systemic therapy. Survival did not differ between patients receiving higher versus lower biologically effective doses around 60 Gy and 39 Gy. 1

Protons vs Photons for NSCLC: Comparable Long-Term Control, Early Survival Signal

This systematic review and meta-analysis pooled seven comparative studies including 244,604 NSCLC patients treated with proton or photon radiotherapy. Protons did not significantly improve OS, PFS, or local PFS versus photons overall (OS HR 0.91; PFS HR 1.09; LPFS HR 0.89). Stage I and stage I–II subgroup analyses similarly showed no clear survival advantage for protons. Exploratory fixed-time analysis suggested improved 1-year survival with protons (OR 0.60), but no benefit at 3 or 5 years. 2

Salvage Focal Therapy vs Radical Prostatectomy After Radiorecurrent Disease

This international multicenter cohort compared salvage focal therapy using HIFU or cryotherapy with salvage radical prostatectomy for localized radiorecurrent prostate cancer. Among 923 eligible patients, 419 underwent salvage focal therapy and 504 underwent salvage prostatectomy across multiple registries. Ten-year cancer-specific survival was high in both groups, 92% after salvage focal therapy and 99% after salvage prostatectomy, without a statistically significant difference. Overall survival and perioperative as well as major complication rates were also evaluated to inform risk–benefit counseling. 3

PD-1 Blockade Plus CRT Improves Disease Control in Locally Advanced NPC

This meta-analysis combined three phase III randomized trials totaling 1237 patients with previously untreated locoregionally advanced nasopharyngeal carcinoma. Adding PD-1 inhibitors to definitive chemoradiotherapy significantly improved event- or failure-free survival (HR 0.66) and distant metastasis-free survival (HR 0.61). Locoregional relapse-free survival showed a nonsignificant trend overall, with clearer benefit in cisplatin-based regimens (HR 0.53). Overall survival data were immature, with no significant difference yet observed (HR 0.94). 4