Radiation Oncology

Neoadjuvant RT sharply reduces local recurrence in primary retroperitoneal well-differentiated liposarcoma

This TARPSWG multicenter study analyzed 582 patients with primary retroperitoneal well-differentiated liposarcoma undergoing curative-intent resection. In the 1:2 propensity-matched cohort of 208 patients, 70 received neoadjuvant RT plus surgery and 138 had surgery alone. At 5 years, local recurrence was 6% with neoadjuvant RT versus 26% with surgery alone; 8-year rates were 10% versus 33%. Overall survival numerically favored neoadjuvant RT, but the difference was not statistically significant (HR 0.50, P = 0.07). These data support routine discussion of preoperative RT with surgery to optimize durable local control in resectable disease. 1

IMPT reduces swallowing-structure dose and acute weight loss in nasopharyngeal chemoradiation

This prospective study compared IMPT (n = 58) versus VMAT (n = 46) for definitive chemoradiotherapy in nasopharyngeal carcinoma. IMPT significantly reduced mean doses to the oral cavity and middle and inferior pharyngeal constrictor muscles, with similar superior constrictor and salivary sparing. IMPT patients had less end-of-RT weight loss (3.4% vs 5.5%) and far lower odds of >10% loss (OR 0.10; 95% CI 0.01–0.80). MDADI swallowing-related quality-of-life scores did not differ by modality at treatment completion or one year. Higher superior constrictor dose consistently predicted worse MDADI scores, with middle constrictor dose linked to acute declines. 2

Induction ipilimumab–nivolumab plus CRT supports bladder preservation in stage II–III MIBC

The single-arm phase 2 INDIBLADE trial treated 50 cT2–4aN0–2 muscle-invasive bladder cancer patients with induction ipilimumab plus nivolumab followed by chemoradiotherapy. After 28.7 months median follow-up, estimated 2-year bladder-intact event-free survival was 78%, meeting the primary efficacy endpoint. Two-year overall survival reached 96%, indicating strong systemic disease control with this bladder-sparing regimen. Grade 3–4 immune-related adverse events occurred in 24% of patients, and grade 3–4 chemoradiotherapy toxicity in 7%, representing manageable but meaningful toxicity. Undetectable circulating tumor DNA after induction immunotherapy correlated with superior bladder-intact event-free survival, suggesting a potential biomarker for response-adapted strategies. 3

Fit elderly glioblastoma patients gain major survival benefit from standard chemoradiation

This multicenter retrospective cohort included 573 glioblastoma patients aged ≥65 years treated between 2009 and 2023. Postoperative strategies were chemoradiotherapy, temozolomide monotherapy, radiotherapy alone, or best supportive care. Median overall survival was 14 months with chemoradiotherapy versus 8 months with temozolomide alone or radiotherapy alone and 2 months with supportive care. Among MGMT-methylated patients, chemoradiotherapy achieved 23-month median survival compared with 8 months for temozolomide monotherapy. Younger age, higher Karnofsky Performance Status, resection, more temozolomide cycles, and salvage therapy were associated with improved outcomes, arguing against age-based de-escalation. 4