30-Second Takeaway
- SBRT for high-risk prostate cancer shows durable 5-year control with acceptable toxicity, especially with intensified ADT and dose-escalation.
- Postoperative brain metastasis trials confirm WBRT improves intracranial control without survival benefit, sharpening trade-offs with SRS or observation.
- New hematologic OAR constraints generally lower dose limits, targeting long-term toxicity reduction in younger patients.
Week ending April 18, 2026
SBRT, CNS metastasis management, and precision tools reshaping contemporary radiation oncology
Intensified ADT and dose-escalated SBRT improve outcomes in high-risk prostate cancer
Among 440 men with high-risk localized prostate cancer treated with SBRT, median follow-up was 60.4 months. Five-year biochemical recurrence and distant metastasis rates were 22% and 9.2%, indicating durable disease control with SBRT. Intensified therapy (≥12 months ADT plus ≥8 Gy/fraction) reduced 5-year biochemical recurrence to 7.4% and distant metastasis to 3.7%. Intensified treatment significantly lowered biochemical recurrence (HR 0.38) and distant metastasis (HR 0.43) versus less intensive regimens.
Post-op brain mets: WBRT improves intracranial control, not overall survival
This meta-analysis pooled seven randomized trials (812 patients) comparing WBRT, SRS, and observation after resection of 1–4 brain metastases. WBRT did not improve overall survival versus observation (HR 1.01) or versus SRS (HR 0.77). WBRT improved surgical bed and intracranial control compared with observation and SRS, with odds ratios around 1.2–1.5. Cognitive decline risk did not differ significantly between WBRT and either observation or SRS, but estimates were imprecise.
Consensus hematologic OAR constraints tighten many dose limits for NCTN trials
The NRG Hematologic Malignancies Working Group produced consensus organ-at-risk constraints for 49 structures in hematologic malignancy radiotherapy trials. Twenty OAR constraints were entirely new compared with CIRO, reflecting disease-specific patterns and lower prescription doses. Of 29 overlapping OARs, most recommended limits were lower than existing CIRO constraints, emphasizing late toxicity mitigation in younger patients. Acceptable and unacceptable variations were defined for select critical organs to standardize plan scoring on NCTN protocols.
ArteraAI-guided ADT is cost-saving versus NCCN risk-based strategy
A Markov model simulated 15-year outcomes for 71-year-old men with intermediate-risk prostate cancer treated with radiotherapy in NRG/RTOG 9408. Strategies compared were ADT-for-all, NCCN unfavorable-only ADT, and ArteraAI-guided ADT restricted to biomarker-positive patients. ADT-for-all was dominated by the NCCN strategy on cost-effectiveness grounds. Compared with NCCN-based ADT, ArteraAI-guided ADT lowered costs by $12,296 and slightly increased QALYs, thus being dominant.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.