Where local control still decides outcomes: dose escalation and adaptive planning, short-course versus long-course scheduling, ablative, intra-arterial and bone-seeking radiopharmaceutical techniques, and when radiotherapy can safely be withheld.
A prospective, 25-center registry analysis of 787 patients treated with laser interstitial thermal therapy (LITT) for primary or metastatic brain tumors — the largest such analysis to date — found that how completely a tumor is ablated, and how small it is to begin with, are the strongest drivers of survival after the procedure.
The phase 2 RADICAL trial (Alliance A031801) tested whether adding the bone-targeted radiopharmaceutical radium-223 to cabozantinib would reduce skeletal morbidity in metastatic renal cell carcinoma (mRCC) with bone metastases. The study closed early for futility after a prespecified interim analysis.
The Step 2 randomization of NRG Oncology/RTOG 0848, a phase III trial of 354 patients with resected pancreatic head adenocarcinoma, found that adding chemoradiotherapy (CXRT) to adjuvant chemotherapy did not significantly improve overall survival across the full study population.
The Phase II FLARE-RT trial used mid-treatment FDG-PET response to selectively boost radiation dose (to 74 Gy, peak >90 Gy) only in the roughly one-third of unresectable NSCLC patients whose tumors were not responding, while treating responders with standard 60 Gy chemoradiation.
Long-term follow-up (median exceeding 10 years) of NRG Oncology RTOG 0539 validates a risk-adapted meningioma strategy: observation after gross total or subtotal resection for low-risk (WHO grade 1) disease, and radiotherapy for intermediate- and high-risk disease.
The phase III STELLAR trial (NCT02533271) randomly assigned 591 patients with distal or middle-third locally advanced rectal cancer to a short-course radiotherapy-based total neoadjuvant therapy regimen (SCRT-TNT) or standard long-course chemoradiotherapy (CRT); this update reports 5-year outcomes at a median follow-up of 68.7 months.
Phase 3 TORCH trial (241 patients, two tertiary centers in China, enrolled 2015-2024) randomized adults with unresectable, liver-confined, intermediate-stage (BCLC stage B) hepatocellular carcinoma 1:1 to transarterial chemoembolization (TACE) plus sequential radiofrequency ablation versus TACE alone.
Multicenter, open-label, randomized phase 2 trial (TREASURE, AIO-TRK-0320) at 20 sites in Germany and Austria testing whether adding consolidative thoracic radiotherapy (TRT, 30 Gy in 10 fractions) to atezolizumab maintenance improves overall survival in extensive-stage small cell lung cancer (ES-SCLC) after induction chemoimmunotherapy; 96 patients screened, 68 randomized 1:1