Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial

Patient-Reported Quality-of-Life Outcomes After Abdominopelvic Stereotactic Body Radiation Therapy Using an MR-Linac System

PURPOSE

Despite the increasing use of MR-Linac (MRL) in the management of patients with oligometastatic or upper gastrointestinal malignancies, health-related quality-of-life (HRQoL) outcomes are lacking. Currently, it is not well established whether treatments using MRL offer HRQoL advantages over CT-based treatments. In this study, we present prospectively collected HRQoL data after abdominopelvic stereotactic body radiation therapy (SBRT) on a 1.5T MRL system.

METHODS AND MATERIALS

We conducted a single-center, prospective observational study of patients receiving MR guided adaptive radiotherapy using the MRL system from September 2019 to November 2024 at Princess Margaret Hospital for abdominopelvic targets. HRQoL assessment was performed using questionnaires from the European Organization for Research and Treatment of Cancer QLQ-C30. Linear mixed-effects models were used to compare the change in the HRQoL domain scores of the QLQ-C30 questionnaire within the MRL cohort from baseline to 3-month and 1-year follow-ups.

RESULTS

Seventy-three patients were included in the analysis. Most patients had pelvic (43.8%) or abdominal (34.2%) targets. Following SBRT, 46.6% of the patients received systemic therapy. There was a significant increase in the symptom scale scores for fatigue (β = 8.9; 95% CI = 4.5, 13.2; P < .001) and nausea and vomiting (β = 3.9; 95% CI = 1.2, 6.6; P = .005) at the final fraction compared with baseline. Fatigue remained significantly increased from baseline to the first follow-up at 3 months (β = 4.7; 95% CI = 0.5, 9.0; P = .03). At 12 months, no significant difference was observed in any scale compared with baseline.

CONCLUSIONS

Stereotactic radiation treatments using online adaptive MR guided radiation therapy on MRL are well tolerated in patients with abdominopelvic metastases, with HRQoL returning to baseline at 12 months.

Stereotactic Magnetic Resonance Guided Adaptive Radiation Therapy for Infradiaphragmatic Oligometastatic Disease: Disrupting the One-Size-Fits-All Paradigm

PURPOSE

Although recent studies have demonstrated the benefits of stereotactic ablative radiotherapy (SABR) in the treatment of oligometastatic (OM) disease, toxicity remains a concern in the infradiaphragmatic region. This is largely because of challenges in soft tissue visualization, motion management, and the proximity of gastrointestinal organs at risk. Stereotactic magnetic resonance guided adaptive radiation therapy (SMART) may enhance the safety and efficacy of SABR in abdominopelvic targets.

METHODS AND MATERIALS

Patients with infradiaphragmatic OM disease, including up to 5 lesions treated with SMART between May 2018 and September 2023, were evaluated. Progression-free survival, overall survival, and local control (LC) were analyzed using Kaplan-Meier and Fine and Gray proportional subhazards models, whereas treatment-related toxicities were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events v4.0 criteria.

RESULTS

One hundred eighty-three targets in 138 patients with primarily lung, colorectal, and noncolorectal gastrointestinal cancers were prescribed a median dose of 50 Gy in 5 fractions on a 0.35-T magnetic resonance-Linac. Overall, 62.8% of treated metastases were within 5 mm of a dose-limiting organs at risk, necessitating online adaptive planning in 670 of 875 (76.6%) delivered SABR fractions. The 1-year progression-free survival rate was 35.8% for the entire population and significantly differed between OM and oligoprogressive patients (42.4% vs 25.4%, P = .03). There was a trend toward lower LC in colorectal versus noncolorectal histology in the definitive dose group (biologically effective dose10 ≥ 75 Gy) with 2-year LC rates of 74.0% versus 86.0%, respectively, P = .08. Acute and late grade ≥3 toxicities were 0% and 2.2%, respectively.

CONCLUSIONS

SMART is feasible and effective for treating OM disease lesions in proximity to dose-limited organs at risk. Safe dose escalation is facilitated by online adaptive radiation therapy and is associated with long-term LC. Patient selection is key to identifying which patients with OM or oligoprogressive disease should be considered most appropriate for SMART.

Results of a Single-Arm Phase 2 Clinical Trial: Online Adaptive Stereotactic Body Radiation Therapy for Abdominal-Pelvic Oligometastases

PURPOSE

This study reports on the clinical outcomes of the single-arm phase-2 STEAL trial investigating online adaptive stereotactic body radiation therapy (SBRT) for abdominal-pelvic lymph node (A-P LN) oligometastases.

METHODS AND MATERIALS

Patients with oligometastatic A-P LN were enrolled and treated to a total dose of 45 Gy in 5 fractions on the CyberKnife. For each patient, a library of 3 plans was created using a pretreatment diagnostic computed tomography (CT) scan and the treatment planning CT scan. Following a decision tree, the radiation therapy technologist (RTT) selected the best plan of the day, ie, the plan with the highest target coverage without exceeding organs at risk constraints. The primary endpoint was local control (LC), and the secondary endpoints were toxicity and overall survival.

RESULTS

In total, 52 patients were included, and 55 online adaptive treatments were performed. The primary tumor was prostate adenocarcinoma in 19 patients (37%), colorectal in 17 (33%), and had a different origin in 16 patients (31%). After a median follow-up of 38.5 months, LC at 1 year was 96% and 80% at 3 years; 20 patients had died, resulting in a median overall survival of 4.1 years. No grade ≥4 toxicity was observed. One patient (2%) developed a grade 3 ureteral stenosis.

CONCLUSIONS

CT-guided online adaptive SBRT for A-P LN oligometastases using an RTT-only library of plans strategy is feasible, safe, and resulted in an excellent LC with a low toxicity rate.

Reducing Number of Treatment Fractions for Patients With Abdominal Lymph Node Oligometastases: The Need for Online Adaptive Radiation Therapy to Provide Personalized Adaptive Fractionation

PURPOSE

The aim of this in silico trial was to explore using online adaptive radiation therapy (OART) for isotoxic personalized fractionation and in-treatment dose adaptation for patients with abdominal-pelvic lymph node oligometastases. We hypothesized that this method could significantly reduce treatment fractions, increase treatment capacity, and improve patient comfort.

METHODS AND MATERIALS

Twenty patients with abdominal-pelvic lymph node metastases from a phase 2 study (STEAL, NL58442.078.17) were included. On the basis of the planning computed tomography (CT) scan, patients received a simulation plan of 5 × 9 Gy. If planning target volume coverage was ≥95% and the dose to the organs at risk (OAR) within constraints, fractions were minimized isotoxically. Daily fraction doses were simulated with and without OART on all fraction CTs (fCT). For patients with favorable anatomy on an fCT, an increase of fraction dose was attempted to conclude treatment.

RESULTS

On the basis of the planning CT, the total number of fractions was reduced by 37% (P < .01). Seven patients could be treated in 1 fraction and 3 patients in 2 fractions. For 10 patients, reduction was not possible. The plans were deliverable on the fCTs with OART in 97.1% of single fraction cases and 53.3% of 2-fraction cases, compared with 34.4% and 20.0% without OART. For 4 patients (40%) with 5 fractions, in-treatment dose adaptation reduced fractions by 16%, increasing total reduction from 37% to 45%. OART significantly increased the planning target volume Dmean, D98%, and coverage, whereas it decreased the OAR Dmax, D0.5cc, D1.0cc, and V50Gy. In non-OART simulations, OAR constraint violations occurred in the 5- and 2-fraction groups, with an exceeded D0.5cc in 60% and 66.7% of cases, respectively. These violations were completely resolved using OART.

CONCLUSIONS

Personalized fractionation with in-treatment dose adaptation reduced treatment fractions significantly by 45% when OART was used. This method provides significant dosimetric benefits and could increase treatment capacity and improve patient comfort. The outcomes of this study will be verified in an upcoming phase 2 trial.

Oligoprogressive liver metastasis from gastrointestinal stromal tumour treated with stereotactic body radiotherapy (SBRT)

While metastatic gastrointestinal stromal tumours (GIST) are generally treated using systemic therapy, surgery and/or ablative procedures, radiotherapy appears to have a restricted role. We present a case of a woman in her 40s with metastatic GIST treated over 10 years with two lines of tyrosine kinase inhibitors (TKIs). During sunitinib therapy, a solitary oligoprogressive lesion was found. Since she was unable to afford a subsequent line of TKI, the lesion was assessed for local ablative options. It was deemed suitable for stereotactic body radiotherapy (SBRT) at a dose of 42 Gy in 6 Fractions. She tolerated the treatment well and continued sunitinib. At the 2-year follow-up, the liver lesion showed partial response, with the patient having no late post-SBRT sequelae and continuing the same TKI. SBRT seems to be a safe and effective local ablative option for the treatment of oligoprogressive lesions in GIST.

Reshaping the landscape of locoregional treatments for breast cancer liver metastases: A novel, intratumoral, p21-targeted percutaneous therapy increases survival in BALB/c mice inoculated with 4T1 triple negative breast cancer cells in the liver

Patients with disseminated metastatic disease from breast cancer are likely to have liver involvement in >50% of cases at some point during disease progression. These patients have a poor prognosis; and, when treated with the standard of care systemic therapy they have a median survival of <9-months. Increasing survival in breast cancer patients will likely require the administration of better therapies that are specifically targeted to treat distant metastases. One approach to increasing treatment efficacy for breast cancer liver metastases is through the application locoregional therapies. Locoregional therapies are an appealing interventional approach for breast cancer patients with liver metastases since these tumor lesions are accessible via minimally invasive procedures that can be administered using either ultrasound or CT imaging. Current locoregional therapies to treat breast cancer liver metastases are non-specific and have not produced significant increases in survival. The goal of this study was to design and test a targeted locoregional therapeutic intervention for breast cancer liver metastases. The lead candidate, a fixed-dose small-molecule drug called MBC-005, was tested in vitro and then the efficacy was evaluated in a BALB/c mouse liver metastases model. A novel formulation of N-allyl noroxymorphone hydrochloride incorporated into an alginate-based gel overcomes many of the limitations associated with the administration of small-molecule drugs, which include solubility, off-target toxicity, and enzymatic degradation. In vitro results demonstrated that MBC-005 mediated its anti-tumorigenic effect through a p21-dependent mechanism via a novel molecular pathway, in which N-allyl noroxymorphone component of MBC-005 stimulated the opioid growth factor receptor to increase p21 expression. Intratumoral administration of MBC-005 increased survival 3.9-fold in mice and significantly decreased tumor volume 4-fold. While many cytotoxic therapies increase p21 expression as a response to DNA damage, MBC-005 increased p21 expression independent cytotoxic DNA damage. MBC-005 did not induce off-target toxicity; and, as such, would be amenable to multiple rounds of administration. Nevertheless, it is notable that the positive effects of MBC-005 treatment on increasing survival and decreasing tumor volume in mice was achieved using a single dose.

Prognostic factors and treatment insights for metastatic malignant phyllode tumors

BACKGROUND

The aim of this study is to contribute a better understanding of metastatic malignant phyllode tumors (MMPTs) by exploring its prognostic factors, describing treatment landscape, and providing optimal treatment choices.

METHODS

This retrospective multicentric study was included 43 patients with MMPTs who received treatment from 2009 to 2023 in four centers. The primary endpoint of the study was overall survival (OS).

RESULTS

The median overall survival of these patients was 7.27 months (range: 0.63-118.53) and the median follow-up time was 16.8 months (range: 2-188). The median age of these patients were 49 years. The median metastasis-free survival (MFS, it is the time between initial diagnosis and diagnosis of metastatic disease) was 7.27 months, and the most common site of metastasis was lung (35/43, 81.4 %). Treatment for MMPTs primarily consisted of systemic chemotherapy and metastasectomy. Multivariate analysis revealed that chemotherapy after metastasis (HR = 0.250, 95 % CI 0.109-0.571; P = 0.001) and MFS >6 months (HR = 0.407, 95 % CI 0.198-0.836; P = 0.014) were independently associated with OS. The most common chemotherapy regimen was anthracyclines along with ifosfamide (AI), with the median progression-free survival of 5.5 months. Metastasectomy did not significantly improve OS.

CONCLUSION

The study findings highlight the significance of systemic treatment (chemotherapy) and the impact of MFS on prognosis of MMPTs. For these patients, systemic treatment may improve survival outcomes. And patients with MFS <6 months appear to have a poorer prognosis.

Consolidative radiotherapy in oligometastatic and oligoprogressive NSCLC: A systematic review

Consolidative radiation is increasingly regarded as an effective treatment for oligometastatic and oligoprogressive non-small cell lung cancer (NSCLC). This systematic review examines the clinical evidence on the significance of consolidative radiation in improving outcomes in NSCLC, including progression-free survival and overall survival. Innovations in radiotherapy, including stereotactic body radiotherapy and intensity-modulated radiotherapy, have enhanced the accuracy and effectiveness of local control in oligometastatic disease. This paper analyzes the integration of consolidative radiotherapy with systemic agents, including immunotherapy and targeted therapy, along with the application of biomarkers such circulating tumor DNA for patient selection. Our findings indicate that consolidative radiotherapy could benefit some patients with controlled oligometastatic NSCLC following systemic therapy, emphasizing the importance of proper patient selection. Additional research is necessary to optimize treatment combinations and develop biomarkers for better patient stratification in consolidative radiotherapy.

The impact of Clinical Trials Radiographers on set-up and recruitment to radiotherapy trials

Background

The primary role of the Clinical Trials Radiographer (CTR) within the UK workforce is the set-up and initiation of new trials, and recruitment of patients. There is very little published evidence to indicate the impact and value of the CTR. The aim of this study is to describe the evolving role of the CTR and to quantify impact on set-up, and recruitment to Radiotherapy (RT) clinical trials.

Results

The number of trials approved and opened annually, number of open studies within the portfolio, and number of patients recruited have all increased alongside the number of CTR hours.

Conclusion

The data provides quantitative evidence to support the impact of the CTR role and its value in a RT department's research infrastructure. This reinforces the need to consider the CTR position in long term funding and future workforce planning.

Reirradiation Practice in Gynecological Cancer: Insights from a National Survey in Spain

PURPOSE

Given the lack of standardisation in gynecological cancer reirradiation, the Gyneacologial Radiation Oncology (GINECOR) working group on behalf of the Spanish Society of Radiation Oncology (SEOR), works towards to inquire the current state of reirradiation practices among the radiation oncology departments in Spain.

METHODS

An online 37-question survey was sent to all GINECOR members, representing most Spanish centers. The survey addressed general aspects of reirradiation, including experience, reirradiation sites, and techniques used. It included seven clinical case scenarios on reirradiation, and a final section on technical aspects of external beam radiotherapy (EBRT) and brachytherapy (BT) treatment. Descriptive statistics were used for data analysis.

RESULTS

Out of 58 centers, 29 responded, with 51.7% performing ≥ 5 reirradiation cases annually. While most centers offer multiple techniques, only 16/29 have access to BT. For in-field local relapse with surgery contraindicated, 79.3% performed BT in endometrial cancer, but only 27.5% treated with BT in cervical cancer recurrence. In this case, 17.2% used SBRT. For endometrial and cervical cancer, 44.8% and 65.4% of centers prescribed doses based on organ-at-risk tolerance, respectively. For pelvic wall/parametrial in-field relapse, 46.4% of the centres reirradiated with stereotactic body radiotherapy (SBRT), and 32.1% with BT. In nodal reirradiation, SBRT was preferred by 90% of centers. Variability was observed in target volume definitions for EBRT and proton therapy.

CONCLUSIONS

Reirradiation for gynecological cancer remains unstandardized, presenting significant challenges in clinical practice. To improve reirradiation protocols in gynecological cancer, the GINECOR working group is currently conducting a systematic review and formulating Delphi recommendations.

Targeting the Enhanced Sensitivity of Radiotherapy in Cancer: Mechanisms, Applications, and Challenges

Cancer is a major public health, societal, and economic challenge worldwide. According to Global Cancer Statistics 2022, it is estimated that by 2050, there will be 35 million new cancer cases globally. Although patient survival rates have improved through various therapeutic approaches, including surgery, chemotherapy, and radiotherapy, treatment efficacy remains limited once tumor metastasis occurs. Among various cancer treatment strategies, radiotherapy plays a crucial role. Along with surgery and chemotherapy, radiotherapy is a cost-effective single-modality treatment, accounting for approximately 5% of total cancer care costs. The use of radiosensitizing agents such as histone deacetylase inhibitors, 2-deoxy-d-glucose, enterolactone, and squalene epoxidase can enhance radiotherapy effectiveness. Recent radiosensitization methods involve physical stimuli and chemical radiosensitizers. However, improving their efficacy, durability, and overcoming radioresistance remain significant challenges. This review first introduces current applications of radiotherapy in cancer treatment, the molecular mechanisms underlying its anticancer effects, and its side effects. Second, it discusses the main types of radiosensitizers, their latest applications, and recent challenges in cancer treatment. Finally, it emphasizes on clinical trials of radiosensitizing agents and explores potential biomarkers for radiotherapy response in cancer. Multifunctional nanoparticles have shown greater clinical applicability than single-functional nanoparticles. Future research will focus on enhancing the drug-carrying capacity of nanomaterials to further improve radiotherapy outcomes.

Contouring compliance and variability of targets and organs at risk in spine stereotactic body Radiotherapy: A 34-Institution study

BACKGROUND AND PURPOSE

To ensure the proper implementation of stereotactic body radiotherapy (SBRT) for spinal metastases in a multicenter clinical trial, this study evaluated the compliance and variability in contouring for spine SBRT.

MATERIALS AND METHODS

A dummy run was conducted at 34 institutions. Computed tomography (CT) and T1/T2-weighted magnetic resonance imaging (MRI) of a patient with fifth thoracic spinal metastasis involving the vertebral body and right pedicle were provided. The observers performed CT-MRI registration and delineated the gross tumor volume (GTV), clinical target volume (CTV), and spinal cord. A radiation oncologist from the study office performed a central review of 17 checklist items. Agreement was assessed using the Dice similarity coefficient.

RESULTS

An average of 3.0 protocol deviations per institution was observed. Deviations related to CTV setting in sectors adjacent to the GTV, the addition of a CTV margin to the paraspinal disease, and accurate delineation of the spinal cord were noted in 11, 13, and 12 institutions, respectively. The mean ± standard deviation Dice similarity coefficients for the GTV, CTV, and spinal cord were 0.84 ± 0.06, 0.85 ± 0.04, and 0.76 ± 0.09, respectively. Although nine institutions had clinically unacceptable errors, all met the criteria on the first resubmission. The mean Dice similarity coefficients for the spinal cord improved from 0.66 to 0.82 after resubmission.

CONCLUSION

This study revealed frequent deviations in CTV setting and spinal cord delineation. This dummy run clarified critical points in contouring for spine SBRT, contributing to the standardization of treatment planning.

Different approach to M descriptor for future staging of oligometastatic disease in SCLC: A cross-sectional survival analysis

PURPOSE

This study aimed to investigate the impact of oligometastasis and the M descriptor on survival in small cell lung cancer (SCLC).

METHODS

This multicenter, retrospective study included patients with newly diagnosed extensive-stage SCLC(ES-SCLC) from 2010 to 2020. Subgroups: Group 1: single metastasis in a single organ, Group 2: 2-5 metastases in a single organ, Group 3: 6 or more metastases in a single organ, and Group 4: metastases in two or more organs. This classification was based on the 9th Staging-M descriptor. Three-year progression-free survival (PFS) and overall survival (OS) analyses were conducted.

RESULTS

The mean age of the 439 patients was 62 ± 10 years, and 89.5% of them were male. The mean PFS for Groups 1, 2, 3, 4 was 10.7 months (95% CI 8.9-12.5), 7.5 months (95% CI 5.6-9.4), 4.3 months (95% CI 2.9-5.7), and 5.4 months (95% CI 4.7-6.1), respectively. PFS in Group 2 was significantly higher. The mean OS for Groups 1, 2, 3, 4 was 13.3 months (95% CI 11.2-15.3), 9.5 months (95% CI 7.1-11.9), 7.1 months (95% CI 4.5-9.7), and 6.9 months (95% CI 6.0-7.9), respectively. OS in Group 1 was significantly higher. OS and PFS in the M1b group were significantly higher than in the M1c1 and M1c2 groups (p < 0.05) with no statistical difference between the M1c1 and M1c2 groups.

CONCLUSION

There is no significant difference in survival between the M1c1 and M1c2 groups. In ES-SCLC, the number of metastases may be a more predictive factor for prognosis than the number of metastatic organs.

MR-guided online adaptive stereotactic body radiotherapy (MRgSBRT) of primary lung tumors and lung oligometastases

PURPOSE

Stereotactic body radiotherapy is pivotal in the treatment of lung tumors, demonstrating effective local control. However, challenges persist with intra-fractional anatomical changes and organs at risk during delivery. Magnetic resonance-guided online adaptive stereotactic body radiotherapy (MRgSBRT) represents a novel technique promising to achieve safe delivery of ablative doses with improved outcomes for primary lung tumors or lung oligometastases.

METHODS

In this single-institution retrospective analysis, we evaluated 64 patients (92 lesions) with primary lung cancer or lung oligometastases treated with MRgSBRT. Using Kaplan-Meier method and log-rank test; we estimated local control (LC), local progression-free survival (LPFS), distant progression-free survival (DPFS), and overall survival (OS).

RESULTS

A total of 64 patients (92 lesions) treated with MRgSBRT were included comprising 14.1% primary lung cancer lesions and 85.9% lung oligometastases. Median total dose, fraction number, fraction dose and BED10 were 50 Gy (range, 21-70 Gy), 5 (range, 1-10), 10 Gy (range, 6-34 Gy), 100 Gy (range, 48-180.0 Gy) respectively. Of the 420 fractions administered, 88.6% (n = 372) involved on-table adapted plans. Median LPFS was not reached and the 1‑ and 3‑year LPFS rates were 96.3% (95% CI 92.4-100.0%) and 86.4% (95% CI 76.9-95.9%), respectively. No local recurrences were observed post-treatment with a total dose of > 50 Gy, BED10 > 100 Gy, fractional dose of > 10 Gy or a CCI > 0.96.

CONCLUSION

Our study of MRgSBRT in 92 lung lesions revealed a 1-year and 3‑year LPFS rates of 96.3 and 86.4%, respectively without ≥ grade 3 toxicity. Future prospective studies evaluating lung MRgSBRT are awaited.

Prognostic factors and overall survival for recurrent and metastatic head and neck squamous cell carcinoma: a multicenter retrospective analysis

BACKGROUND

Immune checkpoint inhibitors (ICIs) improve outcomes in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, some patients remain unresponsive to treatment, necessitating further investigation into optimal therapeutic strategies and prognostic biomarkers. This study aimed to evaluate the efficacy of various therapies and identify factors influencing overall survival (OS) in these patients.

METHODS

We retrospectively analyzed 606 patients (517 men, 89 women; median age 68 years) treated at 13 head and neck cancer specialty facilities in Japan between January 2018 and December 2022. Associations between OS and variables, including age, sex, primary site, Eastern Cooperative Oncology Group performance status, estimated glomerular filtration rate, therapeutic target lesion, history of drug use in systemic chemotherapy, number of treatment lines, nondrug treatments, de novo metastasis, programmed death-ligand 1 combined positive score, and platinum resistance were statistically examined.

RESULTS

Median OS was 14.2 months, and median progression-free survival was 5.0 months. Multivariate analysis identified poor OS in patients with oral cavity tumors and performance status 2-3, whereas ICI therapy and nondrug salvage interventions were associated with improved OS. ICI/non-ICI subgroup analysis revealed that ICI may have a limited effect on oral cancer. Additionally, our results indicated that a history of platinum therapy for R/M HNSCC may not affect the therapeutic efficacy of ICIs.

CONCLUSION

For patients with R/M HNSCC, further OS improvement may be achieved using ICIs or aggressive nondrug salvage therapy and by considering the use of chemotherapy other than ICI for patients with oral cancer or poor PS.

Stereotactic body radiotherapy for oligometastatic disease: current evidence and future perspectives

Oligometastatic disease (OMD) represents an intermediate state between locoregionally advanced and widespread polymetastatic disease, where local therapy may alter disease progression and improve survival. Metastasis-directed therapy (MDT), particularly stereotactic body radiotherapy (SBRT), has been evaluated alongside systemic therapy, yet OMD definitions and criteria for selecting patients who benefit from local therapy remain inconsistent. This review summarizes recent clinical trials on SBRT for OMD across cancer types. The SABR-COMET trial suggested that MDT may improve survival in OMD across various malignancies. In non-small cell lung cancer (NSCLC), phase II and some phase III trials support local therapy's effectiveness, particularly in combination with systemic treatment, though optimal patient selection remains uncertain. In breast cancer, randomized data remain inconclusive, with NRG-BR002 failing to show a survival benefit, highlighting the need for better patient stratification. In prostate cancer, multiple phase II trials suggest that MDT prolongs androgen deprivation therapy (ADT)-free survival, but no phase III trials have confirmed these findings. Emerging data indicate that MDT may also benefit OMD patients with less common primary cancers, including pancreatic and renal cell carcinoma, though further phase III trials are needed. Ongoing research aims to refine patient selection and integrate MDT into clinical practice to optimize outcomes. Standardized OMD definitions, improved biomarkers, and better stratification criteria are crucial to maximizing the benefit of MDT. The results of ongoing phase III trials will be pivotal in determining its role in oligometastatic cancer management.

Preliminary Results of Clinical Experience with Consolidative High-Dose Thoracic Radiotherapy for Patients with Extensive-Stage Small Cell Lung Cancer

OBJECTIVES

Extensive-stage small-cell lung cancer (SCLC) has a poor prognosis, but recently, the combination of immunotherapy and chemotherapy has improved treatment outcomes in some patients, and treatment plans may vary depending on the individual's general condition and tumor response. In addition, intrathoracic tumor control remains a major challenge for this disease. In the current study, we aim to share our clinical experience and demonstrate that consolidative high-dose thoracic radiotherapy effectively reduces intrathoracic tumor recurrence while maintaining acceptable treatment-related toxicities.

MATERIALS AND METHODS

The medical records of 81 SCLC patients treated at Korea University Guro Hospital from January 2019 to December 2023 were reviewed retrospectively. Among them, 22 patients with extensive-stage SCLC who had a favorable tumor response after systemic therapy, including those with oligo-progressive disease limited to the thoracic region and suitable for curative local therapy, received consolidative radiotherapy. A total dose of 52.5 Gy in 25 fractions was administered over 5 weeks to all patients with extensive-stage SCLC.

RESULTS AND CONCLUSIONS

The median follow-up time was 22 months (range: 8-59 months), with the median follow-up period after completing consolidative radiotherapy being 13 months (range: 4-35 months). In-field local recurrence occurred in only one patient after consolidative thoracic radiotherapy. Most importantly, 10 patients with oligo-progressive disease at the thoracic site, at the time of tumor response, remained stable without further intrathoracic in-field recurrence. Additionally, no severe cases of radiation pneumonitis or esophagitis were observed. Based on our institution's experience, consolidative high-dose thoracic radiotherapy is well-tolerated and associated with fewer intrathoracic recurrences, leading to improved long-term survival in carefully selected patients with extensive-stage SCLC. Given these findings, we believe consolidative radiotherapy should be considered more proactively in clinical practice. Furthermore, these results may help guide the design of future clinical trials.

Effectiveness of chemotherapy with/without radiotherapy for stage IVb esophageal squamous cell carcinoma: a population-based target trial emulation study

BACKGROUND

The role of radiation therapy in combination with systemic treatment for stage IVb esophageal squamous cell carcinoma (ESCC) is unclear. We aimed to investigate the effectiveness of primary chemoradiotherapy for these patients and compare it to that chemotherapy alone.

MATERIALS AND METHODS

In this retrospective cohort study, we adopted a target trial emulation framework to identify eligible patients in the Taiwan Cancer Registry diagnosed between 2011 and 2021. In the primary analysis, overall survival (OS) was the primary endpoint, whereas the incidence of esophageal cancer mortality was the secondary endpoint. Extensive supplementary analyses were also conducted.

RESULTS

We included 5294 patients in the primary analysis and found that OS was significantly better for those treated with chemoradiotherapy (n = 5065) than for those treated with chemotherapy only (n = 229). The propensity score weighting adjusted hazard ratio of death was 0.46 (95% confidence interval 0.41-0.52, p < 0.0001). The secondary endpoint and supplementary analyses also favored the chemoradiotherapy group.

CONCLUSION

The OS of stage IVb ESCC patients treated with chemoradiotherapy was significantly better than that of patients treated with chemotherapy alone. The results of relevant ongoing clinical trials are eagerly awaited.

The 2024 State of Science report from the European Organisation for Research and Treatment of Cancer's Radiation Oncology Scientific Council

BACKGROUND

Radiotherapy (RT) is a central pillar of a multimodal cancer treatment approach. The ongoing advances in the fields of RT, imaging technologies, cancer biology, and others yield the potential to refine the use of RT. The European Organisation for Research and Treatment of Cancer (EORTC) hosted a dedicated workshop to identify and prioritize key research questions and to define future RT-based treatment strategies to improve the survival and quality of life of cancer patients.

METHODS

An initial call for relevant RT research topics led to the formation of workgroups to develop these into new clinical research proposals and projects. The EORTC Radiation Oncology Scientific Council (ROSC) State of Science workshop was held in Brussels, Belgium, in February 2024, bringing together EORTC members and international stakeholders to connect and work on the proposals.

RESULTS

Four topics of interest were identified: I) De-escalation of RT, minimizing toxicity while maintaining patients' quality of life, II) Technology-driven RT utilizing advances in treatment techniques, such as spatially fractionated RT to improve outcomes in patients with bulky disease and localized high tumor burden, III) Biology-driven RT, integrating the rapid advances in cancer biology and functional imaging to guide and personalize RT, and IV) New indications adding value and expanding the use of RT.

CONCLUSION

The EORTC ROSC State of Science workshop prioritized clinical questions to be addressed in prospective clinical research projects to advance RT care and improve patient outcomes.

Prospective planning comparison of magnetic resonance-guided vs. internal target volume-based stereotactic body radiotherapy of hepatic metastases - Which patients do really benefit from an MR-linac?

Purpose/objective

To compare online MR-guided SBRT (MRgRT) of liver metastases with state-of-the-art ITV-based SBRT (ITV-SBRT) and assess which patients benefit most from MRgRT.

Materials and methods

In a prospective randomized trial (MAESTRO study, NCT05027711), patients were randomized to either gated and online adaptive MRgRT or ITV-SBRT if a biologically effective dose (BED10) of 100 Gy was feasible with ITV-SBRT. Otherwise, patients were treated with MRgRT. In this subgroup analysis of 20 patients, a dosimetric comparison of MRgRT and ITV-SBRT plans was performed. Tumor control and normal tissue complication probabilities were calculated.

Results

In 40 % of all patients, MRgRT enabled SBRT with less fractions and/or higher prescription BED10. Almost all target volume metrics were improved with MRgRT. MRgRT PTV D95% was significantly higher in the overall cohort (91.0 ± 22.9 Gy vs. 79.5 ± 27.2 Gy, p = 0.001), in uncritical (111.3 ± 6.2 Gy vs. 104.7 ± 4.1 Gy, p = 0.022) and in critical cases with limited healthy liver volume or nearby gastrointestinal organs at risk (74.1 ± 16.9 Gy vs. 58.5 ± 18.5 Gy, p = 0.041). Target volume V100% was also superior with MRgRT. Calculated 2-year tumor control probability was significantly superior with MRgRT overall (73.0 ± 6.2 % vs. 69.7 ± 7.9 %, p = 0.002), in uncritical cases (78.3 ± 1.4 % vs. 76.8 ± 1.0 %, p = 0.022) and in critical cases (68.5 ± 4.8 % vs. 63.8 ± 5.8 %, p = 0.041), without elevated normal tissue complication probability.

Conclusion

Dosimetrically, gated MRgRT was beneficial for virtually all the hepatic metastases analyzed in this study. Patients with metastases located critically near gastrointestinal OAR or with limited healthy liver volume should be allocated to centers providing MRgRT.

Current diagnostic and therapeutical approaches to bone metastases in patients with non-small cell lung cancer: A cross-sectional study

INTRODUCTION

The current study aims to investigate the current practice of bone metastasis management in patients with non-small cell lung cancer.

METHODS

An online questionnaire was administered to 92 oncologists. A survey was developed and revised by dedicated experts and was composed of five sections: i) general and work characteristics, ii) diagnostic issues, ii) bone-targeted agents issues, iii) radiotherapy issues, and iv) supportive care issues. Descriptive statistics was applied.

RESULTS

The 18F-FDG PET is the preferred evaluation for skeletal assessment for both patients with (62 %) and without (54 %) bone lesions at the CT scan; MRI (63 %) and 18F-FDG PET (61 %) are the most chosen radiographic assessments when a bone oligoprogression is suspected. The number of bone metastatic lesions was the main factor considered when deciding whether to start bone-targeted agents (57 %). In choosing between bone-targeted agents, renal toxicity was the most considered factor (62 %). Over half of the participants did not stop the systemic treatment during stereotactic radiotherapy (68 %) and considered re-irradiation on progressive bone metastases at least 6 months after prior radiotherapy (55 %). Overall, 64 % and 41 % of participants assessed patients' body weight and physical activity, respectively. Oral nutritional supplements or a specific diet were recommended by 34 % and 46 % of clinicians; 40 % of them also advised their patients to increase their physical activity levels, while 54 % were worried that exercise might increase the risk of skeletal-related adverse events.

CONCLUSIONS

Lung-cancer dedicated clinicians pay great attention to bone metastases-related diagnostic, bone-targeted agents, and radiotherapy issues, whereas the integration of supportive care approaches seem less standardized.

Hybrid Approaches to Local Management of Pulmonary Metastatic Disease

With increasingly effective systemic therapies for stage IV disease, the addition of local control strategies for a subset of patients with limited metastatic disease has contributed to improved disease control and life prolongation. While surgery has been the mainstay strategy for local control, stereotactic ablative body radiation and percutaneous ablation techniques are alternate methods that have been demonstrated to be safe and effective and offer options to those patients who are unresectable, inoperable, or who do not desire surgery. A hybrid approach combining surgery and radiotherapy can maximize the ability to treat more lesions.

Pulmonary Stereotactic Body Radiation Therapy of Oligometastatic Head-and-Neck Squamous Cell Carcinoma: A Multicenter Retrospective Study

PURPOSE

The value of stereotactic body radiation therapy (SBRT) in patients with oligometastatic head-and-neck squamous cell carcinoma (HNSCC) remains unclear, as existing evidence is primarily derived from retrospective single-center analyses with small patient cohorts. This study aimed to evaluate the outcomes of pulmonary SBRT in patients with oligometastatic HNSCC and to identify factors associated with survival.

METHODS AND MATERIALS

This trinational multicenter cohort study, including 16 centers from Germany, Austria, and Switzerland, retrospectively analyzed patients with oligometastatic HNSCC undergoing SBRT for pulmonary metastases between 2010 and 2023. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival and incidence of local failures.

RESULTS

A total of 178 patients with 284 irradiated lung metastases were analyzed. The most common primary HNSCC subsites were oropharyngeal (n = 71), laryngeal (n = 37), and hypopharyngeal (n = 31). Lung metastases were treated with a median biologically effective dose (BEDα/β=10 Gy) of 105 Gy (IQR, 84-113) at the planning target volume periphery. After a median follow-up of 40 months (95% CI, 34-46), the median OS and progression-free survival were 33 months (95% CI, 26-40) and 9 months (95% CI, 7-11), respectively. The 1-year cumulative incidence of local failures was 5.5% (95% CI, 3.2-8.8). One patient (0.6%) developed acute grade 3 dysphagia, and among 146 patients assessed for chronic toxicities, 2 (1.4%) experienced grade 3 events, with no grade 4-5 toxicities. On multivariable analysis, older (>65 years) patients (hazard ratio [HR], 1.59; 95% CI, 1.02-2.49; P = .040) and females (HR, 1.76; 95% CI, 1.04-2.99; P = .035) exhibited worse OS, whereas longer time between HNSCC diagnosis and first SBRT was associated with longer OS (HR, 0.99; 95% CI, 0.99-1.00; P = .045).

CONCLUSION

SBRT for pulmonary metastases achieves excellent local control with minimal toxicity in patients with oligometastatic HNSCC. Prospective trials are needed to determine the optimal timing for integrating SBRT with systemic treatment.

Review of Bone Metastasis in Gynecologic Malignancies: Evaluation and Treatment

OPINION STATEMENT

Metastatic bone disease (MBD) is a significant source of morbidity and mortality in cancer patients with solid tumors, including those with gynecologic malignancies. Infiltration of tumor cells within the bone microenvironment disrupts bone homeostasis and leads to osteoblastic, osteolytic, or mixed bone lesions. Greater than two thirds of those with MBD experience cancer-induced bone pain (CIBP) and one to two-thirds will develop a skeletal-related event (SRE). Various pharmacologic, surgical, and radiation treatments exist for the palliation of bone metastases and the prevention of SREs. It is paramount to understand the diagnostic evaluation and evidence-based treatment paradigms of bone metastases to decrease healthcare utilization, alleviate financial burden, mitigate disability, and improve quality of life.

Comprehensive cohort study: computer tomography-guided high-dose rate brachytherapy as metastasis-directed therapy for liver metastases from colorectal cancer in repeat oligoprogression

PURPOSE

The standard treatment for oligometastatic colorectal cancer includes systemic therapy, with surgery and metastasis-directed therapy as options. The optimal strategy, especially for repeat oligoprogression (rOP), remains unclear. We report outcomes of liver computer tomography-guided high-dose rate brachytherapy (CT-BRT) in this setting.

METHODS

This retrospective cohort study included colorectal cancer patients with liver-only oligoprogression during systemic therapy, meeting criteria of up to 5 liver metastases, CT-BRT eligibility, and ECOG status ≤ 2. Patients were followed for local response, progression-free survival (PFS), overall survival (OS), and toxicity. Response, according to RECIST 1.1, was initiated 6 months post-CT-BRT.

RESULTS

A total of 262 metastases were treated in 127 patients, with 67.7% receiving third-line or later systemic therapies. One to four liver metastases were found in 29.1%, 42.5%, 21.2%, and 7.1% of patients, respectively, with a median volume of 128 cm3. A median of 3 applicators was used, with CT-BRT doses of 15 Gy, 20 Gy, and 25 Gy given to 29.9%, 41.7%, and 28.3% of patients. At 6 months complete response occurred in 3.1%, progressive disease in 23.6%, partial response in 19.7%, and stable disease in 53.5%. Median PFS was 9 months, median OS was 16 months, with 1-year and 2-year OS rates of 65% and 16%, respectively. Liver-only metastases and objective response were associated with longer PFS. The G3 toxicity was 4.0%; no events > G3 were reported.

CONCLUSIONS

This largest study documents favorable outcomes of liver CT-BRT for rOP, establishing this method as a viable option in this indication.

Predicting 30-day mortality with routine blood tests in patients undergoing palliative radiation therapy: A comparison of logistic regression and gradient boosting models

PURPOSE

This study aimed to estimate the 30-day mortality (30D_M) and compare models for 30D_M prediction in patients undergoing palliative radiation therapy (RT).

MATERIALS AND METHODS

Data from 3,756 patients who underwent palliative RT between 2018 and 2020 at two institutions were retrospectively reviewed. From one institution, 3,315 patients were randomly assigned to the training (N = 2,652) and internal validation (N = 663) cohorts. The remaining 441 patients from the other institution constituted the external validation cohort. Nineteen features, including seven blood test features, were extracted from medical records. For 30D_M prediction, 4 models were constructed: logistic regression comprising all features (LRM-A) and 7 blood test features (LRM-B) and gradient boosting using all features (GBM-A) and 7 blood test features (GBM-B).

RESULTS

The 30D_M rates were 10.6 %, 11.2 %, and 17.5 % in the training, internal validation, and external validation cohorts, respectively. GBM-B demonstrated a good value for the area under the receiver operating characteristic curve (AUC) (0.830-0.863). Among the four models, GBM-A exhibited the highest AUC values, although GBM-B still generally outperformed LRM-A and LRM-B. The 30D_M rates significantly differed across the four prognostic groups according to the quantile values of predictive probability of GBM-B: 0-0.8 % (1st quantile), 1.2-3.4 % (2nd quantile), 8.7-12.9 % (3rd quantile), and 31.1-36.6 % (4th quantile), respectively.

CONCLUSIONS

The 30D_M rates were successfully stratified into distinct prognostic groups by using the GBM-B model. The model could serve as a straightforward and objective tool for predicting mortality in patients undergoing palliative RT.

Transcontinental Differences in Management of Pulmonary Metastatic Disease: Europe

Several international registries, including 4 from Europe-Italy, Spain, the Netherlands, and the European Society of Thoracic Surgeons-are dedicated to addressing deficiencies in pulmonary metastasectomy research. The randomized PulMiCC and SABR-COMET trials provide contradictory outcomes and new randomized trials have been initiated. Europe's metastasectomy approach transitioned from open thoracotomy to video-assisted thoracoscopic surgery, with 72% of surgeons favoring minimally invasive methods by 2023. European Society for Medical Oncology guidelines recommend surgery for completely resectable lesions and propose ablative approaches as supplementary or alternative treatments for inoperable cases due to frailty or unfavorable anatomy.

Intrafractional Motion in Online-Adaptive Magnetic Resonance-Guided Radiotherapy of Adrenal Metastases Leads to Reduced Target Volume Coverage and Elevated Organ-at-Risk Doses

BACKGROUND/OBJECTIVES

Stereotactic body radiotherapy is frequently used in patients with adrenal metastases. Motion of adherent radiosensitive organs at risk (OARs) and tumors influence OAR toxicity and tumor control. Online-adaptive Magnetic Resonance-guided radiotherapy (MRgRT) can address and mitigate interfractional changes. However, the impact of intrafractional variations in adrenal MRgRT is unknown.

METHODS

A total of 23 patients with 24 adrenal metastases were treated with MRgRT. After daily plan adaptation and before beam application, an additional (preRT) 3d MRI was acquired. PreRT target volumes and OARs were retrospectively recontoured in 200 fractions. The delivered, online-adapted treatment plans, as well as non-adapted baseline plans, were calculated on these re-contoured structures to quantify the dosimetric impact of intrafractional variations on target volume coverage and OAR doses with and without online adaptation. Normal tissue complication probabilities (NTCPs) were calculated.

RESULTS

The median time between the two MRIs was 56.4 min. GTV and PTV coverage (dose to 95% of the PTV, D95%, and volume covered by 100% of the prescription dose, V100%) were significantly inferior in the preRT plans. GTV Dmean was significantly impaired in left-sided metastases, but not in right-sided metastases. Compared to non-adapted preRT plans, adapted preRT plans were still significantly superior for all GTV and PTV metrics. Intrafractional violations of OAR constraints were frequent. D0.5cc and the volume exposed to the near-maximum dose constraint were significantly higher in the preRT plans. The volume exposed to the D0.5cc constraints in single fractions escalated up to 1.5 cc for the esophagus, 3.2 cc for the stomach, 5.3 cc for the duodenum and 7.3 cc for the bowel. This led to significantly elevated NTCPs for the stomach, bowel and duodenum. Neither PTV D95%, nor gastrointestinal OAR maximum doses were significantly impaired by longer fraction duration.

CONCLUSIONS

Intrafractional motion in adrenal MRgRT caused significant impairment of target volume coverage (D95% and V100%), potentially undermining local control. Frequent violation of gastrointestinal OAR constraints led to elevated NTCP. Compared to non-adaptive treatment, online adaptation still highly improved GTV and PTV coverage.

Applications of Fibroblast Activation Protein Inhibitor-PET in Interventional Oncology

Molecular imaging-guided techniques increase precision in surgical procedure and reduce postinterventional morbidity. Fibroblast activation protein (FAP) ligands may contribute to the superior preoperative assessment compared with conventional radionuclides due to its higher sensitivity and tumor delineation in epithelial malignancies. Wide spectrum of currently available FAP ligands including diagnostic and therapeutic emitters allows a flexibility regarding the optimal choice for individual need. Moreover, newly introduced hybrid tracers with fluorescence-based FAP probes enrich this spectrum by providing intraoperative FAP-targeting without radiation exposure. Thus, the use of FAP ligands in interventional oncology has great promise in improving the efficiency of local-interventional surgery.

Initial experience with MR-guided adaptive spinal stereotactic radiotherapy: a new indication for the MR-linac

BACKGROUND AND PURPOSE

Stereotactic body radiotherapy (SBRT) is associated with good local control and symptom relief in the management of spinal metastases. Delivery of ablative doses and re-irradiation is challenged by spinal cord toxicity. We hypothesized that lower spinal cord doses as well as better target coverage could be yielded with stereotactic magnetic resonance-guided adaptive radiotherapy (SMART).

MATERIALS AND METHODS

Institutional records were reviewed to retrieve patients who received online MR-guided SBRT for spinal metastases. Each fraction was reviewed to determine the necessity of adaptive planning, to identify reasons for violations that required adaptive planning, and to assess the spinal cord dose. The study also evaluated how adaptive planning contributed to reducing spinal cord doses.

RESULTS

A total of 34 patients with 61 lesions were included. The treatment intent was definitive for 47 (77.1%), palliative for 12 (19.7%), and postoperative for two (3.3%) lesions. The median prescribed Biological Equivalent Dose (BED)10 was 51.3 Gy. Treatment plans often required adaptive adjustments (81.8%). Adaptive planning significantly improved target coverage (median PTV coverage 92.75% vs. 95%; p < 0.001) and reduced spinal cord Dmax (median spinal cord Dmax constraint: 7.3 Gy, median predicted spinal cord Dmax: 7.76, and median adaptive spinal cord Dmax 6.18; p < 0.001). Lesion-based median follow-up from irradiation was 7.5 months (range: 1-46 months). One-year LPFS was 94.3%. Six lesions progressed and none of the progressed lesions received a dose above the median BED10 of 51.3 Gy.

CONCLUSION

Herein we present our institutional experience with SMART for spinal bone metastases. According to our results, adaptive planning yields better target coverage as well as lower spinal cord doses compared to the predicted plan, which translates into a feasible method for delivering SBRT. Future prospective studies evaluating spinal SMART are awaited.

A phase I clinical trial of radiation therapy, durvalumab and tremelimumab in recurrent gynecologic cancer

OBJECTIVE

Dual immune checkpoint blockade (ICB) may synergize with palliative radiotherapy (RT) to improve responses in patients with recurrent/metastatic gynecologic cancer. We conducted an open label prospective phase I trial to assess the safety and tolerability of ICB plus RT.

METHODS

Patients with recurrent/metastatic endometrial, ovarian, cervical, vaginal or vulvar cancer were eligible. The safety lead-in cohort A was treated with programmed death ligand (PD-L1) inhibitor durvalumab 1500 mg IV q4 weeks and palliative RT of 25 Gy in 5 fractions to a single abdominopelvic lesion. Cohort B also received 4 cycles of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor tremelimumab 75 mg IV. The primary endpoint was the rate of dose-limiting toxicities (DLTs) in patients on protocol 8 weeks after RT. Secondary endpoints included the overall response rate (ORR) in non-irradiated lesions.

RESULTS

16 patients were enrolled, with 12 able to be assessed for the primary endpoint. Zero DLTs occurred in cohort A and 1 in cohort B. One patient in cohort B with platinum resistant ovarian cancer with two metastatic sites (a pelvic mass irradiated prior to trial enrollment and a peritoneal nodule irradiated on protocol) had a dramatic reduction in disease burden and remains off all therapy >3 years. The ORR of non-irradiated lesions was 0 %.

CONCLUSIONS

Combining durvalumab, tremelimumab and RT to a single lesion had limited DLTs but no response in non-irradiated lesions in unselected patients with recurrent gynecologic malignancies. One patient with oligometastatic disease experienced prolonged durable benefit.

CLINICAL TRIAL INFORMATION

NCT03277482.

Multimodality treatment in synchronous oligometastatic NSCLC: Analysis of the ETOP CHESS trial

OBJECTIVE

To evaluate the addition of immunotherapy and metastasis-directed stereotactic body radiotherapy (SBRT) to induction chemotherapy followed by definitive local therapy of the locoregional primary tumour in patients with synchronous oligometastatic non-small cell lung cancer (NSCLC).

METHODS

CHESS is a prospective, international, multicentre, single-arm, phase II trial evaluating the efficacy and safety of combined chemotherapy (carboplatin plus paclitaxel), immune checkpoint inhibition (durvalumab) and metastasis-directed SBRT, followed by definitive radiotherapy or surgery of the primary tumour (if no disease progression at the 3-month restaging) and maintenance durvalumab for maximum one year in patients with synchronous oligometastatic NSCLC. The primary endpoint was one-year progression-free survival, aiming to an improvement from 25% to 50%.

RESULTS

A total of 49 patients were enrolled from 11/2019 to 07/2022. Up to 05/2023, the median follow-up was 22 months. Of 47 patients starting treatment, 10 progressed and 2 died before restaging, while 35 proceeded to definitive therapy of the locoregional primary (11surgery, 24 radiotherapy). Among the first 42 evaluable patients, 14 (33%; ≥17 required) reached one year without progression, and the null hypothesis could not be rejected. The one-year overall survival rate for all patients was 74.9% (95% CI: 60.0%-84.9%). Treatment-related grade ≥ 3 adverse events were reported in 34% of patients, with no grade 5 event.

CONCLUSION

The CHESS trial did not meet its primary endpoint. However, the favourable safety profile and promising overall survival provided the basis for further intensification of induction systemic therapy (addition of tremelimumab in a subsequent study cohort; CHESS-Cohort 2).

Modern Treatment of Skeletal Metastases: Multidisciplinarity and the Concept of Oligometastasis in the Recent Literature

Bone metastases are a major concern in cancer management since they significantly contribute to morbidity and mortality. Metastatic lesions, commonly arising from breast, prostate, lung, and kidney cancers, affect approximately 25% of cancer patients, leading to severe complications such as pain, fractures, and neurological deficits. This narrative review explores contemporary approaches to bone metastases, emphasizing a multidisciplinary strategy and the evolving concept of oligometastatic disease. Oligometastases, defined by limited metastatic spread (1-5 lesions), offer a potential window for curative treatment through aggressive interventions, including stereotactic ablative radiotherapy and resection surgery. Tumor boards, integrating systemic therapies with local interventions, are crucial to optimize treatment. Despite promising results, gaps remain in defining optimal treatment sequences and refining patient selection criteria. Future research should focus on personalized approaches, leveraging biomarkers and advanced imaging to enhance outcomes and the quality of life in patients with bone metastases.

Evaluating Toxicity and Interaction Outcomes of Systemic Therapy and Stereotactic Ablative Radiation Therapy for Oligometastatic Disease: A Secondary Analysis of the Phase 2 SABR-5 Trial

PURPOSE

Although stereotactic ablative radiation therapy (SABR) is known for low toxicity and safety, its combined use with specific systemic therapies requires further investigation. This study aims to evaluate the toxicity of SABR in combination with various systemic therapies.

MATERIALS AND METHODS

A secondary analysis of the SABR-5 trial evaluated grade 2+ and 3+ toxicities post-SABR in patients who had received high-risk or non-high-risk systemic therapies before SABR at 4 predefined intervals: concurrent with SABR, 1 day to 1 week prior, 1 to 2 weeks prior, or 2 to 12 weeks prior. High-risk systemic therapy was a priori defined as drugs that may increase treatment toxicity when delivered in close proximity to SABR. This category encompasses cytotoxic chemotherapy, multitargeted tyrosine kinase inhibitors, CDK 4/6 inhibitors, EGFR inhibitors, anti-VEGF agents, and anti-CTLA-4 agents.

RESULTS

Among 380 patients, grade 2+ toxicity rates were 17.3% (35/202) off systemic therapy, 19.2% (19/99) on non-high-risk therapy, and 42.9% (3/7) on high-risk therapy concurrent with SABR. Grade 3+ rates were 3.5% (7/202), 4.0% (4/99), and 28.6% (2/7), respectively. On multivariable analysis, concurrent use of high-risk systemic therapy was associated with a higher risk of grade 3+ toxic effects (OR, 14.88; P = .009). No significant risk was noted when high-risk drugs were used within 1 week, 2 weeks, or 2 to 12 weeks of SABR or with any non-high-risk drugs. Grade 2+ toxic effects associated with concurrent high-risk systemic therapy were primarily bone/pain related. Increased tumor diameter also elevated grade 2+ toxicity risk (per 1 cm increment; G2+ OR, 1.19; P < .001).

CONCLUSION

Concurrent use of high-risk drugs has demonstrated a potential of increased SABR-related toxicity, warranting caution in their concurrent use with SABR. In contrast, combining non-high-risk drugs (eg, hormonal therapy) with SABR did not increase risk. Further research is essential to identify risks associated with this therapeutic combination.

1-year efficacy results after MR-guided risk-adapted stereotactic radiotherapy of infra-diaphragmatic oligometastases in a multicenter phase II trial

BACKGROUND AND PURPOSE

The SOFT (Stereotactic ablative radiotherapy of infra-diaphragmatic sOFT tissue metastases) trial assesses the safety and efficacy of risk-adapted MR-guided stereotactic ablative radiotherapy (SABR) of infra-diaphragmatic soft tissue metastasis in patients with oligometastatic disease (OMD) (clinicaltrials.gov ID NCT04407897). This paper reports the one-year efficacy analysis and evaluates associations between local control (LC) and clinical and dosimetric parameters.

MATERIALS AND METHODS

This investigator-initiated, multicenter, single-arm, phase 2 study recruited patients from four MR-linac centers in Denmark and the US. Patients with De novo or recurrent OMD with ≤5 metastases in ≤3 organs and patients with induced OMD or oligoprogressive disease (OPD) with ≤3 metastases were eligible. Fractionation schemes were 45-75 Gy in 3-8 fractions.

RESULTS

The trial included 121 patients with 147 oligometastatic lesions, primarily in the liver (41 %), lymph nodes (35 %), or adrenal glands (14 %). The median follow-up time was 13.0 months, interquartile range (IQR) (11.7,13.7) months. The 1-year LC rate was 89 %, 95 % confidence interval (CI) (83,94 %). We did not observe any statistically significant associations between LC and clinical and dosimetric parameters. The median progression-free survival was 7.1 months, 95 % CI (6.0,9.4). One- and two-year overall survival was 82.6 %, 95 % CI (76.2 %,89.7 %), and 65.1 %, 95 % CI (56.4 %,75.3 %). Sixty-one patients (50 %) were kept off systemic therapy throughout the one-year follow-up.

CONCLUSION

In our study, treatment with risk-adapted, MR-guided SABR resulted in a high one-year local control and survival rate and could keep half of the patients off systemic therapy within the first year of follow-up.

Stereotactic body radiotherapy for non-spine bone metastases: A meta-analysis and international stereotactic radiosurgery society (ISRS) clinical practice guidelines

BACKGROUND

While SBRT to NSBM has become common, particularly in the oligometastatic population, the approach to treating non-spine bone metastases (NSBM) with stereotactic body radiotherapy (SBRT) varies widely across institutions and clinical trial protocols. We present a comprehensive systematic review of the literatures to inform practice recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS).

METHODS

A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies with at least 10 patients receiving SBRT for NSBM were identified and meta-analyses were completed to estimate pooled local control and overall survival rates. Published guidelines on NSBM SBRT were reviewed and consolidated.

RESULTS

There were 25 studies included for qualitative analysis and 18 studies for quantitative analysis consisting of 13 retrospective studies, 2 non-randomized prospective studies, 1 randomized phase 2/3 trial, and a subgroup analysis of a phase I trial. The pooled local control rates at 1 and 2 years were 95 % (95 % CI: 89 %-98 %) and 94 % (95 % CI: 86 %-98 %), respectively. Pooled overall survival rates at 1 year and 2 years were 84 % (95 % CI: 73 %-91 %) and 81 % (95 % CI: 45 %-95 %), respectively. Consensus was reached on recommendations to inform treatment simulation, target delineation, dose fractionation, and anatomic site-specific recommendations.

CONCLUSION

We present ISRS-endorsed consensus recommendations to inform best practice of SBRT to NSBM, which we found to be efficacious and associated with low rates of adverse events.

Future directions in the evaluation and management of newly diagnosed metastatic cancer

There is much debate regarding optimal selection in patients with metastatic cancer who should undergo local treatment (surgery or radiation treatment) to the primary tumor and/or metastases. Additionally, the optimal treatment of newly diagnosed metastatic cancer is largely unclear. Current prognostication systems to best inform these clinical scenarios are limited, as all metastatic patients are grouped together as having Stage IV disease without further incorporation of patient and disease-specific covariates that significantly impact patient outcomes. Therefore, improving current prognostic scoring systems and incorporation of these covariates is essential to best individualize treatment for patients with metastatic cancer. In this narrative review article, we provide a detailed review of prognostication systems that can be used for both the site of metastasis and primary site to best tailor treatment in these patients. Additionally, we discuss the incorporation and ongoing developments in radiographic, genomic, and biostatistical techniques that can be used as prognostication tools.

Radical hemithorax radiotherapy induces an increase in circulating PD-1+ T lymphocytes and in the soluble levels of PD-L1 in malignant pleural mesothelioma patients: a possible synergy with PD-1/PD-L1 targeting treatment?

Malignant Pleural Mesothelioma (MPM) is an aggressive tumor associated with asbestos exposure, characterized by a poor prognosis, managed with surgery, chemotherapy and radiotherapy. Recently, immunotherapy gives a survival advantage compared to chemotherapy, but limited to the non-epithelioid histotype, the rarest type. Radical hemithorax radiotherapy (RHRT) improves the Overall Survival (OS) of MPM patients, irrespective of histotype, and is able to induce immunomodulatory effects. In this study we aim to investigate changes in circulating T lymphocytes phenotype and activity, in MPM patients undergoing RHRT, to evaluate a possible therapeutic space for immunotherapy in this setting. To assess immunomodulatory effects of RHRT we evaluate peripheral blood samples of 35 MPM patients collected before treatment, at the end of RT, and 1 month later. We first notice that higher Lymphocyte-to-Monocyte Ratio (LMR) levels, before RT, are associated with an improved OS. The immune monitoring performed by ELISA assays reveals a significant increase in the serum levels of soluble PD-L1 (sPD-L1) and IFN-γ at the end of RHRT. Furthermore, the percentage of PD-1+ cells, evaluated by flow cytometry, significantly raise after RHRT in T cells, both CD4+ and CD8+. Also the proportion of proliferative cells is significantly expanded after RHRT in all T cell subtypes. After treatment we observe a significant increase in the number of patients showing WT-1 specific CD4+ T cells, measured by intracellular staining. The TCR repertoire analysis, investigated by Next Generation Sequencing, reveals an increased number of expanded T-cell clones after RHRT, and an association between TCR clonality and the percentage of proliferating cytotoxic T lymphocytes. The comparison of TCR sequences obtained in our cohort with those described in a literature cohort of MPM patients, reveals common entries, specific for MPM-associated antigens including WT-1. In this setting, pre-treatment levels of LMR seem to have a positive prognostic role, and RHRT would appear to induce immunomodulating effects, potential biomarkers for immunotherapy eligibility: i.e. increased PD-1+ T lymphocytes, proliferating T cells, expanded T cell clones and augmented levels of sPD-L1. These data suggest the design of a prospective study evaluating a maintenance immunotherapy after RHRT in MPM, even in the epithelioid histotype.

Survival Without Quality of Life Deterioration in the GORTEC 2014-04 "OMET" Randomized Phase 2 Trial in Patients with Head and Neck Cancer with Oligometastases using Stereotactic Ablative Radiation Therapy (SABR) alone or Chemotherapy and SABR

PURPOSE

Patients with oligometastasis may have prolonged survival with multisite stereotactic ablative radiation therapy (SABR). Evidence to support this paradigm is scarce in squamous cell carcinoma of the head and neck (HNSCC). The multicenter open-label randomized GORTEC 2014-04 (NCT03070366) phase 2 study assesses survival without definitive quality of life (QoL) deterioration of omitting upfront chemotherapy in oligometastatic patients with HNSCC using SABR alone, in the French Head and Neck Intergroup.

METHODS AND MATERIALS

Eligible participants (≥18 years old with 1-3 oligometastases, the Eastern Cooperative Oncology Group score 0-2) were randomly assigned (1:1) to receive chemo-SABR or SABR alone. Salvage treatments were left to the physician's appreciation. The standard therapy was considered to be systemic therapy and SABR (chemo-SABR; EXTREME regimen [5 fluorouracil/platinum/cetuximab]). The primary endpoint was 1-year (±3 months) overall survival rate without definitive deterioration (ie, without subsequent better QoL score) of the global European Organisation for Research and Treatment of Cancer QoL Questionnaire-Core30 score.

RESULTS

Between September 2015 and October 2022, 69 participants were assigned to receive chemo-SABR (N = 35) or SABR alone (N = 34); 57 had lung-only metastases (82.6%), and 40 had isolated metastasis (58.0%). The median baseline QoL score was 66.7 (IQR, [50.0-83.3]). The median follow-up was 55.3 months (95% CI, 45.0-69.7). Of participants (N = 59) evaluable for the primary endpoint, 16 of 29 (55.2%, 90% CI, 0.38-0.71) and 16 of 30 (53.3%, 90% CI, 0.37-0.69) were alive and free of QoL deterioration at 1 year in the SABR-alone and chemo-SABR arms. However, QoL deterioration was deeper with chemo-SABR (50.0; IQR, [41.7-66.7]) than with SABR alone (16.7; IQR, [16.7-41.7]). In intent-to-treat analysis (N = 69), median survival was 42.3 months (95% CI, 26.5-not reached) with chemo-SABR and 41.1 months (95% CI, 32.1-66.9) with SABR alone; median progression-free survival was 12.9 (95% CI, 7.5-17.3) and 7.4 months (95% CI, 4.2-15.6) in the chemo-SABR and SABR alone arms, respectively. Rates of severe treatment-related toxicities were 21 of 35 (60.0%) with chemo-SABR and 3 of 34 (8.8%, no grade 5) with SABR alone.

CONCLUSIONS

Using SABR alone, the omission of upfront EXTREME-based chemotherapy and maintenance cetuximab in oligometastatic patients with HNSCC resulted in similar survival but much less severe QoL deterioration and fewer toxicity rates. SABR alone could be a reasonable alternative in oligometastatic patients with HNSCC.

Predictive Factors for Oligometastatic Renal Cell Carcinoma Treated with Stereotactic Radiation: A Retrospective Study

BACKGROUND AND OBJECTIVE

Stereotactic ablative radiotherapy (SAbR) has shown promise in controlling oligometastatic renal cell carcinoma (omRCC). Careful patient selection is critical, and yet the selection criteria remain unknown for patients who will not be harmed by delayed systemic therapy using SAbR. Here, we analyzed long-term follow-up of omRCC patients treated with SAbR to derive the predictors of survival benefit.

METHODS

We retrospectively reviewed patients with up to five omRCC sites treated with sequential SAbR from November 2007 to July 2022. Overall survival (OS), progression-free survival (PFS), local control (LC), and toxicity were analyzed. The predictors of PFS were analyzed using a univariate analysis and a Cox proportional hazard (CPH) model-based machine learning approach.

KEY FINDINGS AND LIMITATIONS

We analyzed 153 patients who underwent SAbR to 337 metastases with a median follow-up of 27 mo. The median OS and PFS were 61.3 and 32 mo, respectively. The rate of grade ≥3 toxicity was 1.3%, and the 3-yr rate of LC was 98%. Patients with bone and brain metastases had lower PFS on the univariate analysis. When compared with historical controls, the delayed-onset PFS with first-line systemic therapy in this cohort was not compromised. The CPH model found bone, brain, and number of metastases at diagnosis to be the predictors of PFS, with a C-index of 0.66 and 1-yr area under the curve of 0.68.

CONCLUSIONS AND CLINICAL IMPLICATIONS

For selected patients, SAbR is effective in controlling omRCC for >2 yr and can delay systemic therapy without compromising patient outcome. Bone and brain metastases, as well as an increasing number of metastases are poor predictive factors for omRCC patients treated with sequential SAbR who may benefit from upfront systemic therapy. Prospective studies are required to verify these findings.

The Role and Potential of Modern Radiotherapy in the Treatment of Metastatic Prostate Cancer

Background/Objectives: Prostate cancer is one of the most prevalent cancers among men, with a significant proportion progressing to metastatic disease. Traditional treatments for metastatic prostate cancer have primarily been palliative, focusing on symptom relief. However, recent advances in radiotherapy have shown promise in improving outcomes for these patients. Methods: This study presents a modern treatment plan for extensive metastatic prostate cancer. Pre-treatment imaging revealed extensive lymph node metastases and high metabolic activity in the prostate. The treatment regimen included bicalutamide, androgen deprivation therapy with leuprorelin, and six cycles of docetaxel chemotherapy, followed by a targeted radiotherapy regimen aimed at both the primary tumor and metastatic lymph nodes. Results: Following the comprehensive radiotherapy regimen, the patient's PSA level dropped below the edge of detection, indicating complete biochemical remission. Follow-up imaging and clinical assessments confirmed the absence of active metastatic sites. Conclusions: The findings support the integration of radiotherapy into comprehensive treatment plans for metastatic prostate cancer, demonstrating that radiotherapy can achieve complete remission even in patients with extensive metastatic disease. This suggests a need for re-evaluating traditional approaches and exploring more personalized, multimodal treatment strategies. Enhanced imaging techniques, such as PET/PSMA scans, play a crucial role in accurately targeting metastatic sites, enabling more effective and individualized treatment.

A Randomized, Multicenter, Phase 2 Trial of Camrelizumab With or Without Metastasis-directed Stereotactic Body Radiation Therapy in Recurrent or Metastatic Nasopharyngeal Carcinoma

PURPOSE

To investigate the efficacy of metastasis-directed therapy (MDT) when added to camrelizumab (Cam) in patients with recurrent or metastatic nasopharyngeal carcinoma (R/M-NPC).

METHODS AND MATERIALS

We conducted a randomized, controlled, multicenter, phase 2 trial in 3 centers from China (NCT04830267). Patients with R/M-NPC, without prior exposure to immunotherapy, who presented with ≥2 lesions, and at least 1 measurable lesion were randomized 1:1 to either Cam alone or Cam plus MDT (Cam+MDT). Patients randomized to the MDT group must have 1 lesion that is amendable to stereotactic body radiation therapy (SBRT) prescribed to 27 Gy in 3 fractions every other day. The primary endpoint was objective response rate (ORR) of unirradiated lesions using Response Evaluation Criteria in Solid Tumors v1.1.

RESULTS

Between April 2021 and August 2023, 39 patients were randomly assigned to receive either Cam (n = 20) or Cam+MDT (n = 19). In total, 17 out of 39 (43.6%) patients had oligometastatic disease (≤3 lesions), 18 out of 39 (46.2%) had liver involvement, and 3 out of 39 (7.7%) had locoregional recurrent disease. ORR of unirradiated lesions did not differ between the treatment groups (26.3% [Cam+MDT] vs 30.0% [Cam], P = 1.0). The disease control rate of unirradiated lesions was 73.7% in the Cam+MDT group compared with 60.0% in the Cam group (P = .571). After a median follow-up of 25.8 months, median progression-free survival was 9.3 (95% CI, 6.2-not reached [NR]) months in the Cam+MDT group and 8.8 (95% CI, 3.3-NR) months in the Cam group (P = .750). Exploratory analyses suggested a longer overall survival (OS) with Cam+MDT for patients with >3 lesions (HR, 0.23; 95% CI, 0.07-0.77; P = .009). G3 and above adverse events were comparable between the treatment groups (15.8% [Cam+MDT] vs 20.0% [Cam]). The overall rate of capillary proliferation was 17.9% (7/39) for the trial.

CONCLUSIONS

Our study did not meet its primary endpoint of superior ORR of unirradiated lesions with the addition of MDT to Cam in patients with R/M-NPC.

Phase 2 Trial of Consolidative Stereotactic Body Radiation Therapy in Patients With Metastatic Oncogene-driven Non-small Cell Lung Carcinoma Treated With Tyrosine Kinase Inhibitors

PURPOSE

The role of stereotactic body radiation therapy (SBRT) in the management of advanced EGFR/ALK/ROS1-driven non-small cell lung carcinoma (NSCLC) remains undefined. In EGFR-mutant NSCLC, 50-60% of recurrences on first-line tyrosine kinase inhibitors (TKIs) occur in originally involved sites and may lead to subsequent distant failures (DFs). We sought to determine whether consolidative SBRT to residual sites reduces DF.

METHODS AND MATERIALS

This is a single-arm, phase 2 trial of SBRT to residual sites of disease in patients with metastatic oncogene-driven NSCLC with stable or responding disease to TKI within 12 months of treatment start. The primary endpoint was DF frequency at 12 months after SBRT.

RESULTS

The median follow-up was 57.1 months. The trial enrolled 27 of 30 planned patients between 2015 and 2021, stopping early caused by slow accrual. Most (n = 22) had EGFR driver mutations. The majority (59.5%) were treated with later-generation TKIs. The median time from TKI start to SBRT was 6.4 months. Twenty-five patients (92.6%) received SBRT to the residual lung primary only. The 12-month DF rate was 19% (95% CI, 7%-36%). Median progression-free survival from SBRT was 15.0 months (95% CI, 8.6-46.7). The 2-year local failure rate of irradiated sites was 11% (95% CI, 3%-27%). Two-year and median overall survival were 88% (95% CI, 68%-96%) and 59.6 months (95% CI, 42.3-NR), respectively. There were no grade ≥3 adverse events related to SBRT.

CONCLUSIONS

In patients treated with first-line TKIs, consolidative SBRT was associated with improvement in distant disease control compared with historical controls, supporting ongoing randomized trials.

Survival analysis of patients with metastatic head and neck squamous cell carcinoma treated with metastasis-directed radiotherapy and immunotherapy

OBJECTIVE

Immunotherapy combined with chemotherapy is currently the first-line treatment for metastatic head and neck squamous cell carcinoma (HNSCC). This study aims to evaluate whether adding metastasis-directed radiotherapy (MDRT) to immunotherapy and chemotherapy could improve the survival rate of patients with metastatic HNSCC.

MATERIALS AND METHODS

A retrospective analysis was conducted on patients with HNSCC who developed distant metastases after curative treatment. Systemic treatment was determined by the multidisciplinary team, with a programmed cell death-1 (PD-1) inhibitor combined with chemotherapy as the primary approach. The feasibility of radiotherapy was evaluated by clinical and imaging examinations. Stereotactic body radiotherapy (SBRT) was used to deliver different doses according to the number and location of metastatic lesions. Kaplan-Meier method was used to estimate survival, and Cox regression analysis was performed to evaluate the association between clinical factors and survival outcomes.

RESULTS

From January 2018 to June 2023, a total of 94 patients with 164 metastatic sites were included for the analysis. The most common primary tumor was the nasopharynx (77.7%), with the lung being the most frequent site of metastasis (46.8%), followed by bone (37.2%). Radiotherapy was administered to 276 metastatic lesions, with a median dose of 52.3 Gy (range: 24-60 Gy). The median overall survival (OS) was 43.0 months (range: 20.2-65.8). The OS rates at 2 and 5 years were 70.1% (95% CI, 59.7-80.5%) and 30.1% (95%CI 11.7-48.5%), respectively. Univariate and multivariate analysis showed that the number of metastases and the location of the primary tumor were significantly associated with OS.

CONCLUSIONS

In patients with metastatic HNSCC, MDRT combined with immunotherapy and chemotherapy can effectively improve local control and OS. These findings warrant further validation through prospective clinical trials.

Stereotactic body radiotherapy and poly (ADP-ribose) polymerase inhibitors in ovarian cancer: a knowledge and attitudes survey in collaboration with the Italian Association of Radiation Oncology (AIRO) and Multicenter Italian Trials in Ovarian Cancer (MITO) groups

The aim of this study was to present a nationwide survey on the specialist's attitudes towards stereotactic body radiotherapy (SBRT) combined with poly (ADP-ribose) polymerase inhibitors (PARPi) with oligometastatic/oligoprogressive/oligorecurrent ovarian cancer (oMPR-OC) patients. The 19-item questionnaire was developed by specialists and distributed online. Replies were stratified by categories and analyzed using descriptive statistics. Respondents ( N = 100) were radiation oncologists (57%), medical oncologists (32%), and gynecologic oncologists (11%). Fifty-four percent of respondents considered medical oncologists as the primary oncologists for oMPR-OC, while 23% preferred radiation oncologists and 15% favored gynecologic oncologists. Seventy-three percent discuss these cases in the Multidisciplinary Tumor Board, while 15, 6, and 2% send the patients straight to SBRT, surgery, or chemotherapy, respectively. Seventy-four percent of the experts interviewed were treated with SBRT less than 10 oMPR-OC patients. Concomitant treatment was highly heterogeneous, but it had little to no reported side effects. A significant variation in how PARPi is managed during SBRT was found: 34% do not interrupt the administration, while 52% pause and restart it later. Forty-three percent of respondents believe that the PARPi dosage should not be reduced when administered concurrently with SBRT. Sixty-nine percent of respondents believe that the SBRT dose should not be decreased while receiving PARPi if the constraints are met. The majority of respondents (40%) favored expert consensus for enhancing the clinical management of oMPR-OC, while 34% preferred clinical guidelines. A lack of or low toxicity with the combination of PARPi and SBRT was perceived, and a significant degree of heterogeneity concerning clinical protocols for their combination. Moreover, it emphasizes the low number of patients who have received this treatment approach nationwide.

The role of tumor-derived exosomal LncRNA in tumor metastasis

Tumor metastasis regulated by multiple complicated pathways is closely related to variations in the tumor microenvironment. Exosomes can regulate the tumor microenvironment through various mechanisms. Exosomes derived from tumor cells carry a variety of substances, including long non-coding RNAs (lncRNAs), play important roles in intercellular communication and act as critical determinants influencing tumor metastasis. In this review, we elaborate on several pivotal processes through which lncRNAs regulate tumor metastasis, including the regulation of epithelial‒mesenchymal transition, promotion of angiogenesis and lymphangiogenesis, enhancement of the stemness of tumor cells, and evasion of immune clearance. Additionally, we comprehensively summarized a diverse array of potential tumor-derived exosomal lncRNA biomarkers to facilitate accurate diagnosis and prognosis in a clinical setting.

Proceedings of the National Cancer Institute Workshop on combining immunotherapy with radiotherapy: challenges and opportunities for clinical translation

Radiotherapy both promotes and antagonises tumour immune recognition. Some clinical studies show improved patient outcomes when immunotherapies are integrated with radiotherapy. Safe, greater than additive, clinical response to the combination is limited to a subset of patients, however, and how radiotherapy can best be combined with immunotherapies remains unclear. The National Cancer Institute-Immuno-Oncology Translational Network-Society for Immunotherapy of Cancer-American Association of Immunology Workshop on Combining Immunotherapy with Radiotherapy was convened to identify and prioritise opportunities and challenges for radiotherapy and immunotherapy combinations. Sessions examined the immune effects of radiation, barriers to anti-tumour immune response, previous clinical trial data, immunological and computational assessment of response, and next-generation radiotherapy-immunotherapy combinations. Panel recommendations included: developing and implementing patient selection and biomarker-guided approaches; applying mechanistic understanding to optimise delivery of radiotherapy and selection of immunotherapies; using rigorous preclinical models including companion animal studies; embracing data sharing and standardisation, advanced modelling, and multidisciplinary cross-institution collaboration; interrogating clinical data, including negative trials; and incorporating novel clinical endpoints and trial designs.