Radiation Oncology

SCRT plus immunotherapy leads neoadjuvant options for pMMR locally advanced rectal cancer

This network meta-analysis pooled seven randomized trials (1132 patients) comparing SCRT- and LCRT-based neoadjuvant regimens with or without ICIs in pMMR LARC. SCRT plus ICIs had the highest probability of curative-intent response, significantly outperforming SCRT alone and LCRT alone by roughly twofold risk ratios. SCRT plus ICIs also showed a numerical advantage over LCRT plus ICIs for curative-intent response, with consistent ranking for pCR. Adding ICIs to either SCRT or LCRT did not significantly increase grade ≥3 treatment-related adverse events compared with RT alone. These data support SCRT as the preferred platform when integrating ICIs for pMMR LARC, prioritizing curative-intent response without excess toxicity. 1

Hypofractionated prostate RT matches conventional control with distinct acute GI toxicity patterns

This meta-analysis of 41 studies (12,947 localized prostate cancer patients) compared ultra-hypofractionated, moderate hypofractionated, and conventional fractionation regimens. Moderate hypofractionation increased acute GI toxicity versus conventional fractionation, whereas ultra-hypofractionation reduced acute GI events compared with moderate hypofractionation. Acute GU toxicity and late GI/GU toxicity were similar across fractionation schemes in the available comparisons. Moderate hypofractionation showed a modest 5-year failure-free survival benefit versus conventional fractionation, but this was not robust on sensitivity analysis. Overall survival and failure-free outcomes were comparable between ultra-hypofractionated and conventional schedules, supporting hypofractionation as oncologically safe for localized disease. 2

Tri-weekly cisplatin improves tolerability without compromising control in locally advanced cervical cancer

The phase III TACO trial randomized 314 patients with stage IIB–IVA cervical cancer to weekly versus tri-weekly cisplatin during pelvic chemoradiotherapy. Three-year recurrence-free survival and recurrence patterns were similar between arms, indicating no survival disadvantage with tri-weekly dosing. Chemotherapy delays were more frequent with weekly cisplatin, suggesting greater treatment burden and reduced deliverability. Grade 3–4 hematologic toxicities occurred less often in the tri-weekly arm, and quality-of-life scores favored tri-weekly dosing in several domains. These results support tri-weekly cisplatin as a feasible alternative schedule when planning concurrent chemoradiation for locally advanced cervical cancer. 3