30-Second Takeaway
- Sequential RT–immunotherapy may modestly improve OS over concurrent iRT in advanced NSCLC real-world practice.
- Cumulative lung V5, V20, and mean dose tentatively guide thoracic reirradiation pneumonitis risk but remain low-certainty.
- Germline HRR variants selectively increase out-of-field RT-related second neoplasm risk in childhood cancer survivors.
- Anthracycline dose and cardiac-involving RT substantially raise long-term heart failure and valvular risk in DLBCL survivors.
- Preclinical radioimmunotherapy platforms, FLASH-RT sensitizers, skin-injury dressings, and focused ultrasound are reshaping future RT-integrated care.
Week ending March 28, 2026
Radiotherapy timing, late effects, and emerging technologies in contemporary radiation oncology
Sequential rather than concurrent iRT improves survival in advanced NSCLC
In this territory-wide Hong Kong cohort, 335 advanced or refractory NSCLC patients receiving RT plus immune checkpoint inhibitors were analyzed. Among newly diagnosed advanced NSCLC, sequential iRT yielded longer OS than concurrent iRT (median 20.3 vs 16.0 months; adjusted HR 0.68, 95% CI 0.47–0.99). Chemotherapy was also associated with longer survival in newly diagnosed advanced disease, underscoring its importance alongside iRT. In refractory NSCLC, RT plus ICI maintenance showed numerically longer OS than RT alone, but the difference was not statistically significant.
Cumulative lung V5, V20, and mean dose link to pneumonitis risk in thoracic reirradiation
This scoping review synthesized 19 retrospective thoracic reirradiation series reporting lung dose–volume predictors of radiation pneumonitis. Most studies used EQD2 conversion and 3D dose summation, with variable use of deformable registration for cumulative lung dose assessment. Cumulative V5Gy, V20Gy, and mean lung dose were the most frequently associated metrics with pneumonitis, but each relied on a few small heterogeneous studies. Evidence for other lung and cardiac dose parameters was very low-certainty, and clinical risk factors showed inconsistent associations with pneumonitis.
Germline HRR variants double out-of-field RT-related second cancer risk in childhood survivors
This pooled analysis included 12,180 childhood cancer survivors from CCSS and SJLIFE, evaluating deleterious germline homologous recombination repair variants. Overall, 10.3% carried HRR variants and 10.7% developed at least one RT-related subsequent neoplasm, commonly breast cancer, meningioma, thyroid cancer, or sarcoma. HRR variants significantly increased risk of out-of-field RT-related neoplasms (OR 2.5, 95% CI 1.7–3.6), with consistent estimates across cohorts. No association was observed for in-field or near-field subsequent neoplasms, or for neoplasms in survivors not treated with RT.
DLBCL survivors face high long-term heart failure and stroke risk after anthracyclines ± RT
This multicenter cohort followed 2,356 diffuse large B-cell lymphoma survivors, treated at ages 15–61 years, for a median of 14.2 years. Compared with the general population, survivors had markedly increased heart failure risk (SIR 3.9; absolute excess 62.8 per 10,000 person-years). Cerebrovascular accident risk was modestly increased, while coronary artery disease incidence was lower than expected. Heart failure risk was higher in females and in those treated at age ≤40 years, indicating substantial vulnerability in these subgroups. Doxorubicin doses >300 mg/m² increased cardiomyopathy or heart failure risk 2.8-fold, and heart-involving RT nearly doubled valvular heart disease risk.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.