Radiation Oncology

Meta-analysis: moderate BED and concurrent PD‑1/PD‑L1 with RT linked to longer PFS but heterogeneity high

This meta-analysis of 18 studies (727 patients) found reconstructed data suggesting moderate BED (50–100) yielded more favorable median PFS than low or high BED regimens. Concurrent radiotherapy with ICIs produced longer reconstructed median PFS than sequential approaches in pooled analyses. PD‑1/PD‑L1 agents appeared to outperform CTLA‑4-only regimens in these combined strategies. The pooled incidence of grade ≥3 treatment‑related adverse events was 0.22, but extreme between‑study heterogeneity and wide prediction intervals limit direct clinical application. 1

Umbrella review: high burden of oral/dental complications with limited high‑quality evidence for interventions

This umbrella review included 131 systematic reviews and found most evidence rated low or critically low confidence. Oral mucositis, xerostomia, dysphagia, trismus, dental caries, and dysgeusia were common complications after HNC therapy. Photobiomodulation reduced oral mucositis and IMRT reduced xerostomia and mandibular osteoradionecrosis in pooled syntheses. Overall evidence is fragmented, so prevention and management recommendations remain tentative and need higher‑quality trials. 2

Methodology paper: specify estimands and use robust methods for PROs with progression‑related missingness

The authors provide a framework to define estimands for longitudinal PROs facing intercurrent events like disease progression. They compare hypothetical and treatment‑policy strategies and demonstrate methods: implicit multiple imputation, joint longitudinal‑time‑to‑event modelling, and control‑based imputation. Practical tutorials show how supplementary analyses can increase confidence in PRO interpretation despite missing data. Trialists should prespecify estimands and sensitivity analyses to ensure interpretable quality‑of‑life endpoints. 3