Radiation Oncology

Off‑protocol radiotherapy is underreported and unspecified in metastatic NSCLC trials

In a review of 79 prospective systemic therapy trials for metastatic NSCLC, 93.7% allowed radiation before enrollment and 8.9% prohibited off‑protocol radiation. Only 21.5% required a drug washout around radiation, and no trial specified allowable dose, fractionation, technique, or organ‑at‑risk constraints for off‑protocol radiotherapy. Pre‑enrollment radiation was reported in 32.9% of trials and off‑protocol radiation use was never reported or adjusted for in outcomes. The authors conclude that inconsistent reporting and lack of radiotherapy parameters threaten trial interpretability. 1

Adjuvant breast radiotherapy not linked to increased skin cancer in large Korean cohort

In a nationwide cohort of 37,957 breast cancer patients with 1:1 propensity matching (n=19,856), skin cancer incidence was similar: 0.97% with RT versus 1.02% without RT (p=0.720). RT was not significantly associated with malignant melanoma or non‑melanoma skin cancer on multivariable analysis. Older age, presence of moles, premalignant skin lesions, and lymphedema predicted higher skin cancer risk. Findings apply mainly to an Asian population and do not indicate routine skin‑cancer surveillance changes solely due to adjuvant RT. 2

Single‑fraction 19‑Gy urethra‑sparing SBRT yields high 3‑year biochemical control

In this multicenter nonrandomized phase 1/2 trial of 45 men with low‑ or intermediate‑risk prostate cancer, a single 19‑Gy urethra‑sparing SBRT achieved a 3‑year bRFS of 92.9% (95% CI, 85.4%–100%). Grade 2 GU and GI adverse events at 3 years were low (9.8% and 4.9%, respectively), with one grade‑3 proctitis reported. Erectile dysfunction (grade ≥2) increased from 21.4% at baseline to 38.4% at 3 years, and modest declines in patient‑reported GU and sexual QOL were observed. Authors note longer follow‑up is required before adopting single‑fraction SBRT outside trial settings. 3