Great breakdown👇
Clean randomized signal for pembro + MDT in oligometastatic RCC:
RFS 11 → 25.4 mo (HR 0.47), 72% got SABR
Next Q: patterns of recurrence after MDT ± pembro
#radonc #ESMO26
PE-PE is a fantastic study, giving us randomized data on adding pembrolizumab to MDT in oligometastatic RCC!
Phase II, open-label, multicenter trial: 85 pts with prior nephrectomy and ≤3 mets within 5y of nephrectomy or previous metastasectomy, all amenable to surgery or SABR. Randomized 2:1 favoring pembro: MDT alone (n=29) vs pembro + MDT (n=56).
Pembro 400 mg q6w x9c (1y). First dose BEFORE MDT; registry specifies MDT on C1d21-42.
At MFU 17.5 mo, median RFS was 11→ 25.4 mo (HR 0.47, 95CI 0.24-0.92, p=0.024), MDT alone→ pembro + MDT. 35 RFS events, 16→ 19.
SABR 72→ 73%; surgery 28→ 23%. SABR dose/fx and per-site data weren't reported. I'd like to see those details along with local vs distant relapse.
Any AE 21→ 80%; G3 AEs 3→ 7%. The 21% control rate is with no study systemic therapy. Pembro-related AEs occurred in 59%, including G3 in 2 pts; no G4/5 pembro-related events were reported. Four pts stopped pembro for AEs.
Both groups received MDT, so the randomized question is what pembro adds. This doesn't establish the benefit of MDT itself or RT-ICI synergy. With 1 death/arm and no QoL results reported, an OS/QoL benefit remains unestablished.
I'd also like the prior systemic therapy history and the timing/burden at first metastatic presentation. The eligibility window alone doesn't tell us whether these pts were oligometastatic from the outset.
Congratulations to the investigators on this important work!
cslide.ctimeetingtech.com/es…
#radonc #ESMO26 #RCC
Honored to be elected to the @nnecos_oncology Board. NNECOS brings together oncology across ME, NH, and VT & gives our trainees a real regional stage. Looking forward to the work ahead with colleagues across the region.
ENZARAD @JCO | ANZUP 1303
n=802 | mFU 92 mo
ADT+RT ± enza 24 mo vs NSAA 6 mo
MFS/OS overall ⛔️
pelvic RT subgroup 🎯 HR 0.47
no Decipher/PAM50 - still unclear who benefits from intensification
ascopubs.org/doi/10.1200/JCO…
#ESMO26 @niazi_Dr7 DASL-HiCaP (ANZUP1801)
n=1,106 | mFU 3.8 yrs | 85% definitive RT
darolutamide + ADT + RT v placebo + ADT + RT
MFS-CI ➡️ HR 0.42 (0.27–0.66)
4-yr MFS 95% vs 88%
🚨📣📣 #ESMO26 presidential: @niazi_Dr7 Adding darolutamide to ADT + RT dramatically ⬇️ risk of metastasis or death in high-risk localized prostate cancer. Phase 3 DASL-HiCaP = 58% ⬇️ in MFS (HR 0.42) + early OS signal (HR 0.88). #ProstateCancer #RadOnc #pcsm @ChrisSweens1
Nat Lester-Coll, MD retweeted
At #ASTRO26, we are proud to welcome so many Yale attendees, including our current residents and the alumni of our Radiation Oncology Residency Program @YaleRadOnc, all representing @YaleMed @SmilowCancer @YNHH and advancing the field of radiation oncology. @ASTRO_org @OncoAlert
Nat Lester-Coll, MD retweeted
Back in 🇬🇧 but still able to listen to @nickva1 presenting @ASTRO_org #ASTRO26 @royalmarsdenNHS @EmmaHall71 No surprises here, patients have better sexual outcomes after SBRT compared to prostatectomy
Grateful to organizers for PRO 11 @ #ASTRO26:
Trial design keeps getting more complicated. Ph II data, de-escalation/omission studies, new tech routinely reported as practice-changing.
Outstanding talks on how to read that evidence and which results should change practice!
#ASTRO26 climate change, IT risk, and other system shocks make this more relevant every year. The real value here was in the stories: lessons for prevention and prep, and what we can actually do to safeguard RT when the next disruption hits.
Thank you to this panel!
This Sunday!
WHEN DISASTER STRIKES
⛈️ 🌬️ 🌀 🔥
Safeguarding Radiotherapy's Value and Continuity Across Catastrophic Events
#ASTRO26 Annual Meeting
Educational Session 8244
📆 Sunday 9/27/2026
⏰ 2:30 PM - 4:00 PM
📍 Room 257
Excited to see you at this session.
Nat Lester-Coll, MD retweeted
Long-term PACE-A data at #ASTRO26 (van As LBA32, Yasar LBA10): the first randomized comparison of prostatectomy vs SBRT, 36.25 Gy in 5 fractions.
These are contemporary surgical data: all prostatectomies were laparoscopic, 84% robotic.
Using ≥1 pad/day, RP vs SBRT:
• 2 years: 50% vs 7%
• 5 years: 48% vs 8%
Sexual function at 5 years:
• EPIC sexual domain: 62→17 after RP vs 79→58 after SBRT
• Median IIEF-5: 5 vs 19
Important caveats: as-treated analysis, approximately 60% PRO completion at 5 years, baseline sexual function imbalance, and enrollment of 123 of a planned 234 patients.
Biochemical control looks similar through 8 years, but 13 events cannot establish equivalence.
For shared decision-making, these are numbers I’d want patients to see. Every patient considering prostatectomy should have the opportunity to meet with a radiation oncologist before choosing treatment.
#RadOnc #PCSM
#ASTRO26 A071801
1-4 BMs
SRS (12-20Gy by volume) or fSRS (27Gy/3 <30cc or 30Gy/5 >30cc) after resection
fSRS ➡️ superior surgical bed control
no differences in RN or QoL
Nat Lester-Coll, MD retweeted
I’ve been saying this for years…
Now we have randomized data.
GETUG P05: brachytherapy boost vs dose-escalated EBRT in intermediate-risk prostate cancer.
Oncologic outcomes similar but far more toxicity with brachy.
#ASTRO26 #ProstateCancer
@ASTRO_org @NehaVapiwala @AmarUKishan @DrAndrewLoblaw @seanmmcbride @HimanshuNagarMD @TylerSbrt @seanmmcbride @alison_tree @Soum_Roy_RadOnc @NicholasZaorsky @angela_jia_
Nat Lester-Coll, MD retweeted
Boston-bound for #ASTRO26 — “When Disaster Strikes” is feeling particularly timely. Join us Sunday for a conversation on safeguarding radiotherapy continuity through catastrophic events @fumikochino @MDAnderson_ES @DrNogueiraL @AmericanCancer @DartmouthCancer @SpeedofLightFdn
Nat Lester-Coll, MD retweeted
Radiotherapy after surgery halves risk of recurrence in a type of brain tumour that can often grow back, trial shows.
Find out more in The Lancet: spkl.io/60137TUFS #EANO2026
Nat Lester-Coll, MD retweeted
Happening in 2 wks! Join us Sun 9/27, 4:45P #ASTRO26:
Making Sense of Trials in Community Rad Onc: From Headlines to High-Value Care
3 talks on Ph II trials, omission studies & novel RT technologies - practical frameworks for interpreting new data & translating into practice.
Nat Lester-Coll, MD retweeted
Landmark, practice changing study at #WCLC26. The phase III MAVERICK study shows no improvement in OS with PCI for SCLC, across limited and extensive stages, with worse cognitive failure free survival and increased toxicity in PCI arm.
The end of the PCI era.


















































