Congrats to Reck, Spicer, Filippi and team on the full MDT-BRIDGE paper in Nature Medicine! Really appreciate seeing the RT protocol and full denominators alongside the ASTRO results. 👏 This single-arm ph2 enrolled 142 pts with resectable or borderline-resectable stage IIB-selected IIIB, EGFR/ALK-wt NSCLC. Durvalumab + platinum chemo x2c→ MDT reassessment→ additional chemoimmunotherapy and surgery, or CRT, followed by durvalumab. Resection was 74.6% (95CI 66.7-81.6), with R0 in 96.2% of those who started surgery. pCR was 27.3% in the resectable analysis cohort. The 12-mo EFS estimates are 88.5% overall and 90.1% in that resectable cohort. Different denominators, same readout. The RT protocol details are useful: nominal 60/30 (60 Gy ±10% in 2 Gy fx), 5 fx/wk for ~6 wk, concurrent or sequential platinum chemo. SBRT was not allowed. IMRT with daily CBCT was preferred, then consolidation durvalumab q4w up to 12c. All 25 pts who started CRT completed it: 21 concurrent, 4 sequential. 23 received consolidation durvalumab. The post hoc CRT-treated analysis estimated 12-mo PFS at 85% (95CI 59.8-95.0), measured from the FIRST study-treatment dose, including induction. CRT-period G3/4 AEs were 28%; pneumonitis 8% (2 pts, both G2). During consolidation, G3/4 AEs were 17.4%, AE discontinuation 13%, and pneumonitis 8.7% (G1/2). One cardiac-failure AE death occurred during consolidation; the paper reports no treatment-related AE deaths in that period. The safety windows extend beyond treatment delivery and can overlap. The ESMO ctDNA analysis adds an interesting association. Pre-Sx/CRT clearance occurred in 33/90 evaluable pts (36.7%). C2D1 clearance had an 83.3% PPV for pCR (95CI 43.6-99.1). Among resected pts, no EFS events occurred with pre-Sx clearance (n=28); 12-mo EFS without clearance was 88.9% (n=40). In CRT-treated pts, 12-mo PFS was 100% with pre-CRT clearance vs 77.5% without. The paper now supplies those subgroup sizes: just 4 vs 16 pts, with 2 vs 6 at risk at 12 mo. One later event occurred in the clearance group, so 100% is a timepoint estimate, not no events throughout follow-up. Useful prospective evidence that patients can reach definitive CRT after starting on a surgical pathway. The unanswered question remains who benefits from that sequence versus going directly to CRT or selecting for NAC-ICO with intent for organ preservation. Selected cohorts, immature EFS/PFS and no reported OS cannot settle that, and ctDNA does not yet tell us which local therapy to choose or omit. doi.org/10.1038/s41591-026-0… cslide.ctimeetingtech.com/es… #radonc #ESMO26 #LCSM

CRC has been a fascinating space for many years, but in 2026, wow... Just wow! For example, switching gears from dMMR colon in NICHE-2 and going below the peritoneal reflection for pMMR rectal cancer, UNION, STELLAR II, and TORCH-iTNT have shown eye-popping response rates with a short-course RT backbone (?!) plus immunotherapy. @NiuSanford @DrEmmaHolliday @nbn426 @KrishanJethwa @GIMedOnc @adapthyun @TimothyJBrownMD @manjuggm @OncoAlert @OncBrothers #ASTRO26 #ESMO26 #OncTwitter #CRCSM

Improved MFS w/ darolutamide in DASL-HiCaP! 📌 1,106 very high-risk prostate cancer pts, incl persistent/rising PSA after RP. Randomised to darolutamide vs placebo w/ ADT + RT. 📌 Median age 71; GS 9-10 73%; CT N+ 29%; prior RP 15%. 📌 4y MFS on conventional imaging: 95% vs 88%, HR 0.42 (95% CI 0.27-0.66). No clear OS benefit yet. 📌 All prescribed prostate/bed AND pelvic nodal RT, w/ 96 wk ADT. 📌 N+ = CT/MRI >10 mm short axis or path confirmation (PSMA PET alone insufficient if ≤10 mm). Side note: RT dose/fx and PSMA staging use aren't reported in the abstract. #radonc #ESMO26 #PCSM

MASTERPLAN full publication is out!! The RT volumes are worth a closer look. CTV = primary GTV + nodal GTV + tumour-vessel interface. The TVI extends 5 mm proximally and 5 mm distally along involved/closely adjacent vessels, for patients where surgery is likely. PTV = CTV/ITV + 5 mm. No elective nodal irradiation, and no elective perineural or celiac/SMA plexus volume specified in the protocol. That is a focused target, with gross nodal disease included. Real-time RTQA is a big part of this story. Review identified 36 major planning deviations in 12 patients, reduced to 2 deviations in 2 patients after QA. All plans passed independent review before treatment. As a radiation oncologist, I want that detail alongside the outcomes. Reproducing the treatment means reproducing the contour review, OAR constraints and image guidance too. Also worth keeping the treatment delivery denominator in view: only 40/49 patients assigned to SBRT actually received it (82%). The efficacy analysis is intention-to-treat. It should not be read as an outcome series of patients who all completed SBRT. The surgical numbers need some unpacking. All comparisons below are chemo + SBRT vs chemo alone: ✅ Underwent surgery: 62% vs 44% (29/47 vs 11/25). ✅ Completed resection: 53% vs 44% (25/47 vs 11/25). ✅ R0 among all resected patients: 52% vs 36% (13/25 vs 4/11). ✅ R0 in the resected POPC subset: 62% vs 40% (13/21 vs 4/10). POPC is the potentially operable cohort. So the 62% surgery figure includes exploration without resection, while the 62% R0 figure applies only to resected POPC patients. These are different endpoints with different denominators. None of those between-arm surgical comparisons was statistically significant. The paper also defines R0 as more than 1 mm clearance. Adjuvant chemo is another important difference: 80% vs 36% of resected patients received it (20/25 vs 4/11). That complicates attribution within the treatment pathway. Early progression in the control group may have contributed, so this is a post-randomisation imbalance with more than one possible explanation. The post-hoc analyses were directionally consistent, but the authors explicitly caution about selection bias. For the planning details: PTV_EVAL excluded the GI PRVs, with a minimum 3 mm PRV expansion. OAR constraints took priority over target coverage. Duodenum, stomach and small bowel D0.5cc were each constrained to <33 Gy, with V30 <5 cc. Delivery used standard linacs; breath hold was recommended, and fiducials were placed in 35/40 patients (88%). This is relevant to how we would implement the approach in practice. With no elective nodes, isolated regional nodal relapse was 4% vs 8% (2/49 vs 2/25). Reassuring, although that does not establish the optimal elective volume (especially considering these patients went to surgery - ASTRO/NRG recommends inclusion of elective perineural coverage). Overall G3+ AEs were 70% vs 64% (33/47 vs 16/25). One G3 pancreatitis and one G2 small bowel obstruction were attributed to SBRT. The practical takeaway for me is to keep the target definition and prospective QA attached to the results, and to be precise about what the surgery and R0 numbers actually measure.

14.8% invasive local recurrence at 5y after BCS alone in TOP-1. Age 70+, small low-grade ER+ tumors, no RT or ET. Most recurrences were salvaged, but that is still more treatment. I'd be cautious about routinely omitting both. #ESMO26 #radonc cslide.ctimeetingtech.com/es…