2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T52d,Spinal metastases can cause disabling pain and neurological deterioration and have historically been treated with palliative intent and conventional external beam radiotherapy (cEBRT). A fundamental shift away from the short-term palliative goals associated with cEBRT has taken place over the past two decades following the availability of stereotactic body radiotherapy (SBRT). This technique has enabled durable pain relief and local control owing to the ability to precisely deliver high radiation doses across typically up to five fractions, with level 1 evidence supporting superior complete pain response rates and local tumour control compared with cEBRT. The development of spinal SBRT has also resulted in greater multidisciplinary collaboration, with neuroradiologists, spinal surgeons, interventional radiologists, biomechanical engineers, medical physicists, medical oncologists and radiation oncologists working together with the common goal of improving our understanding of the pathophysiology and treatment of spinal metastases. As a result, substantial gains have been realized in refining patient selection and treatment sequencing, and particularly the development of less-invasive surgical procedures. In this Review, we summarize the development and role of SBRT in the management of spinal metastases.31:Tb2c,Standard-of-care management of radiorecurrent prostate cancer (PCa) involves systemic therapy; however, some patients seek to avoid the adverse events (AEs) that are associated with androgen-deprivation therapy (ADT). To determine outcomes of local therapy without systemic therapy for radiorecurrent PCa. MEDLINE, Embase, Web of Science Core Collection, and Google Scholar were searched from inception up to May 2025. No date or language filters were used. Data were analyzed from June to November 2025. Prospective and retrospective studies were selected that investigated local salvage therapies without concomitant systemic treatment for locally recurrent PCa after definitive radiotherapy. Eligible studies provided ADT-free survival (ADT-FS) and/or metastasis-free survival (MFS). Authors were contacted for additional data. This study was prospectively registered and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Individual patient data were reconstructed from Kaplan-Meier curves or retrieved from authors. ADT-FS, MFS, and rates of AEs were pooled in a random-effects models. Main outcomes were ADT-FS and MFS, which were modeled as pooled summary Kaplan-Meier curves, and rates of severe or worse AEs, which were modeled as proportions. Outcomes were stratified by treatment method. Thirty-one studies (4525 patients) were identified that assessed salvage high-dose-rate brachytherapy (HDR-BT; 336 patients), low-dose-rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials. The findings of this systematic review and meta-analysis suggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent PCa. ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years. Approximately one in ten experience an early metastatic event. Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy.32:T10b5, Importance Standard-of-care management of radiorecurrent prostate cancer (PCa) involves systemic therapy; however, some patients seek to avoid the adverse events (AEs) that are associated with androgen-deprivation therapy (ADT). Objective To determine outcomes of local therapy without systemic therapy for radiorecurrent PCa. Data Sources MEDLINE, Embase, Web of Science Core Collection, and Google Scholar were searched from inception up to May 2025. No date or language filters were used. Data were analyzed from June to November 2025. Study Selection Prospective and retrospective studies were selected that investigated local salvage therapies without concomitant systemic treatment for locally recurrent PCa after definitive radiotherapy. Eligible studies provided ADT-free survival (ADT-FS) and/or metastasis-free survival (MFS). Authors were contacted for additional data. Data Extraction and Synthesis This study was prospectively registered and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Individual patient data were reconstructed from Kaplan-Meier curves or retrieved from authors. ADT-FS, MFS, and rates of AEs were pooled in a random-effects models. Main Outcomes and Measures Main outcomes were ADT-FS and MFS, which were modeled as pooled summary Kaplan-Meier curves, and rates of severe or worse AEs, which were modeled as proportions. Outcomes were stratified by treatment method. Results Thirty-one studies (4525 patients) were identified that assessed salvage high-dose–rate brachytherapy (HDR-BT; 336 patients), low-dose–rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials. Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent PCa. ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years. Approximately one in ten experience an early metastatic event. Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy. 33:T7ec,Most patients with high-risk localized prostate cancer (HRLPC) do not undergo stereotactic body radiotherapy (SBRT) in part because of the limited evidence of long-term outcomes. We report long-term efficacy and toxicity outcomes for men treated with SBRT for HRLPC. Individual patient data from ten prospective clinical studies evaluating SBRT for HRLPC across nine institutions were pooled in the Stereotactic Body Radiotherapy for High-Risk Localized Carcinoma of the Prostate consortium. The Kaplan-Meier method was used to estimate 5-yr biochemical recurrence (BCR) and distant metastasis (DM), stratified by receipt of intensified treatment (≥12 mo of androgen deprivation therapy [ADT] with extremely dose-escalated [≥8 Gy/fraction] prostate-directed SBRT). The impact of intensified treatment on BCR-free survival and DM-free survival was evaluated using multivariable Cox proportional hazards models. Late Common Terminology Criteria for Adverse Events grade ≥2 gastrointestinal (GI) and genitourinary (GU) toxicity was analyzed using time-to-event models. In 440 patients with a median follow-up time of 60.4 mo, 5-yr BCR and DM rates were 22% (95% confidence interval [CI] = 17-26%] and 9.2% (95% CI = 6.2-12%), respectively. In the 93 patients (21%) who received intensified treatment, 5-yr BCR and DM rates were 7.4% (95% CI = 1.7-13%) and 3.7% (95% CI = 0-7.9%), respectively. Receipt of intensified therapy was associated with a significant reduction in both BCR (hazard ratio [HR] = 0.38 [95% CI = 0.20-0.74], p = 0.005) and DM (HR = 0.43 [95% CI = 0.18-0.99], p = 0.049). For the overall cohort, 5-yr rates of grade ≥2 GU and GI toxicity were 23% (95% CI = 19-27%) and 10% (95% CI = 7-13%), respectively. Limitations include heterogeneous treatment techniques and the nonrandomized nature of the study. The safety and efficacy profile of SBRT for HRLPC remains favorable at long-term follow-up, and SBRT should be integrated into shared decision-making for treatment of HRLPC.34:Te97, PURPOSE Progression after metastasis-directed therapy via stereotactic body radiotherapy (SBRT) for oligorecurrent hormone-sensitive prostate cancer (orHSPC) is common. We aimed to assess whether the addition of neoadjuvant prostate-specific membrane antigen (PSMA)–targeting radioligand therapy to SBRT would improve outcomes. METHODS The LUNAR trial was a single-center, randomized, open-label, controlled phase II trial conducted at the University of California, Los Angeles. Eligible participants had orHSPC as determined by the presence of one to five lesions identified on PSMA positron emission tomography/computed tomography (PET/CT). After stratifying by stage (N1/M1a v M1b) and lesion count (1 v 2-3 v 4-5), we randomly assigned patients 1:1 to receive SBRT to all lesions or two cycles of 177 Lu-PNT2002 (6.8 GBq/cycle, 2 weeks apart) followed by SBRT to all lesions. The primary end point was progression-free survival (PFS), defined by PSMA PET/CT, salvage hormonal therapy, or death. PSMA PET/CT was acquired systematically at prostate-specific antigen progression and/or 12 months after SBRT. All analyses were done in the intention-to-treat population. The study is registered with ClinicalTrials.gov (identifier: NCT05496959 ). RESULTS From September 2, 2022, to November 9, 2023, 92 patients were randomly assigned (SBRT n = 47 and 177 Lu + SBRT n = 45), with 87 evaluable patients (SBRT n = 42 and 177 Lu + SBRT n = 45). At a median follow-up of 22 months, the addition of 177 Lu to SBRT significantly improved PFS (17.6 months [95% CI 15 months to not reached] v 7.4 months [95% CI, 6.0 to 13.5 months]; hazard ratio, 0.37 [95% CI, 0.22 to 0.61], P < .0001). The only grade 3 adverse events were lymphopenia (two patients [4.8%] in the SBRT group and three patients [6.7%] in the 177 Lu + SBRT group). Prognostic biomarkers for PFS were identified. CONCLUSION Compared with SBRT alone, the addition of 177 Lu-PNT2002 to SBRT significantly improved PFS in patients with orHSPC without an attendant increase in toxicity. 35:T683,In the phase 2 SCIMITAR trial, stereotactic body radiotherapy (SBRT; 30-34 Gy in 5 fractions) was delivered to the prostatic fossa after radical prostatectomy in 100 patients requiring postoperative RT, with or without nodal RT and androgen deprivation therapy (ADT). The primary endpoint was 4-yr biochemical recurrence (BCR)-free survival (BCR-FS), with events defined as BCR (prostate-specific antigen ≥0.2 ng/ml above nadir), salvage ADT, or death. Outcomes were compared to individual patient data (IPD) from a phase 3 trial of conventionally fractionated RT (CFRT) using inverse probability of treatment weighting and Fine-Gray models. At median follow-up of 53 mo, the 4-yr BCR-FS rate was 60% (95% confidence interval [CI] 50-70%). The IPD analysis revealed that for men not receiving ADT, the risk of BCR was lower with SBRT than with CFRT (subdistribution hazard ratio [sHR] 0.49, 95% CI 0.29-0.84; p = 0.008). For men receiving ADT, there was no significant difference in BCR risk between SBRT and CFRT (sHR 1.58, 95% CI 0.81-3.11; p = 0.18), although the asymmetrically broad 95%CI and directionality of the point estimate suggest that a higher BCR risk with SBRT cannot be ruled out. The 4-yr cumulative incidence rates for late grade ≥2 gastrointestinal and genitourinary toxicities were 6.6% and 32%, respectively. At 48 mo, the proportion of patients reporting a decline of more than two times the minimal clinically important difference in urinary incontinence, urinary irritative/obstructive, bowel, and sexual domains was 23%, 6.7%, 13%, and 9.7%, respectively. SBRT to the prostatic fossa appears to be safe and effective through 4 yr.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Stereotactic Body Radiotherapy: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Stereotactic Body Radiotherapy (modality). Clinician-written summaries and actionable practice insights. 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Clinicians should counsel patients that erectile function declines meaningfully in both modalities regardless of fractionation schedule."}},{"doi":"10.1016/s1470-2045(26)00178-6","pmid":"42372744","title":"SBRT plus abiraterone acetate and ADT versus abiraterone acetate and ADT in oligometastatic castrate-resistant prostate cancer (ARTO): long-term, unplanned overall survival analysis of an open-label, randomised, phase 2 trial","journal_title":"The Lancet Oncology","journal_issn":"1470-2045","published_at":"2026-06-29T00:00:00.000Z","url":"https://doi.org/10.1016/s1470-2045(26)00178-6","source_score":59,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-11T13:33:03.856Z","updated_at":"2026-07-11T13:33:03.856Z","tags":[{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"brand","value":"Zytiga","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"condition","value":"Oligometastatic Castrate-Resistant Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"generic","value":"abiraterone acetate","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"modality","value":"Androgen Receptor Signaling Inhibitor","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"modality","value":"Stereotactic Body Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"sample_size","value":"n=157","value_numeric":157},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"warning","value":"The brand name 'Zytiga' is listed as the most common brand for abiraterone acetate, but the paper does not specify which brand was used.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"warning","value":"The 'not reached' median OS in the experimental arm limits precise estimation of survival benefit magnitude.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"warning","value":"The overall survival analysis was unplanned; the power calculation was updated post-hoc before data unmasking, which introduces potential methodological bias and should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"warning","value":"This is a phase 2 trial conducted exclusively in Italy; results may not generalize to other populations or healthcare settings.","value_numeric":null}],"summaries":{"what_studied":"The ARTO trial evaluated whether adding SBRT (metastasis-directed therapy to all sites) to abiraterone acetate plus ADT improved overall survival versus abiraterone acetate plus ADT alone in patients with oligometastatic castrate-resistant prostate cancer (≤3 metastatic sites, no prior systemic therapy for mCRPC), with a median follow-up of 53 months.","key_result":"Median overall survival was 50 months in the control group vs not reached in the SBRT group (HR 0.55, 95% CI 0.33–0.92, p=0.021). Grade 3–4 infectious complications occurred in 5 control vs 0 SBRT patients; one treatment-related death (myocardial failure) occurred in the control group.","limitations":"- Phase 2 trial with a relatively small sample (n=157); overall survival analysis was unplanned and power calculation was updated post-hoc.\n- Open-label design introduces potential performance bias.\n- No race or ethnicity data were collected, limiting generalizability.","practice_takeaway":"In oligometastatic mCRPC with ≤3 sites, adding SBRT to abiraterone acetate plus ADT significantly improved overall survival at ~4 years of follow-up. Clinicians should consider MDT as part of the treatment strategy for eligible patients, pending confirmation in phase 3 trials."}},{"doi":"10.1245/s10434-026-19939-w","pmid":"42303818","title":"Treatment Strategies and Outcomes for Single-Site Recurrent Pancreatic Ductal Adenocarcinoma After Curative-Intent Surgery: Local Therapies are Associated with Longer Survival in Selected Cases: A Systematic Review and Meta-analysis","journal_title":"Annals of Surgical Oncology","journal_issn":"1068-9265","published_at":"2026-06-16T00:00:00.000Z","url":"https://doi.org/10.1245/s10434-026-19939-w","source_score":12,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-21T13:29:55.973Z","updated_at":"2026-06-21T13:29:55.973Z","tags":[{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"condition","value":"Pancreatic Ductal Adenocarcinoma","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"condition","value":"Recurrent Pancreatic Cancer","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"modality","value":"Ablation","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"modality","value":"Chemotherapy","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"modality","value":"Stereotactic Body Radiotherapy","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"modality","value":"Surgical Resection","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"sample_size","value":"n=22","value_numeric":22},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"study_design","value":"Systematic Review and Meta-analysis","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"warning","value":"Impact flag 'practice_changing' applied cautiously: findings are based entirely on observational data; no RCTs exist in this space.","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"warning","value":"SBRT outcomes were not included in the meta-analysis due to insufficient data (3 small series only); conclusions about SBRT efficacy cannot be drawn.","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"warning","value":"Selection bias is a major concern — patients chosen for local therapy were likely healthier, making survival comparisons with conventionally managed patients potentially confounded.","value_numeric":null},{"paper_doi":"10.1245/s10434-026-19939-w","tag_type":"warning","value":"The sample_size tag reflects the number of included studies (n=22), not individual patient count, as total patient N was not reported in the abstract.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis evaluated post-recurrence treatment strategies (local therapies vs. conventional management/chemotherapy) for adults with single-site recurrent PDAC after curative-intent pancreatectomy, analyzing liver-only, lung-only, and locoregional recurrence patterns separately across 22 observational studies.","key_result":"Local therapy was associated with significantly longer survival across all recurrence sites: liver-only (HR 0.26; 95% CI 0.14–0.49), driven by surgical resection (HR 0.18; 95% CI 0.11–0.31); lung-only resection (HR 0.35; 95% CI 0.26–0.48); and locoregional resection (HR 0.52; 95% CI 0.38–0.72). Ablation for liver recurrence and SBRT for locoregional recurrence did not reach statistical significance.","limitations":"All included studies are observational, with inherent selection bias favoring fitter patients for local therapy. SBRT data came from only three small series, precluding quantitative synthesis. No randomized controlled trials exist to confirm causality.","practice_takeaway":"For selected patients with single-site PDAC recurrence (liver-only, lung-only, or locoregional), surgical resection is associated with substantially longer survival and should be considered at experienced centers. 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The impact_flag 'practice_changing' reflects the authors' stated recommendation for integration into shared decision-making, but the non-randomized design means formal practice-change status awaits RCT confirmation.","value_numeric":null}],"summaries":{"what_studied":"Pooled individual patient data from 10 prospective studies across 9 institutions evaluated long-term efficacy and toxicity of SBRT for high-risk localized prostate cancer (HRLPC) in 440 men, with a median follow-up of 60.4 months; a key subgroup (n=93, 21%) received intensified treatment (≥12 months ADT plus ≥8 Gy/fraction SBRT).","key_result":"At 5 years, overall BCR rate was 22% and distant metastasis (DM) rate was 9.2%; intensified treatment cut BCR to 7.4% and DM to 3.7%, with multivariable analysis showing HR 0.38 for BCR (p=0.005) and HR 0.43 for DM (p=0.049); grade ≥2 GU and GI toxicity rates were 23% and 10%, respectively.","limitations":"- Non-randomized, pooled design limits causal inference for the intensified-treatment benefit.\n- Heterogeneous treatment techniques across 10 studies and 9 institutions may introduce confounding.\n- No direct comparison arm with conventional fractionation or standard-of-care EBRT.","practice_takeaway":"SBRT appears safe and effective for high-risk localized prostate cancer at 5 years, and should be included in shared decision-making discussions. Combining SBRT with ≥12 months of ADT and dose-escalated fractionation (≥8 Gy/fraction) was linked to substantially lower biochemical recurrence and metastasis rates."}},{"doi":"10.1016/j.jtho.2026.103643","pmid":"41934464","title":"Definitive Radiotherapy to the Primary Tumor in Stage IV NSCLC: A Consensus Statement From the International Association for the Study of Lung Cancer Advanced Radiation Technology Subcommittee","journal_title":"Journal of Thoracic Oncology","journal_issn":"1556-0864","published_at":"2026-04-04T00:00:00.000Z","url":"https://doi.org/10.1016/j.jtho.2026.103643","source_score":33,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:50:00.740Z","updated_at":"2026-05-07T22:50:00.740Z","tags":[{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"condition","value":"EGFR-Mutant NSCLC","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"condition","value":"Metastatic NSCLC","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"condition","value":"Non-Small Cell Lung Cancer","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"condition","value":"Oligometastatic NSCLC","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"modality","value":"EGFR Tyrosine Kinase Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"modality","value":"Stereotactic Body Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"study_design","value":"Consensus Statement / Systematic Review","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"warning","value":"Level of evidence set to 5 (expert consensus/systematic review without meta-analysis) given the methodology described.","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"warning","value":"No sample size tag was applied — this is a consensus/review document, not a single primary study with a defined patient cohort.","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"warning","value":"The consensus is based on a narrative synthesis of randomized trials rather than a formal meta-analysis; no statistical pooling was performed, which limits the strength of the evidence grading.","value_numeric":null},{"paper_doi":"10.1016/j.jtho.2026.103643","tag_type":"warning","value":"The 'practice_changing' impact flag applies specifically to the EGFR-mutant oligometastatic subgroup; evidence in non-AGA populations is explicitly described as insufficient for definitive recommendations.","value_numeric":null}],"summaries":{"what_studied":"This IASLC consensus statement evaluates the role, timing, dosing, target volumes, and safety of definitive-dose radiotherapy (RT) to the primary lung tumor in stage IV NSCLC — covering both actionable genomic alteration (AGA, e.g., EGFR-mutant) and non-AGA metastatic populations — based on randomized studies published 2010–2025.","key_result":"In EGFR-mutant oligometastatic NSCLC, randomized phase III evidence supports early consolidative RT to the primary tumor as a life-prolonging approach. In non-AGA populations, direct randomized evidence isolating primary-tumor irradiation remains limited; dose escalation of thoracic RT may improve locoregional control over lower-dose regimens, but no definitive recommendations can yet be made.","limitations":"- Direct randomized evidence isolating the impact of primary-tumor RT in non-AGA populations is sparse.\n- Optimal target volumes (including whether to exclude involved lymph nodes) are unresolved and unstudied in large randomized trials.\n- Optimal RT sequencing, fractionation, and integration with modern systemic agents remain undefined.","practice_takeaway":"For EGFR-mutant oligometastatic NSCLC, consider early consolidative RT to the primary tumor after induction systemic therapy, as phase III data suggest a survival benefit. For non-AGA metastatic NSCLC, definitive RT to the primary tumor should not yet be standard practice outside of prospective trials — carefully monitor for additive toxicity when combining RT with systemic agents."}},{"doi":"10.1200/jco-25-01553","pmid":"41223345","title":"¹⁷⁷\n Lu-Prostate-Specific Membrane Antigen Neoadjuvant to Stereotactic Ablative Radiotherapy for Oligorecurrent Prostate Cancer (LUNAR): An Open-Label, Randomized, Controlled, Phase II Study","journal_title":"Journal of Clinical Oncology","journal_issn":"0732-183X","published_at":"2025-11-12T00:00:00.000Z","url":"https://doi.org/10.1200/jco-25-01553","source_score":127,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-12-22","doi":"10.1200/jco-25-01553","days":"30","issn":"0732-183X","rank":"10","field":"Clinical Medicine","score":"127","category":"Oncology","categories":["Oncology"],"_categories":["Oncology"]},"pubmed":{"doi":"10.1200/JCO-25-01553","title":"","journal":"Journal of clinical oncology : official journal of the American Society of Clinical Oncology","methods":"","results":"From September 2, 2022, to November 9, 2023, 92 patients were randomly assigned (SBRT n = 47 and ","abstract":"Progression after metastasis-directed therapy via stereotactic body radiotherapy (SBRT) for oligorecurrent hormone-sensitive prostate cancer (orHSPC) is common. 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Trial","updated":"2025-12-12T00:23:00+00:00","published_date":"2025-10-01","best_oa_location":null}},"created_at":"2026-01-09T17:12:27.221Z","updated_at":"2026-01-09T17:12:27.221Z","tags":[{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"modality","value":"Stereotactic Body Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"sample_size","value":"n=100","value_numeric":100},{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"study_design","value":"Phase 2 Trial","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"warning","value":"ADT subgroup effect is uncertain due to wide confidence intervals and point estimate directionality.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"warning","value":"Age and sex distribution were not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2025.09.4149","tag_type":"warning","value":"Nonrandomized single‑arm phase 2 with IPD comparator; not a head‑to‑head randomized trial.","value_numeric":null}],"summaries":{"what_studied":"A phase 2 trial (SCIMITAR) tested stereotactic body radiotherapy (30–34 Gy in five fractions) to the prostate bed after radical prostatectomy in 100 patients needing postoperative radiotherapy, with optional nodal RT and androgen deprivation therapy. The primary endpoint was 4-year biochemical recurrence–free survival; outcomes were also compared to individual patient data from a phase 3 trial of conventional fractionation using inverse probability weighting and Fine–Gray models.","key_result":"At a median 53 months, 4-year biochemical recurrence–free survival was 60% (95% CI 50–70%); in the weighted IPD comparison, SBRT lowered BCR risk vs conventional fractionation in men not receiving ADT (sHR 0.49, 95% CI 0.29–0.84; p=0.008) but not in those receiving ADT (sHR 1.58, 95% CI 0.81–3.11; p=0.18). Four-year cumulative incidence of late grade ≥2 gastrointestinal and genitourinary toxicities was 6.6% and 32%, and >2×MCID declines at 48 months occurred in 23% (incontinence), 6.7% (irritative/obstructive), 13% (bowel), and 9.7% (sexual).","limitations":"Single-arm phase 2 design with a nonrandomized IPD comparison to a different trial introduces potential selection and confounding biases. ADT use varied, and the ADT subgroup had wide confidence intervals, so a higher BCR risk with SBRT cannot be excluded.","practice_takeaway":"Post‑prostatectomy SBRT to the prostate bed achieved a 60% 4‑year BCR‑free survival with low GI but notable GU toxicity rates. In men not receiving ADT, SBRT was associated with lower BCR risk than conventional fractionation; with ADT, no advantage was seen and possible harm cannot be ruled out."}}],"initialOffset":10,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Stereotactic Body Radiotherapy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Stereotactic Body Radiotherapy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Stereotactic Body Radiotherapy"}}}]]

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