Current Controversies and Challenges in Non-Oncogene-Addicted Synchronous Oligometastatic Non-Small Cell Lung Cancer: A Review.

Importance: It has been stated that especially with the advancements in imaging, systemic therapy, and local radical treatment (LRT) that patients with synchronous oligometastatic disease (sOMD) can potentially benefit from curative-intent treatment. This statement is challenged by the results of the NRG-LU002 randomized phase 2/3 trial, showing no significant progression-free survival and overall survival improvements with the addition of LRT to maintenance systemic therapy in patients with oligometastatic non-small cell lung cancer (NSCLC) who achieved at least stable disease after induction systemic therapy (approximately 90% received an immunotherapy-based regimen). This Review discusses the current challenges and controversies in the treatment of non-oncogene-addicted sOMD.

Multinational validation of distant metastasis velocity as a post-progression prognostic score in patients with oligometastatic cancer treated with metastasis-directed stereotactic body radiotherapy.

Background: Distant progression is the predominant failure pattern after metastasis-directed stereotactic body radiotherapy (SBRT) for oligometastatic disease, but prognostic tools to guide post-progression management are lacking. We aimed to validate the prognostic value of distant metastasis velocity (DMV) for overall survival (OS) and widespread failure-free survival (WFFS) after distant progression.

Methods: Two independent international cohorts of patients with extracranial oligometastatic disease (≤5 lesions) who developed distant progression after SBRT were analyzed.

Quality assurance in the randomized multicentre phase III trial EORTC-1709-BTG/CCTG CE.8 (MIRAGE) for glioblastoma: Results of the radiotherapy delineation benchmark case procedure.

Purpose: The multicentre randomised phase III trial EORTC-1709-BTG/CCTG CE.8 (MIRAGE) (NCT03345095) analysed the addition of the proteasome inhibitor marizomib to temozolomide-based chemoradiotherapy with 60 Gy in 30 fractions in patients with newly diagnosed glioblastoma. Here, we analysed the benchmark case procedure for delineation and planning radiotherapy quality assurance (RTQA) that was performed before patient inclusion.

Female breast cancer burden among adolescent and young adults in North Africa.

Introduction: This study examines the growing burden of breast cancer among adolescents and young adults (AYAs, ages 15-39) in North Africa from 1990 to 2021. Despite breast cancer primarily affecting postmenopausal women, its increasing incidence among AYAs presents unique clinical and biological challenges that remain under explored in North Africa.

Methods: Using Global Burden of Disease 2021 data, we analyzed temporal trends in AYA breast cancer incidence and mortality across North Africa compared to other global regions (seven GBD super regions and Central Africa, Eastern Africa, Northern Africa, Southern Africa, and Western Africa).

Rationale and Design of the AUSTRAL trial: An Open-Label, Multicenter, Phase II Study Evaluating Radiotherapy Followed by Durvalumab (MEDI4736) and Ceralasertib (AZD6738) in Stage III NSCLC Patients With Thoracic Relapses and/or Oligometastases After the PACIFIC Regimen.

Non-small-cell lung cancer (NSCLC) is a leading cause of death for cancer worldwide. Standard treatment for patients for whom surgical resection is not feasible is concurrent (PACIFIC regimen) or sequential (PACIFIC-like regimen) chemoradiotherapy with platinum-based doublet chemotherapy followed by durvalumab maintenance. The progression-free survival (PFS) rate after the PACIFIC regimen was 55.

Head and Neck Cancer in Southeast Asia: 2022 Incidence, Mortality, and Projections to 2050.

Objectives: To characterize the incidence, mortality, and disparities in head and neck cancer (HNC) across Southeast Asia (SEA) in 2022 and project trends to 2050 to inform cancer planning.

Methods: We conducted a population-based analysis using 2022 Global Cancer Observatory data from 11 SEA countries. We analyzed cancers of the lip and oral cavity, salivary glands, oropharynx, nasopharynx, hypopharynx, larynx, and thyroid.

Predicting the impact of target volume contouring variations on the organ at risk dose: results of a qualitative survey.

Purpose: Integrating auto-contouring in radiotherapy workflows is shifting the role of radiation oncologists from manual delineation to reviewing and correcting automatically generated contours. However, we postulate that this process is hindered by significant inter-evaluator variability in assessing the dosimetric impact of contour variations. This study investigates how radiation oncologists and medical physicists evaluate the impact of glioblastoma target volume (TV) variations on the dose to organs at risk (OARs), focusing on understanding inter-evaluator variability and decision-making patterns.

Evaluation of the prognostic value of the ESTRO/EORTC classification of reirradiation in patients with non-small cell lung cancer.

Background: Retreatment with thoracic radiotherapy for recurrent, metastatic, or new primary non-small cell lung cancer (NSCLC) is increasingly used, yet evidence remains limited. This study evaluated the efficacy and safety of radical thoracic retreatment classified by the ESTRO/EORTC reirradiation definition.

Methods: This retrospective single-center study included patients with NSCLC undergoing retreatment with a second course of radical thoracic radiotherapy (≥40 Gy EQD2) between 2015 and 2023.

Reirradiation: Standards, challenges, and patient-focused strategies across tumor types.

Reirradiation (reRT), defined as administering a course of radiation therapy to a specific area previously irradiated, is an evolving treatment strategy for locoregionally recurrent cancer that offers significant potential and poses inherent challenges. Advances in such techniques as intensity-modulated and stereotactic body radiation therapy have improved precision, making reRT a viable option for complex scenarios previously deemed high-risk. Nevertheless, reRT remains associated with substantial risks-including life-threatening side effects, functional impairments, and psychosocial effects-which must be carefully balanced against the patient's overall health and the likelihood of achieving cancer control or palliation.

Prevalence and Development of Cachexia Before and After Diagnosis of Non-small Cell Lung Cancer.

Objective: Cachexia is commonly defined based on weight loss at the time of cancer diagnosis. However, regular weight measurements before cancer diagnosis are often lacking and may be subject to recall bias if retrospectively self-reported by patients. To analyze the development and progression of cachexia, we employ body weight trajectories from 1 year before and after diagnosis of non-small cell lung cancer (NSCLC).

Implementation of a comprehensive clinical quality assurance system in radiation oncology.

Objective: The objective of this project was to develop and evaluate a comprehensive clinical quality assurance system for radiation oncology, and assess the system using definitive radiation therapy for prostate cancer as a first use case.

Methods: The Zurich Clinical Quality Assurance System in Radiation Oncology (ZH-CLASSIC) was initiated to allow for continuous quality assurance in radiation oncology with respect to indication for radiation therapy, practice of radiation therapy and patient outcome. Data from the sources of the hospital information system, the Radiation Oncology Record and Verify System and a dedicated follow-up database were automatically retrieved, and combined using a unique patient-ID.

National Cancer System Characteristics and Prostate Cancer Outcomes: An Analysis of Global Data.

Importance And Objective: Prostate cancer is the second most common cancer among men globally and the number of cases is expected to double from 2020 to 2040. A greater understanding of health system factors that can be leveraged to improve prostate cancer control may guide health system planning in anticipation of the growing global burden of prostate cancer.

Design: This ecological cross-sectional study made use of the most recent available national health system metrics for countries with prostate cancer incidence and mortality estimates available from the International Agency for Research on Cancer (IARC).

National Cancer System Characteristics and Global Pan-Cancer Outcomes.

Importance: Approximately 29.9 million cancer cases and 15.3 million deaths are anticipated by 2040 globally, necessitating cancer system strengthening.

Ongoing prospective studies on reirradiation: A systematic review of a clinical trials database.

Introduction: Reirradiation has gained increasing interest, as advances in systemic therapy increase the survival of patients with cancer, and modern radiation techniques allow more precise treatments. However, high-quality prospective evidence on the safety and efficacy of reirradiation to guide clinical practice remains scarce. This systematic review evaluates ongoing prospective studies on reirradiation to identify research gaps and priorities.

Reirradiation - still navigating uncharted waters?

With the emergence of high-precision radiotherapy technologies such as stereotactic ablative radiotherapy (SABR), MR guided brachytherapy, image guided intensity modulated photon and proton radiotherapy and most recently daily adaptive radiotherapy, reirradiation is increasingly recognized as a viable treatment option for many patients. This includes those with recurrent, metastatic or new malignancies post initial radiotherapy. The primary challenge in reirradiation lies in balancing tumor control against the risk of severe toxicity from cumulative radiation doses to previously irradiated normal tissue.

Clinical management of oligometastatic cancer: Applying multidisciplinary tumor board recommendations in practice.

Aims: Multidisciplinary tumor boards (MDTs) are an integral part of ensuring high-quality, evidence-based and personalized cancer care. In this study, we aimed to evaluate the adherence to and implementation of MDT recommendations in patients with oligometastatic disease (OMD).

Methods: We screened all oncologic positron emission tomography (PET) scans conducted at a single comprehensive cancer center in 2020.

Criteria for Re-Irradiation.

Background: The treatment options for patients with progressive malignant tumors despite primary radiotherapy are often limited. In selected cases, re-irradiation can be offered. This article concerns the selection criteria and results of re-irradiation for certain types of cancer.

Longitudinal cell-free DNA characterization by low-coverage whole-genome sequencing in patients undergoing high-dose radiotherapy.

Background And Purpose: Current radiotherapy guidelines rely heavily on imaging-based monitoring. Liquid biopsy monitoring promises to complement imaging by providing frequent systemic information about the tumor. In particular, cell-free DNA (cfDNA) sequencing offers a tumor-agnostic approach, which lends itself to monitoring heterogeneous cohorts of cancer patients.

Stereotactic body radiotherapy for oligoprogression with or without switch of systemic therapy.

Background: Oligoprogression is defined as cancer progression of a limited number of metastases under active systemic therapy. The role of metastasis-directed therapy, using stereotactic body radiotherapy (SBRT), is controversial as is the continuation versus switch of systemic therapy. We report outcomes of oligoprogressive patients after SBRT, and compare those patients that continued or switched their current line of systemic therapy.