Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
reminding #radonc dose >100% of Rx dose inside PTV not a "hotspot" it is a heterogeneity
Hot spots *always* outside PTV
little pedantry for @Advances_ASTRO, @HoppeBrad et al ;)
should be "Heterogeneity <120%" etc
aekwl.de/fileadmin/qualitaet…
teapaw.org/toddscarbrough/status/…
🫁🌶️ SPICE-ing up lung SBRT
Intentional tumor 🔥hotspot (PTV Dmax ≥120%) vs <120% in VMAT SBRT for early-stage NSCLC
3-year local recurrence rates:
🔥0% with ≥120% hotspot
🧊8-9% with <120% hotspot
📚 Not a novel concept. Prior work has suggested that higher intratumoral dose improves local control!
✅ What this study contributes is additional clinical evidence, plus a practical planning strategy (SPICE: Stereotactic Planning with Intentional Central Escalation).
⚠️ No PFS or OS advantage seen.
🎯Take-home: Another data point supporting intentional hotspot escalation in lung SBRT, rather than proof of a brand-new concept
@ASTRO_org
advancesradonc.org/article/S…
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
👋Congratulations to @imrtlee @EChrisDee @xrtGenomics @seanmmcbride @DrPaulRomesser and the entire team at @MSKCancerCenter @MSK_RadOnc. Many, many years in the making! 🚨Quad Shot (14.8 Gy BID*4fx; q 3 weeks) is an excellent re-RT option for centers yet to adopt it.
🧵 Excited to share our multicenter, prospective phase 2 trial of proton re-irradiation for people with recurrent head & neck cancer, now in @JournalCancer
Grateful to Dr @IMRTLee @xrtGenomics @DrPaulRomesser and team for the opportunity to write 🙏
🔗 acsjournals.onlinelibrary.wi…
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
Important limitations:
This was a nonrandomized phase 2 trial, not a proton-versus-photon comparison.
The cohorts differed in disease burden, prior treatments, and clinical goals.
We cannot conclude that protons are superior or that one fractionation approach is better.
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
But we must be transparent about toxicity.
Late grade 3 toxicity occurred in 20%, grade 4 in 11%, and grade 5 in 4%.
Three patients experienced fatal bleeding events, all after biopsies.
These risks must be central to counseling and shared decision-making.
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
Optimizing Therapy for Locally Advanced #ProstateCancer. Presented by @BarbaraJereczek. #ESMO26 written coverage by @zklaassen_md > bit.ly/4z7fiav #RadOnc #GUOnc @myESMO
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
Excited to share our new study in Eur J Cancer @EORTC, led by Drs @Haoshen_Cheng, @Alex_Terry1, @imrtlee, @TabarViviane, and team!
Does proton therapy affect the risk of RT-induced brain necrosis compared with IMRT in patients w nasopharyngeal cancer?
🔗 pubmed.ncbi.nlm.nih.gov/4294…
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
CAN-2409 + valacyclovir added to RT improved DFS in intermediate/high-risk prostate cancer (HR 0.70; phase 3, n=745). Grade ≥3 AEs were 8% vs 7%. Long-term follow-up is ongoing; the therapy remains investigational.
pubmed.ncbi.nlm.nih.gov/4222…
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
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
Proud to report at #ESMO2026 the results of PE-PE trial. Oligometastatic #RCC pts have a significant benefit when pembro was added to MDT irrespectively of the type of MDT used and up to 5y from previous surgery.
Thanks to the 🇮🇹 team and special thanks to @DrChoueiri!
@OncoAlert @urotoday @myESMO @KidneyCancer @Sebastiano_Buti @ciccarese_c @fmassari79 @mimma_rizzo @elena_verzoni @MatteoSantoniMD
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
Revisit this phase 3 study from @ESTRO_RT @EORTC_BCG: Nodal irradiation for breast cancer decreases breast-cancer related mortality but increases non-breast cancer related mortality after 22.2 years in @EORTC trial 22922/10925.
🔗: acsjournals.onlinelibrary.wi…
@OncoAlert #BCSM
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
Hear the latest on MDT for oligomets from the first author himself, @AlexSherryMD!
Check out the paper📜 AND the podcast🎙️ for some main highlights! ☢️
📜ascopubs.org/doi/10.1200/JCO…
🎙️ascopubs.org/do/jco-article-…
@ChadTangMD @ebludmir
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
📢 Our practical guide to EBRT for HCC is out in PRO
Less of a lit review, more of a how-to for #radonc: pt selection, techniques, treatment delivery, special scenarios
Many thanks to all coauthors!
@ldawsonmd @AndrewMMoon @hmaxi_MD @MichaelYanMD
🔗 tinyurl.com/PROHCC
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
Long-term OS benefit w/ abiraterone in PEACE-1 (2215O). Note this is triplet vs ADT + docetaxel, not vs ADT + ARPI.
📌 Randomized phase 3, 2x2 factorial, 1,173 men w/ de novo mCSPC. High / low volume 57 / 43%.
📌 R 1:1:1:1 to SoC (ADT ± docetaxel), SoC + prostate RT 74/37, SoC + abi/prednisone, or SoC + abi/prednisone + RT.
📌 Median follow-up 7.7y. Among control-arm pts whose disease progressed, 86% received an ARPI.
📌 Adding abi to SoC: OS HR 0.75 (95% CI 0.65-0.87; p=0.0001). Pooled mOS 4.6→ 6.1y (ESMO press release).
📌 ADT + docetaxel ± abi (n=710): mOS 4.4→ 6.2y; HR 0.68 (95% CI 0.56-0.82). 8y OS 27.1→ 40.3%. This was not triplet vs ADT + ARPI doublet.
📌 High-volume mOS 3.5→ 4.6y, HR 0.68 (95% CI 0.54-0.85); low-volume 6.2→ 7.8y, HR 0.74 (95% CI 0.52-1.05). No detected volume interaction (p=0.56); low-volume OS not independently significant.
📌 G3-4 AEs, doublet→ triplet without RT (press release): HTN 14→ 21%; hypokalemia 1→ 4%. No new long-term safety signal reported.
Side note on RT: in the 2024 Lancet RT analysis, prostate RT did not improve OS, but improved CRPC-free survival regardless of burden (HR 0.79, 95% CI 0.69-0.90), low-volume rPFS w/ abi (4.4→ 7.5y; aHR 0.65, 99.9% CI 0.36-1.19; RT effect p=0.019; no rPFS gain w/o abi; RT x abi interaction p=0.026), and reduced serious GU events (22.3→ 12.2%). ESMO 2026 reports RT only through four-arm mOS: SoC / SoC + RT / SoC + abi / SoC + abi + RT 4.6 / 4.6 / 5.7 / 6.4y. No new CRPC-free or GU-event RT data.
cslide.ctimeetingtech.com/es…
#ESMO26 #PCSM #radonc
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
Impressive IST (as always!) from @DrIacovelli. We often talk about application of pembro as “adjuvant” after treating oligometastatic disease. Now we have data to back it up. Maybe (as med oncs) we get pembro going as we work out MDT approach for oligomets? Discussant suggests a P3 - I’m not sure it will get done. With reasonable data for pembro in M1 NED, I say go for it. #ESMO26 @OncoAlert
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
#ESMO26 PE-PE: Does periop pembro improve outcomes after MDT for oligometastatic ccRCC?
Ph 2, n=85
2:1 randomized:
🔹 Pembro → MDT (SABR/surgery) → pembro
🔹 MDT alone
🚨Perioperative pembrolizumab significantly improved RFS🚨
🔹 Median RFS: 25.4 vs 11 mo (HR 0.47, p=0.024)
🔹 94% of progression events were distant
🔹 Distant RFS: 25.4 vs 11.5 mo
🔹 Grade ≥3 AEs: 7.1% vs 3.4%
🔹 No grade ≥3 SABR-related AEs
🔑 Even in low-volume omRCC treated definitively with MDT, systemic relapse remains common. Perioperative pembrolizumab more than doubled median RFS and supports integrating systemic therapy with MDT.
@urotoday
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
🇮🇳 Promising practice-changing data from @TataMemorial India 🇮🇳 at #ESMO2026!
Phase III trial (n=475) in technically unresectable oral cancer:
Weekly paclitaxel-carboplatin + oral metronomic therapy (PCm) vs DCF
✅ Higher response rates
✅ Greater conversion to resectability
✅ Significantly less toxicity
✅ Non-inferior overall survival
✅ Outpatient-friendly, without central line
2-year OS: 38.9% vs 29.4%, favouring PCm.
An innovative, pragmatic, potentially more accessible and cost effective regimen from India!
👏 Congratulations @VanitaNoronha and the entire team from @TataMemorial
#ESMO26 @OncoAlert @oncodaily @myESMO @montypal @neerajaiims
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
UNION's 24.5% pCR improvement w short course RT/IO impressive, but some context:
Control pCR only 15%, v 29% in GI002 & up to 38% in TIMING (both long course CRT/6c FOLFOX, no IO).
Hence magnitude of benefit may partly reflect less preop chemo in UNION control (just 2c CAPOX).
Full UNION paper is out in Lancet Oncol. Supplement Table S4 caught my eye: median time from RT start to surgery was 72 vs 113 days (SCRT/IO vs control), yet pCR was 39.8% vs 15.3%.
I would've expected LOWER pCR with surgery that much sooner(!), as we've seen in past short-course RT trials. Makes that response signal even more interesting!
Adding ICI in rectal cancer sure seems enticing! Are we entering a new frontier?!?
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#ASTRO26 STELLAR II (Li): phase 2/3, 588 pts w/ pMMR LARC, SCRT 25/5 → CAPOX x4 +/- sintilimab. Adding sintilimab increased CR (pCR + cCR) from 27% → 52% (p<0.001). pCR among operated pts went from 19% → 42%. G3-4 toxicity also went up, 20% → 28%. Looking forward to the primary phase 3 endpoint, 3y DFS, which is still pending.
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#ASTRO26 TORCH-iTNT (Wang) asks a different question: randomized phase II, pMMR LARC, CAPOX + toripalimab x6 w/ vs w/o SCRT 25/5. CR was 37% w/o RT → 62% w/ SCRT. IO in both arms here.
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Unlike UNION, both ASTRO trials allowed watch-and-wait / organ preservation, so CR includes cCR. These aren't all pCR comparisons. Oh and of course standard caveat that cross trial comparisons are a sin.
UNION enrolled only surgery-intended pts, and both arms got just 2 cycles of consolidation chemo vs the 4-6 now recommended. I wonder how this compares w/ modern TNT, especially when organ preservation is the goal.
doi.org/10.1016/s1470-2045(2…
#ESMO26 #radonc #OncTwitter #CRCSM
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
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…
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
Practice changing data from the SARON study at #ESMO26 from @fifimcdrmh @royalmarsdenNHS
👏 Herculean effort, run over 10 years
🤔 Does adding radiotherapy to SACT in the immunotherapy era improve survival in synchronous oligometastatic NSCLC?
What do we know already?
✅ LCT improves outcomes in pre-immuno era & with AGA+ NSCLC
❌ More recently, no survival benefit with niv/ipi regimens (LONESTAR)
What does SARON add?
✅ Well designed, randomised, multicentre prospective study
✅ Comprehensive baseline assessments with PET and MRI
✅ Appropriate definition of OMD (1-5 sites)
✅ PFS benefit, and reduces progression at treated sites
❌ No OS benefit, and no reduction progression at new sites of disease
✅ No additional toxicity
Thoughts:
🤔 Great academic 🇬🇧 study 👏
🤔 Addresses important & relevant question
🤔 Presumably parents have more metastases than we can detect, which then progress, losing OS benefit
🤔 Patients must be informed of lack of OS benefit if LCT being considered
🤔 Is LCT appropriate if OS not improved?
(❗️LCT in AGA+ NSCLC, and LCT in metachronous OMD not answered here)
#LCSM
Marc Vincent Barcelona, MD, FPCR, DPBR-RO retweeted
IMO SANO neither positive b/c similar 5yr OS nor negative b/c higher DM w surveillance.
Raises q: traditionally organ pres accepted only if all onc outcomes preserved, but worth discussing if some tradeoffs (? imaging-based endpts) reasonable for reduced morbidity, better QOL.
Full SANO paper is out! (Ann Oncol, open access)
What it adds:
Death from esophageal cancer at 5y: 40% with active surveillance vs 30% with surgery (HR 1.67, 95% CI 1.02–2.73). Other-cause death: 10% vs 15% (HR 0.49, 0.22–1.09). These are competing-risk secondary outcomes.
Of 91 metastases in the surveillance arm, 44 came after delayed oesophagectomy, a median 11.1 mo after regrowth (not after surgery). 22 were found within 6 mo of nCRT.
Regrowth was associated with later metastasis (HR 2.49), but the trial can't separate seeding from biology.
Regrowth risk comes early: ~21% remaining if still in cCR at 1 year, 2% at 3 years.
The "43% spared esophagectomy" figure includes patients with early metastases. Durable organ preservation: 32% in cCR at last evaluation, and 21% completed 5 years of surveillance.
The protocol does define volumes (§8.3.2): regional nodes within ≥3 cm craniocaudal, 3 mm radial CTV, 1 cm PTV. There's no RTQA or adherence analysis.
Adjuvant systemic therapy isn't reported.
The authors now call it "selectively delayed surgery rather than surgery avoidance." Fair.
#ESMO26 #radonc
linkinghub.elsevier.com/retr…
