Author: Caleb Dulaney
A randomized trial demonstrated adding to usual counseling and pharmacotherapy up to $600 financial incentives for biochemically confirmed 6-month smoking abstinence among medically-underserved adult smokers increased success rates from 4.3% to 8.8%. | Hart, JAMA 2026
This contemporary review of esophageal cancer recognizes adenocarcinoma is increasingly prevalent in Western populations while squamous-cell carcinoma remains dominant worldwide. Major risk factors differ by histology, with reflux and obesity strongly linked to adenocarcinoma and tobacco and alcohol particularly important for squamous-cell carcinoma. Early detection remains challenging because dysphagia and weight loss occur late, although endoscopic screening of selected high-risk patients (age 50+ with chronic reflux) and ongoing surveillance of those with noted Barett’s provide opportunities for prevention and earlier diagnosis. When it comes to the use of chemoradiation: it is favored as definitive therapy for proximal SCC, is used…
Top Line: Is it safe to do sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer patients with locally advanced T4 or N2-3 breast cancer?The Study: Multiple prospective trials have established that SLNB is feasible after nCT for node positive breast cancer, and the false negative rate is <10% dual tracer mapping is used and 3 or more nodes are retrieved. However, these trials largely included cN1 disease with little if any representation from those with more advanced primary or nodal disease. This trial enrolled 145 patients with locally advanced breast cancer (cT4 or cN2-3 at presentation) who had…
The German/Dutch phase 3 ROBOT-2 trial demonstrated higher median lymph-node yield (36 vs 32) with robotic versus laparoscopic minimally invasive esophagectomy with no difference in surgical complications or cancer outcomes thus far. | Berlth, JAMA Surg 2026
Here is a retrospective look at 85 patients receiving circulating tumor (ct)DNA surveillance from 2024–2025 following definitive surgery or ablative radiation for non-small cell lung cancer One in five (n=17) had at least one positive test; notably, 10/17 (59%) subsequently reverted to negative without radiographic recurrence, and 11/17 (65%) had tumor fractions at or near the assay’s limit of detection. In contrast, three of six patients with ctDNA fractions above the limit of detection (0.25%, 0.55%, and >10%) had confirmed recurrence, while none of the 68 ctDNA-negative patients recurred, yielding an overall specificity of 84%. The study found no consistent…
Top Line: Is there a benefit from adjuvant radiation after complete resection of WHO grade 2 meningioma?The Study: Guidelines recommend considering adjuvant RT after complete resection for WHO grade 2 meningioma. This is based on prospective single arm trials, such as RTOG 0539, as well as retrospective data that show favorable outcomes with adjuvant RT. ROAM EORTC-1308 is the first randomized, phase 3 trial in this setting. The trial included 157 patients who were randomized to observation or adjuvant RT (60 Gy in 30 fractions). At 5 years, adjuvant RT significantly improved disease free survival (79.9% v 64.3%). Meningioma recurrence…
Siemens Healthineers/Varian announced a new LINAC platform called Accela. It appears to be a C-arm linac platform, and the big upgrades appear to be speed. They report increased gantry speed as high as 2.5 RPM, CBCT in as few as 15 seconds, and dose rates as high as 40 Gy per minute. | Siemens/Varian, ASTRO 2026
The Headline: Protons are no better than photons in treating hepatocellular carcinoma.The Study: Does proton dosimetry actually translate to better clinical outcomes compared with photons? In GI003, this long standing question was applied to the liver. It included 115 patients with unresectable or locally recurrent HCC who were randomized to receive proton therapy or photon therapy. In both arms, dose fractionation (30-50 Gy in 5 fractions or 37.5-67.5 Gy in 15 fractions) was individualized based on mean liver dose. At 24 months, protons did not significantly increase OS (56.2% v 69.3%), PFS (31.6% v 30.4%), or local progression (19.8% v…
The Headline: Fractionated SRS is the way to go when treating brain metastasis resection cavities. The Study: The N107C trial found that local control was worse with single fraction SRS than whole brain radiation for resected brain metastases. The concern is that relatively large resection cavity volumes result in the use of relatively low single fraction doses. In Alliance A071801, 242 patients with 1-4 brain metastases and at least one measuring 2cm or more that was resected were randomized to receive single fraction SRS or fractionated SRS. Doses were guided by cavity volumes with single fraction doses ranging from 12-20…
In this phase 2 trial, 20 patients with cutaneous angiosarcoma received induction paclitaxel followed by concurrent paclitaxel and radiation (50-50.4 Gy in 25-28 fractions). Almost all (95%) underwent resection. The pathologic complete response rate was 56%. At 2 years local control was 82.5%, and OS was 87.4%. | Raju-Salicki, ASTRO 2026