{"slug":"radiation-wave4","tag":"radiation-wave4","variants":["radiation-wave4"],"description":"Landmark radiotherapy trials added in the fourth radiation wave.","count":20,"kinds":{"trial":20},"related":[],"records":[{"id":"int-0116","kind":"trial","name":"INT-0116 (Macdonald trial)","route":"/trials/int-0116/","status":"positive","tldr":"The Macdonald trial made postoperative chemoradiation the US standard for resected stomach cancer in 2001, though later trials with better surgery and chemotherapy have largely replaced it."},{"id":"cao-aro-aio-94","kind":"trial","name":"CAO/ARO/AIO-94 (German Rectal Cancer Study)","route":"/trials/cao-aro-aio-94/","status":"positive","tldr":"The German rectal trial moved chemoradiation to before surgery: local recurrence halved, more sphincters were saved and toxicity fell, with survival unchanged."},{"id":"rapido","kind":"trial","name":"RAPIDO","route":"/trials/rapido/","status":"positive","tldr":"RAPIDO showed that giving one week of radiotherapy and then all the chemotherapy before surgery cuts distant spread and doubles complete responses in high-risk rectal cancer, establishing total neoadjuvant therapy."},{"id":"prodige-23","kind":"trial","name":"PRODIGE 23","route":"/trials/prodige-23/","status":"positive","tldr":"PRODIGE 23 showed that six cycles of intensive chemotherapy before chemoradiation improves disease-free survival in rectal cancer and, on longer follow-up, overall survival, the second pillar of total neoadjuvant therapy."},{"id":"act-ii","kind":"trial","name":"ACT II","route":"/trials/act-ii/","status":"positive","tldr":"ACT II, the largest anal cancer trial, confirmed mitomycin-fluorouracil chemoradiation as the standard, showed that swapping in cisplatin or adding maintenance chemotherapy gave nothing, and taught doctors to wait six months before judging response."},{"id":"rtog-91-11","kind":"trial","name":"RTOG 91-11","route":"/trials/rtog-91-11/","status":"positive","tldr":"RTOG 91-11 established concurrent cisplatin with radiotherapy as the way to keep the voice box in advanced larynx cancer: more patients kept their larynx than with induction chemotherapy or radiotherapy alone, with no loss of survival."},{"id":"bonner-cetuximab-rt","kind":"trial","name":"Bonner trial (cetuximab plus radiotherapy)","route":"/trials/bonner-cetuximab-rt/","status":"positive","tldr":"The Bonner trial was the first to show that a targeted antibody improves survival when added to radiotherapy: cetuximab with radiotherapy lengthened survival in head and neck cancer, and became the option for patients who cannot have cisplatin."},{"id":"rtog-1016","kind":"trial","name":"RTOG 1016","route":"/trials/rtog-1016/","status":"negative","tldr":"RTOG 1016 tried to spare HPV-positive throat cancer patients the toxicity of cisplatin by using cetuximab instead, and found that survival was worse: cisplatin stays the standard."},{"id":"de-escalate","kind":"trial","name":"De-ESCALaTE HPV","route":"/trials/de-escalate/","status":"negative","tldr":"De-ESCALaTE, the European counterpart of RTOG 1016, found that cetuximab gave no less toxicity than cisplatin and worse tumour control in HPV-positive throat cancer."},{"id":"rtog-9601","kind":"trial","name":"RTOG 9601","route":"/trials/rtog-9601/","status":"positive","tldr":"RTOG 9601 showed that adding two years of hormone therapy to salvage radiotherapy after prostate surgery lengthens survival, mainly in men with higher PSA levels at relapse."},{"id":"horrad","kind":"trial","name":"HORRAD","route":"/trials/horrad/","status":"negative","tldr":"HORRAD found no overall survival benefit from irradiating the prostate in men presenting with bone metastases, though a possible gain in those with few metastases fed into STAMPEDE's later positive finding."},{"id":"pop-rt","kind":"trial","name":"POP-RT","route":"/trials/pop-rt/","status":"positive","tldr":"POP-RT, from Mumbai, showed that treating the pelvic lymph nodes as well as the prostate improves disease control in high-risk prostate cancer, reviving a question earlier trials had left unanswered."},{"id":"slotman-pci-es-sclc","kind":"trial","name":"EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancer","route":"/trials/slotman-pci-es-sclc/","status":"positive","tldr":"Slotman's trial showed that irradiating the brain before metastases appear cuts symptomatic brain metastases and lengthens survival in extensive-stage small-cell lung cancer, though a later Japanese trial with MRI screening did not confirm the survival gain."},{"id":"takahashi-pci","kind":"trial","name":"Takahashi trial: prophylactic cranial irradiation with MRI surveillance in extensive-stage small-cell lung cancer","route":"/trials/takahashi-pci/","status":"negative","tldr":"When patients were checked with brain MRI first, prophylactic brain irradiation no longer lengthened survival in extensive-stage small-cell lung cancer, so many centres now offer MRI surveillance instead."},{"id":"eortc-22922","kind":"trial","name":"EORTC 22922/10925","route":"/trials/eortc-22922/","status":"positive","tldr":"EORTC 22922 showed that irradiating the internal mammary and supraclavicular nodes reduces breast cancer recurrence and death, with a small effect on overall survival, and made regional nodal irradiation standard for node-positive disease."},{"id":"ma-20","kind":"trial","name":"NCIC MA.20","route":"/trials/ma-20/","status":"positive","tldr":"MA.20, published alongside EORTC 22922, showed that adding nodal irradiation after lumpectomy improves disease-free survival, mainly by preventing distant spread, without a survival difference at ten years."},{"id":"dbcg-82bc","kind":"trial","name":"DBCG 82b and 82c","route":"/trials/dbcg-82bc/","status":"positive","tldr":"The Danish postmastectomy trials proved that radiotherapy to the chest wall and nodes after mastectomy not only prevents local recurrence but saves lives in women with node-positive disease."},{"id":"rtog-9402","kind":"trial","name":"RTOG 9402","route":"/trials/rtog-9402/","status":"positive","tldr":"RTOG 9402 looked negative at first and then, with long follow-up, showed that adding PCV chemotherapy to radiotherapy doubles survival in oligodendrogliomas with 1p/19q co-deletion, from about seven to fourteen years."},{"id":"eortc-26951","kind":"trial","name":"EORTC 26951","route":"/trials/eortc-26951/","status":"positive","tldr":"EORTC 26951, the European twin of RTOG 9402, confirmed that PCV chemotherapy after radiotherapy greatly lengthens survival in 1p/19q co-deleted oligodendrogliomas."},{"id":"eortc-22033","kind":"trial","name":"EORTC 22033-26033","route":"/trials/eortc-22033/","status":"negative","tldr":"EORTC 22033 asked whether temozolomide could replace radiotherapy as the first treatment for high-risk low-grade glioma and found no difference in progression-free survival, with the molecular subtype mattering more than the choice of treatment."}]}