radiation-wave2

N0574 showed that adding whole-brain radiotherapy to radiosurgery for a few brain metastases damages memory and thinking without lengthening life, and radiosurgery alone became the standard.

CALGB 9343 showed that older women with small hormone-sensitive breast cancers taking tamoxifen gain only a small reduction in local recurrence from radiotherapy and no survival benefit, opening the door to omitting it.

CATNON showed that a year of temozolomide after radiotherapy lengthens survival in anaplastic gliomas that lack the 1p/19q co-deletion, and that the benefit is concentrated in IDH-mutant tumours.

CHHiP showed that four weeks of prostate radiotherapy in 3 Gy fractions is as effective as seven and a half weeks of conventional treatment, and 60 Gy in 20 fractions became the standard of care.

CHISEL is the randomised trial that proved stereotactic radiotherapy beats conventional radiotherapy for early lung cancer in patients who cannot have surgery, with better local control and longer survival.

DAHANCA 5 is the trial that made hypoxic sensitisation real in the clinic: nimorazole with radiotherapy improved control of head and neck cancer, and Denmark has used it as standard ever since.

FAST-Forward cut breast radiotherapy to five treatments in a single week and showed the same low relapse rate as the three-week standard, with similar late effects at five years.

The Scandinavian HYPO-RT-PC trial showed that seven large radiotherapy doses control intermediate- to high-risk prostate cancer as well as 39 conventional ones, with similar late side effects.

IMPORT LOW showed that treating only the part of the breast around the tumour bed, with the same simple technique and schedule, is as safe as whole-breast radiotherapy and causes fewer changes to the breast.

JCOG0403 gave the first prospective evidence that stereotactic lung radiotherapy works in patients who could have had surgery, not only in those too frail for it, and set the 48 Gy in four fractions schedule used across Japan.

LUMINA used tumour biology, not just age, to pick women who can skip breast radiotherapy: with a luminal A profile and endocrine therapy, local recurrence at five years was about two percent.

NRG CC001 showed that shaping whole-brain radiotherapy to spare the hippocampus, the seat of memory, reduces cognitive decline without any loss of tumour control.

The largest partial-breast trial found recurrence rates within one percentage point of whole-breast treatment but could not formally prove equivalence, so accelerated partial-breast irradiation is offered to selected lower-risk women rather than everyone.

PACE-B showed that five stereotactic treatments control low- and intermediate-risk prostate cancer as well as four to eight weeks of conventional radiotherapy, with similar side effects at five years.

PRIME II confirmed in a larger and more recent population that omitting radiotherapy in older women with low-risk hormone-sensitive breast cancer raises local recurrence modestly without affecting survival.

QUARTZ found that whole-brain radiotherapy added nothing measurable, in survival or quality of life, for lung cancer patients whose brain metastases could not be treated with surgery or radiosurgery.

RTOG 0617 is the trial that stopped dose escalation in lung cancer: patients given 74 Gy lived shorter than those given the standard 60 Gy, and cetuximab added nothing.

START-B showed that three weeks of breast radiotherapy in larger daily doses controls the cancer as well as five weeks of smaller ones, with fewer late changes to the breast, and made 40 Gy in 15 fractions the UK standard.