radiation-wave4

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.

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.

The German rectal trial moved chemoradiation to before surgery: local recurrence halved, more sphincters were saved and toxicity fell, with survival unchanged.

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.

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.

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.

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.

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.

EORTC 26951, the European twin of RTOG 9402, confirmed that PCV chemotherapy after radiotherapy greatly lengthens survival in 1p/19q co-deleted oligodendrogliomas.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.