Patients (N=246) with resectable/borderline resectable pancreatic cancer were randomly assigned to receive preop chemoRT or immediate surgery in this phase 3 trial. Overall survival trended towards improvement with preop chemoRT (16.0 months, HR 0.78 (95% confidence interval [CI], 0.58 to 1.05), N=119) vs 14.3 months, (N=127), with P=0.096). R0 resection occurred in 71% vs 40% of patients with vs without preop chemoRT. Disease-free and locoregional failure-free survival were improved with vs without preop chemoRT. Overall survival was improved in a subset of patients who underwent resection and adjuvant chemotherapy with vs without preop chemoRT.

Reference (PubMed Link): Versteijne E, Suker M, Groothuis K, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: Results of the dutch randomized phase iii preopanc trial. J Clin Oncol 2020;38:1763-1773.

Key Institution: Multi-Institutional (Netherlands)
Keywords: Pancreas, Surgery, Chemoradiation 

Twenty-one participants had locally advanced, unresectable, stage III NSCLC, Eastern Cooperative Oncology Group performance status 0 or 1, and adequate hematologic, renal, and hepatic function.

Pembrolizumab was combined with concurrent chemoradiotherapy (weekly carboplatin and paclitaxel with 60 Gy of radiation in 2 Gy per d). Progression-free survival was good, with relatively few serious immune-related adverse events.

Consolidative immunotherapy following chemoradiation for locally advanced NSCLC was shown to improve survival in the PACIFIC trial. The use of concurrent immunotherapy with radiation in intriguing but there is little data regarding safety and efficacy. This Phase 1 study demonstrates that concurrent chemoimmunoradiotherapy is tolerable in this population, with further studies required to evaluate efficacy.

(Open Access)

Reference (PubMed Link): Jabbour SK, Berman AT, Decker RH, et al. Phase 1 trial of pembrolizumab administered concurrently with chemoradiotherapy for locally advanced non-small cell lung cancer: A nonrandomized controlled trial. JAMA Oncol 2020;6:1-8.

Key Institution: Multi-Institutional (Royal Marsden Hospital, Institute of Cancer Research, London, UK)
Keywords: Immunotherapy, Chemoradiotherapy, Locally Advanced Non-small Cell Lung Cancer 

This is a large, multi-institutional, retrospective, nonrandomized comparative effectiveness study that included 1483 adult patients with nonmetastatic, locally advanced cancer that was treated with concurrent chemotherapy and radiotherapy with curative intent. The primary endpoint was 90-day CTCAE adverse events of grade3 or above. The results showed that proton chemoradiotherapy was associated with a significantly lower relative risk of 90-day adverse event of at least grade 3 (relative risk = 0.31, with 95% confidence interval 0.65- 0.93, p=0.006), as well as decline in performance status during treatment (relative risk = 0.561, 95% confidence interval0.37 - 0.71, p<0.001). There was no difference in disease-free or overall survival.

Reference (PubMed Link): Baumann BC, Mitra N, Harton JG, et al. Comparative effectiveness of proton vs photon therapy as part of concurrent chemoradiotherapy for locally advanced cancer. JAMA Oncol 2019.

Key Institution: Multi-Institutional (US)
Keywords: Proton therapy, toxicity

Cancer outcomes are relatively good for patients with hereditary retinoblastoma. However, long term survivors are at risk for developing secondary cancers as a result of radiotherapy. This study analyzed 952 long-term survivors diagnosed between 1914 and 2006. The authors found that there were 105 bone and 124 soft tissue sarcomas, more than half in the head and neck (in/near the radiation field), one quarter in the body and extremities, and about 1/5th elsewhere. These were diagnosed as early as early childhood and well into adulthood. These data provide some guidance as to the risk of developing secondary sarcomas after radiation therapy in childhood and point to the need for effective and risk-based screening. 

(Open Access)

Reference (PubMed Link): Kleinerman RA, Schonfeld SJ, Sigel BS, et al. Bone and soft-tissue sarcoma risk in long-term survivors of hereditary retinoblastoma treated with radiation. J Clin Oncol 2019;37:3436-3445.

Key Institution: National Cancer Institute, Bethesda, MD
Keywords: Retinoblastoma, radiation, secondary malignancy 

471 patients with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), of whom 251 were early stage, 76 were intermediate stage, and 144 were advanced stage.  All received first line treatment in the randomized GHSG HD7 to HD15 studies, which consisted of radiation alone, chemotherapy alone, or chemo-RT. 

Median follow up was 9.2 years. PFS and OS estimates were 75.5% and 92.1% respectively.  Early stage PFS and OS were 79.7% and 93.3%, intermediate stage PFS and OS were 72.1% and 96.2%, and advanced stage PFS and OS were 69.8% and 87.4%.  Patients older than 45 years and with splenic involvement at diagnosis had worse survival outcomes, as did patients with liver or bone marrow involvement. 10% of patients developed a secondary malignancy, of which almost half were solid tumors.  Only 9% of patients died. Among these, the majority of causes of death were from secondary malignancies or from non-malignant conditions possibly associated with RT or chemotherapy (such as cardiovascular disease), rather than from NLPHL. 

Given the good cause-specific survival of patients with NLPHL treated on GHSG protocols, treatment optimization with consideration of long-term side effects from radiation and/or chemotherapy should be evaluated. 

Reference (PubMed Link): Eichenauer DA, Plutschow A, Fuchs M, et al. Long-term follow-up of patients with nodular lymphocyte-predominant hodgkin lymphoma treated in the hd7 to hd15 trials: A report from the german hodgkin study group. J Clin Oncol 2019:Jco1900986.

Key Institution: German Hodgkin Study Group
Keywords: Hodgkin Lymphoma, RT, chemotherapy, chemoradiotherapy, secondary malignancy