S3019
Invited Speaker
ESTRO 2026
can provide insight into patient selection regarding efficacy and safety. Newer methods such as computational modelling and network medicine can provide additional information on safety and effectiveness, by simulation and prediction of drug- target interactions, adverse event pathways and patient-specific responses. Another challenge is how to efficiently summarize the continuously newly published data. Initiatives such as the ESTRO-ESMO systematic review and Delphi consensus provide an important overview of the available knowledge and can provide valuable treatment recommendations. However, these initiatives are often limited by the time needed to perform the literature systematic review and Delphi consensus. For example, for the ESTRO- ESMO initiative, the searches were performed in December 2020 and March 2021. In the meantime, many new publications, including also new drugs, have been published, emphasizing the need for faster summarizing and analysis of published data. To keep up with this rapidly moving field, we are currently developing a living systematic review with a website and mobile app to allow physicians to quickly look up the latest published evidence on a drug in combination with SRT: the LINACS initiative. A systematic literature search was conducted in PubMed (May 2025, update planned in April 2026). This living review undergoes biannual updates to maintain currency. The search in May 2025 identified 3,369 unique records. Following screening and risk-of-bias assessment, 292 manuscripts were included: 112 prospective studies, 108 retrospective studies, and 71 case reports. Notably, 138 studies (47%) were published from 2022 onwards, underscoring the field's rapid evolution. 5373 Where should we be going? Remaining challenges in MV photon clinical practice and potential solutions Diego Jurado-Bruggeman Medical Physics, Institut Català d'Oncologia, Girona, Spain Modern treatment planning systems for megavoltage (MV) photon radiotherapy enable the reporting of different dose quantities. For a given irradiation—and, therefore, a given dose delivered to the patient—these quantities may differ due to variations in radiation transport and dose deposition processes, leading to different reported dose values. While differences between them are generally small in soft tissues, they can become significant in media such as air, bone, or metallic implants. Therefore, the current transition of
as a paradigm for integrating RT with systemic therapies, offering transferable principles applicable to other tumour types. Future progress will depend on prospective studies specifically designed to evaluate RT-drug combinations, improved biological stratification, and sustained international collaboration to refine and standardise clinical practice. References: Meattini I, et al. Repositioning Radiation Oncology at the centre of integrated oncology care: A manifesto of the European Society for Radiotherapy and Oncology (ESTRO). Radiother Oncol. 2025 Sep;210:111035. Meattini I, et al. International multidisciplinary consensus on the integration of radiotherapy with new systemic treatments for breast cancer: European Society for Radiotherapy and Oncology (ESTRO)- endorsed recommendations. Lancet Oncol. 2024 Feb;25(2):e73-e83. Kaidar-Person O, et al. Essential requirements for reporting radiation therapy in breast cancer clinical trials: An international multi-disciplinary consensus endorsed by the European Society for Radiotherapy and Oncology (ESTRO). Radiother Oncol. 2024 Jun;195:110060. 5372 Beyond consensus definitions and towards prospective evidence generation Esmée L Looman Radiation Oncology, University Hospital Zurich, Zuirch, Switzerland. Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland Oncology research and treatment development have been marked by rapid development of new (targeted) systemic drugs, partly due to increased industry funding for trials. Often there is no available evidence yet for the combination of these systemic therapies with stereotactic radiotherapy (SRT), because of the rapid drug development and because drug registration studies usually do not allow simultaneous radiotherapy. Simultaneously, cancer heterogeneity is a universal problem, with the consequences of oligoprogression, for which SRT might be indicated. Multiple methods were developed to efficiently collect data on the combination of systematic therapies with SRT. Registry studies, such as OligoCare or OligoRare, provide constant and continuous collection of data at multiple international centers, resulting in a comprehensive and up-to-date database. Another possibility for analyzing effectiveness and safety of combined multimodality treatment could be the use of organoid models, which can also replicate the heterogeneity and can be used for dose testing. Pharmacology approaches such as biomarker studies
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