S1270
Clinical - Urology
ESTRO 2026
+ chemo-RT]) with or without systemic therapy and (ii) systemic therapy alone. Because of heterogeneity in populations, interventions, and reporting, we conducted a narrative comparative synthesis. The study adhered to PRISMA guidelines. Results: Out of 1707 articles, we selected 41 eligible studies encompassing 16,829 patients with node-positive bladder cancer, treatment strategies were heterogeneous. Two studies were prospective. Neoadjuvant chemotherapy followed by radical cystectomy (RC) was reported in seven studies, RC with adjuvant chemotherapy in six, and RC with adjuvant radiotherapy in two. Bladder-sparing trimodality therapy was described in two series, while systemic therapy with or without immunotherapy but no definitive local treatment was reported in one. Cystectomy with pelvic lymph-node dissection of any extent appeared in six studies. Outcomes most frequently assessed were overall survival (33 studies), cancer-specific survival (28), metastasis-free and local disease-free survival (24 each), bladder-intact event- free survival (24), progression-free survival (23), recurrence-free survival (25), and treatment-related morbidity (24).In clinically node-positive (cN ⁺ ) cohorts, comparisons were limited by near-universal use of neoadjuvant systemic therapy among RC-eligible patients, and no consistent advantage for extended lymph-node dissection emerged. Consolidative local therapy after induction treatment was associated with improved local control compared with systemic therapy alone, although evidence selection bias persists. For pathologically node-positive (pN ⁺ ) disease in absence of neoadjuvant treatment, adjuvant nivolumab provided evidence of disease-control benefit, whereas adjuvant radiotherapy and chemotherapy signals remained suggestive but still not well established in literature, constrained by retrospective design and survivor bias. Conclusion: Current evidence for node-positive bladder cancer remains heterogeneous; while local therapy after systemic treatment appears to improve local control, robust randomized data are lacking. Keywords: bladder, trimodal, nodal involvement SBRT for oligoprogressive metastatic renal cell carcinoma: systemic treatment dynamics and clinical outcomes Rodrigo Cartes 1 , Ciro Franzese 1,2 , Raffaella Lucchini 1 , Luciana Di Cristina 1 , Lorenzo Lo Faro 1 , Marie Lohmer 1 , Marta Scorsetti 1,2 1 Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Italy. Digital Poster 3544
Moderate hypo-fractionated radiotherapy with long- term androgen deprivation achieved excellent biochemical control in high-risk prostate cancer. Pre- radiotherapy PSA ≤ 0.5 ng/mL was the strongest independent predictor of biochemical control, while higher pre-RT PSA values correlated with progressively increased recurrence risk. Pre-RT PSA represents a simple, key biomarker for treatment optimization and risk stratification, warranting prospective validation in multimodal management. Keywords: PSA, biochemical recurrence, prognostic factors Node-Positive Muscle-Invasive Bladder Cancer: Emerging Landscape of Local and Systematic Treatments – A Systematic Review Federico Mastroleo 1,2 , Giulia Marvaso 1,2 , Paolo Ambrosini 3 , Federica Mascaro 3 , Amedeo Nuzzo 3 , Marcin Miszczyk 4,5 , Keiichiro Miyajima 6 , Barbara Alicja Jereczek-Fossa 1,2 , Patrizia Giannatempo 3 1 Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy. 2 Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. 3 Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4 Department of Urology, , Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 5 Collegium Medicum - Faculty of Medicine, WSB Digital Poster 3542 University, D ą browa Górnicza, Poland. 6 Department of Urology, The Jikei University School of Medicine, Tokyo, Japan Purpose/Objective: For muscle-invasive bladder cancer (MIBC) with nodal involvement, practice is bifurcated between clinical node-positive (cN ⁺ ) disease at presentation and incidental pathologic node-positive (pN ⁺ ) after radical cystectomy. Peri-operative systemic therapy is current standard of care in radical cystectomy (RC) eligible MIBC, extended pelvic nodal dissection has not shown incremental benefit, and the contribution of radiotherapy (adjuvant or bladder-sparing chemoradiation/TMT) remains to be defined. In the present fragmented scenario, we performed a systematic descriptive synthesis focusing on current evidence in MIBC N ⁺ settings. Material/Methods: Search was limited to studies published after 01/01/2001 and included Medline, Scopus, Web of Science and CENTRAL databases, and abstracts from international congress meetings up to 2025. We screened and extracted data from studies of MIBC with N1–N3 involvement for (1) local treatment (radical cystectomy ± PLND; trimodality treatment [max TURBT
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