KEY POINTS
- This radiation-oncology-focused summary of ELCC 2026 covers small-cell lung cancer, non-small-cell lung cancer, thymic malignancies and oligometastatic disease, with biomarker-guided selection and integration of local therapy with modern systemic treatment emerging as common themes.
- In extensive-stage SCLC, the authors highlight renewed interest in thoracic RT alongside immunotherapy. A phase II series of 56 responding patients receiving 15 Gy in five 3-Gy fractions to thoracic disease during chemoimmunotherapy reported 57.4% three-year overall survival, although its selected single-arm design prevents comparison with systemic-therapy trials.
- SCLC brain management is also shifting. In the MRI and immunotherapy era, prophylactic cranial irradiation is being reconsidered, while hippocampal-avoidance PCI is under prospective study and emerging evidence—including ENCEPHALON—supports SRS for selected patients with SCLC brain metastases rather than reflexive whole-brain RT.
- In locally advanced NSCLC unsuitable for concurrent chemoradiotherapy, a 50-patient phase II study tested five-fraction SBRT, with median doses of 45 Gy to the primary and 40 Gy to involved nodes. Despite 80% ultra-central tumors, three-year overall survival was 72%, three-year local relapse-free survival 56%, and no grade ≥3 toxicity was reported.
- For oligoprogressive disease, CURB showed a progression benefit from adding SBRT (HR 0.53; p=0.0035), but the effect was observed in lung cancer rather than breast cancer. SBRT also delayed switching to the next systemic line, while falling circulating tumor DNA after treatment emerged as a possible response marker.
- NORTHSTAR extended the local-therapy question beyond classic oligometastatic disease. In EGFR-mutated locally advanced or metastatic NSCLC, osimertinib plus local consolidative treatment improved median PFS from 17.5 to 25.3 months (HR 0.66; p=0.025); notably, 71% of enrolled patients were initially polymetastatic. A secondary ELCC analysis linked primary-tumor BED ≥75 Gy, nodal clearance and absence of pleural effusion with better outcomes.
- For thymic carcinoma, retrospective ITMIG data cited in the review found five-year overall survival of 68% with postoperative RT versus 53% without it after resection; three ongoing phase III studies are now addressing postoperative RT prospectively in stage II–III thymoma.
CLINICAL TAKEAWAY
The recurring ELCC message is that radiotherapy is increasingly being positioned inside systemic-treatment strategies rather than before or after them as an isolated modality. The strongest emerging opportunities involve SBRT for oligoprogression/local consolidation and better biological selection, but several highlighted results remain early, secondary or nonrandomized and should not yet be treated as universal standards.