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Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation. It is the curative treatment for cervical, anal, laryngeal and oropharyngeal cancers, stage III lung cancer and glioblastoma, and is given before surgery in oesophageal and rectal cancer, at the cost of more acute mouth and gullet inflammation.
Concurrent chemoradiation (usually with cisplatin, or 5-FU and mitomycin, or carboplatin-paclitaxel) is definitive treatment for cervical, anal, laryngeal and oropharyngeal cancers, stage III lung cancer (followed by durvalumab, PACIFIC), glioblastoma (with temozolomide) and bladder preservation (trimodality with TURBT), and is preoperative in oesophageal (CROSS) and rectal cancer. Concurrent beats sequential in most comparisons at the cost of more acute toxicity (mucositis, oesophagitis). Chemotherapy acts as a radiosensitiser rather than for its own systemic effect, so doses are lower than in systemic regimens.
Patients with limited-stage small-cell lung cancer who complete chemoradiotherapy without progression should now be offered up to two years of durvalumab consolidation, which extends life by almost two years on average. This is the first survival improvement for limited-stage disease since twice-daily radiotherapy and prophylactic cranial irradiation, and small-cell lung cancer is no longer a disease where immunotherapy gives only marginal gains.
Stage III lung cancer is now treated by genotype as well as by stage: an EGFR mutation moves a patient from durvalumab consolidation to osimertinib consolidation. It is also the strongest hazard ratio in the lung cancer literature, which is a reason to read the overall survival data carefully when they arrive.
The current standard for unresectable stage III lung cancer, and the clearest evidence in the disease that consolidation immunotherapy converts responses into cures for some patients rather than merely delaying relapse.
The second total neoadjuvant therapy schedule to change practice, and the one that shows the advantage is partly deliverability: chemotherapy given before an operation is completed by far more patients than chemotherapy given after one.
The first total neoadjuvant therapy trial to change practice in high-risk rectal cancer, and the schedule that makes organ preservation possible by giving the tumour months rather than weeks to respond.
India carries a large share of the world's gallbladder cancer and this is the only randomised test of radiotherapy's role before surgery; the registry's actual enrolment of 124 against a plan of 314 means the answer will be less certain than designed.
The document behind the MRI-first rectal cancer pathway used across Europe and the UK; the total neoadjuvant therapy trials (RAPIDO, PRODIGE 23, OPRA) that came after it are the main reason an update was needed.
This single-arm trial is why NCCN lists chemoradiation after a positive margin or involved nodes. The near-identical survival after R0 and R1 resection is suggestive but unproven; no randomised trial has followed, and the UK does not routinely offer it.
Shares PATHOS, Small cell neuroendocrine carcinoma of the cervix, Adenosquamous carcinoma of the cervix, Squamous cell carcinoma of the urethra.
Shares A Prospective, Single-Arm, Phase II Study: PD-L1 Monoclonal Antibody + Chemoradiotherapy as Bridge Therapy to Liver Transplantation for Locally Advanced Perihilar Cholangiocarcinoma (ACHIEVE-LT), Efficacy and Safety of Postoperative Concurrent Chemoradiotherapy for Extrahepatic Cholangiocarcinoma and Gallbladder Carcinoma: A Multicenter Prospective Phase II Study, Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer, Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016).
Shares Abdominoperineal resection, PROSPECT (Alliance N1048), Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016), Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
Shares A phase III randomised clinical trial of perioperative therapy (neoadjuvant chemotherapy versus chemoradiotherapy) in locally advanced gallbladder cancers (POLCAGB): study protocol, Locally advanced and locoregional disease, Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer, Sauer 2004: chemoradiotherapy before rather than after surgery for rectal cancer (CAO/ARO/AIO-94).
Shares Angelita Habr-Gama, Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results, PRODIGE 23, OPRA.
Shares INT-0116 (Macdonald trial), CATNON (EORTC 26053-22054), PATHOS, De-ESCALaTE HPV.
Shares INT-0116 (Macdonald trial), ACT II, RTOG 91-11, Sauer 2004: chemoradiotherapy before rather than after surgery for rectal cancer (CAO/ARO/AIO-94).
Shares International Watch & Wait Database, CAO/ARO/AIO-12, Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results, OPRA.