ASTRO Meeting Features New Prostate Trial Results and Bladder Guidelines

Research presented around the 2026 ASTRO meeting covered efforts to tailor radiation treatment and included new prostate-cancer trial results and ASTRO’s first bladder-cancer radiation guidelines. In a phase III trial, 25 sessions of postoperative prostate radiation produced five-year patient-reported quality-of-life and cancer-control outcomes similar to a 37-session course, but caused more severe physician-reported urinary side effects, including cystitis and blood in the urine. The bladder guidelines address bladder-preserving chemoradiation and other settings; radiation for recurrent high-grade non-muscle-invasive disease is a conditional option for select patients who lack or decline alternatives. MD Anderson researchers also reported that healthy-brain exposure varied substantially across more than 800 stereotactic radiosurgery plans from over 650 institutions, with planning choices—especially how tightly radiation was shaped around the target—accounting for more variation than equipment on standard linear accelerators, and highlighted a genomic reanalysis of a major prostate-cancer radiotherapy trial. Mayo Clinic presentations covered stereotactic radiation and metastasis-directed treatment for metastatic Ewing sarcoma, as well as AI to personalize radiation planning and care; Sylvester researchers presented work on functional radiation treatments, biomarkers, imaging, AI and precision oncology.
The NRG-GU003 phase III trial enrolled 296 patients; the 25-session arm received 62.5 Gy, compared with 66.6 Gy over 37 sessions in the standard-treatment arm.
ASTRO’s 34 bladder-cancer recommendations were developed from a review of literature published from 2009 to 2024, with input from radiation, medical and urologic oncologists, a medical physicist and a patient representative.
The conditional recommendation to use trimodal therapy for recurrent high-grade non-muscle-invasive bladder cancer rests largely on an encouraging single-arm study of 37 patients. Task-force chair Jason Efstathiou cautioned that it “should not be interpreted as a general recommendation for radiation in non-muscle invasive bladder cancer.”
Mayo researchers said their study of stereotactic body radiation and comprehensive metastasis-directed treatment for metastatic Ewing sarcoma reported the highest event-free survival to date in cooperative-group trials of the disease.
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