Clinicians are concerned about the overuse of Stereotactic Body Radiation Therapy (SBRT) for oligoprogressive disease, a practice dubbed 'Pokemon' (gotta catch 'em all). This approach of sequentially radiating new lesions can delay the start of more effective systemic therapies and is not considered a standard of care.

The failure of the concurrent chemo-immuno-radiation approach has not stalled progress. Instead, new clinical trials are actively exploring novel strategies like SBRT boosts, dual checkpoint inhibitors, radiosensitizing nanoparticles, and induction immunotherapy to improve upon the current standard of care.

In cases of suspected glioma recurrence post-radiation, FET PET imaging can provide a more accurate diagnosis than MRI perfusion, even when MRI findings suggest tumor growth. This allows clinicians to avoid unnecessary changes in therapy based on potentially misleading MRI data.

With new CNS-active drugs dramatically improving survival after a brain metastasis diagnosis, some experts are now advocating for routine screening brain MRIs in high-risk patients. The goal is to detect asymptomatic lesions early, potentially preventing catastrophic neurologic events like seizures.

For patients with otherwise well-controlled disease who develop isolated oligoprogression in the brain, evidence suggests a better survival outcome from adding local therapy (like SRS) and continuing the current effective systemic therapy, rather than switching the systemic regimen entirely.

In survivors over 50, an increased risk of secondary cancers is specifically associated with prior radiation treatment received 30+ years ago. The study found no similar association with chemotherapy exposures, highlighting the exceptionally long-term and distinct risks of radiation. This underscores the importance of modern efforts to reduce or eliminate its use.

The InVigor11 study was the first to show that detecting recurrence via a ctDNA test before it's visible on scans is not just a prognostic sign, but an actionable clinical state. Intervening with therapy at this early stage was proven to improve patient outcomes, establishing a new paradigm for cancer surveillance.

For very early-stage small cell lung cancer, surgical resection is an important and perhaps underutilized option. Beyond its therapeutic potential, surgery provides a definitive pathological diagnosis, which is crucial as some cases that appear to be small cell on biopsy may actually be other tumor types, like atypical carcinoid.

Experts are divided on the optimal strategy for CT-DNA negative patients post-surgery. One side advocates for monitoring to spare patients from unnecessary treatment toxicity, while the other questions if this delay is non-inferior to immediate adjuvant therapy, a critical question not yet answered by trials.