Radiotherapy indications

Definitive concurrent chemoradiation; surgery is generally salvage.

RT for positive margins not correctable surgically, gross/named-nerve PNI, recurrent disease, bone/cartilage invasion or other high-risk primary-site features.

RT for multiply recurrent, gross residual, or incompletely resected disease when further surgery would cause unacceptable morbidity.

Early salvage RT to the prostate bed with pelvic nodes selectively.

Selective chemoradiation or SBRT after multiagent chemotherapy based on anatomy and response.

Pelvic chemoradiation for positive pelvic nodes, positive margins or parametrial involvement.

Pelvic RT alone for Sedlis-qualified combinations of tumor size, LVSI and stromal invasion.

Selective high-dose RT for unresectable or margin-positive disease when adequate resection is not feasible.

High-dose proton/particle RT after maximal safe resection and for unresectable disease.

Consider focal postoperative RT/chemoradiation for T4 tumor penetrating a fixed structure or R1 margin when further surgery is not feasible.

RT for positive margins not correctable surgically, gross/named-nerve PNI, recurrent disease, bone invasion, node-positive disease or ENE.

Whole-breast RT; partial-breast RT is appropriate for selected patients.

No routine postmastectomy RT after negative-margin mastectomy.

RT when adequate re-excision/Mohs is not feasible for positive margins, recurrent disease, or selected high-risk/fibrosarcomatous cases.

RT for progressive, symptomatic, unresectable disease when morbidity is acceptable.

Pelvic RT with systemic chemotherapy, or combined-modality therapy, for integrated high-risk disease.

Vaginal brachytherapy or pelvic RT according to integrated recurrence risk.

Observation for molecularly and clinicopathologically low-risk disease.

No additional adjuvant RT after standard neoadjuvant CRT and R0 surgery; give adjuvant nivolumab.

Consider chemoradiation particularly for R1 disease after systemic therapy.

Preoperative RT when local-recurrence risk justifies RT; generally preferred because of lower late morbidity.

Postoperative RT when preoperative RT was not given and local-recurrence risk justifies treatment.

Pembrolizumab with definitive chemoradiation and brachytherapy for eligible patients.

Consider chemoradiation particularly for R1 disease after systemic therapy.

Postoperative chemoradiation mainly after less-than-D2 dissection or for R1/R2 when further resection is not feasible.

Definitive RT is a standard organ-preserving option for early glottic cancer; chemoradiation is used in appropriate locally advanced disease.

No routine adjuvant liver RT after R0 resection.

PORT for pT3–4, >2 involved nodes, a node >3 cm, close margin, PNI or LVI when no positive margin/ENE.

PORT for pT3–4, close margin, PNI/LVI, substantial nodal burden or other high-risk features.

RT followed by chemotherapy when tumor-directed treatment is required.

Defer immediate RT and chemotherapy while using an IDH inhibitor in an eligible patient.

Focal RT for incompletely resected intracranial disease and most grade 3 tumors; many pediatric cases receive focal RT after gross total resection.

Consider focal RT/chemoradiation for R1 margin when further surgery is not feasible.

Whole-breast RT; partial-breast RT for suitable patients.

PMRT for most pN+ disease, locally advanced presentation, residual nodal disease after neoadjuvant therapy, and selected high-risk node-negative disease.

PCI for responding stage II–III limited-stage patients after shared decision-making.

PORT for positive/close margin not amenable to re-resection, PNI, LVI, pT3–4, or substantial nodal risk.

Definitive external-beam RT or brachytherapy as an alternative to surgery for selected early lip cancers.

Ablative SBRT for selected oligometastatic/oligoprogressive liver disease when surgery/ablation is unsuitable.

Definitive pelvic chemoradiation plus image-guided brachytherapy.

Use upfront PD-1 blockade in an expert organ-preservation program; omit RT and surgery after a sustained clinical complete response with intensive surveillance.

PORT for high grade, T3–4, node-positive disease, positive/close margins, PNI, LVI, recurrence, and many adenoid cystic carcinomas.

RT after decompression/stabilization when surgery is performed.

Urgent RT for appropriate nonsurgical patients.

Nodal-basin RT when high regional-recurrence risk and improved control justifies toxicity.

RT for WHO grade 3, recurrent grade 2, generally subtotal-resected grade 2, and selected recurrent/progressive grade 1 disease.

Risk-adapted primary-site and/or nodal RT for positive/close margins, larger tumor, LVI, immunosuppression, unreliable/positive SLNB, nodal disease or ENE.

Trimodality bladder preservation: maximal TURBT followed by concurrent chemoradiation.

Post-cystectomy RT/CRT only for positive margins or selected very high pelvic-recurrence risk.

Treat as systemic AML; RT is not routine adjuvant therapy.

Focal RT for symptomatic, residual, refractory, cord-threatening or organ-threatening disease.

Definitive IMRT alone for T1N0; concurrent chemoradiation for most stage II–IVA disease.

No curative adjuvant or neoadjuvant RT role.

PORT for pT3–4, close margin, PNI, LVI, multiple/large nodes or other substantial locoregional-risk features.

Selective high-dose RT for unresectable or margin-positive disease when further surgery is not feasible.

Fractionated RT or SRS for unresectable, progressive, symptomatic or residual disease when treatment is warranted.

No routine postoperative hemithoracic RT package; selected expert-center use for local control.

Selective RT for unresectable positive margins, recurrence, extensive neurotropism/PNI or other high local-recurrence risk.

Routine preoperative RT is not recommended; consider selectively at an expert center when local recurrence risk dominates.

Routine postoperative RT should be avoided because target definition and bowel toxicity are unfavorable.

Definitive pelvic RT with brachytherapy; add concurrent cisplatin for appropriate locally advanced disease.

Routine adjuvant RT is not preferred for most patients with undetectable PSA; use PSA surveillance and early salvage RT.

Total neoadjuvant therapy using long-course chemoradiation or short-course RT plus systemic chemotherapy.

Start neoadjuvant FOLFOX with selective chemoradiation only for inadequate response; most eligible patients can omit pelvic RT.

Postoperative chemoradiation only when indicated preoperative therapy was omitted and high-risk pathology or a positive margin is found.

Neoadjuvant CROSS-type chemoradiation followed by surgery.

Perioperative FLOT is often preferred over neoadjuvant chemoradiation for locally advanced adenocarcinoma.

Perioperative systemic therapy is preferred; routine preoperative RT is not indicated for gastric cancer.

Routine induction RT is not preferred for non-superior-sulcus resectable disease.

Postoperative cavity SRS/fSRS after resection of limited brain metastases.

Use biomarker-directed adjuvant systemic therapy; this is not a PORT indication.

Routine PORT is not recommended after complete resection, including most adequately dissected pN2 disease.

PORT for R1/R2 when re-resection is not feasible; selected unusually high-risk pN2 after multidisciplinary review.

Adjuvant multiagent chemotherapy is central; RT is not routine for every resected patient.

Consider fluoropyrimidine-sensitized chemoradiation after systemic chemotherapy for selected patients, particularly pathologic node-negative pancreatic-head cancer when local control is a major concern.

PORT for T3–4 disease, positive/close margin, PNI, LVI, nodal disease or aggressive histology.

Surveillance is preferred; adjuvant RT is a selective alternative.

Involved-site RT remains an option for selected stage IIA and nonbulky IIB disease.

PORT for pT3–4, close margin, PNI/LVI, substantial nodal burden or other high-risk features.

Neoadjuvant concurrent chemoradiation followed by surgery for resectable disease.

PORT for pT3–4, close margin, PNI/LVI, substantial nodal burden or other high-risk features.

PORT for R1/R2; generally for stage III–IVA thymoma and more strongly considered for thymic carcinoma.

Postoperative RT based on nodal burden, ENE and operative/pathologic findings.

Neoadjuvant chemoradiation to improve resectability of selected fixed T4 disease.

Definitive concurrent chemoradiation.

Adjuvant EBRT and/or brachytherapy for positive/close margins, node-positive disease, or other high local-regional risk.

RT for positive margin not amenable to re-excision, involved nodes/ENE, and selected locally advanced/high-risk disease.