Innovations in radiotherapy: highlights from ASTRO 2026

Shorter courses of treatment

For many cancers radiotherapy that once took five to seven weeks can now be given in far fewer visits, with the same chance or curative treatment outcomes.

Prostate cancer: Stereotactic radiotherapy (SBRT) in five treatments controlled prostate cancer as well as surgery at eight years in the PACE-A trial, with less urinary leakage and better sexual function. Five-treatment SBRT is already established as an alternative to longer courses of treatment.

Head and neck cancer: Trials of four-week courses, in place of the usual six to seven weeks, showed similar results, with fewer treatment visits.

Early lung cancer: In more than 1,100 patients, a single stereotactic treatment worked as well as three for small tumours.

Brain metastases: After surgery to remove a brain metastasis, giving stereotactic radiotherapy over three to five treatments rather than one improved the control of the cancer and was linked to longer survival.

Protecting quality of life

Much of this year’s research focused on reducing side effects while keeping treatment effective.

• Treating less where it is safe to do so: Some women aged 50 to 69 with small, low-risk breast cancers, selected using a genomic test, had very low recurrence rates on hormone therapy alone, giving them the option to avoid radiotherapy after discussion with their specialist.

• Avoiding unnecessary treatment to the brain: In small cell lung cancer, regular MRI scans instead of preventative brain radiotherapy protected memory and thinking.

• Lower doses to surrounding tissue: In anal cancer, a lower dose to the lymph node areas reduced side effects without loss of control in an early trial.

• Life after treatment: Research highlighted how common sexual and pelvic side effects are after pelvic radiotherapy, and the value of specialist support such as pelvic floor physiotherapy.

Precision treatment for cancer that has spread to a few sites

When cancer has spread to only a small number of places, known as oligometastatic disease, highly focused radiotherapy can treat each site in a few short sessions. ASTRO 2026 added to the evidence.

Prostate cancer: Treating every spot of recurrence seen on PSMA PET scans with stereotactic radiotherapy (SBRT) reduced the chance of the PSA rising again within three years from 60% to 21%, compared with hormone treatment alone.

Brain metastases: Stereotactic radiosurgery (SRS) was effective, protected thinking in patients with many brain metastases and was associated with longer survival than whole brain radiotherapy in small cell lung cancer.

Kidney and liver cancer: SBRT controlled kidney cancers in patients unsuitable for surgery while preserving kidney function, and matched radiofrequency ablation for small liver cancers in an early analysis.

Treatment matched to the individual

Tests on the patient’s tumour, blood and their own genes are increasingly used to determine who needs treatment, how much and which type.

Genomic tests on the tumour help identify which patients need hormone treatment with prostate radiotherapy, and which breast cancer patients may safely avoid radiotherapy.

A simple cheek swab can identify men at higher risk of bladder side effects after prostate SBRT, helping to choose the best treatment schedule.

Specialist imaging, such as PSMA PET for prostate cancer and hypoxia PET in research for throat cancer, guides where and how much radiotherapy is given.

Blood tests for tumour DNA may detect recurrence months before scans and are being studied as a way to monitor patients after treatment.

Radiotherapy with immunotherapy

Immunotherapy is now being combined with radiotherapy in several cancers. Notable results included higher rates of complete tumour disappearance in rectal cancer when immunotherapy was added to short course radiotherapy, improved long-term survival when radiotherapy was added to stereotactic radiotherapy for early lung cancer, and fewer recurrences when immunotherapy followed surgery and radiotherapy for high-risk skin cancer. Some of these results need confirmation in larger trials before they change routine care.

What this means for patients at HCA Healthcare UK

We’re committed to providing the latest and most advanced treatment options through investment in technology, working with leading clinicians to bring new treatment options in at the earliest opportunity and ongoing clinical research through early phase clinical trials. This means that many of the advances in this summary are already part of care at HCA UK. 

MR-guided adaptive radiotherapy: Our Elekta Unity MR-Linac combines MRI scanning with radiotherapy, so that each treatment can be adapted to the patient’s anatomy on the day. This supports precise, short-course SBRT for cancers such as prostate, pancreas and liver. 

Stereotactic treatment for limited spread: Our oligometastatic service offers SABR and SRS for patients whose cancer has spread to a small number of sites, including the brain.

Personalised decisions: Genomic and other biomarker tests are a routine part of planning treatment, discussed by our specialist multidisciplinary teams.

Choice of treatment: Men with prostate cancer can discuss surgery and radiotherapy with both a urologist and clinical oncologist before deciding on what’s right for them.

^{*This summary describes research presented at the ASTRO 2026 Annual Meeting. Some results are early and may change as trials mature. It is not a substitute for individual medical advice.}