ASTRO 2026 Preview: Dr Raj Singh on De-Escalation, Brain Metastases, and What's Next in Radiation Oncology

Ahead of the 2026 ASTRO Annual Meeting, Dr Raj Singh of Baptist Health joins the podcast to break down the studies he's watching most closely. The conversation opens with a pooled analysis of 3 phase 2 trials using FMISO PET imaging to identify hypoxic tumor regions and select patients with HPV-positive head and neck cancer who may safely de-escalate radiation dose, and Singh discusses what it would take to move this biomarker-driven approach beyond a single high-volume academic center. He then turns to updated C-POST data on the timing of cemiplimab initiation after radiotherapy in high-risk cutaneous squamous cell carcinoma, and to Alliance A071801, a phase 3 trial comparing single-fraction vs fractionated stereotactic radiosurgery to the resection cavity after brain metastasis surgery, including why patient-reported cognitive and emotional well-being end points matter alongside recurrence-free survival.

The discussion moves to two practice-shaping trials in small cell lung cancer: MAVERICK, which found no overall survival benefit for prophylactic cranial irradiation over MRI surveillance alone in limited-stage disease, and NRG CC009, comparing radiosurgery with hippocampal-avoidance whole brain radiotherapy plus memantine for patients with limited brain metastatic disease. Singh explains how these results may accelerate an already-underway shift away from whole brain radiotherapy. The episode closes with a look at TRIDENT, a tumor-treating fields trial in newly diagnosed glioblastoma that missed its primary end point, and what subgroup data might still reveal—plus Singh's broader take on radiation oncology's shift toward patient-reported, quality-of-life-focused outcomes.