The QuadShot heard ‘round the world.

For rad onc residents, it’s that time of year. Time for the annual in-service exam, which means shots--QuadShots--the most shots you've seen since Cancun ‘06. Cheers. CNS | In CATNON, TMZ improves 5y OS for non-codeleted gliomas (44v55%). For GBM, consolidative TTF improves OS (16v21mo), and adding TMZ to 40 Gy / 15 improves OS for old people (7v9mo). For mets, delaying SRS to give EGFR agents reduces survival. For post-op mets, LC is improved with SRS v obs (72v43%) and with WBRT+/-SRS v SRS alone (81v61%). In QUARTZ, WBRT is no better than BSC for non-SRS candidates. Breast | In 10y outcomes of Z0011, SLND remained noninferior to ALND for OS (86 v 84%) and DFS (80 v 78%) with only 1v0 regional recurrences at 5-10y. Melanoma | For stage III/IV, either BRAF or nivo+/-ipi improves RFS 10-20%. In MSLT-II, completion LND improved nodal control (77v92%) but not the 1° endpoint of OS. Lung | [NSCLC] In PACIFIC, durvalumab after chemoRT improves PFS (6v17mo). There’s no difference in pneumonitis or local failure between photons v protons. SABR to oligomets improves PFS (3.5v10mo). In ADJUVANT, post-op gefitinib for pN+ improves DFS (18v29mo). [SCLC] In CONVERT, 66 Gy daily was NOT superior to 45 Gy BID. HNSCC | cECE is now N3 for HPV(-) OPX, and mets are necessary to be stage IV for HPV(+) OPX. Concurrent cisplatin q1wk has lower 2y LRC than q3wk (72v85%). Number of nodes (not size or laterality) predict survival for larynx/hypoPX. In MARCH-HPV,HPV(+) has no special benefit from altered fx. Prostate | 24mo of bicalutamide with salvage RT improves 12y rates of OS (71v76%), prostate cancer death (13v6%), and mets (23v14.5%). Post-op endometrial | In GOG 258, there was no difference in RFS for stage III/IVA with chemo v chemoRT. In GOG 249, there was no difference in RFS at 3y (82%) for HIR with pelvic RT v chemo + brachy. In PORTEC 3, stage III (RFS) and pts ≥70 (OS) benefited from addition of chemo to pelvic RT. GI | Peri-op FLOT is the new standard for gastric cancer, and adding cetuximab to chemoRT for esophageal cancer improves nothing. But who are we kidding, hope you brushed up on ESPAC data.