Treatment of locally advanced rectal cancer (LARC), clinical stages II–III, typically involves multimodal treatment options. Over the past decade, the role of radiation therapy as a neoadjuvant treatment for LARC has evolved and is currently a part of total neoadjuvant therapy (TNT). Some recently published studies advocate for the omission of radiation therapy entirely, while others report on a non-operative approach that emphasizes the use of higher radiation therapy doses. This review aims to evaluate the latest literature on the current role of radiation therapy in the management of LARC, with a discussion of how to best select the most appropriate treatment protocol based on individual patient and tumor characteristics, comorbidities, and personal needs and preferences.

Background: Brain metastasis represents the most prevalent form of brain tumors in adults, with a rising incidence resulting from significant advancements in cancer detection and therapeutic interventions. Current treatment protocols advocate for whole brain radiotherapy (WBRT) for patients who are not candidates for either surgical resection or stereotactic irradiation. However, cognitive decline remains a major side effect of this treatment modality. Hippocampal‐sparing WBRT (HA‐WBRT) has been shown to decrease brain toxicity, with the main concern being the probability of developing new brain metastasis in the hippocampal avoidance region.Case: We report a case of a 73‐year‐old male presenting with multiple brain metastases and treated with HA‐WBRT, who then developed a new single pontine lesion shortly after that was found to be located in an under‐dosed peri‐hippocampal area. We dosimetrically compared the patient's original IMRT plan to three new plans: a standard VMAT plan, an optimized IMRT plan, and an optimized VMAT plan, where optimization incorporated brainstem coverage as a planning objective, resulting in a notable improvement in brainstem dose distribution.Conclusion: HA‐WBRT poses a risk of peri‐hippocampal metastasis due to underdosing of the upper brainstem that is inherent in HA‐WBRT plans. Planning techniques should focus on optimizing coverage of the brainstem in an attempt to decrease this uncommon occurrence.

PURPOSE: One crucial use of telemedicine that is underreported is its role in providing health services in conflict-affected zones. The aim of this report is to describe the process and challenges of implementing a telemedicine-based radiation oncology (RO) clinic in a war zone in southern Lebanon, and to assess its effectiveness in providing care to patients with cancer residing in this unsafe, resource-limited area. METHODS: After the outbreak of the Lebanese-Israeli war in October 2023, we had to shift our RO clinic in Nabatieh Governmental Hospital to an exclusively remote clinic without on-site physicians. Consultations, treatment planning, and follow-ups were conducted virtually by physicians at the American University of Beirut Medical Center. Patient data and imaging were shared electronically between both hospitals, and treatment was administered locally by trained staff. RESULTS: From October 2023 to September 2024, 669 new patient consultations were completed remotely. Despite infrastructure limitations, including lack of electronic health records and occasional connectivity issues, we developed a model to ensure care continuity was largely maintained for the local patients with cancer. CONCLUSION: Telemedicine can serve as a tool for delivering cancer care in times of war, improving access and equity for underprivileged groups in the face of severe logistical and infrastructural challenges.

To evaluate real-world survival outcomes of consolidation immunotherapy after concurrent chemoradiotherapy (cCRT) in patients with unresectable stage III non–small cell lung cancer (NSCLC) treated at a tertiary cancer center in Lebanon. This is a retrospective cohort study that included patients with unresectable stage III NSCLC treated between 2019 and 2025 with definitive cCRT, with or without ICIs (durvalumab or atezolizumab). The primary endpoint was progression-free survival (PFS), analyzed using Kaplan-Meier and Cox regression methods, adjusting for variables, including PD-L1 status. Among 92 eligible patients, 52 (56.5%) received consolidation immunotherapy, and 40 (43.5%) received cCRT alone. Median follow-up was 22.3 months. Median PFS was 19.0 months (95% CI: 12.8–25.2) with ICIs versus 10.0 months (95% CI: 7.0–13.1) without (log-rank P =0.210). On multivariable Cox analysis, immunotherapy was associated with a favorable trend toward improved PFS (HR=0.53, 95% CI: 0.26–1.11; P =0.09). PD-L1 positivity independently predicted longer PFS (HR=0.42, 95% CI: 0.21–0.84; P =0.014), while high tumor grade predicted inferior outcomes (HR=1.89, 95% CI: 1.04–3.43; P =0.038). Immunotherapy after cCRT was associated with numerically and clinically meaningful improvement in PFS, consistent with the landmark PACIFIC trial. PD-L1 expression emerged as an independent prognostic and predictive biomarker, supporting biomarker-driven treatment strategies. These findings validate the clinical benefit of ICIs in a Middle Eastern low- and middle-income setting, reinforcing the importance of equitable access to immunotherapy.