Fabio Ynoe de Moraes: Radiotherapy Cures Cancer – And Words Can Help Us Cure Mistrust

Fabio Ynoe de Moraes, Radiation Oncologist and Associate Professor at Queen’s University, shared a post on LinkedIn:

“A call to celebrate evidence, outcomes, and patient-centered communication

Key messages

• Radiotherapy (RT) is central to cancer cure, organ preservation, palliation, and value. Multiple randomized trials and meta-analyses across common tumor sites demonstrate clear gains in local control, disease-specific outcomes, and overall survival.
• Our language matters. Small, deliberate shifts in terminology make communications clearer and less alarming for patients, caregivers, policymakers, media, and colleagues outside our specialty – without sacrificing scientific accuracy.
• As we prepare abstracts and talks for major meetings (including European Society for Radiotherapy and Oncology (ESTRO) 2026), we can model precision and empathy in equal measure.

Why language matters in radiation oncology

Words shape perceptions – and perceptions drive trust, adherence, and policy. Some long-standing terms in our field can sound unduly threatening or be misinterpreted by non-specialists. Inspired by the recent ESTRO communication from Prof. Matthias Guckenberger (Chair, ESTRO 2026 Scientific Programme Committee) and Prof. Barbara Jereczek-Fossa (Chair, Interdisciplinary Track), here are simple substitutions that preserve rigor while improving clarity:

From → To (recommended)

• ‘Toxicity’ – ‘Side effects’ or ‘Adverse events’
• ‘Dose constraints’ – ‘Dose guidance’
• ‘Organs at risk’ – ‘Organs of interest’
• ‘(Set-up) errors’ – ‘(Set-up) variations’

These refinements do not dilute science; they align with how we already practice – planning proactively, measuring variation, and communicating risks alongside benefits. Better wording supports informed consent, shared decision-making, and public trust in RT as a curative, organ-sparing, high-value therapy.

The evidence base: selected landmark trials and reviews* (that some recommendations are practice-influencing but not yet universal standards.)

Breast cancer

• Breast-conserving surgery (BCS) → RT The Early Breast Cancer Trialists’ meta-analyses show that RT after BCS roughly halves 10-year local recurrence and reduces long-term breast-cancer mortality.
• Post-mastectomy RT (PMRT) in node-positive disease In women with 1–3 positive nodes, PMRT reduces locoregional recurrence and breast-cancer mortality, establishing PMRT as standard for appropriately selected patients.
• Hypofractionation as default The UK START trials and the Canadian RCT demonstrated non-inferior local control and favorable late effects with 40–42.5 Gy in 15–16 fractions versus 50 Gy in 25 fractions; long-term follow-up confirmed safety and efficacy.
• Ultra-short schedules FAST-Forward showed 26 Gy in 5 daily fractions is non-inferior to 40 Gy/15 for local control and normal-tissue effects at 5 years – enabling access, convenience, and system efficiency.

Prostate cancer (locally advanced/high-risk)

• ADT + RT vs ADT alone SPCG-7/SFUO-3 and NCIC PR3/MRC PR07 established that adding definitive RT to androgen deprivation improves overall survival with acceptable quality-of-life trade-offs.
• Systemic therapy optimization on an RT backbone Trials comparing ADT durations show long-term ADT with RT yields superior outcomes to short-term approaches in high-risk disease.

Cervical cancer (locally advanced)

• Concurrent chemoradiation as standard Multiple RCTs and pooled analyses demonstrated that cisplatin-based concurrent chemoradiation improves progression-free and overall survival versus RT alone – cementing chemo-RT as the global standard.

Rectal cancer

• Neoadjuvant over adjuvant CAO/ARO/AIO-94 (German trial) showed pre-operative chemoradiation improves local control and reduces toxicity versus post-operative therapy – defining modern sequencing.
• Short-course vs long-course Polish and TROG trials indicate short-course RT (5×5 Gy) and long-course CRT offer comparable oncologic outcomes overall, allowing tailoring to tumor, pelvis, timeline, and system constraints.

Brain metastases

• SRS-alone to preserve cognition For patients with limited brain metastases, stereotactic radiosurgery (SRS) alone compared with SRS + WBRT reduces cognitive decline without compromising overall survival – prioritizing neurocognitive outcomes while managing intracranial control.

Oligometastatic disease

• Ablative RT can extend survival SABR-COMET (randomized phase II) reported a clinically meaningful overall-survival improvement when stereotactic ablative RT was delivered to all sites of limited metastases, with maintained quality of life on long-term follow-up. Phase III programs are underway.

Palliative effectiveness and value

• Painful bone metastases Multiple RCTs (e.g., Dutch Bone Metastasis Study; RTOG 9714) show 8 Gy × 1 achieves equivalent pain relief to multi-fraction regimens (with higher retreatment rates as the trade-off), underscoring patient convenience and health-system efficiency.

Small-cell lung cancer (PCI)

• Prophylactic cranial irradiation In limited-stage SCLC, PCI reduces brain metastases and improves survival. For extensive-stage disease, older RCTs suggested survival benefit pre-routine MRI; with modern imaging, selection is individualized.

Population-level impact and equity

• RT is fundamental to cure and control. Global modeling consistently estimates that ~50% of patients with cancer should receive RT at least once during their illness and that RT contributes substantially to the overall proportion of cancer cures worldwide.
• Access gaps remain. Under-utilization relative to evidence-based need persists in many regions. Investment in modern equipment, planning systems, QA programs, workforce training, and integrated pathways is high-value health policy – improving survival, quality of life, and system efficiency.

Communicating with precision and empathy: a practical checklist

1. Lead with benefit, pair with risk. ‘Curative, organ-sparing treatment with manageable side effects’ frames an accurate expectation set.
2. Use patient-friendly terms. Prefer ‘side effects’/’adverse events,’ ‘dose guidance,’ ‘organs of interest,’ and ‘set-up variations.’
3. Quantify clearly. Where possible, present absolute risks, absolute benefits, and time horizons (e.g., 5- and 10-year outcomes).
4. Acknowledge uncertainty. Explain where evidence is evolving (e.g., oligometastatic disease, MRI-era PCI).
5. Invite questions and preferences. Align plans with patient priorities (work, caregiving, neurocognition, travel).
6. Be consistent across teams. Mirror language in clinic notes, consent forms, patient leaflets, MDT minutes, and conference abstracts.

For ESTRO 2026 abstracts and talks: phrasing templates you can borrow

• Background: ‘Radiotherapy is a curative, organ-preserving modality; optimizing dose guidance and sparing organs of interest remain central to outcomes.’
• Methods: ‘We prospectively quantified set-up variations and incorporated adaptive planning triggers.’
• Results: ‘Adverse events were reported using CTCAE and communicated to patients as side effects with absolute risks.’
• Conclusion: ‘Patient-centered terminology complements technical advances, strengthening trust without compromising scientific precision.’

Acknowledgment

Grateful to ESTRO and to Prof. Matthias Guckenberger and Prof. Barbara Jereczek-Fossa for highlighting the importance of patient-friendly terminology in radiation oncology. Their leadership reinforces what the evidence already shows: radiotherapy cures cancer – and how we talk about it helps patients benefit from it.

Call to action

At your next clinic, MDT, or abstract draft: try one language substitution, add one absolute-risk figure, and invite one patient or caregiver to react to your wording. Then share your best phrasing with the community. Small, consistent improvements in how we speak about RT will amplify the large, consistent improvements RT already makes in how our patients live.”

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