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01.
arXiv (CS.CV) 2026-06-16

Temporal Difference Learning for Diffusion Models

Diffusion models are typically trained with objectives that focus on local denoising targets at individual time steps (or adjacent pairs), which do not enforce consistency between predictions along the denoising trajectory. This lack of cross-time consistency can degrade performance, especially for few-step samplers. We introduce a temporal difference (TD) objective that penalizes inconsistency of the model's multi-step progress along the denoising path. By reformulating the diffusion process as a Markov reward process and casting denoising as a policy evaluation problem in reinforcement learning, we derive a unified TD approach that applies to both discrete- and continuous-time diffusion formulations. We further propose a principled sample-based reweighting method that stabilizes training. Empirically, we show that using our TD training can significantly improve sample quality measured by FID, with stronger advantages when the number of sampling steps is small, highlighting its practical utility under low-computation-budget scenarios. We provide ablation studies to justify our design choices, including pairwise loss reweighting, regularization weight, and one-step stride. Overall, our TD approach can be a general drop-in that enforces cross-time consistency and improves generation quality across different diffusion generative models.

02.
arXiv (CS.CV) 2026-06-16

Text region detection in historical astronomical diagrams

Text detection is a crucial task in the analysis of historical documents. While datasets and benchmarks exist for text detection in manuscripts and maps, the study of text in mathematical diagrams has received little attention. To address this, we introduce a large-scale, diverse, open-access dataset of 948 historical astronomical diagrams containing 10,940 oriented polygonal text regions. Our dataset spans ten centuries (8th to 18th) and seven main linguistic traditions: Arabic and Persian (115), Chinese (332), Byzantine (233), Latin (185), Hebrew (48), and Sanskrit (35). It captures a wide range of diagram styles and textual content, from symbols to multi-line paragraphs. Each text instance is annotated with ordered polygons that precisely delineate text regions and encode the reading direction. In addition, we annotated the 2,293 regions in Latin diagrams with 20 class labels. We evaluated several strong baselines on our dataset, including TESTR, DeepSolo++, and Poly-DETR, a simple extension of DINO-DETR that we design to predict ordered polygon vertices. Poly-DETR achieves state-of-the-art performance on the MTHv2 and cBAD2019 benchmarks and provides a solid, simple baseline on our dataset. Code and dataset available online.

03.
arXiv (CS.CL) 2026-06-11

SoftMatcha 2: A Fast and Soft Pattern Matcher for Trillion-Scale Corpora

We present SoftMatcha 2, an ultra-fast and flexible search algorithm that enables search over trillion-scale natural language corpora in under 0.3 seconds while allowing semantic variations in the form of substitution, insertion, and deletion. Our approach employs string matching based on suffix arrays that scales well with corpus size, and represents words as vectors, which underpin its semantic flexibility. To mitigate the combinatorial explosion induced by the semantic relaxation of queries, our method is built on two key algorithmic ideas: dynamic corpus-aware pruning and fast exact lookup enabled by a disk-aware design. We theoretically analyze the efficiency of the proposed method, indicating that it can mitigate exponential growth in the search space. Empirically, on FineWeb-Edu (Lozhkov et al., 2024) (1.4T tokens), it attains substantially lower search latency than existing methods: infini-gram (Liu et al., 2024), infini-gram mini (Xu et al., 2025), and SoftMatcha (Deguchi et al., 2025). As a practical application, our method uncovers benchmark contamination in training corpora that existing approaches miss, and it also benefits information retrieval and paraphrase detection. We also provide an online demo of fast, soft search across corpora in seven languages.

04.
arXiv (math.PR) 2026-06-16

Quantitative Oppenheim Conjecture for Random Quadratic Forms and Optimal Variance Bounds in Function Fields

arXiv:2606.16699v1 Announce Type: cross Abstract: We prove a quantitative version of Oppenheim's conjecture in the function field setting. In order to do so, we compute the higher moments of the Siegel transform. In particular, we find an optimal bound on the variance of the number of lattice points in a set. Moreover, we compute the exact variance of the number of lattice points in a ball, which is of independent interest.

05.
arXiv (CS.CV) 2026-06-12

MPMWorlds: Material-Point-Method Simulations for Inferring and Extrapolating Physical Dynamics

To study the ability to infer physical dynamics from videos and extrapolate them forward in time, we assemble a dataset of 2D Material Point Method (MPM) physical simulations covering rich physical phenomena such as deformable objects, fluids, kinetic objects, and emitters. We study code generation and video diffusion approaches on this dataset, identifying their strengths and weaknesses by varying the amount of physically relevant side information. The code generation model, beyond giving a working demonstration of automatic synthesis of MPM simulations, reveals that such an approach struggles with inferring physical parameters from visual input, but relative to video diffusion, produces physically and temporally stable extrapolations forward in time, while the video diffusion model more strongly identifies geometric properties from visual input but produces physically implausible extrapolations.

06.
arXiv (CS.AI) 2026-06-17

Visored: A Controlled-Natural-Language Prover for LLM-Generated Mathematics

arXiv:2606.17581v1 Announce Type: cross Abstract: We present a dependent-type-based prover designed around the way LLMs (and humans) tend to write mathematics, complementing existing systems such as Lean and Rocq. Its core design choices are a surface that imitates mathematical natural language and a rule-driven automation layer that closes the routine steps a textbook would omit, so that an accepted proof can be re-emitted as a checked Lean file. Early experiments suggest that, even without any prover-specific training data, LLMs can learn to use it effectively on the miniF2F benchmark. Lean output excerpts: https://github.com/xiyuzhai-husky-lang/visored/

07.
arXiv (CS.AI) 2026-06-16

Rethinking Scaffolding in LLM Tutors: The Interactional Mismatch Between Benchmarks and Real-World Deployments

arXiv:2606.15766v1 Announce Type: new Abstract: A central pedagogical value evaluated in AI tutor benchmarks is scaffolding: guiding students through graduated steps toward a solution. Alignment and evaluation methods for embedding scaffolding behaviour into chatbots, however, rest on an implicit assumption: that students will take up the scaffolding and engage in the conversation. To examine whether this assumption holds, we introduce an evaluation pipeline around two metrics - Chatbot Scaffolding and Student Uptake - and apply them across nine datasets of 9,490 chats, spanning AI tutor benchmarks and real-world deployments of educational chatbots. Our analysis reveals that while benchmarks assume a high-scaffolding, high-student-uptake environment, students in real-world settings exhibit lower levels of uptake overall - frequently bypassing the chatbot's pedagogical framing to drive the interaction toward their own learning goals at little interpersonal cost. We argue that bypassing scaffolding is not necessarily detrimental; rather, it frequently highlights a mismatch between a chatbot's pedagogical framing and the student's learning goals. To meaningfully evaluate the effectiveness of a chatbot's assistance, future benchmarks must move beyond the assumption that students will simply take up the scaffolding, and instead evaluate how these chatbots navigate diverse learning contexts and student-driven interaction patterns.

08.
arXiv (math.PR) 2026-06-11

Sample Path Properties of the Fractional Wiener–Weierstrass Bridge II

arXiv:2606.11994v1 Announce Type: new Abstract: Fractional Wiener–Weierstrass bridges are a class of Gaussian processes obtained by replacing trigonometric functions in the construction of classical Weierstrass functions by fractional Brownian bridges. A number of their sample path properties were derived in Schied–Zhang (2024,2026). The analysis in these papers left several open questions, most of which are addressed here. Specifically, we prove that, in the regime in which the Weierstrass mechanism dominates the underlying fractional Brownian bridge, the limiting $b$-adic variation coefficient has an absolutely continuous distribution and is therefore genuinely random. At the critical point between the two roughness regimes, we establish the power-variation formula and the critical $\Phi$-variation limit conjectured in Schied–Zhang (2024). Finally, we derive the Hausdorff dimension for the graphs of the sample paths by proving a conjecture from Schied–Zhang (2026) for the missing high-Hurst case.

09.
arXiv (CS.CV) 2026-06-11

MedVeriSeg: Teaching LISA-Like Medical Segmentation Models to Verify Query Validity Without Extra Training

Despite recent progress in text-prompt-based medical image segmentation, existing LISA-like MLLM-based methods typically generate masks regardless of whether the target specified in the query is present, leading to hallucinated segmentation. In this work, we propose MedVeriSeg, a training-free query verification framework that enables LISA-like medical segmentation models to reject false segmentation queries. MedVeriSeg first quantifies the response quality between the [SEG] token and image features through a Similarity Response Quality Scoring Module. To further improve robustness, it employs a Lightweight Routed Multi-Agent Verification Module, which fuses quantitative score evidence with qualitative agent evidence to comprehensively verify the validity of the query. To support systematic evaluation, we construct MedVeriSeg-Bench, a benchmark designed for query verification in medical image segmentation. Experimental results demonstrate that MedVeriSeg effectively identifies false segmentation queries and reduces hallucinated segmentation, while maintaining a high acceptance rate for valid queries, thereby largely preserving the segmentation utility of LISA-like medical segmentation models.

10.
arXiv (CS.CL) 2026-06-16

RASST: Retrieval-Augmented Simultaneous Speech Translation

Simultaneous speech translation produces target text incrementally from partial speech input. Recent speech large language models have markedly improved SST quality but still struggle with rare and domain-specific terminology. Retrieval augmentation has helped in automatic speech recognition and neural machine translation, but extending it to SST is non-trivial: retrieval must be fast and accurate under partial speech, and the model must decide whether and when to apply retrieved terms during incremental generation. We propose Retrieval-Augmented Simultaneous Speech Translation (RASST), which addresses both challenges. For accurate cross-modal retrieval under partial input, RASST trains a lightweight speech-text retriever that produces chunkwise terminology hints for the Speech LLM via multi-scale retrieval. To use these hints correctly, we synthesize training data that teaches the Speech LLM to decide whether and when to apply each retrieved term. Experiments on ACL 60/60 dev set and the ESO test set show that RASST improves terminology accuracy by nearly 40% and overall translation quality by up to 3 BLEU points, with negligible computational overhead.

11.
arXiv (CS.LG) 2026-06-16

Rethinking Structural Anomaly Detection: From Decision Boundaries to Projection Operators

arXiv:2606.15280v1 Announce Type: new Abstract: Most existing anomaly detection methods rely on estimating a probability density or learning an enclosing decision boundary, implicitly assuming that normal data occupies a region of non-zero volume in the ambient space. In contrast, structural anomaly detection considers data that lies near a low-dimensional manifold, creating a mismatch between the inductive bias of existing methods and the structure of the data, often resulting in degraded performance. To address this mismatch, we introduce a geometric perspective. Specifically, we learn a projection operator onto the manifold of normal samples and define a sample as anomalous if it is altered by this projection. This formulation naturally integrates the inductive bias of manifold-supported data and reframes anomaly detection in terms of a projection residual, thereby resolving issues arising from modeling degenerate distributions. Notably, it provides a unifying interpretation of reconstruction-based methods by explaining their success and failure in terms of projection quality. In particular, it explains the strong generalization ability of projection-aligned models as a consequence of contraction behavior toward the manifold. Moreover, by decoupling anomaly detection from probabilistic modeling, it reduces the tendency to misclassify rare but normal samples, a widely recognized limitation of existing approaches. Empirically, we demonstrate that projection-aligned methods achieve strong performance, outperforming boundary-based methods while improving upon existing reconstruction-based approaches.

12.
arXiv (CS.CL) 2026-06-17

Olmo Hybrid: From Theory to Practice and Back

Recent work has demonstrated the potential of non-transformer language models, especially linear recurrent neural networks (RNNs) and hybrid models that mix recurrence and attention. Yet there is no consensus on whether the potential benefits of these new architectures justify the risk and effort of scaling them up. To address this, we provide evidence for the advantages of hybrid models over pure transformers on several fronts. First, theoretically, we show that hybrid models do not merely inherit the expressivity of transformers and linear RNNs, but can express tasks beyond both, such as code execution. Putting this theory to practice, we train Olmo Hybrid, a 7B-parameter model largely comparable to Olmo 3 7B but with the sliding window layers replaced by Gated DeltaNet layers. We show that Olmo Hybrid outperforms Olmo 3 across standard pretraining and mid-training evaluations, demonstrating the benefit of hybrid models in a controlled, large-scale setting. We find that the hybrid model scales significantly more efficiently than the transformer, explaining its higher performance. However, its unclear why greater expressivity on specific formal problems should result in better scaling or superior performance on downstream tasks unrelated to those problems. To explain this apparent gap, we return to theory and argue why increased expressivity should translate to better scaling efficiency, completing the loop. Overall, our results suggest that hybrid models mixing attention and recurrent layers are a powerful extension to the language modeling paradigm: not merely to reduce memory during inference, but as a fundamental way to obtain more expressive models that scale better during pretraining.

13.
arXiv (quant-ph) 2026-06-11

Quantum ergodicity and semiclassical measures: mathematical results

arXiv:2606.12098v1 Announce Type: new Abstract: In this chapter we review some results describing the high-frequency eigenmodes of the Laplacian on compact manifolds, or Euclidean domains, for which the geodesic flow is chaotic. We focus on the macroscopic distribution of these eigenmodes, which is described by the concept of semiclassical measure. The main result on the question is the Quantum Ergodicity theorem, originally due to Schnirelman. We provide the detailed proof of this theorem, including the adjustments necessary to treat the case of manifolds with boundary. We also discuss the Quantum Unique Ergodicity conjecture, and some progress towards this conjecture for strongly chaotic (Anosov) systems. In particular, we describe the constraints on admissible semiclassical measures, in terms of their Kolmogorov-Sinai entropy, as well as more recent delocalization results.

14.
arXiv (quant-ph) 2026-06-17

Manipulation of Topological Corner States via Subchiral Symmetry

arXiv:2606.17975v1 Announce Type: new Abstract: Higher-order topological phases provide robust corner modes, but their use requires controllable creation, isolation, and transfer of individual modes and their superpositions. Here we demonstrate, using the two-dimensional Benalcazar-Bernevig-Hughes model as an example, that subchiral symmetry provides a general control principle for manipulating topological corner modes. The conventional chiral symmetry decomposes into four subchiral symmetries, each associated with one zero-energy corner mode. By selectively breaking these subsymmetries with controlled intercell hoppings, we reduce the fourfold corner-state manifold step by step to single isolated modes. We further design adiabatic protocols that transfer either a single corner state or a superposition of two corner states between selected corners, while preserving the relative phase in the latter case. Both numerical simulations and IBM quantum-processor implementations show that the proposed protocols can be executed with high fidelity, establishing subchiral symmetry as a route to programmable higher-order topological state manipulation.

15.
arXiv (CS.CL) 2026-06-19

MiqraBERT: Regression-Based Sentence-BERT Finetuning for Biblical Hebrew Parallel Detection

Textual reuse pervades the Hebrew Bible, yet the computational methods used to detect it still rest largely on lexical overlap, and they falter once a parallel involves paraphrase, lexical substitution, or syntactic reworking. This paper introduces MiqraBERT, a Sentence-BERT model finetuned from AlephBERT (a Modern Hebrew encoder) for verse-level semantic similarity in Biblical Hebrew. The training set comprises 1,650 labeled verse and half-verse pairs: 825 true parallels drawn from the Chronicles synoptic material and from foundational studies of poetic parallelism, balanced against 825 randomly sampled negatives. Through cosine-similarity regression, the model learns an embedding space in which parallel verses cluster together and unrelated verses move apart. We evaluate separation with distribution-based metrics, Wasserstein distance and the overlap coefficient, across ten random seeds. MiqraBERT improves distributional separation 2.7-fold over the pre-trained baseline and reduces the ambiguous overlap region from roughly 24% to about 6%. Narrative synoptic parallels reach a recall@10 of 87.1%; poetic parallels remain difficult, below 9%. This genre-dependent asymmetry confines the model's reliable scope to narrative textual reuse. MiqraBERT is publicly available at https://huggingface.co/davidmsmiley/MiqraBERT

16.
arXiv (CS.AI) 2026-06-18

Compute Efficiency and Serial Runtime Tradeoffs for Stochastic Momentum Methods

arXiv:2606.19179v1 Announce Type: cross Abstract: Stochastic momentum methods such as heavy ball (HB), Nesterov momentum, and variants of Accelerated SGD (ASGD) [Kidambi et al., 2018] are widely used in modern training, but their stochastic benefits depend on two distinct quantities: serial runtime, the number of iterations needed to reach a target accuracy, and compute efficiency (CE), the inverse total gradient-query or FLOP cost. Larger batches reduce serial runtime without hurting CE only when the contraction gap grows linearly with batch size. We study stochastic HB and ASGD for consistent linear regression with Gaussian covariates and prove finite-dimensional, discrete-time lower bounds on their batch-size tradeoffs. Our first result shows that HB does not improve the CE frontier over SGD for arbitrary spectra; rather, it preserves SGD-level CE over a larger batch-size window, allowing larger batches to reduce serial runtime until HB reaches its deterministic accelerated scale. This window can be a factor $\sqrt{\kappa}$ larger than the SGD critical batch size. For ASGD, the picture is more spectrum-dependent: for rapidly decaying power-law spectra, ASGD improves small-batch CE over HB/SGD, but as batch size grows it trades this CE advantage for improved serial runtime. Synthetic linear-regression experiments verify these qualitative regimes, including near-overlap of ASGD and HB for slowly decaying spectra and the predicted CE–serial tradeoff for rapidly decaying spectra.

17.
Science (Express) 2026-06-18

Dynamic asymmetric strain imprinted into substrates by an oxide thin film | Science

Authors: Unknown Author

In film-substrate systems, the substrate role is often considered to be limited to providing static mechanical constraints. Dynamic film-substrate interactions when a structural change in the film modifies the substrate are generally disregarded. Using combined X-ray and electron microscopies, we observed that the electrically induced filament in a VO 2 film created strong asymmetric strain in the underlying Al 2 O 3 substate. This asymmetric substrate strain fed back into the film and defined the filament expansion direction, revealing the importance of film-substrate dynamic interactions in determining film functionality. Furthermore, the strain imprint propagated at least tens of microns deep into the substrate, exceeding the film thickness more than 200 times, potentially enabling substrate functionalization as an active mechanical coupling media in 3D-integrated microelectronics architectures.

18.
arXiv (CS.CL) 2026-06-17

Implicit vs. Explicit Prompting Strategies for LVLMs in Referential Communication

Two recent studies (Jones et al. (2026); Zeng et al. (2026)) reach apparently contradictory conclusions about whether LVLMs can coordinate on efficient referring expressions. We control for task differences between the studies while directly comparing their prompting styles. We replicate the finding that models can coordinate efficient referring expressions when explicitly prompted to do so, suggesting that other task differences are not responsible for divergent results. However, we also find that the same models fail to infer the need for communicative efficiency from a more implicit prompt, highlighting critical differences between how humans and AI systems communicate.

19.
arXiv (CS.AI) 2026-06-17

AnchorKV: Safety-Aware KV Cache Compression via Soft Penalty with a Refusal Anchor

arXiv:2606.17872v1 Announce Type: cross Abstract: Large language models (LLMs) outperform earlier architectures on generative inference and long-context tasks, but their large size introduces significant challenges in memory usage, energy cost, and on-device deployment. Since scaling pre-trained language models improves downstream capability [zhao2023survey], the key-value (KV) cache becomes a dominant inference bottleneck. Recent KV cache compression methods [jo2025fastkv,li2024snapkv,zhou2024dynamickv] reduce this cost by retaining only a subset of attention-relevant tokens. However, while these approaches preserve accuracy on benign workloads, their compression policies either fail to defend against jailbreak attacks [jiang2024robustkv] or degrade safety alignment under aggressive eviction. We propose AnchorKV, a drop-in modification to KV cache compression that biases token retention scores away from directions in key space associated with harmful prompts. AnchorKV constructs an offline safety anchor by adapting a difference-of-means representation engineering approach [arditi2024refusal,zou2023representation] to the layer-specific key projection space used in KV caching. Based on this anchor, a soft penalty token selection rule trades a small amount of utility for substantially improved safety alignment, while reducing to the original compressor when the penalty is zero.

20.
arXiv (CS.AI) 2026-06-19

ParaScale: Scale-Calibrated Camera-Motion Transfer via a Gauge-Invariant Parallax Number

Authors:

arXiv:2606.19805v1 Announce Type: cross Abstract: Transferring the camera motion of a reference video to a freshly generated one lets creators reuse cinematic moves. Yet reference and target often live at incompatible scales – a sweep across a galaxy versus a nudge across a desk – and naively reusing the recovered trajectory yields either imperceptible or violently exaggerated motion. We trace this to a geometric fact: translation-induced image motion scales as ||T||/Z, so a monocular trajectory is meaningful only up to a depth-scale gauge. We distill this into the Parallax Number Pi = ||Delta T|| / Zbar, a dimensionless, gauge-invariant descriptor of how strongly a camera move is felt, and prove that it – not the raw trajectory – is the quantity that scale-faithful transfer must preserve. ParaScale is a plug-and-play module that reads Pi off any reference video and re-realizes it against the target scene's own depth, per frame, leaving rotation untouched. Sitting between pose extraction and pose injection, it requires no retraining and drops into any pose-conditioned generator. We further introduce the Parallax Consistency Error (PCE), a scale-symmetric metric that – unlike the similarity-aligned TransErr – exposes scene-scale mismatch. Across scale regimes spanning four orders of magnitude and multiple backbones, ParaScale keeps the realized parallax on the identity line and cuts PCE by more than 3x over uncalibrated transfer with no loss of visual fidelity.

21.
arXiv (CS.CL) 2026-06-11

External Experience Serving in Production LLM Systems: A Deployment-Oriented Study of Quality-Cost Trade-offs

Production LLM systems accumulate reusable operational experience, but the practical deployment issue is not merely whether such experience can help. It is how different serving strategies trade off quality against online cost under realistic constraints. Injecting external experience can improve task quality, yet it also increases prompt burden, latency, and serving pressure. We study external experience serving as a deployment-oriented quality-cost trade-off problem. We evaluate this question in a real production moderation setting, with tool-use and GPQA as supporting contrast tasks that expose different output-cost regimes. We compare no-experience baselines, random experience controls, global prompt injection, and retrieval-based selective injection, and analyze both task quality and serving cost. The results show that, once experience becomes case-dependent, selective retrieval provides a stronger operating point than unconditional global injection. They further show that retrieval quality matters more than simply increasing Top-$K$, and that the same serving policy can exhibit substantially different cost-benefit profiles across short-output and decode-heavy regimes. These findings suggest that external experience is best treated as a selective, cost-aware serving decision rather than as a universal add-on. Overall, in the settings studied here, external experience pays off only when both the serving interface and the task-specific cost structure make its quality gains worth the online cost.

22.
arXiv (CS.AI) 2026-06-11

SpikeDecoder: Realizing the GPT Architecture with Spiking Neural Networks

arXiv:2606.12287v1 Announce Type: cross Abstract: The Transformer architecture is widely regarded as the most powerful tool for natural language processing, but due to a high number of complex operations, it inherently faces the issue of high energy consumption. To address this issue, we consider Spiking Neural Networks (SNNs), which are an energy-efficient alternative to conventional Artificial Neural Networks (ANNs) due to their naturally event-driven approach to processing information. However, this inherently makes them difficult to train. Often, many SNN-based models circumvent this issue by converting pre-trained ANNs. More recently, attempts have been made to design directly trainable SNN-based adaptations of the Transformer model structure. Although the results showed great promise, the application field was computer vision. Moreover, the proposed model incorporates only encoder blocks. In this paper, we propose SpikeDecoder, a fully SNN-based implementation of the Transformer decoder block, for applications in natural language processing. In a series of experiments, we analyze the impact of exchanging different blocks of the ANN model with spike-based alternatives to identify trade-offs and significant sources of performance loss. We further investigate the role of residual connections and the selection of SNN-compatible normalization techniques. Besides the work on the model architecture, we formulate and compare different embedding methods to project text data into spikes. Finally, we demonstrate that our proposed SNN-based decoder block reduces the theoretical energy consumption by 87% to 93% compared to the ANN baseline.

24.
arXiv (CS.AI) 2026-06-19

Exploring Feature Extraction Technique Parameters for Acoustic Gunshot Classification

arXiv:2606.19568v1 Announce Type: cross Abstract: Acoustic gunshot detection is a problem with applications across civilian public safety, military operations, and wildlife conservation, yet the field lacks a rigorous exploration of feature extraction techniques with a focus on generalization to realistic data. The mixed effectiveness of commercial gunshot detection and classification systems indicates an open problem that is not adequately addressed by the current literature. In this paper, we present a systematic investigation of common feature extraction techniques using a dataset of 23,000 gunshot recordings across 85 firearms and 21 calibers. We benchmark three feature extraction techniques with 12 total unique parameter sets using ResNet-18. Our results demonstrate that using the correct feature extraction technique can improve top-1 accuracy by up to 20%, and utilizing the correct parameters for a given feature extraction technique can improve that value by up to 4.7%.

25.
PLOS Medicine 2026-05-27

Sequential chemo-immunotherapy followed by standard versus reduced thoracic radiotherapy for older and/or frail stage III non-small-cell lung cancer: A randomized open-label cohort trial

Authors:

by Wei-Xiang Qi, Shuyan Li, Mengdi Wang, Huan Li, Feifei Xu, Lei Yao, Biao Yu, Linlin Chen, Gang Cai, Cheng Xu, Xianwen Sun, Zhiyao Bao, Jiayi Chen, Yi Xiang, Shengguang Zhao Background The appropriateness of concurrent chemoradiotherapy (cCRT) for older or clinically vulnerable stage III unresectable non-small-cell lung cancer (NSCLC) patients remains contentious. Furthermore, the survival implications of de-escalating thoracic radiotherapy (RT) intensity in this population have not been conclusively elucidated. Methods and findings We conducted a phase II randomized, open-label, two-cohort (non-comparative) trial at a tertiary hospital in China (NCT05557552). Between September 30, 2022 and April 30, 2024, we enrolled 56 older and/or frail patients with stage III NSCLC who were ineligible for cCRT. The primary endpoint was the 1-year progression-free survival (PFS) rate estimated using the Kaplan–Meier method. Secondary endpoints included objective response rate (ORR), overall survival (OS), and safety. In the intention-to-treat (ITT) set, which included all 56 randomized patients who received at least one dose of study treatment, the 1-year PFS was 84.3% (95% confidence interval [CI] [70.3%, 98.3%]) in the standard RT group and 70.7% (95% CI [54.3%, 87.1%]) in the reduced RT group. In the per-protocol set (53 patients), the 1-year PFS was 82.9% (95% CI [68.9%, 98.8%]) in the standard RT group and 73.4% (95% CI [58.3%, 92.4%]), with a median follow-up of 24 months. Among 56 patients in the safety analysis set, 71.4% of patients experienced grade 3/4 adverse events (AEs) in the standard RT group and 53.6% in the reduced RT group. One patient (3.6%) in the reduced RT and three patients (10.7%) in the standardized RT experienced grade 5 AEs. The main limitations are the non-comparative design, small sample size, and lack of power to establish non-inferiority or superiority. Conclusion The current study suggested that reduced RT combined with sequential chemo-immunotherapy might be feasible for older/frail patients intolerant to cCRT, showing numerically similar survival outcomes. These exploratory findings warrant confirmation in larger, adequately powered randomized trials. Trial registration The trial had been registered on ClinicalTrials.gov on Sep 30, 2022.ClinicalTrials.gov NCT05557552