New ASTRO Guidelines Recommend Hypofractionated Breast Irradiation

Excerpt:

“An expert panel convened by the American Society for Radiation Oncology (ASTRO) released a set of recommendations regarding fractionation for whole-breast irradiation (WBI) in women with breast cancer. The guideline includes recommendations for standard practice, factors that should influence fractionation decision making, and issues surrounding tumor bed boost, among other issues.

” ‘Breast cancer is the most common malignancy treated with radiation therapy in the United States, and WBI is the most common radiotherapeutic approach for breast cancer,’ wrote authors led by Benjamin D. Smith, MD, of MD Anderson Cancer Center in Houston. The standard of care for WBI has involved conventional fractionation (CF), with daily doses of 180 to 200 cGy up to approximately 4,500 to 5,000 cGy; research in the 1990s and 2000s looked into whether moderate hypofractionation (HF) with daily doses of 265 to 330 cGy could offer similar outcomes.”

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Accelerated WBI Should be the Norm for Most Breast Cancers

Excerpt:

“Most women with breast cancer should receive accelerated whole-breast irradiation (WBI) as the standard of care, according to a new guideline from the American Society for Radiation Oncology (ASTRO).

“Accelerated, or hypofractionated, WBI is the preferred form of radiotherapy for breast cancer, regardless of a patient’s age, tumor stage, or whether the patient has received chemotherapy. The guideline replaces an ASTRO guideline published in 2011, which recommended hypofractionated WBI for selected patients: primarily older patients and those with less advanced disease.”

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Combination of Optune® with Temozolomide Demonstrates Unprecedented Five-Year Survival for Newly Diagnosed Glioblastoma Patients

Excerpt:

“Novocure (NVCR) announced today results from its phase 3 pivotal EF-14 trial adding Optune to temozolomide for the treatment of newly diagnosed glioblastoma (GBM), including results from health-related quality of life analyses, were presented at the American Society for Radiation Oncology’s (ASTRO) 2017 Annual Meeting in San Diego. This marks the first presentation of EF-14 five-year survival and quality of life data at a radiation oncology conference.

“A late-breaking oral presentation focused on Novocure’s EF-14 phase 3 pivotal trial, which demonstrated unprecedented five-year survival results in newly diagnosed GBM. Patients treated with Optune in combination with temozolomide experienced a significant extension of overall survival without added toxicity compared to patients treated with temozolomide alone. The data also showed that Optune-treated patients were able to maintain quality of life for longer compared to patients treated with temozolomide alone.”

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Long-Term Survival Rates More Than Double Previous Estimates for Locally Advanced Lung Cancer

Excerpt:

“Long-term results of a phase III clinical trial indicate that survival rates for patients receiving chemoradiation for unresectable, locally advanced non-small cell lung cancer (NSCLC) may be more than twice as high as previous estimates. At five years following treatment with a standard dose of 60 Gray (Gy) radiation delivered in 30 fractions, the overall survival rate was 32 percent, setting a new benchmark of survival for patients with inoperable stage III NSCLC. The trial, RTOG 0617, also confirms that a standard dose of radiation therapy is preferable to a higher dose and that cetuximab offers no additional survival benefit for these patients. Findings will be presented today at the 59th Annual Meeting of the American Society for Radiation Oncology (ASTRO) in San Diego.”

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ASTRO: Little Growth of Protons for Prostate Cancer

Excerpt:

“Use of proton therapy to treat cancer continued a modest but steady increase, although the biggest driver of the therapy — prostate cancer — remained stagnant, according to data from a national trade group.

“From 2012 through 2015, the annual photon therapy case volume increased from 5,377 to 7,711 at the centers in operation during that period. Prostate cancer remained the largest single contributing condition to case volume throughout the period. However, any hoped-for increase in volume never materialized.”

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Prostate Cancer Study Shows Hypofractionation Comparable to Standard Radiation in Low-risk Patients

“Hypofractionated radiotherapy can achieve similar cure rates with similar side effects compared with conventional radiotherapy for men with low-risk, early prostate cancer, according to follow-up RTOG 0415 study data presented October 20, 2015, during a scientific session at the 2015 ASTRO Annual Meeting.

“Hypofractionated radiotherapy is delivered in larger doses over 5.5 weeks whereas conventional radiotherapy requires 8 weeks of treatment. ‘Results of our study demonstrate that for men with low-risk prostate cancer, hypofractionated radiotherapy offers a shorter, more convenient treatment schedule without compromising cure or causing additional side effects,’ said lead author W. Robert Lee, MD, professor of radiation oncology at Duke University School of Medicine, Durham, NC.”


Men's Health Supplements Fail to Improve Prostate Cancer Outcomes

“Using men’s health supplements did not help prevent distant metastases, cancer-related death or adverse events among men undergoing definitive radiation therapy for localized prostate cancer, according to the results of a retrospective study presented at the ASTRO Annual Meeting.

“ ‘Around 50% of the patients we see are on any kind of supplement,’ Nicholas G. Zaorsky, MD, resident physician in radiation oncology at Fox Chase Cancer Center, told HemOnc Today. ‘At least 10% are on men’s health supplements. We wanted to understand whether these supplements actually made a difference in terms of outcomes or side effects.’

“The researchers defined men’s health supplements as supplements specifically labeled and marketed with the terms ‘men’s health’ or ‘prostate health.’ These supplements are frequently labeled as having potential anticancer benefits, although no associations have been proven, according to the researchers.”


ASTRO Issues Guideline on Definitive and Adjuvant RT for Locally Advanced Non-Small Cell Lung Cancer

“The American Society for Radiation Oncology (ASTRO) is issuing a new guideline, “Definitive and adjuvant radiotherapy in locally advanced non-small cell lung cancer: An American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline.” The guideline’s executive summary is published in the May-June issue of Practical Radiation Oncology (PRO), ASTRO’s clinical practice journal. The complete guideline, which cites 35 years of data to help guide current treatment and future research, is available online as an open-access article in PRO. The American Society of Clinical Oncology (ASCO) today issued an endorsement of ASTRO’s guideline.

“ASTRO’s guideline panel included 14 leading lung cancer oncologists in the U.S. and Canada, reviewed 74 studies from English language publications within the PubMed database, published from January 1, 1966 to March 15, 2013. The panel developed five Key Questions on the role of definitive and adjuvant radiation therapy (RT) for locally advanced non-small cell lung cancer (LA NSCLC), which represents nearly one-quarter of all lung cancer patients. In addition to the 74 studies, 27 published clinical practice guideline documents that were relevant to one or more of the five Key Questions were reviewed to ensure the guideline panel obtained all appropriate clinical trial reports.”


Select Group of Stage IV Lung Cancer Patients Achieve Long-Term Survival After Aggressive Treatments

The gist: A recent research study examined the effects of particularly aggressive treatment for stage IV non-small cell lung cancer (NSCLC). Aggressive treatment can significantly prolong life for some patients, but for other patients it may not. Aggressive treatment can have bad side effects, so the more certain a doctor can be that it’s the right choice, the better. In this study, researchers were able to pinpoint characteristics of a patient that could be used to identify which patients might benefit from aggressive treatment and which patients might be better off with less-aggressive treatment. Further studies are needed to refine these factors.

“A large, international analysis of patients with stage IV non-small cell lung cancer (NSCLC) indicates that a patient’s overall survival (OS) rate can be related to factors including the timing of when metastases develop and lymph node involvement, and that aggressive treatment for “low-risk” patients leads to a five-year OS rate of 47.8 percent, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting.

“When lung cancer has spread from an original tumor to other sites of the body, it is classified as metastatic (Stage IV), and the goal of treatment is to slow the cancer down with chemotherapy or radiation, but these treatments are unable to eradicate the cancer and survival is usually in the range of only a few months.

“However, when there are only a few locations of metastatic lung cancer (called oligo-metastatic), some studies suggest that by removing or eradicating each of those cancer deposits with aggressive treatments such as surgery or high-dose, precise radiation called stereotactic ablative radiotherapy or SABR, the cancer may be controlled for a long period of time…

” ‘Our study finds some stage IV NSCLC patients can achieve long-term survival after aggressive treatments; however, it is important to note that the patients in this study are a very select minority of stage IV patients who are younger, more physically fit, with a lower burden and slower pace of disease than the average stage IV patient,’ said lead study author Allison Ashworth, MD, a radiation oncologist who completed the study as part of her training at the London Health Sciences Centre at Western University, in London, Ontario. ‘We hope our study’s results will help determine which stage IV NSCLC patients are most likely to benefit from aggressive treatments, and equally as important, help identify those patients most likely to fail, thus sparing them from futile and potentially harmful treatments. Our research, however, cannot answer the question of whether the longer survival is due to the treatments or simply because these patients have less aggressive disease. We must await the results of randomized clinical trials to answer this question. In the meantime, it is our hope that our study will help cancer specialists in making treatment decisions and in the development of clinical trials. ‘”