Accuracy and Precision Define Radiation Oncology

A Q&A with Eddy Yang, MD, PhD, Professor and Vice Chair of Translational Sciences Department of Radiation Oncology; Deputy Director, Associate Director of Precision Oncology at the Hugh Kaul Precision Medicine Institute; Birmingham, AL; shyang@uabmc.edu

Originally published December 5, 2017

Q: You are a radiation oncologist with a particular interest in cancer of the prostate. How does the molecular study of prostate, as well as other cancers, including Next Generation Sequencing (NGS), help inform Precision Radiation Oncology?

A: Radiation oncology is a specialty where the accuracy and precision of treatment delivery is vital to the safety and outcomes of our patients. Many specialized techniques are utilized to enhance this precision, including intensity modulated radiation therapy, image-guided radiation therapy, and volumetric arc therapy. Emerging modalities such as proton and carbon therapy take advantage of the physics of heavy ions to potentially minimize normal tissue toxicity. With these methods, we are in essence, performing precision oncology, tailoring radiotherapy to each individual patient. However, precision oncology is much more than that, as novel technologies have expanded our understanding of the drivers of cancer that may be targetable or dictate response to treatment. Currently, emerging evidence has shown the benefits of biomarker-directed systemic treatments, but what about genomic markers to guide radiation therapy? Although the preclinical and retrospective data supports the notion of this possibility, results from prospective studies are not yet available. Continue reading…


Circulating Tumor Cells and Benefit of Adjuvant Radiotherapy in Early Breast Cancer

Excerpt:

“In a study reported in JAMA Oncology, Goodman et al found that adjuvant radiotherapy was associated with better outcome in patients with early breast cancer who had detectable circulating tumor cells (CTCs).

“The analysis included data from patients with stage pT1 to pT2 and pN0 to pN1 breast cancer and known CTC status from the National Cancer Database (NCDB) from January 2004 to December 2014 and the phase III SUCCESS trial from September 2005 to September 2013.”

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Breast Cancer Therapy: All Clear for the Heart

Excerpt:

“Many breast cancer therapies cause damage to the heart. However, in the largest study of its kind so far, scientists from the German Cancer Research Center (DKFZ) in Heidelberg have now shown that the risk of death from heart disease in breast cancer patients following radiotherapy or chemotherapy is no higher than it is among the average population. Good risk management in the hospitals as well as control screenings at short intervals seem to make up for elevated risks.”

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Adjuvant Radiotherapy Improves Outcomes for High-Risk Prostate Cancer

Excerpt:

“Adjuvant radiotherapy appeared associated with better outcomes than surveillance followed by early-salvage radiotherapy among patients with prostate cancer with adverse pathological features who underwent prostatectomy, according to study results published in JAMA Oncology.

” ‘It remains very controversial whether patients with high-risk features after a radical prostatectomy for prostate cancer should receive adjuvant radiation therapy to prevent a recurrence of their prostate cancer as measured by a rise in PSA, or whether we should observe patients after surgery and only radiate those who demonstrate a detectable PSA,’ Rahul D. Tendulkar, MD, of the department of radiation oncology at Cleveland Clinic, told HemOnc Today.”

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Radiation-Immunotherapy Combination Can Slow Tumor Growth for Some Patients With Metastatic Late-Stage Cancer

Excerpt:

“A new study involving patients with stage IV cancer finds that treatment with radiation therapy and immunotherapy can halt the growth of tumors by stimulating the body’s immune system to attack the cancer. In the phase II trial, patients with end-stage cancer that had spread to the lungs or liver demonstrated a favorable response to the combined treatment. Between 30 and 60 percent of the patients, depending on the treatment arm, found that their cancer stopped spreading. Findings will be presented today at the 59th Annual Meeting of the American Society for Radiation Oncology (ASTRO).”

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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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Targeted Radiotherapy Limits Side Effects of Breast Cancer Treatment

Excerpt:

“Breast cancer patients who have radiotherapy targeted at the original tumour site experience fewer side effects five years after treatment than those who have whole breast radiotherapy, and their cancer is just as unlikely to return, according to trial results published* in The Lancet (link is external) today (Wednesday).

“The Cancer Research UK-funded IMPORT LOW trial** revealed that five years after treatment, almost all patients were disease free.***

“The researchers at 30 radiotherapy centres across the UK, led by The Institute of Cancer Research, London(link is external), and the Cancer Research UK Cambridge Centre(link is external), studied more than 2,000 women aged 50 or over who had early stage breast cancer that was at a low risk of coming back.”

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Proton Tx Plus Chemo Seen Beneficial in NSCLC

Excerpt:

“The use of proton beam radiotherapy and concurrent chemotherapy may improve clinical outcomes for patients with inoperable stage III non-small cell lung cancer (NSCLC), while reducing the toxic effects of treatment, researchers from MD Anderson Cancer Center have found.

“The researchers, led by Joe Y. Chang, MD, PhD, reported that the median overall survival of 26.5 months observed in their study ‘was encouraging, and in accord with our original statistical goal of 24 months.’ ”

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Brain Cancer Like McCain’s Has Hundreds Of Experimental Therapies (With Little Success)

Excerpt:

“The type of brain cancer John McCain was diagnosed with July 14, glioblastoma, is among the most difficult cancers to beat. The reasons it’s so hard to treat, as I discussed previously, include its location, its genetic diversity within and across patients, and its aggressiveness. Glioblastoma (GBM) is also among the most devastating cancers in its effects since it attacks the brain, the control center for the body’s functions and the essence of an individual’s personality. Even people who survive rarely remain the same person after their treatment.”

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