ASTRO Presidential Address “Sculpting the Landscape of Radiation Oncology”

Abstract

It has been exciting and gratifying to work in the field of radiation oncology as significant advances have been made through coordinated intraand inter-disciplinary research activities. Three decades of intensive studies on how to rationally fractionate radiotherapy or to combine radiation with chemotherapy have changed the standard-of-care for many cancers. Progress in high-precision radiotherapy with superior topographic tumor targeting have begun to yield benefit in a number of tumor sites in terms of improving tumor control and reducing some toxicity. Further investigations are ongoing to assess its full potential in a variety of tumors. Better understanding of molecular processes underlying neoplastic transformation-progression and those governing cellular radiation responses prompted the development of strategies for selective enhancement of tumor response by modulating specific signaling pathways. For example, coordinated laboratory-clinical studies led to the demonstration that a short course of biologically targeted therapy with cetuximab (antibody against the epidermal growth factor receptor) combined with radiotherapy improved the local-regional control and survival rates in patients with locally advanced head and neck carcinoma without increasing radiation-induced side effects. Validation of this concept has inspired further methodical testing of many classes of novel agents.