Minimizing morbidity in radiation oncology: a special issue from Future Oncology.

Abstract

21st Century Oncology, 801 WH Smith Boulevard, Greenville, NC 27834, USA Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA *Author for correspondence: rallison@rtsx.com This issue of Future Oncology highlights some of the accomplishments, limitations and promises of the field of Radiation Oncology, with a focus on means to minimize normal tissue toxicity. Today, more patients than ever who receive radiation therapy experience improved outcomes with lower morbidity than patients treated even a decade ago. This is due in large part to technological advances as outlined in the article by Allison et al. [1]. While the laws of physics that govern radiation therapy has not changed, the ability to accurately deliver tumoricidal doses to the cancer while also reducing dose to critical surrounding tissues has. The widespread use of imaging both during the development and delivery of a patient’s treatment has created a new level of treatment accuracy. Various forms of image-guided radiation therapy are currently used, with computed tomography-based most common. As detailed in this article, new forms of imaging including magnetic resonance and biologic approaches may soon come to the forefront, all with the promise of further limiting exposure and dose to normal tissues. Additionally, treatment delivery has simultaneously advanced allowing worldwide introduction of intensitymodulated radiation therapy to become the standard. When appropriate, this delivery technique allows for higher doses of radiation to be delivered to the tumor while simultaneously diminishing radiation dose to normal tissues. Another emerging treatment delivery technique is termed ‘radiosurgery.’ With these tools, very large doses of radiation are delivered to relatively small volumes. This ideally minimizes normal tissue exposure and injury. With these new technologies may also come unintended consequences. A relatively unusual potential morbidity has been attributed to lung radiosurgery in which rib fracture or injury appears to be enhanced. In the article by Podder et al., the risk appears to be acceptable and the literature is reviewed [2]. The current state of the art of clinical outcomes for radiosurgery is highlighted by Mahadevan et al.’s report from the 2014 Radiosurgery Society Annual meeting [3]. The future of radiation therapy will also “Today, more patients than ever who receive radiation therapy experience improved outcomes with lower morbidity than patients treated even a decade ago.”