Radiotherapy In Metastatic Cancer Research Articles

Biology-guided radiotherapy: redefining the role of radiotherapy in metastatic cancer.

The emerging biological understanding of metastatic cancer and proof-of-concept clinical trials suggest that debulking all gross disease holds great promise for improving patient outcomes. However, ablation of multiple targets with conventional external beam radiotherapy systems is burdensome, which limits investigation and utilization of complete metastatic ablation in the majority of patients with advanced disease. To overcome this logistical hurdle, technical innovation is necessary. Biology-guided radiotherapy (BgRT) is a new external beam radiotherapy delivery modality combining positron emission tomography-computed tomography (PET-CT) with a 6 MV linear accelerator. The key innovation is continuous response of the linear accelerator to outgoing tumor PET emissions with beamlets of radiotherapy at subsecond latency. This allows the deposited dose to track tumors in real time. Multiple new hardware and algorithmic advances further facilitate this low-latency feedback process. By transforming tumors into their own fiducials after intravenous injection of a radiotracer, BgRT has the potential to enable complete metastatic ablation in a manner efficient for a single patient and scalable to entire populations with metastatic disease. Future trends may further enhance the utility of BgRT in the clinic as this technology dovetails with other innovations in radiotherapy, including novel dose painting and fractionation schemes, radiomics, and new radiotracers.

Patient-Provider Communication and Decision-Making in Palliative Radiotherapy for Metastatic Cancer

Patient-Provider Communication and Decision-Making in Palliative Radiotherapy for Metastatic Cancer

Effects of radiotherapy and short-term starvation combination on metastatic and non-tumor cell lines

BackgroundSince its discovery in the late 19th century, radiotherapy has been one of the most important medical treatments in oncology. Recently, fasting or short-term starvation (STS) in cancer patients undergoing chemotherapy has been studied to determine its potential for enhancing the therapeutic index and for preventing side- effects, but no data are available in the radiotherapy setting. We thus decided to investigate the effects in vitro of STS in combination with radiotherapy in metastatic cancer cells and non-cancer cells. MethodsCells were incubated in short-term starvation medium (STS medium, 0·5 g/L glucose + 1% FBS) or in control medium (CM medium, 1 g/L glucose + 10 % FBS) for 24 h and then treated with single high-dose radiation. A plexiglass custom-built phantom was used to irradiate cells. DNA damage was evaluated using alkaline comet assay and theCometAnalyser software. The cell surviving fraction was assessed by clonogenic assay. FindingSTS followed by single high-dose radiation significantly increased DNA damage in metastatic cancer cell lines but not in normal cells. Furthermore, STS reduced the surviving fraction of irradiated tumor cells, indicating a good radio-sensitizing effect on metastatic cell lines. This effect was not observed in non-tumor cells. InterpretationOur results suggest that STS may alter cellular processes, enhancing the efficacy of radiotherapy in metastatic cancer cellsin vitro. Interestingly, STS has radioprotective effect on the survival of healthy cells.

Patterns of palliative care among patients receiving palliative radiotherapy.

55 Background: Few studies have examined how palliative care (PC) delivered by a dedicated PC team is integrated at the time of radiotherapy (RT) consultation. We aimed to characterize patterns of PC in relation to RT, predictors of PC, and outcomes based on PC integration. Methods: We retrospectively reviewed 162 patients with metastatic cancer who received palliative RT at a single institution (7/2017-2/2018). PC integration was defined as: no PC, concurrent PC (PC initiated +/- 4 weeks within RT consult), established PC (any PC visit in the 6 months prior to RT consult), and subsequent PC (PC initiated > 4 weeks after RT consult). Logistic regression analyses determined predictors of receiving any PC. Cox proportional hazards regression identified predictors of OS. Results: Median follow-up was 7.8 months (range: 0.3-20.6). Patients (56% female; 84% white; median age: 64 years (range: 22-94)) had a median of 2 metastatic sites (range: 1-6) and 2 prior courses of palliative chemotherapy (range: 0-7). Of the 74 patients (46%) with any PC, 24 (32%) had concurrent PC, 21 (28%) had established PC, and 29 (39%) had subsequent PC. The most common reasons for PC initiation were pain (58%) and goals of care/end-of-life care management (20%). Nearly half (49%) of PC consults occurred in an inpatient setting; a minority (22%) of RT consults were inpatient. On multivariate analysis, receiving any PC significantly differed by race (non-white vs white, OR = 6.40 [95% CI 1.98-20.69], p = 0.002), cancer type (lung vs non-breast other histology, OR = 0.15 [95% CI 0.06-0.35], p < 0.001), and RT consult setting (inpatient vs outpatient, OR = 3.32 [95% CI 1.36-8.13], p = 0.009). On multivariate analysis, male sex (HR = 1.51 [95% CI 1.01-2.27], p = 0.046) and ECOG 2-4 (HR = 2.22 [95% CI 1.47-3.36], p < 0.001) predicted worse OS. Age, marital status, language, insurance type, metastatic burden, prior palliative chemotherapy, and PC integration were not independent predictors of OS. Conclusions: At our institution, dedicated PC occurred in < 50% of patients receiving palliative RT for metastatic cancer. We need initiatives to increase PC for all palliative RT patients, especially in the outpatient setting and for those with lung cancer who were less likely to receive dedicated PC.

OncoLOGIC: Tumors of the Eye and Ocular Adnexae

This book, the 16th volume of OncoLOGIC: Multidisciplinary Decisions in Oncology , was written by a radiologist and ophthalmologist as a study guide to enable the reader to examine his decision-making ability in the management of ocular and adnexal tumors. By sending in his answers for grading, he can be awarded 15 hours of category 1 continuing medical education credit. Many of the tables in this volume, reproduced from the literature, concern the clinical characteristics and prognosis following various types of treatment. The text is typewritten and reproduced on poor paper, making the illustrations poor in quality and somewhat inadequate in labeling and legends. The ultimate in useless illustrations is Fig 122, a line drawing showing a doctor talking to a patient. Flow sheets on management are not helpful. One might quarrel with some of the recommendations that are heavily weighted toward irradiation, eg, radiation therapy for metastatic cancer to