Perspectives on Patient Access to Radiation Oncology Facilities and Services in Mainland China
In this report, we would highlight the positive changes that have occurred during the time and outline what is still needed for the future of this important cancer specialty in China. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 18, 2017 Category: Cancer & Oncology Authors: Luhua Wang, Jiade J. Lu, Weibo Yin, Jinyi Lang Source Type: research

Perspectives on Patient Access to Radiation Oncology Services in South America
Cancer represents a fast-growing challenge worldwide, and is being recognized as an emerging and critical issue in low- and middle-income countries, such most of South America. This subcontinent is unique for its geography, culture, and ethnical diversity. Most of its countries have large expanses of jungle and desert where underserved population groups including indigenous (native Indians), represent a challenge for cancer care. Many indigent patients have no access to preventive care nor early diagnosis. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 18, 2017 Category: Cancer & Oncology Authors: Beatriz Amendola, Aldo Quarneti, Arthur Accioly Rosa, Gustavo Sarria, Marco Amendola Source Type: research

South East Asia, Differing Socioeconomic Factors, Differing Access to Radiotherapy: The Philippines, a Microcosm
The accessibility of radiotherapy in Southeast Asia, a region characterized by diversity in both economy and culture, differ widely among its member countries. In most countries, access is not universal and is generally limited by radiotherapy resources and the health-seeking behavior of patients. This in turn relates to the current health policy in place, the practice of radiation oncology, and cultural factors such as religion and family dynamics. Although it is clear that radiotherapy access parallel economic development, it is also affected by different social factors that work to facilitate or impede its improvement. ...
Source: Seminars in Radiation Oncology - March 18, 2017 Category: Cancer & Oncology Authors: Miriam Joy C. Calaguas, Johannes A. Gubat Source Type: research

Challenges and Prospects for Providing Radiation Oncology Services in Africa
There are considerable challenges to meeting the demands of the impending cancer crisis in Africa. These include a rising incidence of cancer and cancer-related deaths, equipment and maintenance costs, and deficits in human resources and training. Addressing these issues would be crucial to tackling the increasing burden of cancer on the continent. Innovations in technology and collaborative efforts within the global oncology community have created promising solutions for establishing quality cancer care in Africa and eradicating the massive disparities that currently exist. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 18, 2017 Category: Cancer & Oncology Authors: Onyinye Balogun, Danielle Rodin, Wilfred Ngwa, Surbhi Grover, John Longo Source Type: research

Implementing Cancer Care for the Undeserved Globally: From the “5 R’s” of Radiobiology to the “7 P’s” of Global Cancer Care
From the 5 R ’s of radiobiology that underpin clinical radiation therapy (repair, reoxygenation, redistribution, repopulation, and radiosensitivity) we propose, somewhat tongue-in-cheek, the 7 P’s for implementing cancer care to the underserved globally. What are they? Well, we needed some suspense for you t o read an editorial introduction to a terrific set of articles so we held off this magnificent new construct to the end. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 18, 2017 Category: Cancer & Oncology Authors: Tim R. Williams, C. Norman Coleman Source Type: research

Radiation Oncology in the Developing Economies of Central and Eastern Europe
Eastern Europe is represented by 22 countries of significant variability in population density and degree of economic development. They have been affected by past geopolitical isolation due to their association with the “Soviet Block.” Currently, all Eastern European countries except Slovenia are low- or middle-income level and 10 of them are part of European Union. Health care systems in Central and Eastern Europe have been influenced by the legacy of centralized soviet-era governance; however, most countries, particularly in European Union zone, have gone through health care reforms directed toward modernizin...
Source: Seminars in Radiation Oncology - March 18, 2017 Category: Cancer & Oncology Authors: Natia Esiashvili Source Type: research

Prostate Cancer Genetics: Variation by Race, Ethnicity, and Geography
Prostate cancer rates vary substantially by race, ethnicity, and geography. These disparities can be explained by variation in access to screening and treatment, variation in exposure to prostate cancer risk factors, and variation in the underlying biology of prostate carcinogenesis (including genomic propensity of some groups to develop biologically aggressive disease). It is clear that access to screening and access to treatment are critical influencing factors of prostate cancer rates; yet, even among geographically diverse populations with similar access to care (eg, low- and medium-income countries), African descent m...
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: Timothy R. Rebbeck Source Type: research

Beyond Just Androgen Deprivation Therapy: Novel Therapies Combined With Radiation
External beam radiation therapy (EBRT) combined with androgen deprivation are standard of care for selected patients with prostate cancer. In recent years, multiple therapies have been experimentally combined with EBRT either concomitantly or adjuvantly. These therapies include chemotherapies, immunotherapies, and novel hormones. In addition to EBRT, clinical trials with radiopharmaceuticals are planned or have been performed with concomitant chemotherapy, immunotherapies, novel hormones, and inhibitors of DNA damage repair. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: Oliver Sartor, Brian Lewis Source Type: research

Emerging Technologies and Techniques in Radiation Therapy
The past decade has brought an improved ability to precisely target and deliver radiation as well as other focal prostate-directed therapy. Stereotactic body radiotherapy (SBRT), proton beam radiation, high-dose-rate (HDR) brachytherapy, as well as nonradiotherapy treatments such as cryoablation and high-intensity focused ultrasound are several therapeutic modalities that have been investigated for the treatment of prostate cancer in an attempt to reduce toxicity while improving cancer control. However, high-risk prostate cancer requires a comprehensive treatment of the prostate as well as areas at risk for cancer spread. ...
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: William J. Magnuson, Amandeep Mahal, James B. Yu Source Type: research

Postoperative Radiation After Radical Prostatectomy
A total of 3 randomized clinical trials have demonstrated a significant clinical benefit with adjuvant radiation in patients with high-risk prostate cancer after radical prostatectomy, with each showing improved biochemical control outcomes, and one trial (SWOG 8794) also demonstrating increased overall survival. How broadly these results have informed clinical practice has evolved over time, given the widespread availability of ultrasensitive prostate-specific antigen level testing and increased awareness that the high-risk patients are not a uniform cohort. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: Eric C. Ko, Anthony L. Michaud, Richard K. Valicenti Source Type: research

Management of Node-Positive and Oligometastatic Prostate Cancer
Historically, stage IV prostate cancer was considered incurable. Although node-positive and oligometastatic prostate cancers are both classified as stage IV, these likely represent distinct clinical groups, and some patients may be curable with aggressive multimodality treatments. There is a lack of randomized evidence, but retrospective studies suggest that radical prostatectomy or radiotherapy may improve survival in these patients. This is an area of great current research interest and prospective randomized trials are needed to help define the optimal treatments for these patients. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: James R. Broughman, Ronald C. Chen Source Type: research

Options for Salvage of Radiation Failures for Prostate Cancer
Biochemical failure after primary external beam radiotherapy for prostate cancer is common, and a significant proportion of these failures are due to local residual or recurrent disease. Early or delayed palliation using androgen deprivation therapy is the most common approach. Although a conservative approach is appropriate for many individuals, selected patients would benefit from retreatment with curative intent. We review the pertinent literature on salvage of locally recurrent prostate cancer after primary radiotherapy, including the modalities of surgery, cryotherapy, high-intensity focused ultrasound, or reirradiati...
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: Audrey Tetreault-Laflamme, Juanita Crook Source Type: research

Advances in Prostate Cancer Magnetic Resonance Imaging and Positron Emission Tomography-Computed Tomography for Staging and Radiotherapy Treatment Planning
Conventional prostate cancer staging strategies have limited accuracy to define the location, grade, and burden of disease. Evaluations have historically relied upon prostate-specific antigen levels, digital rectal examinations, random systematic biopsies, computed tomography, pelvic lymphadenectomy, or 99mtechnetium methylene diphosphonate bone scans. Today, risk-stratification tools incorporate these data in a weighted format to guide management. However, the limitations and potential consequences of their uncertainties are well known. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: Drew Moghanaki, Baris Turkbey, Neha Vapiwala, Behfar Ehdaie, Steven J. Frank, Patrick W. McLaughlin, Mukesh Harisinghani Source Type: research

Optimization of the Radiation Management of High-Risk Prostate Cancer
Radiation and androgen-deprivation therapy (ADT) are mainstays of treatment for men with high-risk prostate cancer. High-risk disease is heterogeneous and subcategories of “favorable” high risk and very high risk can identify subgroups with particularly good or poor prognosis to help personalize treatment. Overall, randomized trials show that the combination of radiation and ADT improves survival when compared with either by itself. The optimum duration of ADT rem ains controversial, but for most healthy men with aggressive disease, approximately 2-3 years of ADT is well supported by the literature. (Source: Se...
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: Paul L. Nguyen Source Type: research

Biomarkers of Outcome in Patients With Localized Prostate Cancer Treated With Radiotherapy
Prostate cancer represents one of the most prevalent malignancies in the world. Although subsets of prostate cancer are aggressive and can metastasize, it is also evident that most patients harbor indolent disease. Although current risk-stratification approaches use both clinical and pathologic factors, it is clear that biomarkers can be used to improve on these approaches. In this article, we review the currently published literature on prostate cancer molecular biomarkers, primarily in the context of radiation therapy, focusing on those found in serum, plasma, urine, and within the tumor biopsy itself. (Source: Seminars ...
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: William A. Hall, Colleen A. Lawton, Ashesh B. Jani, Alan Pollack, Felix Y. Feng Source Type: research

Introduction
The landscape of prostate cancer and its management has undergone significant changes over the past decade. Notably, there has been a decrease in the use of PSA screening since such testing was offered a Grade D recommendation by the United States Preventative Services Task Force (USPSTF) guidelines in late 2011.1 As a result, large observational database studies have suggested a relative decrease in incident prostate cancer and low-risk disease in the United States.1 There has also been a shift in management toward active surveillance for lower-risk disease and radical prostatectomy for higher-risk disease, seemingly at t...
Source: Seminars in Radiation Oncology - December 14, 2016 Category: Cancer & Oncology Authors: Jason A. Efstathiou Source Type: research

Successes and Failures of Combined Modalities in Upper Gastrointestinal Malignancies: New Directions
Upper gastrointestinal malignancies generally have moderate to poor cure rates, even in the earliest stages, thereby implying that both local and systemic treatments have room for improvement. Therapeutic options are broadening, however, with the development of new immunotherapies and targeted agents, which can have synergistic effects with radiotherapy. Here we discuss the current state of combined modality therapy for upper gastrointestinal malignancies, specifically recent successes and setbacks in trials of radiation therapy with targeted therapies, vaccines, immunotherapies, and chemotherapies. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Daniel S. Jamorabo, Steven H. Lin, Salma K. Jabbour Source Type: research

Recent Advances and Prospects for Multimodality Therapy in Pancreatic Cancer
The outcomes for treatment of pancreatic cancer have not improved dramatically in many decades. However, the recent promising results with combination chemotherapy regimens for metastatic disease increase optimism for future treatments. With greater control of overt or occult metastatic disease, there will likely be an expanding role for local treatment modalities, especially given that nearly a third of pancreatic cancer patients have locally destructive disease without distant metastatic disease at the time of death. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Awalpreet S. Chadha, Allison Khoo, Maureen L. Aliru, Harpreet K. Arora, Jillian R. Gunther, Sunil Krishnan Source Type: research

New Strategies for Multimodality Therapy in Treating Locally Advanced Cervix Cancer
Cervical cancer is the fourth most common cause of cancer of women worldwide. In the developing world, it comprises 12% of all cancers of women. Since 1999, the mainstay of treatment for locally advanced cervical cancer (LACC) has been concurrent cisplatin-based chemoradiation. However, outcomes in this disease remain suboptimal, with long-term progression-free survival and overall survival rates of approximately 60%. There are several new strategies of combined modality treatment under evaluation in LACC, including chemotherapy before and after treatment as well as novel agents such as poly-adenosine diphosphate ribose po...
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Jonathan Verma, Bradley J. Monk, Aaron H. Wolfson Source Type: research

Successes and Failures of Combined Modality Therapies in Head and Neck Cancer
The paradigms for treating head and neck squamous cell carcinoma are changing as new subgroups are defined. The technical successes of improved radiation therapy are many; however, the success of novel combined therapies are few. With the emergence of human papillomavirus and the development of immunooncology agents, such as checkpoint inhibitors, are we ready to reevaluate how we use radiation and chemotherapy for locally advanced and metastatic disease —will we remain the fire or become the fire starter? (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Daniel W. Bowles, Eric Deutsch, David Raben Source Type: research

Translation of Targeted Radiation Sensitizers into Clinical Trials
Over the past century, technologic advances have promoted the evolution of radiation therapy into a precise treatment modality allowing for the maximal administration of dose to tumors while sparing normal tissues. Coinciding with this technological maturation, systemic therapies have been combined with radiation in an effort to improve tumor control. Conventional cytotoxic agents have improved survival in several tumor types but cause increased toxicity due to effects on normal tissues. An increased understanding of tumor biology and the radiation response has led to the nomination of several pathways whose targeted inhib...
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Zachery R. Reichert, Daniel R. Wahl, Meredith A. Morgan Source Type: research

Current Instrumentation and Technologies in Modern Radiobiology Research —Opportunities and Challenges
There is a growing awareness of the gaps in the technical methods employed in radiation biology experiments. These quality gaps can have a substantial effect on the reliability and reproducibility of results as outlined in several recent meta-studies. This is especially true in the context of the newer laboratory irradiation technologies. These technologies allow for delivery of highly localized dose distributions and increased spatial accuracy but also present increased challenges of their own. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Eric Ford, Jim Deye Source Type: research

Success and Failures of Combined Modalities in Glioblastoma Multiforme: Old Problems and New Directions
Glioblastoma multiforme (GBM) is an aggressive intracranial tumor characterized by local and distant brain relapse despite aggressive therapy. Current standard treatment includes surgical resection followed by radiation with concurrent and adjuvant temozolomide as part of a combined modality approach. In this review, the historical basis for the current standard treatment is discussed as well as other recent combined modality successes and failures. An overview of emerging combined modality therapies for GBM is presented including immunotherapy, and rationally designed radiosensitizers. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Christopher D. Corso, Ranjit S. Bindra Source Type: research

Targeted Therapy for Hepatocellular Carcinoma
Hepatocellular cancer (HCC) is a leading cause of cancer death worldwide, and most patients who are diagnosed with HCC are ineligible for curative local therapy. The targeted agent sorafenib provides modest survival benefits in the setting of advanced disease. Novel systemic treatment options for HCC are sorely needed. In this review, we identify and categorize the drugs and targets that are in various phases of testing for use against HCC. We also focus on the potential for combining these agents with radiotherapy. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Nitin Ohri, Andreas Kaubisch, Madhur Garg, Chandan Guha Source Type: research

Radiation —Therapeutic Agent Clinical Trials: Leveraging Advantages of a National Cancer Institute Programmatic Collaboration
A number of oncology phase II radiochemotherapy trials with promising results have been conducted late in the overall experimental therapeutic agent development process. Accelerated development and approval of experimental therapeutic agents have stimulated further interest in much earlier radiation-agent studies to increase the likelihood of success in phase III trials. To sustain this interest, more forward-thinking preclinical radiobiology experimental designs are needed to improve discovery of promising radiochemotherapy plus agent combinations for clinical trial testing. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Naoko Takebe, Mansoor M. Ahmed, Bhadrasain Vikram, Eric J. Bernhard, James Zwiebel, C. Norman Coleman, Charles A. Kunos Source Type: research

Exploiting Gene Expression Kinetics in Conventional Radiotherapy, Hyperfractionation, and Hypofractionation for Targeted Therapy
The dramatic changes in the technological delivery of radiation therapy, the repertoire of molecular targets for which pathway inhibitors are available, and the cellular and immunologic responses that can alter long-term clinical outcome provide a potentially unique role for using the radiation-inducible changes as therapeutic targets. Various mathematical models of dose and fractionation are extraordinarily useful in guiding treatment regimens. However, although the model may fit the clinical outcome, a deeper understanding of the molecular and cellular effect of the individual dose size and the adaptation to repeated exp...
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Adeola Y. Makinde, Iris Eke, Molykutty J. Aryankalayil, Mansoor M. Ahmed, C. Norman Coleman Source Type: research

Current Insights in Radiation Combination Therapies: Influence of Omics and Novel Targeted Agents in Defining New Concepts in Radiation Biology and Clinical Radiation Oncology
Radiotherapy is a critical and integral part of cancer care for over 50% of patients with cancer, where it is either used alone or in combination with other treatment modalities. Studies using an optimal radiotherapy utilization tree estimate that the optimal proportion of cancer patients that should receive external beam radiotherapy is 52%. A further Monte Carlo analysis demonstrated that, with a 95% confidence limit, 51.7%-53.1% of cancer patients should be treated with radiotherapy,1 a projection further supported by recent data from both resource-rich and resource-limited settings. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 10, 2016 Category: Cancer & Oncology Authors: Mansoor M. Ahmed, Amogh Narendra, Pataje Prasanna, C. Norman Coleman, Sunil Krishnan Source Type: research

Definitive Chemoradiotherapy ( “Watch-and-Wait” Approach)
Preoperative chemoradiotherapy (CRT) followed by total mesorectal excision has been the standard of care for locally advanced patients with rectal cancer. Some patients achieve a pathologic complete response (pCR) to CRT and the oncologic outcomes are particularly favorable in this group. The role of surgery in patients with a pCR is now being questioned as radical rectal resection is associated with significant morbidity and long-term effects on quality of life. In an attempt to better tailor therapy, there is an interest in a “watch-and-wait” approach in patients who have a clinical complete response (cCR) af...
Source: Seminars in Radiation Oncology - June 30, 2016 Category: Cancer & Oncology Authors: Karyn A. Goodman Source Type: research

Magnetic Resonance Imaging and Other Imaging Modalities in Diagnostic and Tumor Response Evaluation
This study reviews the potential role of functional imaging for the diagnosis, treatment monitoring, and assessment of prognosis in patients with rectal cancer. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Doenja M.J. Lambregts, Monique Maas, Marcel P.M. Stokkel, Regina G.H. Beets-Tan Source Type: research

Drug Combinations in Preoperative Chemoradiation for Rectal Cancer
Preoperative radiotherapy has an accepted role in reducing the risk of local recurrence in locally advanced resectable rectal cancer, particularly when the circumferential resection margin is breached or threatened, according to magnetic resonance imaging. Fluoropyrimidine-based chemoradiation can obtain a significant down-sizing response and a curative resection can then be achieved. Approximately, 20% of the patients can also obtain a pathological complete response, which is associated with less local recurrences and increased survival. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Rob Glynne-Jones, Carlos Carvalho Source Type: research

Definitive Chemoradiotherapy (“Watch-and-Wait” Approach)
Preoperative chemoradiotherapy (CRT) followed by total mesorectal excision has been the standard of care for locally advanced patients with rectal cancer. Some patients achieve a pathologic complete response (pCR) to CRT and the oncologic outcomes are particularly favorable in this group. The role of surgery in patients with a pCR is now being questioned as radical rectal resection is associated with significant morbidity and long-term effects on quality of life. In an attempt to better tailor therapy, there is an interest in a “watch-and-wait” approach in patients who have a clinical complete response (cCR) af...
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Karyn A. Goodman Source Type: research

Irradiation of Very Locally Advanced and Recurrent Rectal Cancer
Adjuvant therapy with chemoradiation or short-course radiation in addition to improvements in surgical technique has led to improved outcomes for patients with locally advanced rectal cancer. Local recurrence rates of less than 10% and 5-year survival rate of 60% or higher is expected. However, for patients with very locally advanced primary or locally recurrent disease in whom surgical resection is likely to be associated with incomplete resection, survival and disease control rates are poor and standard doses of adjuvant radiation or chemoradiation are relatively ineffective. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Michael G. Haddock Source Type: research

Advancing Techniques of Radiation Therapy for Rectal Cancer
Since the advent of radiation therapy for rectal cancer, there has been continual investigation of advancing technologies and techniques that allow for improved dose conformality to target structures while limiting irradiation of surrounding normal tissue. For locally advanced disease, intensity modulated and proton beam radiation therapy both provide more highly conformal treatment volumes that reduce dose to organs at risk, though the clinical benefit in terms of toxicity reduction is unclear. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Sagar A. Patel, Jennifer Y. Wo, Theodore S. Hong Source Type: research

Which Patients With Rectal Cancer Do Not Need Radiotherapy?
According to current guidelines, the standard treatment for locally advanced rectal cancer patients is preoperative (chemo)radiotherapy followed by total mesorectal excision surgery and adjuvant chemotherapy. Improvements in surgical techniques, imaging modalities, chemotherapy regimens, and radiotherapy delivery have reduced local recurrence rates to less than 10%. The current challenge in rectal cancer treatment lies in the prevention of distant metastases, which still occur in more than 25% of the patients. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Ines Joye, Karin Haustermans Source Type: research

Preoperative Treatment of Locally Advanced Rectal Cancer: Assets and Drawbacks of Short Course and Long Course in Clinical Practice
Preoperative short-course radiotherapy and preoperative long-course chemoradiotherapy are the standards of care for high-risk rectal cancer in different parts of the world. Both treatments are effective in local control and carry a low morbidity. The advantage of short course is its simplicity, whereas long course has the advantage of downsizing tumors thus increasing the chance of sphincter preservation. Although 2 randomized trials comparing short course and long course have been performed, the better form of preoperative treatment remains a subject of discussion. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Samuel Y. Ngan Source Type: research

Timing of Therapies in the Multidisciplinary Treatment of Locally Advanced Rectal Cancer: Available Evidence and Implications for Routine Practice
A multimodality disciplinary approach is paramount for the management of locally advanced rectal cancer. Over the last decade, (chemo)radiotherapy followed by surgery plus or minus adjuvant chemotherapy has represented the mainstay of treatment for this disease. Nevertheless, robust evidence suggesting the optimal timing and sequence of therapies in this setting has been overall limited. A number of questions are still unsolved including the length of the interval between neoadjuvant radiotherapy and surgery or the timing of systemic chemotherapy. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Francesco Sclafani, Ian Chau Source Type: research

Rectal Cancer: The Radiation Oncologist: The Great Watchmaker
Even with the passage of time, the management of rectal cancer remains a fascinating challenge for the clinician. Firstly, the dramatic reduction in the rate of pelvic failure should be considered as one of the major achievements in oncology over the past decades. Keeping in mind that in the 1980s, up to 50% of the patients suffering from a locally advanced tumor developed a pelvic recurrence, the decrease in this fearsome event to less than 10% without any contribution from new drugs is an important observation. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Philippe Maingon, Florence Huguet Source Type: research

Toward Restored Bowel Health in Rectal Cancer Survivors
As technology gets better and better, and as clinical research provides more and more knowledge, we can extend our ambition to cure patients from cancer with restored physical health among the survivors. This increased ambition requires attention to grade 1 toxicity that decreases quality of life. It forces us to document the details of grade 1 toxicity and improve our understanding of the mechanisms. Long-term toxicity scores, or adverse events as documented during clinical trials, may be regarded as symptoms or signs of underlying survivorship diseases. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - May 27, 2016 Category: Cancer & Oncology Authors: Gunnar Steineck, Heike Schmidt, Eleftheria Alevronta, Fei Sjöberg, Cecilia Magdalena Bull, Dirk Vordermark Source Type: research

Validity of Current Stereotactic Body Radiation Therapy Dose Constraints for Aorta and Major Vessels
Understanding dose constraints for critical structures in stereotactic body radiation therapy (SBRT) is essential to generate a plan for optimal efficacy and safety. Published dose constraints are derived by a variety of methods, including crude statistics, actuarial analysis, modeling, and simple biologically effective dose (BED) conversion. Many dose constraints reported in the literature are not consistent with each other, secondary to differences in clinical and dosimetric parameters. Application of a dose constraint without discriminating the variation of all the factors involved may result in suboptimal treatment. (S...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Jinyu Xue, Gregory Kubicek, Ashish Patel, Benjamin Goldsmith, Sucha O. Asbell, Tamara A. LaCouture Source Type: research

Dose and Volume of the Irradiated Main Bronchi and Related Side Effects in the Treatment of Central Lung Tumors With Stereotactic Radiotherapy
High radiation dose to the main bronchi can result in stenosis, occlusion or fistula formation, and death. Only 8 articles have reported side effects to the main bronchi from stereotactic body radiation therapy (SBRT), mostly with only one symptomatic complication per article. Therefore, we calculated the dose to the bronchial structures, such as trachea; mainstem bronchi; intermediate bronchus; upper-, middle-, and lower-lobe bronchus; and the segmental bronchi in 134 patients with central tumors and calculated the normal tissue complication probability (NTCP) for each of these structures, with toxicity determination base...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Marloes Duijm, W. Schillemans, Joachim G. Aerts, B. Heijmen, Joost J. Nuyttens Source Type: research

Dose-Response Model for Chest Wall Tolerance of Stereotactic Body Radiation Therapy
Many recent studies have described rib fractures and chest wall pain following stereotactic body radiation therapy (SBRT). Although these toxicities generally are not life-threatening, the chest wall and ribs are considered dose-limiting tissues because of the potential effect on patients׳ quality of life. Few studies have reported dose-response models that can provide quantitative estimates of risk as a function of dose and volume. Notably, Memorial Sloan Kettering Cancer Center (Mutter et al8) analyzed grade 2 or higher chest wall toxicity in a cohort of 126 patients treated with linear accelerator–based SBRT; the...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Frank Kimsey, Jesse McKay, Jeffrey Gefter, Michael T. Milano, Vitali Moiseenko, Jimm Grimm, Ronald Berg Source Type: research

Multisession Radiosurgery for Hearing Preservation
Clinically relevant dose-tolerance limits with reliable estimates of risk in 1-5 fractions for cochlea are still unknown. Timmerman׳s limits from the October 2008 issue of Seminars in Radiation Oncology have served as the basis for clinical practice, augmented by updated constraints in TG-101 and QUANTEC, but the corresponding estimates of risk have not yet been well-reported. A total of 37 acoustic neuroma CyberKnife cases from Medstar Georgetown University Hospital treated in 3 or 5 fractions were combined with single-fraction Gamma Knife data from the 69 cases in Timmer 2009 to form an aggregate dataset of 106 cochlea ...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Abdul Rashid, Sana D. Karam, Beenish Rashid, Jeffrey H. Kim, Dalong Pang, Walter Jean, Jimm Grimm, Sean P. Collins Source Type: research

Introduction and Clinical Overview of the DVH Risk Map
Radiation oncologists need reliable estimates of risk for various fractionation schemes for all critical anatomical structures throughout the body, in a clinically convenient format. Reliable estimation theory can become fairly complex, however, and estimates of risk continue to evolve as the literature matures. To navigate through this efficiently, a dose-volume histogram (DVH) Risk Map was created, which provides a comparison of radiation tolerance limits as a function of dose, fractionation, volume, and risk level. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Sucha O. Asbell, Jimm Grimm, Jinyu Xue, Meng-Sang Chew, Tamara A. LaCouture Source Type: research

Esophageal Dose Tolerance in Patients Treated With Stereotactic Body Radiation Therapy
Mediastinal critical structures such as trachea, bronchus, esophagus, and heart are among the dose-limiting factors for stereotactic body radiation therapy (SBRT) to central lung lesions. The purpose of this study was to characterize the risk of esophagitis for patients treated with SBRT and to develop a statistical dose-response model to assess the equivalent uniform dose, D10%, D5cc, D1cc, and Dmax, to the esophagus and the risk of toxicity. Toxicity outcomes of a dose-escalation study of 56 patients who had taken CyberKnife treatment from 45-60Gy in 3-7 fractions at the Erasmus MC-Daniel den Hoed Cancer Center were util...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Joost J. Nuyttens, Vitali Moiseenko, Mark McLaughlin, Sheena Jain, Scott Herbert, Jimm Grimm Source Type: research

Toxicities Following Stereotactic Ablative Radiotherapy Treatment of Locally-Recurrent and Previously Irradiated Head and Neck Squamous Cell Carcinoma
Stereotactic ablative radiotherapy (SABR) with concomitant cetuximab is an effective treatment option for previously irradiated, locally recurrent squamous cell carcinoma of the head and neck. Its local control and overall survival are similar to those of other available treatment options. Each retreatment depends heavily on the prior treatment and every patient is a special case. Based on the experience of our institution and previously published studies, for patients who receive concomitant cetuximab with a median prior radiation therapy dose of 70Gy, we recommend a total dose of 40-44Gy delivered in 5 fractions on alter...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Kimmen Quan, Karen M. Xu, Yongqian Zhang, David A. Clump, John C. Flickinger, Ron Lalonde, Steven A. Burton, Dwight E. Heron Source Type: research

Dose-Response Modeling of the Visual Pathway Tolerance to Single-Fraction and Hypofractionated Stereotactic Radiosurgery
Patients with tumors adjacent to the optic nerves and chiasm are frequently not candidates for single-fraction stereotactic radiosurgery (SRS) due to concern for radiation-induced optic neuropathy. However, these patients have been successfully treated with hypofractionated SRS over 2-5 days, though dose constraints have not yet been well defined. We reviewed the literature on optic tolerance to radiation and constructed a dose-response model for visual pathway tolerance to SRS delivered in 1-5 fractions. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Susan M. Hiniker, Leslie A. Modlin, Clara Y. Choi, Banu Atalar, Kira Seiger, Michael S. Binkley, Jeremy P. Harris, Yaping Joyce Liao, Nancy Fischbein, Lei Wang, Anthony Ho, Anthony Lo, Steven D. Chang, Griffith R. Harsh, Iris C. Gibbs, Steven L. Hancock, Source Type: research

Small Bowel Dose Tolerance for Stereotactic Body Radiation Therapy
Inconsistencies permeate the literature regarding small bowel dose tolerance limits for stereotactic body radiation therapy (SBRT) treatments. In this review, we organized these diverse published limits with MD Anderson at Cooper data into a unified framework, constructing the dose-volume histogram (DVH) Risk Map, demonstrating low-risk and high-risk SBRT dose tolerance limits for small bowel. Statistical models of clinical data from 2 institutions were used to assess the safety spectrum of doses used in the exposure of the gastrointestinal tract in SBRT; 30% of the analyzed cases had vascular endothelial growth factor inh...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Tamara A. LaCouture, Jinyu Xue, Gopal Subedi, Qianyi Xu, Justin T. Lee, Gregory Kubicek, Sucha O. Asbell Source Type: research

Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord
A literature review of more than 200 stereotactic body radiation therapy spine articles from the past 20 years found only a single article that provided dose-volume data and outcomes for each spinal cord of a clinical dataset: the Gibbs 2007 article (Gibbs et al, 20071), which essentially contains the first 100 stereotactic body radiation therapy (SBRT) spine treatments from Stanford University Medical Center. The dataset is modeled and compared in detail to the rest of the literature review, which found 59 dose tolerance limits for the spinal cord in 1-5 fractions. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Jimm Grimm, Arjun Sahgal, Scott G. Soltys, Gary Luxton, Ashish Patel, Scott Herbert, Jinyu Xue, Lijun Ma, Ellen Yorke, John R. Adler, Iris C. Gibbs Source Type: research

Dose Tolerance for Stereotactic Body Radiation Therapy
Normal tissue complication probability (NTCP) results were detailed in the July 2001 issue of Seminars in Radiation Oncology1 for conventionally fractionated radiation therapy. After 7 years, an extensive collection of stereotactic ablative body radiotherapy (SABR) or stereotactic body radiation therapy (SBRT) dose-tolerance limits was presented in the October 2008 issue of Seminars in Radiation Oncology,2 but estimates of risk were not yet available. We now have sufficient data to combine the 2: NTCP for SBRT. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Jimm Grimm Source Type: research

Dose-Volume Histogram Analysis of Stereotactic Body Radiotherapy Treatment of Pancreatic Cancer: A Focus on Duodenal Dose Constraints
Pancreatic carcinoma is an aggressive disease and radiotherapy treatment delivery to the primary tumor is constrained by the anatomical close location of the duodenum, stomach, and small bowel. Duodenal dose tolerance for radiosurgery in 2-5 fractions has been largely unknown. The literature was surveyed for quantitative models of risk in 1-5 fractions and we analyzed our own patient population of 44 patients with unresectable pancreatic tumors who received 3 or 5 fractions of stereotactic body radiotherapy (SBRT) between March 2009 and March 2013. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Christy Goldsmith, Patricia Price, Timothy Cross, Sheila Loughlin, Ian Cowley, Nicholas Plowman Source Type: research