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A Review of Advances in Radiotherapy in the Setting of Esophageal Cancers
Esophageal cancer is the eighth most common cancer worldwide and is the sixth most common cause of cancer-related mortality. The paradigm has shifted to include a multimodality approach with surgery, chemotherapy, targeted therapy (including immunotherapy), and radiation therapy. Advances in radiotherapy through techniques such as intensity modulated radiotherapy and proton beam therapy have allowed for the more dose homogeneity and improved organ sparing. In addition, recent studies of targeted therapies and predictive approaches in patients with locally advanced disease provide clinicians with new approaches to modify mu...
Source: Surgical Oncology Clinics of North America - May 13, 2023 Category: Surgery Authors: Joshua Cinicola, Swati Mamidanna, Nikhil Yegya-Raman, Kristen Spencer, Matthew P. Deek, Salma K. Jabbour Source Type: research

Advances in Radiotherapy
SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 13, 2023 Category: Surgery Authors: Terence M. Williams Source Type: research

Copyright
ELSEVIER (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 13, 2023 Category: Surgery Source Type: research

Contributors
TIMOTHY M. PAWLIK, MD, MPH, PhD, FACS, FRACS (Hon.) (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 13, 2023 Category: Surgery Source Type: research

Contents
Timothy M. Pawlik (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 13, 2023 Category: Surgery Source Type: research

Forthcoming Issues
Personalizing Breast Cancer Care (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 13, 2023 Category: Surgery Source Type: research

Lasting Impacts of the COVID-19 Pandemic on Breast Cancer Diagnosis and Treatment in the United States
The COVID-19 pandemic was an unprecedented time that placed unique challenges on the screening and treatment of breast cancer in the United States. Collaboration amongst medical disciplines and societies provided guidelines and strategies to mitigate exposure of patients and medical providers to the virus and provide optimal care. We discuss the changes that the pandemic had on the multidisciplinary management of breast cancer. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 10, 2023 Category: Surgery Authors: Jenna L. Sturz, Judy C. Boughey Source Type: research

Modern Radiation for Hematologic Stem Cell Transplantation
The development of large-field intensity-modulated radiation therapy (IMRT) has enabled the implementation of total marrow irradiation (TMI), total marrow and lymphoid irradiation (TMLI), and IMRT total body irradiation (TBI). IMRT TBI limits doses to organs at risk, primarily the lungs and in some cases the kidneys and lenses, which may mitigate complications. TMI/TMLI allows for dose escalation above TBI radiation therapy doses to malignant sites while still sparing organs at risk. Although still sparingly used, these techniques have established feasibility and demonstrated promise in reducing the adverse effects of TBI ...
Source: Surgical Oncology Clinics of North America - April 8, 2023 Category: Surgery Authors: Claire Hao, Colton Ladbury, Jeffrey Wong, Savita Dandapani Source Type: research

Advances in Proton Therapy for the Management of Head and Neck Tumors
Proton therapy (PBRT) is a form of external beam radiotherapy with several dosimetric advantages compared with conventional photon (x-ray) radiotherapy. Unlike x-rays, protons deposit most of their dose over a finite range, with no exit dose, in a pattern known as the Bragg peak. Clinically, this can be exploited to optimize dose to tumors while delivering a lower integral dose to normal tissues. However, the optimal role of PBRT is not as well-defined as advanced x-ray-based techniques such as intensity-modulated radiotherapy. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - April 6, 2023 Category: Surgery Authors: Jacob Trotter, Alexander Lin Source Type: research

Current State and Future Directions of Radiation Therapy for Pancreas Adenocarcinoma
Studies suggest select patients from across the pancreatic adenocarcinoma (PDAC) disease spectrum may benefit from adding radiation therapy (RT) to multi-modality care. In resectable PDAC, there is an evolving role for neoadjuvant RT with adjuvant RT reserved for patients with increased recurrence risk. In borderline resectable PDAC, neoadjuvant chemoradiation likely improves R0 resection rates and in unresectable PDAC, definitive RT may prolong survival for some patients. Recent developments in RT delivery are promising but additional studies are needed to determine the benefit of these technologies and to optimize the ro...
Source: Surgical Oncology Clinics of North America - April 4, 2023 Category: Surgery Authors: Sujana Gottumukkala, Samer Salamekh, Nina N. Sanford Source Type: research

Advances in Radiation Therapy for Primary Liver Cancer
This report reviews recent advances in radiation therapy for primary liver cancers including hepatocellular carcinoma and intrahepatic cholangiocarcinoma. First, studies focusing o n liver stereotactic body radiation therapy (SBRT) are reviewed focusing on lessons learned and knowledge gained from early pioneering trials. Then, new technologies to enhance SBRT treatments are explored including adaptive therapy and MRI-guided and biology-guided radiation therapy. Finally, treat ment with Y-90 transarterial radioembolization is reviewed with a focus on novel approaches focused on personalized therapy. (Source: Surgical Oncol...
Source: Surgical Oncology Clinics of North America - April 4, 2023 Category: Surgery Authors: Kyle C. Cuneo, Daniel J. Herr Source Type: research

Advances in Radiotherapy for Rectal Cancer
The current preferred standard of care management for patients with locally advanced rectal cancer is total neoadjuvant therapy, in which all chemotherapy and radiotherapy is delivered before surgery. Within this approach, developed in response to persistently high distant failure rates despite excellent local control with preoperative chemoradiotherapy, there remains questions regarding the optimal radiotherapy regimen (short course vs long course) and sequencing of chemotherapy (induction vs consolidation). (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - April 4, 2023 Category: Surgery Authors: Timothy Lin, Amol Narang Source Type: research

The Emerging Role of Radiotherapy in Oligoprogressive Non-Small Cell Lung Cancer
Oligoprogressive disease (OPD) is an emerging concept that describes patients who have progression of disease in a limited number of metastatic sites while on systemic therapy. Growing evidence has suggested the integration of local ablative therapy with systemic agents in patients with OPD further improves survival. In oligoprogressive non-small cell lung cancer, stereotactic body radiotherapy may have an important role in the effective local control of selective progressing metastases, which may translate to better patient outcomes. This review explores the treatment paradigm of this subset of patients and provides an up...
Source: Surgical Oncology Clinics of North America - April 4, 2023 Category: Surgery Authors: Andrew Tam, Nicholas Eustace, Ari Kassardjian, Howard West, Terence Williams, Arya Amini Source Type: research

Intraoperative Radiation Therapy for Gastrointestinal Malignancies
Despite improvements in definitive therapy, many patients with gastrointestinal malignancies experience local recurrences or have unresectable disease making subsequent management often challenging and morbid. Although higher doses of radiation may offer improved local control, the ability for dose escalation of external beam radiation therapy is often limited by adjacent radiosensitive structures. Intraoperative radiation therapy allows for additional radiotherapy to be delivered directly to the tumor or areas at highest risk for local recurrence while minimizing toxicity to adjacent structures, offering potentially impro...
Source: Surgical Oncology Clinics of North America - April 4, 2023 Category: Surgery Authors: Alex R. Ritter, Eric D. Miller Source Type: research

Advances in Radiotherapy for Brain Metastases
Radiotherapy remains a cornerstone treatment of brain metastases. With new treatment advances, patients with brain metastases are living longer, and finding solutions for mitigating treatment-related neurotoxicity and improving quality of life is important. Historically, whole-brain radiation therapy (WBRT) was widely used but treatment options such as hippocampal sparing WBRT and stereotactic radiosurgery (SRS) have emerged as promising alternatives. Herein, we discuss the recent advances in radiotherapy for brain metastases including the sparing of critical structures that may improve long-term neurocognitive outcomes (e...
Source: Surgical Oncology Clinics of North America - April 4, 2023 Category: Surgery Authors: Jennifer K. Matsui, Haley K. Perlow, Rituraj Upadhyay, Aliah McCalla, Raju R. Raval, Evan M. Thomas, Dukagjin M. Blakaj, Sasha J. Beyer, Joshua D. Palmer Source Type: research