Radiation Therapy Oncology Group 9802: Controversy or Consensus in the Treatment of Newly Diagnosed Low-Grade Glioma?
Treatment of newly diagnosed or suspected low-grade glioma (LGG) is one of the most controversial areas in neuro-oncology. The heterogeneity of these tumors, concern regarding morbidity of treatment, and absence of proven overall survival benefit from any known treatment have resulted in a lack of consensus regarding the timing and extent of surgery, timing of radiotherapy (RT), and role of chemotherapy. The long-term results of Radiation Therapy Oncology Group (RTOG) 9802, a phase III randomized trial comparing RT alone with RT and 6 cycles of adjuvant procarbazine, CCNU, vincristine (PCV), demonstrated an unprecedented 5...
Source: Seminars in Radiation Oncology - June 5, 2015 Category: Cancer & Oncology Authors: Nadia N. Laack, Jann N. Sarkaria, Jan C. Buckner Source Type: research
Neurocognitive Function Following Therapy for Low-Grade Gliomas
Low-grade gliomas (LGGs) are a heterogenous group of primary brain neoplasms that most commonly occur in children and young adults, characterized by a slow, indolent course and overall favorable prognosis. Standard therapies used to treat LGGs have included surgical resection, radiotherapy, chemotherapy, or a combination thereof. Given the anticipated long survival and typical young age of patients with LGG, the long-term sequelae of therapy require special attention, especially as they affect neurocognitive function and quality of life. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - June 5, 2015 Category: Cancer & Oncology Authors: Mary Frances McAleer, Paul D. Brown Source Type: research
Molecular Markers in Low-Grade Glioma—Toward Tumor Reclassification
Low-grade diffuse gliomas are a heterogeneous group of primary glial brain tumors with highly variable survival. Currently, patients with low-grade diffuse gliomas are stratified into risk subgroups by subjective histopathologic criteria with significant interobserver variability. Several key molecular signatures have emerged as diagnostic, prognostic, and predictor biomarkers for tumor classification and patient risk stratification. In this review, we discuss the effect of the most critical molecular alterations described in diffuse (IDH1/2, 1p/19q codeletion, ATRX, TERT, CIC, and FUBP1) and circumscribed (BRAF-KIAA1549, ...
Source: Seminars in Radiation Oncology - June 5, 2015 Category: Cancer & Oncology Authors: Adriana Olar, Erik P. Sulman Source Type: research
Advances in the Surgical Management of Low-Grade Glioma
Over the past 2 decades, extent of resection has emerged as a significant prognostic factor in patients with low-grade gliomas (LGGs). Greater extent of resection has been shown to improve overall survival, progression-free survival, and time to malignant transformation. The operative goal in most LGG cases is to maximize extent of resection, while avoiding postoperative neurologic deficits. Several advanced surgical techniques have been developed in an attempt to better achieve maximal safe resection. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - June 5, 2015 Category: Cancer & Oncology Authors: Todd Hollon, Shawn L. Hervey-Jumper, Oren Sagher, Daniel A. Orringer Source Type: research
Indications for Treatment: Is Observation or Chemotherapy Alone a Reasonable Approach in the Management of Low-Grade Gliomas?
The treatment of newly diagnosed low-grade gliomas remains controversial. Recently published results from the long-term follow-up of Radiation Therapy Oncology Group (RTOG) trial 9802 demonstrated medically meaningful and statistically significant survival prolongation by adding chemotherapy with procarbazine, lomustine (CCNU), and vincristine after radiotherapy (RT) vs RT alone for “high”-risk patients (median 13.3 vs 7.8 years, hazard ratio = 0.59, P = 0.03). However, in the 17 years since that trial was launched, there have been advances in the understanding of low-grade gliomas biology and patient heterogeneity, an...
Source: Seminars in Radiation Oncology - June 5, 2015 Category: Cancer & Oncology Authors: Lauren R. Schaff, Andrew B. Lassman Source Type: research
Clinical Management of Seizures in Patients With Low-Grade Glioma
Seizures, transient disruptions of normal brain electrical activity, are common for patients with low-grade glioma (LGG) and significantly affect quality of life. Up to 75% of patients with a LGG will have seizures in the course of their disease (compared with 1%-2% of the general population). Depending on the type of abnormal electrical activity, the functional implications of seizure can impact any domain, including mental status, sensation or strength. In most cases, either the seizure or the medications used to treat the seizure may contribute to cognitive and psychosocial difficulties of various degrees of severity. (...
Source: Seminars in Radiation Oncology - June 5, 2015 Category: Cancer & Oncology Authors: Anna F. Piotrowski, Jaishri Blakeley Source Type: research
Introduction
In this issue of Seminars in Radiation Oncology, we survey the recent advances in the biology and treatment of low-grade gliomas. Recent developments in the treatment of low-grade gliomas such as those that follow from the updates to the randomized clinical trial Radiation Therapy Oncology Group (RTOG) 98-021 are practice-changing. The following articles offer insight into the reasoning and the data in support of current treatment options, novel therapies, and future trends. In doing so, the articles highlight a common theme: the need for a multidisciplinary treatment approach to low-grade gliomas. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - June 5, 2015 Category: Cancer & Oncology Authors: Christina Tsien Source Type: research
International Patterns of Radiotherapy Practice for Non–Small Cell Lung Cancer
Radiotherapy is an important treatment modality for non–small cell lung cancer (NSCLC). There are models of radiotherapy utilization that estimate the proportion of patients with NSCLC who have an evidence-based indication for radiotherapy. These estimates range from 46%-68% for radiotherapy utilization at diagnosis and 64%-75% overall. However, actual radiotherapy utilization throughout much of the world is lower than this, ranging from 28%-53%, with the largest differences between actual and estimated radiotherapy utilization seen in stage III NSCLC. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 14, 2015 Category: Cancer & Oncology Authors: Shalini K. Vinod Source Type: research
Intensity-Modulated Radiotherapy, Not 3 Dimensional Conformal, Is the Preferred Technique for Treating Locally Advanced Lung Cancer
This article summarizes these strategies and reviews published findings supporting the safety and efficacy of IMRT for lung cancer. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 14, 2015 Category: Cancer & Oncology Authors: Joe Y. Chang Source Type: research
Superiority of Concomitant Chemoradiation Over Sequential Chemoradiation in Inoperable, Locally Advanced Non–Small Cell Lung Cancer: Challenges in the Selection of Appropriate Chemotherapy
Treatment of inoperable, locally advanced non–small cell lung cancer (LA-NSCLC) is challenging and requires a multidisciplinary approach considering both local therapy and systemic therapy. Based on the results from several phase III studies and 2 meta-analyses, the use of concomitant chemoradiation therapy (ChRT) could significantly improve overall survival and is considered the standard of care in LA-NSCLC with good performance status. Currently, no evidence has shown a significant survival benefit of third-generation regimens applied in combination with ChRT compared with second-generation regimens. (Source: Seminars ...
Source: Seminars in Radiation Oncology - March 14, 2015 Category: Cancer & Oncology Authors: Nan Bi, Luhua Wang Source Type: research
Intensity-Modulated Radiotherapy, Not 3 Dimensional Conformal, Is the Preferred Technique for Treating Locally Advanced Disease With High-Dose Radiotherapy: The Argument Against
Intensity-modulated radiotherapy (IMRT) allows the delivery of high-dose radiotherapy to target volumes, while sparing adjacent normal tissues. This has been mooted as a method of treating larger and otherwise untreatable lung cancers or of escalating radiotherapy doses. The possibility of achieving these aims has been confirmed in many planning studies, but there is little supporting clinical data. No randomized trial has compared conformal and IMRT, few studies have reported the late outcomes of IMRT, and there is no evidence for improved control of lung cancer with increased radiation dose. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 14, 2015 Category: Cancer & Oncology Authors: Allan Price Source Type: research
To SABR or Not to SABR? Indications and Contraindications for Stereotactic Ablative Radiotherapy in the Treatment of Early-Stage, Oligometastatic, or Oligoprogressive Non–Small Cell Lung Cancer
Stereotactic ablative radiotherapy (SABR) is a highly effective treatment for early-stage non–small cell lung cancer. Although direct comparisons from randomized trials are not available, rates of both primary tumor control and distant metastasis are similar between SABR and surgery. Overall survival is lower after SABR compared with surgery, largely reflecting that a primary selection criterion for SABR has been medical inoperability because of decreased cardiopulmonary function and other comorbidities that lead to decreased survival independent of non–small cell lung cancer. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 14, 2015 Category: Cancer & Oncology Authors: David Benjamin Shultz, Maximilian Diehn, Billy W. Loo Tags: Invited Review Source Type: research
Hypoxia as a Cause of Treatment Failure in Non–Small Cell Carcinoma of the Lung
Hypoxia is an important factor in tumor biology and is both a predictive and a prognostic factor in non–small cell lung cancer. The negative effect of low oxygenation on radiation therapy effect has been known for decades, but more recent research has emphasized that hypoxia also has a profound effect on a tumor’s aggression and metastatic propensity. In this review, current knowledge on both these aspects of treatment failure in NSCLC due to hypoxia has been discussed, along with a presentation of modern methods for hypoxia measurement and current therapeutical interventions to circumvent the negative effect of hypoxi...
Source: Seminars in Radiation Oncology - March 14, 2015 Category: Cancer & Oncology Authors: Odd Terje Brustugun Source Type: research
The Evolving Role of Molecular Imaging in Non–Small Cell Lung Cancer Radiotherapy
Molecular imaging with positron emission tomography (PET) has dramatically changed the management of patients with lung cancer who are treated with radiotherapy. Uptake of the most widely used PET radiopharmaceutical 18F-fluorodeoxyglucose identifies lung nodules or intrathoracic lymph nodes as likely to be malignant and frequently identifies previously unsuspected sites of malignant disease outside the thorax. Patients with non–small cell lung cancer, especially those with apparently more advanced locoregional disease to start with, are often upstaged, and this has a profound effect on their subsequent management. (Sour...
Source: Seminars in Radiation Oncology - March 14, 2015 Category: Cancer & Oncology Authors: Michael MacManus, Sarah Everitt, Rodney J. Hicks Source Type: research
Accelerated Repopulation as a Cause of Radiation Treatment Failure in Non–Small Cell Lung Cancer: Review of Current Data and Future Clinical Strategies
Despite convincing evidence that the principles of accelerated repopulation would open up additional therapeutic opportunities in the treatment of advanced-stage non–small cell lung cancer, this strategy has been generally underexplored. The implementation of accelerated radiotherapy schedules has been hampered by logistical barriers, concerns about acute toxicity, and the prioritization of integrating concurrent chemotherapy into the standard treatment platform. At present, it is unclear to what extent accelerated fractionation will influence future treatment paradigms in non–small cell lung cancer, although technical...
Source: Seminars in Radiation Oncology - March 14, 2015 Category: Cancer & Oncology Authors: Sue S. Yom Source Type: research
