Role of Immunotherapy in Head and Neck Cancer
Immune system dysfunction plays a role in both the development and progression of head and neck squamous cell carcinoma (HNSCC), highlighting the potential role for immunotherapy to improve outcomes in this disease. The application of anti-PD-1 therapies for recurrent or metastatic HNSCC has found promising results. This has led to interest in combining immunotherapy with radiation therapy (RT) for the primary treatment of locally advanced HNSCC. RT with concurrent cetuximab is an option for patients who are medically unfit to receive cisplatin, and ongoing trials seek to determine to role of cetuximab-RT in treatment de-i...
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Diane C. Ling, Chris J. Bakkenist, Robert L. Ferris, David A. Clump Source Type: research
Mechanisms of Normal Tissue Injury From Irradiation
Normal tissue injury from irradiation is an unfortunate consequence of radiotherapy. Technologic improvements have reduced the risk of normal tissue injury; however, toxicity causing treatment breaks or long-term side effects continues to occur in a subset of patients. The molecular events that lead to normal tissue injury are complex and span a variety of biologic processes, including oxidative stress, inflammation, depletion of injured cells, senescence, and elaboration of proinflammatory and profibrogenic cytokines. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: Deborah E. Citrin, James B. Mitchell Source Type: research
Radiation-Induced Liver Toxicity
The advent of highly conformal radiation therapy (RT) has defined a new role for RT in the treatment of both primary and metastatic liver cancer. Despite major advances in how RT is delivered, radiation-induced liver disease (RILD) remains a concern. Classic RILD, characterized by anicteric ascites and hepatomegaly, is unlikely to occur if treating to doses of ≤30Gy in 2Gy per fraction in patients with baseline Child-Pugh A liver function. On the other hand, nonclassic RILD is a spectrum of liver toxicity, including a general decline in liver function and elevation of liver enzymes. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: Pablo Munoz-Schuffenegger, Sylvia Ng, Laura A. Dawson Source Type: research
Functional Assays for Individual Radiosensitivity: A Critical Review
This article is a critical review devoted to the major functional assays to predict radiosensitivity and their strengths and weaknesses, notably those based on the quantification of clonogenic cell survival, micronuclei, p21 expression, apoptosis, chromosome and DNA repair, and signaling. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: M élanie L. Ferlazzo, Michel Bourguignon, Nicolas Foray Source Type: research
Imaging Radiation-Induced Normal Tissue Injury to Quantify Regional Dose Response
Noninvasive imaging has and will continue to play a pivotal role in the assessment of radiation-induced normal tissue toxicity. In this review, we will examine key literature regarding the use of anatomic and physiological imaging in relation to radiation-induced normal tissue toxicity. Additionally, this review contains a novel methodology for potentially incorporating dose-response data into treatment planning and normal tissue toxicity modeling. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: David V. Fried, Shiva K. Das, Lawrence B. Marks Source Type: research
Radiogenomics: Identification of Genomic Predictors for Radiation Toxicity
The overall goal of radiogenomics is the identification of genomic markers that are predictive for the development of adverse effects resulting from cancer treatment with radiation. The principal rationale for a focus on toxicity in radiogenomics is that for many patients treated with radiation, especially individuals diagnosed with early-stage cancers, the survival rates are high, and therefore a substantial number of people will live for a significant period of time beyond treatment. However, many of these patients could suffer from debilitating complications resulting from radiotherapy. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: Barry S. Rosenstein Tags: Articles Source Type: research
Radiation Toxicity in the Central Nervous System: Mechanisms and Strategies for Injury Reduction
The potential for radiation-induced toxicities in the brain produces significant anxiety, both among patients receiving radiation therapy and those radiation oncologists providing treatment. These concerns often play a significant role in the medical decision-making process for most patients with diseases in which radiotherapy may be a treatment consideration. Although the precise mechanisms of neurotoxicity and neurodegeneration after ionizing radiation exposure continue to be poorly understood from a biological perspective, there is an increasing body of scientific and clinical literature that is producing a better under...
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: DeeDee Smart Source Type: research
Emphasis on Repair, Not Just Avoidance of Injury, Facilitates Prudent Stereotactic Ablative Radiotherapy
Stereotactic ablative radiotherapy (SAbR) is a potent, hypofractionated treatment against cancer which puts adjacent normal tissue in potential peril. Accurate delineation of normal tissue injury risks from SAbR has been challenging, and lack of clear understanding of SAbR tolerance continues to limit its potential. In this review, we contend that SAbR effects on normal tissue could be akin to a surgical “wound,” and that adequate wound repair of organs at risk is an essential component of effective SAbR therapy. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: D.W. Nathan Kim, Paul M. Medin, Robert D. Timmerman Source Type: research
Management of Radiation Toxicity in Head and Neck Cancers
Head and neck cancers account for approximately 3% of all cancers in the United States with 62,000 new cases diagnosed annually. The global incidence is approximately 700,000 new cases a year. There has also been a recent increase in human papilloma virus –related oropharyngeal cancers. External beam radiation therapy (RT) is commonly used as an effective therapy for head and neck (H&N) cancers. This is used as a definitive treatment (alone or in combination with chemotherapy) or as an adjuvant treatment after surgical resection of the tumors. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: Farzan Siddiqui, Benjamin Movsas Tags: Articles Source Type: research
Thoracic Radiation Normal Tissue Injury
Thoracic malignancies are often a difficult group of tumors to treat definitively as the radiation doses needed to achieve a high probability for tumor control are often associated with high rates of radiation-induced toxicities. The lungs are particularly radiosensitive and are susceptible to radiation pneumonitis in the acute and subacute settings and pulmonary fibrosis in the late setting. Acute esophagitis is common and affects patient quality of life. Beyond acute pericarditis, late cardiac toxicities are increasingly being recognized as clinically relevant when delivering thoracic radiotherapy and can affect overall ...
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: Charles B. Simone Source Type: research
Pelvic Radiation and Normal Tissue Toxicity
Radiation is a component of treatment for many pelvic malignancies, most often originating in the gynecologic, gastrointestinal, and genitourinary systems. Therefore, the management of acute and long-term side effects is an important part of practice as a radiation oncologist, and limiting morbidity is a primary goal. Toxicities vary and are dependent on treatment techniques. Advances in radiation delivery, imaging, and knowledge of underlying biologic determinants of radiation-induced normal tissue toxicity can guide treatment of acute and long-term side effects from pelvic radiation. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: Sarah Nicholas, Linda Chen, Amanda Choflet, Amanda Fader, Zachary Guss, Sarah Hazell, Daniel Y. Song, Phuoc T. Tran, Akila N. Viswanathan Source Type: research
Introduction
Technological advancements in Radiation Oncology have occurred at an impressive pace over the past few decades, fundamentally altering the practice of radiotherapy. The development of modern imaging modalities has enhanced our certainty of tumor location and extent. Simultaneously, radiation treatment delivery has undergone a revolution of conformality spurred by techniques such as intensity-modulated radiation therapy, image-guided radiation therapy, and proton therapy. The proliferation of these techniques into clinical practice has not only led to enhanced certainty of the accuracy of daily tumor targeting, but has also...
Source: Seminars in Radiation Oncology - September 1, 2017 Category: Cancer & Oncology Authors: Deborah E. Citrin Source Type: research
Normal Tissue Constraints for Abdominal and Thoracic Stereotactic Body Radiotherapy
This article reviews the modern toxicity literature and provides updated clinically practical and useful recommendations of SBRT dose constraints for extracranial sites. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - June 1, 2017 Category: Cancer & Oncology Authors: Erqi L. Pollom, Alexander L. Chin, Maximilian Diehn, Billy W. Loo, Daniel T. Chang Source Type: research
Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma
Stereotactic Body Radiation Therapy (SBRT) is an emerging effective treatment for hepatocellular carcinoma (HCC) associated with acceptable rates of toxicity in appropriately selected patients. Despite often being reserved for patients unsuitable for other local treatments, prospective and retrospective studies have demonstrated excellent long-term control. SBRT may be used as a stand-alone treatment, or as an adjunct to other HCC therapies. Based on available data, SBRT appears to complement existing local liver therapies. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - June 1, 2017 Category: Cancer & Oncology Authors: Louise J. Murray, Laura A. Dawson Source Type: research
Safety Considerations in Stereotactic Body Radiation Therapy
Although many error pathways are common to both stereotactic body radiation therapy (SBRT) and conventional radiation therapy, SBRT presents a special set of challenges including short treatment courses and high-doses, an enhanced reliance on imaging, technical challenges associated with commissioning, special resource requirements for staff and training, and workflow differences. Emerging data also suggest that errors occur at a higher rate in SBRT treatments. Furthermore, when errors do occur they often have a greater effect on SBRT treatments. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - June 1, 2017 Category: Cancer & Oncology Authors: Eric Ford, Sonja Dieterich Source Type: research
