Seminars in Radiation Oncology最新文献

{"title":"Metastatic Head and Neck Cancer: Immunotherapy and Beyond","authors":"Kirsten V. Nguyen ,&nbsp;Cody M. Lebeck Lee ,&nbsp;Jennifer H. Choe","doi":"10.1016/j.semradonc.2025.02.004","DOIUrl":"10.1016/j.semradonc.2025.02.004","url":null,"abstract":"<div><div>Head and neck cancer is estimated to result in 71,000 new cancer diagnoses and 16,000 deaths in 2024. Of these cases, approximately 14% will be metastatic. Recent changes in treatment paradigms have established immunotherapy as a cornerstone of treatment in the metastatic and recurrent setting. While immunotherapy has undoubtedly improved outcomes and can lead to long term durable responses in select patients, overall response rates remain suboptimal, with approximately 13%-20% of patients responding to immunotherapy in most studies. This review aims to provide an overview of the current treatment landscape of immunotherapies in head and neck malignancies. Additionally, we aim to discuss the future of immunotherapy, as well as novel targets and therapeutic platforms that may continue to change the treatment paradigm in this disease.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 259-270"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of Head and Neck Radiotherapy: Not Your Father's Three-Field","authors":"David J. Sher MD, MPH ,&nbsp;Yvonne M. Mowery MD, PhD","doi":"10.1016/j.semradonc.2025.02.010","DOIUrl":"10.1016/j.semradonc.2025.02.010","url":null,"abstract":"","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 141-142"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Radiation Resistance and Novel Radiation Sensitizers in Head and Neck Cancers: Advancing Radiotherapy Efficacy","authors":"Aastha Sobti,&nbsp;Heath Skinner,&nbsp;Christopher T. Wilke","doi":"10.1016/j.semradonc.2025.02.008","DOIUrl":"10.1016/j.semradonc.2025.02.008","url":null,"abstract":"<div><div>Radiation resistance in head and neck squamous cell carcinoma (HNSCC), driven by intrinsic and extrinsic factors, poses a significant challenge in radiation oncology. The key contributors are tumor hypoxia, cancer stem cells, cell cycle checkpoint activation, and DNA repair processes (homologous recombination and non-homologous end-joining). Genetic modifications such as <em>TP53</em> mutations, <em>KRAS</em> mutations, EGFR overexpression, and abnormalities in DNA repair proteins like BRCA1/2 additionally affect radiation sensitivity.</div><div>Novel radiosensitizers targeting these pathways demonstrate the potential to overcome resistance. Hypoxia-activated drugs and gold nanoparticles enhance the efficacy of radiotherapy and facilitate targeted distribution. Integrating immunotherapy, especially immune checkpoint inhibitors, with radiation therapy, enhances anti-tumor responses and reduces resistance. Epigenetic alterations, such as DNA methylation and histone acetylation, significantly influence radiation response, with the potential for sensitization through histone deacetylase inhibitors and non-coding RNA regulators. Metabolic changes linked to glucose, lipid, and glutamine metabolism influence radiosensitivity, uncovering new targets for radiosensitization. Human papillomavirus (HPV)-associated malignancies exhibit increased radiosensitivity relative to other tumors due to impaired DNA repair mechanisms and heightened immunogenicity. Furthermore, understanding the interplay between HPV oncoproteins and p53 functionality can enhance treatment strategies for HPV-related cancers. Using DNA damage response inhibitors (PARP, ATM/ATR), cell cycle checkpoint inhibitors (WEE1, CHK1/2), and hypoxia-targeted agents as radiosensitizing strategies exhibit considerable promise. Immunomodulatory approaches, including PD-1 and CTLA-4 inhibitors in conjunction with radiation, enhance anti-tumor immunity.</div><div>Future directions emphasize personalized radiation therapy using genetics, sophisticated medication delivery systems, adaptive radiotherapy, and real-time monitoring. These integrated strategies seek to diminish radiation resistance and improve therapeutic efficacy in HNSCC.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 224-242"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head and Neck Cancer of Unknown Primary: A Surgical Perspective","authors":"Michael S. Chow ,&nbsp;Umamaheswar Duvvuri","doi":"10.1016/j.semradonc.2025.02.007","DOIUrl":"10.1016/j.semradonc.2025.02.007","url":null,"abstract":"<div><div>Head and neck squamous cell carcinoma of unknown primary (SSCUP) presents a clinically challenge disease process requiring elaborate multidisciplinary collaboration for effective treatment. With the rise in prevalence HPV associated squamous cell carcinoma, it has become the predominant etiology SCCUP of the head and neck. Advances in the diagnostic evaluation and treatment of SCCUP have led to higher detection rates of primary lesions, improved disease-free and overall survival outcomes, and reduced morbidity for patients. Furthermore, delineation of the molecular implications of HPV positivity and disease behavior has opened avenues for successful de-escalation of treatment. Transoral robotic surgery (TORS), as well as dose reduction protocols show significant promise for oncologic efficacy with minimization of treatment related morbidity.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 207-213"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Survivorship Paradigms in Head/Neck Cancer","authors":"Maria Armache ,&nbsp;Alexis Larson ,&nbsp;Rachel Stemme ,&nbsp;Callie Walsh-Bailey ,&nbsp;Kelli Scott ,&nbsp;Timothy Pearman ,&nbsp;Katelyn O. Stepan ,&nbsp;Michelle L. Mierzwa ,&nbsp;Leila J. Mady ,&nbsp;Laila A. Gharzai","doi":"10.1016/j.semradonc.2025.02.003","DOIUrl":"10.1016/j.semradonc.2025.02.003","url":null,"abstract":"<div><div>Long<strong>-</strong>term care for head and neck cancer (HNC) survivors is complex. Despite an improvement in survival and the evolution of treatment paradigms (de-escalation, targeted therapy), notably in the context of human papillomavirus (HPV)-related oropharyngeal cancers, HNC survivors still experience a wide range of side effects and needs, which impact their functionality, quality of life, survival and require concerted, coordinated survivorship care. In this review, we perform an overview of existing HNC survivorship recommendations within the context of novel evidence, our current understanding of survivorship care, and incorporate them into the Nekhluydov Survivorship Care Framework. This framework provides a novel way to appreciate and comprehensively address all aspects of HNC survivorship care. Further research is crucial to develop evidence-based, patient-centered personalized approaches to survivorship care in different HNC populations and understand barriers to successful implementation.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 285-300"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contemporary spectrum of radiotherapy for hematologic malignancies involving the central nervous system: From focal therapy to craniospinal","authors":"Gustav Y. Cederquist ,&nbsp;Kathryn Tringale ,&nbsp;Joachim Yahalom ,&nbsp;Brandon S. Imber","doi":"10.1016/j.semradonc.2024.11.001","DOIUrl":"10.1016/j.semradonc.2024.11.001","url":null,"abstract":"<div><div>The contemporary landscape of systemic therapy options for hematologic malignancies involving the central nervous system (CNS-HM) is rapidly evolving; a key question is how radiotherapy (RT) can be optimally integrated to improve patient outcomes. Historically, use of RT to treat CNS-HM was defined by broad fields and high doses. While effective, this approach raised concerns of potential neurotoxicity which significantly decreased RT utilization. RT was replaced by high-dose, CNS-penetrant, systemic therapies that offered durable control with lower perceived neurotoxic risk. But, as the therapeutic toolbox for CNS-HM expands, so too does the complexity and diversity of potential clinical scenarios where RT should be considered. In this review, we describe both well-established and emerging opportunities for RT integration, emphasizing how dose selection and field design could balance neurotoxicity risk and disease control. We propose an anatomical framework that captures the diverse utilization of RT for CNS-HM and serves as a practical guide for RT volume and dose design.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 126-137"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating Between Radiation Dose and Late Toxicity for Lymphoma Survivors: Implications on Toxicity Counseling and Survivorship","authors":"David J. Cutter ,&nbsp;Berthe M.P. Aleman","doi":"10.1016/j.semradonc.2024.08.004","DOIUrl":"10.1016/j.semradonc.2024.08.004","url":null,"abstract":"<div><div>Radiation therapy (RT) is an important modality in the modern management of lymphoma. RT has long been recognized as a cause of late toxicity in lymphoma survivors, including serious morbidity and increased mortality from second cancers and cardiovascular disease. Many studies have quantified the relationships between radiation dose to normal tissues and the risk of late toxicities. These relationships offer the opportunity to estimate future risks for patients on an individual basis. This knowledge has the potential to effect up-front management decisions regarding the use of RT, optimize radiotherapy planning for treatment, guide the evolution of future RT technologies and identify past and future patients whose risk of late toxicity is sufficient to warrant specific screening and surveillance strategies. Despite these potential applications the challenges around translating between radiation dose and accurate predictions of late toxicities are many and substantial. This article summarizes the current state of knowledge, the inherent challenges and possible directions for future research to address this area.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 27-39"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation as an Immune Modulator: Where We Are With Modern Total Body Irradiation","authors":"Eric Simiele ,&nbsp;Savita Dandapani ,&nbsp;Chunhui Han ,&nbsp;Jeffrey Wong ,&nbsp;Susan M. Hiniker ,&nbsp;Nataliya Kovalchuk","doi":"10.1016/j.semradonc.2024.10.003","DOIUrl":"10.1016/j.semradonc.2024.10.003","url":null,"abstract":"<div><div>Total body irradiation (TBI) has been an important component of myeloablative and nonmyeloablative conditioning regimens for allogeneic hematopoietic stem cell transplantation (HSCT) for decades. Playing a dual role, both cytotoxic and immuno-suppressive, TBI eliminates residual disease while also impairing the immune system from rejecting the foreign donor cells being transplanted. Unlike chemotherapy, radiotherapy is not hampered by perfusion, diffusion, or the blood-barrier effect and can effectively treat sanctuary sites. However, radiotherapy is subject to radiobiological trade-offs between destroying cancer cells, preserving immune and hematopoietic stem cells, and causing various adverse effects in normal tissue. Optimizing the immuno- suppressive effect of fractionated TBI while sparing normal organs requires careful consideration of total dose, dose per fraction, dose rate, target dose coverage, and dose to organs. Prospective multi-institutional trials are required to elucidate this matter further. However, as various recent surveys across the world indicate, the heterogeneity of 2D TBI practices, inaccurate dose calculation and dosimetry, and differences in reporting across institutions makes conducting these multi-institutional studies of TBI challenging. Technological advancements in radiotherapy planning and delivery are prompting a transition to modern intensity modulated techniques such as Volumetric Modulated Arc Therapy (VMAT) TBI and helical TomoTherapy^TM TBI, which can better spare normal organs and potentially reduce radiotherapy-related toxicities without compromising TBI effectiveness. This review discusses the present developments and outcomes and toxicity for modern TBI techniques as well as total marrow irradiation (TMI), and total marrow and lymphoid irradiation (TMLI).</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 67-86"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Stage Hodgkin and Diffuse Large B-Cell Lymphomas: Is There Still a Role for Consolidation Radiotherapy in the PET Era?","authors":"Mario Levis ,&nbsp;Michael Oertel","doi":"10.1016/j.semradonc.2024.07.013","DOIUrl":"10.1016/j.semradonc.2024.07.013","url":null,"abstract":"<div><div>The role of radiotherapy in the treatment of lymphoma is rapidly evolving. The development of modern systemic therapies and the adoption of FDG-PET-scanning as metabolic prognosticators are leading to a process of refinement of the treatment regimens. In this scenario, radiotherapy utilization is decreasing in several settings, including lower risk patients, to prevent the risk of long-term complications. Over the last decade, the most relevant changes in the treatment landscape are evident for advanced stage Hodgkin lymphoma and diffuse large B cell lymphoma. The main purpose of this paper is to review radiotherapy indications in these settings, to highlight pros and cons of a PET-guided strategy for radiotherapy recommendations, and to introduce future perspectives on the combination of radiotherapy and modern systemic therapies in both frontline and relapsed setting of advanced stage Hodgkin and diffuse large B cell lymphomas.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 16-26"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Radiotherapy in the Management of Elderly Patients With Lymphoma","authors":"Ritesh Kumar,&nbsp;Rahul R. Parikh","doi":"10.1016/j.semradonc.2024.08.003","DOIUrl":"10.1016/j.semradonc.2024.08.003","url":null,"abstract":"<div><div>Lymphoma in elderly patients has unique treatment challenges due to baseline co-morbidities, nutrition status, impairment in functional capacities and fitness. While geriatric-specific assessment can be used to tailor treatment decisions, lack of adequate representation of elderly patients in lymphoma clinical trials impairs generalizability. Radiation treatment has traditionally been associated with high response and local control for lymphomas. The volume and dose of radiation in lymphomas has gradually decreased over the decades, which has led to improved compliance and lower toxicities. The use of radiation in Hodgkin and aggressive B-cell non-Hodgkin lymphomas has allowed for reduction in the number systemic therapy cycles, which is important in elderly patients who may be at high risk for treatment-related adverse events. Current strategies include a risk-adapted approach with minimal chemo-immunotherapy followed by radiation treatment, with dose adapted by response. Here, we provide a review of the literature regarding the role of radiation in the management of elderly patients with lymphoma, especially in follicular lymphoma, diffuse large cell lymphoma and Hodgkin lymphoma.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 57-66"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}