Seminars in Radiation Oncology最新文献

{"title":"The Role of Radiation Therapy for Palliation of Hematologic Malignancies","authors":"Joanna C. Yang","doi":"10.1016/j.semradonc.2024.10.002","DOIUrl":"10.1016/j.semradonc.2024.10.002","url":null,"abstract":"<div><div>Palliative RT is an effective tool in management and treatment of patients with hematologic malignancies. Even relatively low doses of palliative RT can quickly and effectively relieve pain and other symptoms impairing quality of life and function. As so many diseases are represented by the umbrella term, “hematologic malignancies,” and each disease has its own natural history and prognosis, the indications for palliative RT are heterogeneous. The following review provides a discussion of when palliative RT should be considered, as well as data-supported dose/fractionation schemes, for non-cutaneous lymphomas and leukemias. It also offers a suggested approach to the patient with a hematologic malignancy requiring palliative RT.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 11-15"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822856","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 Role of Radiotherapy in Lymphoma Patients Undergoing CAR T Therapy: Past, Present, and Future","authors":"David G. Wallington ,&nbsp;Brandon S. Imber ,&nbsp;Michael Scordo ,&nbsp;Timothy J. Robinson","doi":"10.1016/j.semradonc.2024.10.005","DOIUrl":"10.1016/j.semradonc.2024.10.005","url":null,"abstract":"<div><div>Chimeric antigen receptor (CAR) T-cell receptor therapy has transformed outcomes for patients with relapsed and refractory diffuse large B-cell lymphoma (R/R DLBCL). It is currently approved in the third line for all patients and in the second line for early relapsed or primary refractory disease. Although CAR T cell therapy offers the potential for improved outcomes, its use may also include logistical delays related to referral, medical, social, and financial clearance as well as manufacturing time; more than half of patients experience disease recurrence or progression while awaiting CAR T infusion. Bridging radiotherapy, defined as radiation delivered between the decision to pursue CAR T and infusion of CAR T cells, has become an attractive option for patients who would benefit from local disease control or palliation of symptoms. Additionally, patterns of failure analyses have revealed a dominant role of local disease progression, which has fueled investigations on bridging and early salvage radiation to improve long-term outcomes in patients, particularly those with localized or high-risk disease. Several potential mechanisms by which radiation therapy may improve CAR T efficacy have been proposed that include cytoreduction, tumor debulking, neutralization of immunosuppressive hypoxic and acidic tumor microenvironments, and immunologic and pro-apoptotic synergy between radiation and CAR T. Prospective clinical trials and translational work are ongoing and are needed to inform our conceptual understanding of potential mechanisms by which radiation therapy may improve CAR T efficacy and toxicity, identify which patients may be most likely to benefit, and confirm proposed clinical benefits.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 99-109"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822869","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 Role of Radiotherapy in Hematologic Malignancies in Children, Adolescents, and Young Adults","authors":"Sarah A. Milgrom ,&nbsp;Andrea C. Lo","doi":"10.1016/j.semradonc.2024.07.011","DOIUrl":"10.1016/j.semradonc.2024.07.011","url":null,"abstract":"<div><div>Hematologic cancers in pediatric, adolescent, and young adult populations include a diverse spectrum of malignancies. The cornerstone of treatment is multiagent chemotherapy. While radiation therapy (RT) is highly effective and played a pivotal role historically, its use has evolved. In classic HL, advancements in systemic therapy have allowed for reduced RT volumes and doses and careful patient selection. Similarly, NLPHL management has shifted toward observation after complete resection, or limited chemotherapy after incomplete resection with RT used only for partially responding disease sites. In primary mediastinal B-cell lymphoma, the role of RT is an area of active study, and treatment with chemotherapy alone has shown promise in adults. Frontline treatment of diffuse large B-cell lymphoma and Burkitt lymphoma relies on chemotherapy; evidence do not support a role for consolidative RT. In leukemia, the use of prophylactic cranial and testicular RT is declining in the setting of modern chemotherapy regimens. RT may play an important role in the salvage of relapsed/refractory lymphomas and leukemias. In addition, palliative RT is often integral to symptom relief and function preservation. Future research aims to refine risk stratification, personalize treatment approaches, and incorporate novel therapies to maintain or improve oncologic outcomes while mitigating late effects.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 47-56"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822864","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":"Radiation for Multiple Myeloma in the Era of Novel Agents: Indications, Safety, and Dose Selection","authors":"Samuel C. Zhang,&nbsp;Leslie K. Ballas","doi":"10.1016/j.semradonc.2024.10.004","DOIUrl":"10.1016/j.semradonc.2024.10.004","url":null,"abstract":"<div><div>Survival outcomes for multiple myeloma (MM) have drastically improved over the past two decades with the advent of highly effective biologic agents and integration of autologous stem cell transplant (ASCT) for select patients. Despite these advances, MM remains an incurable disease and duration of remission decreases with each relapse. Palliative radiotherapy (RT) for MM, including treatment of pain, relief of compression, and prevention of fracture, is highly effective and generally well tolerated. Though RT can be delivered concurrently with biologic agents, caution should be exercised for potential added hematologic toxicity that may disrupt systemic therapy, especially in heavily pretreated patients, who have limited bone marrow reserve. In this review, we discuss the safety of RT with biologic agents (proteasome inhibitors, immunomodulators, monoclonal antibodies), review indications for palliative RT in MM, and present a framework for how to personalize RT based on goals of treatment, classification of uncomplicated versus complicated lesions, and patient and lesion characteristics. Additionally, we discuss the emerging role of bridging RT prior to chimeric antigen receptor (CAR) T-cell therapy.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 87-98"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822806","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":"Breaking Down the Barriers for Patients With Cutaneous T-Cell Lymphoma: Current Controversies and Challenges for Radiation Oncologists in 2024","authors":"Belinda A. Campbell ,&nbsp;H. Miles Prince ,&nbsp;Karin Thursky ,&nbsp;Bouthaina Dabaja ,&nbsp;Richard Hoppe ,&nbsp;Lena Specht ,&nbsp;Stephen Morris ,&nbsp;Sandro V. Porceddu","doi":"10.1016/j.semradonc.2024.08.005","DOIUrl":"10.1016/j.semradonc.2024.08.005","url":null,"abstract":"<div><div>Cutaneous T-cell lymphomas (CTCL) are a rare collection of diseases, frequently associated with diagnostic challenges and complex management dilemmas. The multidisciplinary team is vital for accurate clinico-pathological diagnoses and for collaborative therapeutic decisions throughout the management journey, which frequently involves multiple lines of therapy. Radiotherapy (RT) is a highly effective skin-directed therapy for CTCL, commonly delivered as localised fields or as total skin electron beam therapy (TSEBT). Mycosis fungoides (MF) is the most common of the CTCL, and patients typically experience high rates of morbidity and long natural histories of relapse and progression. Patients with MF typically present with incurable disease; in these patients, RT has an established role in symptom- and disease-control, achieving excellent response rates and proven therapeutic benefits. The role of RT continues to evolve, with modern practices favouring lower doses to reduce toxicity risks and allow for re-irradiation. Less commonly, there are situations where RT has an integral role in the potential cure of patients with MF: firstly, in the setting of unilesional MF where localised RT alone may be curative, and secondly, in the setting of preconditioning prior to curative-intent allogeneic hematopoietic stem cell transplant for patients with advanced MF/Sezary syndrome, where conventional-dose TSEBT is indicated as the most effective single agent for maximal debulking of skin disease. Radiotherapy also has an important role in the management of the less common CTCL, including the curative treatment of localised primary cutaneous anaplastic large cell lymphoma. Despite proven efficacy and quality of life benefits, disparity exists in access to RT and TSEBT. World-wide, stronger multidisciplinary collaborations and greater patient advocacy are required to increase access to RT and improve equity of care for our patients with CTCL.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 110-125"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822841","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 seemingly contradictory roles of radiation as focal to systemic therapy in hematologic malignancies","authors":"Yolanda D. Tseng MD, MPhil ,&nbsp;N. George Mikhaeel MD","doi":"10.1016/j.semradonc.2024.12.001","DOIUrl":"10.1016/j.semradonc.2024.12.001","url":null,"abstract":"","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 1-3"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822872","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":"Rising to the Top: How Immune-Checkpoint Inhibitors are Changing the Landscape of Treatment for Classic Hodgkin Lymphoma","authors":"Ryan C. Lynch ,&nbsp;Michael Sargent Binkley","doi":"10.1016/j.semradonc.2024.11.002","DOIUrl":"10.1016/j.semradonc.2024.11.002","url":null,"abstract":"<div><div>Immune checkpoint inhibitors have transformed the future management of classic Hodgkin lymphoma (CHL) in the frontline and salvage settings. Both nivolumab and pembrolizumab have high efficacy in CHL allowing for reduction of chemotherapy and possibly the use of radiotherapy based on short-term follow-up. In this review article, we highlight recent trials enrolling patients with relapse and refractory classic Hodgkin lymphoma receiving monotherapy with PD-1 inhibitors as well as PD-1 and chemotherapy regimens. We also highlight frontline trials utilizing PD-1 inhibitors with chemotherapy with or without radiotherapy. Collectively, the role for radiotherapy in the frontline or salvage setting will become more defined with long-term follow-up of completed studies and results generated from future studies.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 40-46"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822809","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":"Modern Treatment Delivery of Radiotherapy for Lymphomas and Leukemias: Making Every Gy Count","authors":"Chirayu G. Patel ,&nbsp;Pierre Loap ,&nbsp;Youlia M. Kirova","doi":"10.1016/j.semradonc.2024.10.001","DOIUrl":"10.1016/j.semradonc.2024.10.001","url":null,"abstract":"<div><div>Radiotherapy has a long history in the treatment of lymphoma and leukemia, in which late toxicity outcomes have motivated current goals to improve how radiotherapy is delivered. Contemporary advanced radiotherapy techniques, including intensity modulated radiation therapy (IMRT), proton therapy, deep inspiration breath hold (DIBH), aim to reduce the risk of cardiac morbidity and second cancers caused by radiotherapy while maintaining local control. We use treatment of mediastinal and gastric lymphomas to introduce how modern techniques are chosen for optimal dose delivery, followed by an anatomic site-specific discussion of testicular, bone, and central nervous system disease.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 4-10"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822845","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":"Future of Multidisciplinary Team in the Context of Adaptive Therapy","authors":"H.A. McNair PhD ,&nbsp;M.F. Milosevic MD ,&nbsp;P.J. Parikh MD ,&nbsp;U.A. van der Heide PhD","doi":"10.1016/j.semradonc.2024.08.006","DOIUrl":"10.1016/j.semradonc.2024.08.006","url":null,"abstract":"<div><p>The implementation and early adoption of online adaptive radiotherapy (oART) has required the presence of clinicians, physicists and radiation therapists (RTT) at the treatment console. The impact on each of them is unique to their profession and must be considered for safe and efficient implementation. In the short term future, widespread adoption will depend on the development of innovative workflows, and rethinking of traditional roles and responsibilities may be required. For the future, technologies such as artificial intelligence promise to change the workflow significantly in terms of speed, automation and decision-making. However, overall communication within the team will persist in being one of the most important aspects.</p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 4","pages":"Pages 418-425"},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168296","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":"Green Horizons in Oncology: A Blueprint for Environmentally Sustainable Radiation Therapy Facilities","authors":"Claire C Baniel ,&nbsp;Rachel A. Sabol ,&nbsp;Robert Nieto ,&nbsp;Jessica Scholey ,&nbsp;Alon Witztum ,&nbsp;Robert Chuter ,&nbsp;Erqi Pollom ,&nbsp;Seema Gandhi ,&nbsp;Kaiyi Wang ,&nbsp;Kavita K. Mishra ,&nbsp;Katie E. Lichter ,&nbsp;Catherine Park","doi":"10.1016/j.semradonc.2024.07.004","DOIUrl":"10.1016/j.semradonc.2024.07.004","url":null,"abstract":"","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 4","pages":"Pages 426-432"},"PeriodicalIF":2.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053429624000559/pdfft?md5=d0c713ed3402efa2b50a81b555dd685c&pid=1-s2.0-S1053429624000559-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168297","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}