Hiba Othman , Joel Shapiro , Peter Chung , Rebecca A. Gladdy
{"title":"Progress in Retroperitoneal Sarcoma Management: Surgical and Radiotherapy Approaches","authors":"Hiba Othman , Joel Shapiro , Peter Chung , Rebecca A. Gladdy","doi":"10.1016/j.semradonc.2024.02.002","DOIUrl":"https://doi.org/10.1016/j.semradonc.2024.02.002","url":null,"abstract":"<div><p>Surgical resection is the cornerstone of curative treatment for retroperitoneal sarcomas (RPS), aiming for complete excision, yet the complexity of RPS with its proximity to vital structures continues to lead to high local recurrence rates after surgery alone. Thus, the role of radiotherapy (RT) continues to be refined to improve local control, which remains an important goal to prevent RPS recurrence. The recently completed global randomized trial to evaluate the role of surgery with and without preoperative RT – STRASS1, did not demonstrate a significant overall benefit for neoadjuvant RT based on the pre-specified definition of abdominal recurrence-free survival, however, sensitivity analysis using a standard definition of local recurrence and analysis of outcomes by compliance to the RT protocol suggests histology-specific benefit in well- and some de-differentiated liposarcomas. Ultimately, multidisciplinary collaboration and personalized approaches that consider histological sarcoma types and patient-specific factors are imperative for optimizing the therapeutic strategy in the management of RPS.</p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 2","pages":"Pages 164-171"},"PeriodicalIF":3.5,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053429624000031/pdfft?md5=6db0653db9f0e408b8f9dfb4e27ddfcf&pid=1-s2.0-S1053429624000031-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140160574","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}
Myrsini Ioakeim-Ioannidou , Melanie Rose , Yen-Lin Chen , Shannon M. MacDonald
{"title":"The Use of Proton and Carbon Ion Radiation Therapy for Sarcomas","authors":"Myrsini Ioakeim-Ioannidou , Melanie Rose , Yen-Lin Chen , Shannon M. MacDonald","doi":"10.1016/j.semradonc.2024.02.003","DOIUrl":"https://doi.org/10.1016/j.semradonc.2024.02.003","url":null,"abstract":"<div><p>The unique physical and biological characteristics of proton and carbon ions allow for improved sparing of normal tissues, decreased integral dose to the body, and increased biological effect through high linear energy transfer. These properties are particularly useful for sarcomas given their histology, wide array of locations, and age of diagnosis. This review summarizes the literature and describes the clinical situations in which these heavy particles have advantages for treating sarcomas.</p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 2","pages":"Pages 207-217"},"PeriodicalIF":3.5,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140160578","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":"Opportunity in Complexity: Harnessing Molecular Biomarkers and Liquid Biopsies for Personalized Sarcoma Care","authors":"Agnes Ewongwo , Caressa Hui , Everett J. Moding","doi":"10.1016/j.semradonc.2023.12.002","DOIUrl":"https://doi.org/10.1016/j.semradonc.2023.12.002","url":null,"abstract":"<div><p><span>Due to their rarity and complexity, sarcomas represent a substantial therapeutic challenge. However, the incredible diversity within and across sarcoma subtypes presents an opportunity for </span>personalized care<span><span><span> to maximize efficacy and limit toxicity. A deeper understanding of the molecular alterations that drive sarcoma development and treatment response has paved the way for molecular biomarkers to shape sarcoma treatment. Genetic, </span>transcriptomic, and protein biomarkers have become critical tools for diagnosis, prognostication, and treatment selection </span>in patients<span> with sarcomas. In the future, emerging biomarkers like circulating tumor DNA analysis offer the potential to improve early detection, monitoring response to treatment, and identifying mechanisms of resistance to personalize sarcoma treatment. Here, we review the current state of molecular biomarkers for sarcomas and highlight opportunities and challenges for the implementation of new technologies in the future.</span></span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 2","pages":"Pages 195-206"},"PeriodicalIF":3.5,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140160577","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}
Qian S. Zhang , John P. Hayes , Vinai Gondi , Seth M. Pollack
{"title":"Immunotherapy and Radiotherapy Combinations for Sarcoma","authors":"Qian S. Zhang , John P. Hayes , Vinai Gondi , Seth M. Pollack","doi":"10.1016/j.semradonc.2023.12.005","DOIUrl":"https://doi.org/10.1016/j.semradonc.2023.12.005","url":null,"abstract":"<div><p><span><span>Sarcomas are a heterogeneous group of bone and soft tissue tumors. Survival outcomes for advanced (unresectable or metastatic) disease remain poor, so therapeutic improvements are needed. </span>Radiotherapy<span><span> plays an integral role in the neoadjuvant and adjuvant treatment of localized disease as well as in the treatment of </span>metastatic disease<span>. Combining radiotherapy with immunotherapy<span> to potentiate immunotherapy has been used in a variety of cancers other than sarcoma, and there is opportunity to further investigate combining immunotherapy with radiotherapy to try to improve outcomes in sarcoma. In this review, we describe the diversity of the tumor immune microenvironments for sarcomas and describe the immunomodulatory effects of radiotherapy. We discuss studies on the timing of radiotherapy relative to immunotherapy and studies on the radiotherapy dose and fractionation regimen to be used in combination with immunotherapy. We describe the impact of radiotherapy on the tumor immune microenvironment. We review completed and ongoing </span></span></span></span>clinical trials combining radiotherapy with immunotherapy for sarcoma and propose future directions for studies combining immunotherapy with radiotherapy in the treatment of sarcoma.</p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 2","pages":"Pages 229-242"},"PeriodicalIF":3.5,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140160580","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}
Keith A. Cengel, Michele M. Kim, Eric S. Diffenderfer, Theresa M. Busch
{"title":"FLASH Radiotherapy: What Can FLASH's Ultra High Dose Rate Offer to the Treatment of Patients With Sarcoma?","authors":"Keith A. Cengel, Michele M. Kim, Eric S. Diffenderfer, Theresa M. Busch","doi":"10.1016/j.semradonc.2024.02.001","DOIUrl":"https://doi.org/10.1016/j.semradonc.2024.02.001","url":null,"abstract":"<div><p>FLASH is an emerging treatment paradigm in radiotherapy (RT) that utilizes ultra-high dose rates (UHDR; >40 Gy)/s) of radiation delivery. Developing advances in technology support the delivery of UHDR using electron and proton systems, as well as some ion beam units (eg, carbon ions), while methods to achieve UHDR with photons are under investigation. The major advantage of FLASH RT is its ability to increase the therapeutic index for RT by shifting the dose response curve for normal tissue toxicity to higher doses. Numerous preclinical studies have been conducted to date on FLASH RT for murine sarcomas, alongside the investigation of its effects on relevant normal tissues of skin, muscle, and bone. The tumor control achieved by FLASH RT of sarcoma models is indistinguishable from that attained by treatment with standard RT to the same total dose. FLASH's high dose rates are able to mitigate the severity or incidence of RT side effects on normal tissues as evaluated by endpoints ranging from functional sparing to histological damage. Large animal studies and clinical trials of canine patients show evidence of skin sparing by FLASH vs. standard RT, but also caution against delivery of high single doses with FLASH that exceed those safely applied with standard RT. Also, a human clinical trial has shown that FLASH RT can be delivered safely to bone metastasis. Thus, data to date support continued investigations of clinical translation of FLASH RT for the treatment of patients with sarcoma. Toward this purpose, hypofractionated irradiation schemes are being investigated for FLASH effects on sarcoma and relevant normal tissues.</p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 2","pages":"Pages 218-228"},"PeriodicalIF":3.5,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140160579","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}
Cecil M. Benitez , Michael D. Chuong , Luise A. Künzel , Daniela Thorwarth
{"title":"MRI-Guided Adaptive Radiation Therapy","authors":"Cecil M. Benitez , Michael D. Chuong , Luise A. Künzel , Daniela Thorwarth","doi":"10.1016/j.semradonc.2023.10.013","DOIUrl":"10.1016/j.semradonc.2023.10.013","url":null,"abstract":"<div><p>Magnetic resonance imaging-guided radiation therapy<span><span> (MRIgRT) has improved soft tissue contrast over computed tomography (CT) based image-guided RT. Superior visualization of the target and surrounding radiosensitive structures has the potential to improve oncological outcomes partly due to safer dose-escalation and adaptive planning. In this review, we highlight the workflow of adaptive MRIgRT planning, which includes simulation imaging, daily MRI, identifying </span>isocenter shifts, contouring, plan optimization, quality control, and delivery. Increased utilization of MRIgRT will depend on addressing technical limitations of this technology, while addressing treatment efficacy, cost-effectiveness, and workflow training.</span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 1","pages":"Pages 84-91"},"PeriodicalIF":3.5,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138692366","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":"Rectal Cancer MRI Guided Radiotherapy: A Practical Review for the Physician","authors":"Giuditta Chiloiro , Cihan Gani , Luca Boldrini","doi":"10.1016/j.semradonc.2023.10.004","DOIUrl":"10.1016/j.semradonc.2023.10.004","url":null,"abstract":"<div><p>MR-guided radiotherapy<span><span><span> is a treatment approach that combines the advantages of </span>magnetic resonance imaging (MRI) with the precision of radiation therapy. This practical review provides an overview of the current state-of-the-art of MR-guided radiotherapy for </span>rectal cancer, including its technical aspects, clinical outcomes, and existing limitations. Even though some studies have demonstrated the feasibility and safety of this treatment modality, challenges remain in terms of patient selection, treatment planning optimization, and long-term follow-up. Despite these issues, MR-guided radiotherapy shows promise as a potentially valuable rectal cancer treatment approach.</span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 1","pages":"Pages 64-68"},"PeriodicalIF":3.5,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138692034","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}
Sabrina Prime , Joshua P. Schiff , Ali Hosni , Teodor Stanescu , Laura A. Dawson , Lauren E. Henke
{"title":"The Use of MR-Guided Radiation Therapy for Liver Cancer","authors":"Sabrina Prime , Joshua P. Schiff , Ali Hosni , Teodor Stanescu , Laura A. Dawson , Lauren E. Henke","doi":"10.1016/j.semradonc.2023.10.006","DOIUrl":"10.1016/j.semradonc.2023.10.006","url":null,"abstract":"<div><p><span>The role of radiotherapy<span> in the management of primary and metastatic liver malignancies has expanded in recent years due to advances such as </span></span>IGRT<span><span><span> and SBRT. MRI-guided radiotherapy (MRgRT) has arisen as an excellent option for the management of hepatocellular carcinoma, </span>cholangiocarcinoma, and </span>liver metastases due to the ability to combine improved hepatic imaging with conformal treatment planning paradigms like adaptive radiotherapy and advanced motion management techniques. Herein we review the data for MRgRT for liver malignancies, as well as describe workflow and technical considerations for the 2 commercially available MRgRT delivery platforms.</span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 1","pages":"Pages 36-44"},"PeriodicalIF":3.5,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714416","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}
Lois A. Daamen , Parag J. Parikh , William A. Hall
{"title":"The Use of MR-Guided Radiation Therapy for Pancreatic Cancer","authors":"Lois A. Daamen , Parag J. Parikh , William A. Hall","doi":"10.1016/j.semradonc.2023.10.002","DOIUrl":"10.1016/j.semradonc.2023.10.002","url":null,"abstract":"<div><p><span><span>The introduction of online adaptive magnetic resonance (MR)-guided radiation therapy<span><span> (RT) has enabled safe treatment of </span>pancreatic cancer with ablative doses. The aim of this review is to provide a comprehensive overview of the current literature on the use and clinical outcomes of MR-guided RT for treatment of pancreatic cancer. Relevant outcomes included toxicity, tumor response, survival and </span></span>quality of life<span>. The results of these studies support further investigation of the effectiveness of ablative MR-guided SBRT as a low-toxic, minimally-invasive therapy for localized pancreatic cancer in prospective </span></span>clinical trials.</p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 1","pages":"Pages 23-35"},"PeriodicalIF":3.5,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714411","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}
Daniel A. Low , B. Gino Fallone , Bas W. Raaymakers
{"title":"MRI-Guided Radiation Therapy Systems","authors":"Daniel A. Low , B. Gino Fallone , Bas W. Raaymakers","doi":"10.1016/j.semradonc.2023.10.009","DOIUrl":"10.1016/j.semradonc.2023.10.009","url":null,"abstract":"<div><p>MR-Guided Radiation Therapy<span> (MRIgRT) has been made possible only due to the ingenuity and commitment of commercial radiation therapy system vendors. Unlike conventional linear accelerator<span> systems, MRIgRT systems have had to overcome significant and previously untested techniques to integrate the MRI systems with the radiation therapy delivery systems. Each of these three commercial systems has developed different approaches to integrating their MR and Linac functions. Each has also decided on a different main magnetic field strength, from 0.35T to 1.5T, as well as different design philosophies for other systems, such as the patient support assembly and treatment planning workflow. This paper is intended to provide the reader with a detailed understanding of each system's configuration so that the reader can better interpret the scientific literature concerning these commercial MRIgRT systems.</span></span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"34 1","pages":"Pages 14-22"},"PeriodicalIF":3.5,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138692037","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}