{"title":"Precision Radiation for Brain Metastases With a Focus on Hypofractionated Stereotactic Radiosurgery","authors":"Kevin Shiue , Arjun Sahgal , Simon S. Lo","doi":"10.1016/j.semradonc.2023.01.004","DOIUrl":"10.1016/j.semradonc.2023.01.004","url":null,"abstract":"<div><p>There are multiple published randomized controlled trials<span><span><span> supporting single-fraction stereotactic radiosurgery (SF-SRS) for patients presenting with 1 to 4 brain </span>metastases, with the benefit of minimizing radiation-induced neurocognitive </span>sequelae<span> as compared to whole brain radiotherapy<span><span> . More recently, the dogma of SF-SRS as the only means of delivering an SRS treatment has been challenged by hypofractionated SRS (HF-SRS). The ability to deliver 25-35 Gy in 3-5 HF-SRS fractions is a direct consequence of the evolution of radiation technologies to allow </span>image guidance<span>, specialized treatment planning, robotic delivery and/or patient positioning corrections in all 6 degrees-of-freedom, and frameless head immobilization. The intent is to mitigate the potentially devastating complication of radiation necrosis and improve rates of local control for larger metastases. This narrative review provides an overview of outcomes specific to HF-SRS in addition to the more recent developments of staged SRS, preoperative SRS, and hippocampal avoidance-whole brain radiotherapy with simultaneous integrated boost.</span></span></span></span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 2","pages":"Pages 114-128"},"PeriodicalIF":3.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282557","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}
Michelle Iocolano , Alyssa Langi , Kavita V. Dharmarajan , Joshua Jones
{"title":"Palliative Care Delivery Systems and Integration With Palliative Care Teams","authors":"Michelle Iocolano , Alyssa Langi , Kavita V. Dharmarajan , Joshua Jones","doi":"10.1016/j.semradonc.2022.11.003","DOIUrl":"10.1016/j.semradonc.2022.11.003","url":null,"abstract":"<div><p>Radiotherapy<span> (RT) plays a critical role in the palliation<span> of symptoms in patients<span> with advanced or metastatic cancer. To address the growing need for these services, multiple dedicated palliative RT programs have been established. This article serves to highlight the novel ways in which palliative RT delivery systems support patients with advanced cancer. Through early integration of multidisciplinary palliative supportive services, rapid access programs facilitate best practices for oncologic patients at the end of life.</span></span></span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 2","pages":"Pages 211-217"},"PeriodicalIF":3.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10107680/pdf/nihms-1890031.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9319855","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}
Ciro Franzese MD , Sara Stefanini , Marta Scorsetti
{"title":"Radiation Therapy in the Management of Adrenal Metastases","authors":"Ciro Franzese MD , Sara Stefanini , Marta Scorsetti","doi":"10.1016/j.semradonc.2022.11.001","DOIUrl":"10.1016/j.semradonc.2022.11.001","url":null,"abstract":"<div><p><span><span>Adrenal glands<span><span> represent a common site of metastases<span> from several primary tumors, including lung cancer, breast cancer and melanoma. Surgical resection is considered the </span></span>standard of care, but surgery is not always feasible given the challenges related to anatomical site and/or due to patient and/or disease characteristics. </span></span>Stereotactic body radiation therapy<span> (SBRT) represents a promising treatment for oligometastases, though the literature on its role for </span></span>adrenal metastases<span><span><span> is still heterogeneous. Herein are summarized the most relevant published studies on the efficacy and safety of SBRT for adrenal gland metastases. The preliminary data suggests that SBRT yields high local control rates and symptom relief with a mild pattern of toxicity. Advanced radiotherapy<span> techniques including IMRT and VMAT, a BED10 > 72 Gy and the use of </span></span>4DCT for motion control should be considered for a high quality </span>ablative treatment of adrenal gland metastases.</span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 2","pages":"Pages 193-202"},"PeriodicalIF":3.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9287575","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}
Lara Michal Skarf , Katie Fitzgerald Jones , Jordana L. Meyerson , Janet L. Abrahm
{"title":"Pharmacologic Pain Management: What Radiation Oncologists Should Know","authors":"Lara Michal Skarf , Katie Fitzgerald Jones , Jordana L. Meyerson , Janet L. Abrahm","doi":"10.1016/j.semradonc.2023.01.002","DOIUrl":"10.1016/j.semradonc.2023.01.002","url":null,"abstract":"<div><p><span><span>Individuals with cancer experience a host of symptoms, especially when the malignancy is advanced. Pain occurs from the cancer itself or related </span>treatments<span><span>. Undertreated pain contributes to patient suffering and lack of engagement in cancer-directed therapies. Adequate pain management includes thorough assessment; treatment by radiotherapists or anesthesia pain specialists; anti-inflammatory medications, oral or intravenous opioid analgesics, and topical agents; and attention to the emotional and functional effects of pain, which may involve social workers, psychologists, </span>speech therapists, nutritionists, </span></span>physiatrists<span> and palliative medicine<span> providers. This review discusses typical pain syndromes arising in cancer patients undergoing radiotherapy and provides concrete recommendations for pain assessment and pharmacologic treatment.</span></span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 2","pages":"Pages 93-103"},"PeriodicalIF":3.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9287578","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":"Radiotherapy for Lung Metastases: Conventional to Stereotactic Body Radiation Therapy","authors":"Avipsa Das , Meredith Giuliani , Andrea Bezjak","doi":"10.1016/j.semradonc.2022.11.007","DOIUrl":"10.1016/j.semradonc.2022.11.007","url":null,"abstract":"<div><p><span><span><span>The lung parenchyma and adjacent tissues are one of the most common sites of </span>metastatic disease<span>. Traditionally, the approach to treatment of a patient with </span></span>lung metastases has been with systemic therapy, with </span>radiotherapy<span> being reserved for palliative management of symptomatic disease. The concept of oligo metastatic disease has paved the way for more radical treatment options, administered either alone or as local consolidative therapy in addition to systemic treatment. The modern-day management of lung metastases is guided by a number of factors, including the number of lung metastases, extra-thoracic disease status, overall performance status, and life expectancy, which all help determine the goals of care. Stereotactic body radiotherapy (SBRT) has emerged as a safe and effective method in locally controlling lung metastases, in the oligo metastatic or oligo-recurrent setting. This article outlines the role of radiotherapy in multimodality management of lung metastases.</span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 2","pages":"Pages 172-180"},"PeriodicalIF":3.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282556","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":"Personalization of Radiation Therapy in the Primary Treatment of Malignant Epidural Spinal Cord Compression (MESCC)","authors":"Dirk Rades , Steven E. Schild","doi":"10.1016/j.semradonc.2022.11.005","DOIUrl":"10.1016/j.semradonc.2022.11.005","url":null,"abstract":"<div><p><span>“True” malignant epidural spinal cord compression<span><span> (MESCC) is used here to describe a lesion compressing of infiltrating the spinal cord associated with neurologic deficits. Radiotherapy alone is the most common </span>treatment<span>, for which several dose-fractionation regimens are available including single-fraction, short-course and longer-course regimens. Since these regimens are similarly effective regarding functional outcomes, patients with poor survival are optimally treated with short-course or even single-fraction radiotherapy. Longer-course radiotherapy results in better local control of malignant epidural spinal cord compression. Since most in-field recurrences occur 6 months or later, local control is particularly important for longer-term survivors who, therefore, should receive longer-course radiotherapy. It is important to estimate survival prior to treatment, which is facilitated by scoring tools. Radiotherapy should be supplemented by corticosteroids, if safely possible. </span></span></span>Bisphosphonates<span><span> and RANK-ligand inhibitors may improve local control. Selected patients can benefit from upfront decompressive surgery. Identification of these patients is facilitated by prognostic instruments considering degree of compression, </span>myelopathy, radio-sensitivity, spinal stability, post-treatment ambulatory status, and patients’ performance status and survival prognoses. Many factors including patients’ preferences must be considered when designing personalized treatment regimens.</span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 2","pages":"Pages 148-158"},"PeriodicalIF":3.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9287573","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}
Matthias Guckenberger MD , Max Dahele MBChB, PhD , Wee Loon Ong MBBS , Arjun Sahgal MD
{"title":"Stereotactic Body Radiation Therapy for Spinal Metastases: Benefits and Limitations","authors":"Matthias Guckenberger MD , Max Dahele MBChB, PhD , Wee Loon Ong MBBS , Arjun Sahgal MD","doi":"10.1016/j.semradonc.2022.11.006","DOIUrl":"10.1016/j.semradonc.2022.11.006","url":null,"abstract":"<div><p>Progress in biological cancer characterization, targeted systemic therapies and multimodality treatment strategies have shifted the goals of radiotherapy for spinal metastases from short-term palliation to long-term symptom control and prevention of compilations. This article gives an overview of the spine stereotactic body radiotherapy (SBRT) methodology and clinical results of SBRT in cancer patients with painful vertebral metastases, metastatic spinal cord compression, oligometastatic disease and in a reirradiation situation. Outcomes after dose-intensified SBRT are compared with results of conventional radiotherapy and patient selection criteria will be discussed. Though rates of severe toxicity after spinal SBRT are low, strategies to minimize the risk of vertebral compression fracture, radiation induced myelopathy, plexopathy and myositis are summarized, to optimize the use of SBRT in multidisciplinary management of vertebral metastases.</p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 2","pages":"Pages 159-171"},"PeriodicalIF":3.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282554","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":"Pushing the Envelope: The Role of Radiation Therapy in Non-muscle-Invasive Bladder Cancer","authors":"Sri Harsha Kombathula , Peter Hoskin","doi":"10.1016/j.semradonc.2022.10.003","DOIUrl":"10.1016/j.semradonc.2022.10.003","url":null,"abstract":"<div><p><span><span><span>The standard of care for non-muscle-invasive bladder cancer (NMIBC) is </span>transurethral resection<span> followed by risk stratified use of intravesical immune- or chemotherapy and for multifocal, recurrent and high grade disease, radical cystectomy with high rates of cure. </span></span>Bladder<span> preservation analogous to the trimodality therapy approach in muscle-invasive bladder cancer (MIBC) has not been adequately explored but the available data suggests that NMIBC is a radioresponsive malignancy and that in a proportion of patients bladder preservation would be possible. Combination modality with chemotherapy, </span></span>hypoxia<span><span> sensitisation, hyperthermia and immunotherapy are all approaches which have been shown effective. Unfortunately the quality of the available data is poor. Although there are many putative prognostic biomarkers for progression in NMIBC none have emerged in clinical use and there are none predictive for response to non-surgical treatment. This would be an important component of future large scale studies to evaluate the precise role of </span>radiotherapy within a multimodality schedule for bladder reservation in NMIBC.</span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 1","pages":"Pages 21-25"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9175431","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 Neoadjuvant Chemotherapy in Bladder Preservation Approaches in Muscle-Invasive Bladder Cancer","authors":"Carlos Stecca , Timur Mitin , Srikala S. Sridhar","doi":"10.1016/j.semradonc.2022.10.006","DOIUrl":"10.1016/j.semradonc.2022.10.006","url":null,"abstract":"<div><p><span><span>Neoadjuvant chemotherapy (NAC), which aims to eliminate micrometastatic disease, has been established as the </span>standard of care<span> for patients with muscle-invasive bladder cancer (MIBC) undergoing </span></span>radical cystectomy<span> (RC). This is based on randomized controlled trials<span> showing a survival benefit of NAC prior to RC compared to RC alone. It was anticipated that a similar survival benefit would also be seen when NAC was given prior to bladder preserving approaches, but the e phase III RTOG 8903 study which explored this concept was reported to be a negative study. However, there are a number of important caveats to be considered. First, the profile of patients opting for bladder preservation has changed from the older, frailer non-surgical candidates, to now also include younger, fitter patients opting for bladder preservation and who are also more likely to tolerate NAC. In recent years, there have also been important advances in systemic chemotherapy, immunotherapy, radiation techniques, and supportive care. As such revisitng the role of NAC prior to bladder preserving approaches in MIBC appears warranted.</span></span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 1","pages":"Pages 51-55"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9189543","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}
Jenna M. Kahn , Geert A.H.J. Smits , Bernard J. Oosterveld , Elzbieta M. van der Steen-Banasik
{"title":"How Small Can We Go? Partial Bladder Radiation Therapy and Brachytherapy","authors":"Jenna M. Kahn , Geert A.H.J. Smits , Bernard J. Oosterveld , Elzbieta M. van der Steen-Banasik","doi":"10.1016/j.semradonc.2022.10.010","DOIUrl":"10.1016/j.semradonc.2022.10.010","url":null,"abstract":"<div><p><span>Organ preservation for muscle-invasive </span>bladder<span> cancer (MIBC) may use trimodality therapy. This includes transurethral resection<span><span><span><span> followed by radiation therapy<span><span>. Radiosensitization has become one of the </span>standard of care<span> approaches for MIBC with high rates of local disease control and overall survival. The goal of organ preservation is to treat MIBC while preserving a well-functioning natural bladder. Debate remains over the best way to optimize radiation therapy in bladder cancer. In MIBC the role of </span></span></span>partial cystectomy has been utilized in smaller solitary tumors with adequate local control and good </span>urinary<span> function. As radiation therapy techniques improve and modernize, smaller radiation volumes to a partial bladder may play an increasing role as we utilize imaging techniques coupled with adaptive </span></span>radiation therapy planning<span> and other techniques such as brachytherapy<span>. In this review, we explore the use of brachytherapy and partial bladder fields of external beam radiation therapy in the treatment of MIBC.</span></span></span></span></p></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"33 1","pages":"Pages 76-81"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9175434","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}