Seminars in radiation oncology
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Oligometastatic non-small cell lung cancer (NSCLC) has been recognized as a unique, yet common, clinical entity over the past 2-3 decades. Numerous retrospective series and early phase single arm trials have demonstrated the efficacy and safety of aggressive approaches in select patients. ⋯ Advances in late stage randomized trials with biological correlatives may further clarify the role of LAT to assist with clinical decision making in treating patients with oligometastatic NSCLC. In this review, we discuss the clinical and biologic data surrounding patient selection for LAT in oligometastatic NSCLC, as well as future directions in prospective and translational studies.
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Radiation oncologists and nuclear medicine physicians have seen a resurgence in the clinical use of radiopharmaceuticals for the curative or palliative treatment of cancer. To enable the discovery and the development of new targeted radiopharmaceutical treatments, the United States National Cancer Institute has adapted its clinical trial enterprise to accommodate the requirements of a development program with investigational agents that have a radioactive isotope as part of the studied drug product. One change in perspective has been the consideration of investigational radiopharmaceuticals as drugs, with maximum tolerable doses determined by normal organ toxicity frequency like in drug clinical trials. ⋯ Arising from this enterprise, the study and clinical use of alpha-particle and beta-particle emitters have emerged as an important approach to cancer treatment. Resources allocated to this enterprise have brought forward biomarkers of molecular pathophysiology now used to select treatment or to evaluate clinical performance of radiopharmaceuticals. The clinical use of diagnostic and therapeutic radionuclide pairs is anticipated to accelerate radiopharmaceutical clinical development.
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Image guidance technology has evolved and seen widespread application in the past several decades. Advancements in the diagnostic imaging field have found new applications in radiation oncology and promoted the development of therapeutic devices with advanced imaging capabilities. ⋯ Volumetric imaging, in particular, offers more precise localization of soft tissue targets and critical organs which reduces setup uncertainty and permit the use of smaller setup margins. We present a review of the status of current imaging modalities available for radiation oncology and its impact on target margins and use for adaptive therapy.
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The massive global shortfall in radiotherapy equipment and human resources in developing countries is an enormous challenge for international efforts in cancer control. This lack of access to treatment has been long-standing, but there is now a growing consensus about the urgent need to prioritize solutions to this problem and that a global strategy is required for them to be successful. An essential element of making radiotherapy universally accessible is a coordinated approach to clinical training and practice. ⋯ We explore how defining specific competencies in this area can help trainees and practitioners integrate their activities in global health within their existing roles as clinicians, educators, or scientists. This would also help create a new global health track for academic advancement, which could focus on such domains as implementation science, health service, and advocacy. We discuss how effective mentorship models, international partnerships, and institutional twinning arrangements support this work and explore how new resources and funding models might be used to further develop and expand radiation oncology services globally.
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In recent years, the management of glioma has evolved significantly, reflecting our better understanding of the underlying mechanisms of tumor development, tumor progression, and treatment response. Glioma grade, along with a number of underlying molecular and genetic biomarkers, has been recognized as an important prognostic and predictive factor that can help guide the management of patients. This article highlights advances in magnetic resonance imaging (MRI), including diffusion-weighted imaging, diffusion tensor imaging, magnetic resonance spectroscopy, dynamic contrast-enhanced imaging, and perfusion MRI, as well as position emission tomography using various tracers including methyl-(11)C-l-methionine and O-(2-(18)F-fluoroethyl)-l-tyrosine. Use of multiparametric imaging data has improved the diagnostic strength of imaging, introduced the potential to noninvasively interrogate underlying molecular features of low-grade glioma and to guide local therapies such as surgery and radiotherapy.