By Gita Suneja, MD, MS, and Malika Siker, MD
As the field of radiation oncology continues to make tremendous biomedical advancements in patient care, we know that these breakthroughs are not reaching all patients equally. We are aware of the outstanding research documenting the disparities that exist in the field, both in terms of patient care and the composition of our work force. It is critical that we focus on improving health equity to devise new and innovative solutions to bring change to the field. To this end, the ROI has issued a new request for proposals (RFP), “Improving Diversity and Inclusion in Radiation Oncology,” to award research grants focused on developing and testing practical applications that will help change the current state of affairs for radiation oncology professionals and their patients.
This new funding opportunity from the ROI will support innovative ideas to:
- Reduce disparities in patient care.
- Increase participation of underrepresented groups in clinical trials.
- Improve diversity in the radiation oncology workforce.
The proposed research must also focus on one or more of the topics that make up the ROI’s research agenda: communication, quality and safety, toxicity management, comparative effectiveness and value of radiation therapy. The grants typically will be approximately $50,000 to be paid over two years, but budgets of up to $100,000 will be considered for projects with a large scope of work. We encourage all interested, eligible applicants to submit a Letter of Intent (LOI) by 5:00 p.m. Eastern time, October 28, 2019, on the ROI portal on proposalCENTRAL. Full proposals will be due at the end of January for invited applicants only.
The ROI and ASTRO’s Committee on Health Equity, Diversity and Inclusion (CHEDI) are excited to be partnering on this new grant opportunity to ensure that the ROI is supporting the highest priority research that will address some of the most pressing challenges to improve equity, diversity and inclusion in radiation oncology. Our collaboration began with the development of the RFP and will continue through the review of the LOIs and proposals, when members of CHEDI will serve as guest reviewers. We are hoping to see many proposals for groundbreaking initiatives to improve recruitment and inclusion of underrepresented minorities into cancer clinical trials, one of CHEDI’s top priorities for the year, in response to this RFP.
We are proud to support this new funding opportunity that could help transform the field. We invite all members of the radiation oncology community to review the complete RFP and propose your best ideas for how to improve health equity and ensure that all patients have access to the lifesaving and quality-of-life benefits of radiation therapy.
Gita Suneja, MD, MS, is chair of the ROI Research Committee and vice-chair of CHEDI, and Malika Siker, MD, is chair of CHEDI, a member of the ROI Development Committee and chair of its Communications Subcommittee.
By Manisha Palta, MD, and Albert Koong, MD, PhD
The role of radiation therapy (RT) in pancreatic cancer is rapidly evolving. Until recently, 3-D conformal RT was the primary technique for treating patients. However, the emergence of intensity-modulated radiation therapy (IMRT) has allowed greater dose conformality, resulting in reduced dose to organs at risk. Together with advancements in simulation and image guidance, these developments have facilitated the use of hypofractionated RT, including stereotactic body RT. Simultaneously, more effective systemic therapies have also been developed. As these systemic therapies improve overall survival, local regional treatments like RT and surgery have become more important.
To address the questions surrounding RT for patients with pancreatic cancer, ASTRO launched a guideline on this topic, published online in Practical Radiation Oncology on August 29. The guideline task force comprised of not only radiation oncologists, including those working in community practice and Veterans Affairs and a resident representative, but also members from medical and surgical oncology, medical physics and the patient community. The guideline considered indications for RT in the adjuvant, neoadjuvant and definitive settings, along with doses, target volumes and sequencing with systemic therapies. It also made recommendations on simulation and treatment planning, technique and use of prophylactic medications to mitigate toxicity. Recommendations are rated as either strong or conditional, and the quality of the evidence is also graded for each recommendation.
For conventionally fractionated RT, the task force made a conditional recommendation supporting its use in the adjuvant setting if patients have high-risk features such as positive lymph nodes and margins. It conditionally recommended neoadjuvant RT in patients with borderline resectable tumors following chemotherapy, as well as RT as an option for definitive therapy in those with locally advanced disease. In addition, for borderline and locally advanced pancreatic cancer, SBRT is conditionally recommended. However, the task force recognized that ongoing clinical trials, including the Alliance for Clinical Trials in Oncology study, may provide new data for patients with borderline pancreatic cancer.
For RT simulation, the guideline recommends that patient-specific motion assessment should be utilized along with image guidance. Use of IMRT is recommended for treatment delivery.
Finally, there was strong consensus, even with limited clinical data, that patients undergoing RT for pancreatic cancer should receive prophylactic anti-nausea medications and agreement that patients may benefit from anti-acid or acid-reducing drugs.
Throughout the guideline, the task force sought to promote a patient-centered approach that integrates the patient's values, preferences and ability to tolerate short and late toxicities, and how those considerations are balanced against outcomes like local control. Given the many controversies and nuances of RT, it is especially important that every patient who might be appropriate for RT have a nuanced discussion with a radiation oncologist about the risks and benefits of RT, ideally in a multidisciplinary setting that also includes a surgeon and a medical oncologist.
Although many of the current guideline recommendations are conditional recommendations, reflecting limitations in the available data, ongoing and recently completed trials continue to add to the evidence available to make decisions on RT for pancreatic cancer and may alter the guideline in future years.