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Journals Highlights

Read the highlights of recent articles in ASTRO's Journals.

International Journal of Radiation Oncology • Biology • Physics

Practical Radiation Oncology

Advances in Radiation Oncology

Highlights from International Journal of Radiation Oncology • Biology • Physics

July 1, 2020
BRAINSTORM: A Multi-Institutional Phase 1/2 Study of RRx-001 in Combination with Whole Brain Radiation Therapy for Patients with Brain Metastases
Kim et al.

The authors of this study sought to determine the recommended Phase 2 dose of RRx-001, a radiosensitizer with vascular normalizing properties, when used with whole-brain radiation therapy (WBRT) for brain metastases and to assess whether quantitative changes in perfusion magnetic resonance imaging (MRI) after RRx-001 correlate with response. RRx-001 was given once pre-WBRT and then twice weekly during WBRT. Four dose levels were planned (5 mg/m2, 8.4 mg/m2, 16.5 mg/m2, 27.5 mg/m2). Dose escalation was managed by the time-to-event continual reassessment method algorithm. The addition of RRx-001 to WBRT is well tolerated with favorable intracranial response rates. Because activity was observed across all dose levels, the recommended Phase 2 dose is 10 mg twice weekly. A reduction in fractional plasma volume on dynamic contrast-enhanced MRI 24 hours after RRx-001 suggests antiangiogenic activity associated with longer-term tumor response.

August 1, 2020
The Utility of Liquid Biopsies in Radiation Oncology
De Michino et al.

Molecular biomarkers currently play a comparatively minor role in most therapeutic settings. Liquid biopsies provide a rich source of noninvasive tumor-specific biomarkers and are amenable to repeated and noninvasive assessment. In this paper, the authors review the current status of liquid biopsies and such biopsies’ potential impact on the field of radiation oncology. They focus on established and emerging approaches to analyze circulating tumor DNA and circulating tumor cells from peripheral blood. These promising classes of biomarkers could have an outsized impact on cancer management by meaningfully stratifying patients into risk groups, tracking radiation therapy efficacy during and after treatment and identifying patients with radiosensitive or radioresistant disease. Finally, the authors highlight opportunities for future investigation including the need for prospective interventional studies employing liquid biopsies to guide the management of radiation therapy-treated patients.

September 1, 2020
The Promise of Combining Radiation Therapy with Immunotherapy
Jagodinsky et al.

In this Open Access article from the special issue “Radiation Therapy and the Immune Response,” the authors reflect on the development of immunotherapy in oncology, arguing that it builds upon many years of scientific investigation into the cellular mechanics underlying interactions between tumor cells and immune cell populations. In this review, Jagodinsky and colleagues discuss the interaction of radiation with the immune system and the potential to augment antitumor immunity through combined-modality approaches that integrate radiation and immunotherapies. Using immune checkpoint blockade as a primary example, they discuss recent preclinical and clinical studies that illustrate the potential synergy of such therapies in combination with radiation and highlight the potential clinical value of such interactions.

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Highlights from Practical Radiation Oncology

Articles in Press

NCI Workshop on Artificial Intelligence in Radiation Oncology: Training the Next Generation
Kang et al.

Attendees of the National Cancer Institute (NCI) Workshop on Artificial Intelligence (AI) formed the Training and Education Working Group with the goal of providing a foundation for educating radiation oncologists and medical physicists in data science to help guide AI solutions in clinical practice as it becomes more prevalent in treatment planning, therapy delivery, outcomes modeling and more. This perspective article includes action points for future trainees in radiation oncology including (1) creating AI awareness and responsible conduct; (2) implementing a practical didactic curriculum; (3) creating a publicly available database of training resources; and (4) accelerating learning and funding opportunities. These action points will help facilitate the application of a rapidly developing technology into clinical practice.

18F-Fluciclovine Positron Emission Tomography in Men with Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy and Planning to Undergo Salvage Radiotherapy: Results from LOCATE
Solanki et al.

The authors of this prospective multicenter trial investigated the impact of 18F-fluciclovine positron emission tomography/computed tomography (PET/CT) on the management of patients with biochemical recurrence of prostate cancer after curative intent radiation or radical prostatectomy and negative or equivocal conventional imaging. The authors found that use of 18F-fluciclovine PET/CT altered treatment for nearly half the patients enrolled in the trial, despite prior negative conventional imaging and that 18F-fluciclovine PET/CT results were able to define the anatomical extent of disease in clinically meaningful ways. The authors conclude that 18F-fluciclovine PET/CT has significant potential to inform treatment management but caution that further data are needed to verify that changes in management based on PET/CT findings favorably impact clinical outcomes.

Safety First: Developing and Deploying a System to Promote Safety and Quality in Your Clinic
Wright, Terezakis and Ford

The authors of this review article summarize key elements that should be considered when implementing a practice-based approach to safety and quality (SAQ) in radiation oncology. The authors note that both the “what” and the “how” of SAQ are varied due to the wide range of indicators that fall under SAQ and the unique needs of individual practices. The authors feature strategies and resources that have been published over the last decade and aggregate them into 10 key elements including establishing a strong safety culture, having a system for peer review, development and review of meaningful quality metrics and more. The authors hope that an internal assessment of the 10 parameters described in this review can be used to inform SAQ programs and lay the groundwork for external validation via accreditation.

Highlights from Advances in Radiation Oncology

Volume 5, Issue 4; Special Issue: Radiation Oncology and COVID-19

Prostate Cancer Radiation Therapy Recommendations in Response to COVID-19
Zaorsky et al.

This article tackles how to manage prostate cancer patients during the COVID-19 pandemic. The RADS framework (remote visits, avoid radiation, defer radiation and shorten radiation therapy) was applied to determine appropriate approaches. Within the framework, the authors sought to answer the following key questions: 1) Which patients can have in-person clinic visits safely delayed or converted to telehealth visits? 2) Which patients can safely avoid treatment or have treatment deferred, and for how long? 3) Which patients can have radiation therapy safely deferred with the initiation of androgen deprivation therapy, and for how long? 4) For patients undergoing treatment, what are the preferred treatment modalities and fractionation schedules by disease risk? They concluded that resources can be reduced for all stages of prostate cancer and that the framework can be applied to other cancers.

Computed Tomography in Radiation Oncology During the Coronavirus Disease 2019 Pandemic
Marcus et al.

The article discusses the use of computer tomography to diagnose COVID-19 prior to symptom development and provides guidance for radiation oncologists on how to identify cases to protect patients and staff. Patients undergoing RT who have COVID-19 are a high risk to staff and other patients because of limited ventilation in treatment areas and numerous interactions involved in each visit. Some studies show that CT can accurately diagnose asymptomatic COVID-19 patients, which is critical to limit spread. The Radiologic Society of North America suggests the following four categories for reporting image findings of suspected COVID cases: typical appearance, indeterminate appearance, atypical appearance and negative for pneumonia. The authors conclude that radiation oncologists should carefully review images using the descriptions of characteristics and signs that have been outlined by several organizations.

Article in Press

Nutrition in Cancer: Evidence and Equality
Haskins et al.

This article discusses the importance of nutrition in cancer treatment and survival. They conducted a literature review focused on the molecular and clinical interplay of nutrition and cancer studies. The studies showed that poor nutrition is linked to poorer cancer outcomes among patients with various cancers, such as head and neck, gynecologic and genitourinary. The article indicates that health centers that treat underserved populations are treating patients that do not have the nutritional resources to withstand aggressive treatment and live healthy as cancer survivors. Therefore, it is essential that patients have a high-quality diet to mitigate problems faced by cancer survivors and to tolerate treatment. The authors conclude that more research is needed that addresses nutritional interventions during oncological treatment as the importance of nutrition becomes more apparent.