Curing cancer and maintaining high quality of life for patients
with cancer are the foremost goals of those in radiation oncology. Recently, research in genomics, proteomics and immunology have
provided a greater understanding of how cancer grows, spreads and how it can
be stopped. Improvements in technology and therapy have led to improved
outcomes and patient care with precision targeting of treatment and a reduction
in toxicity and detrimental side effects. Increasingly, it is evident that combination
therapy that includes a mix of modalities – radiation, surgery, chemotherapy,
targeted therapy and immunotherapy – is the most effective treatment option.
Because there are still many unanswered questions, ASTRO has outlined five key
areas of research of interest for the radiation oncology field.
Precision medicine is redefining treatment options and treatment regimens for patients. Increasingly, patients receive treatments based on the profile of their disease (genomics of the tumor,
location, morphology). Understanding how changes in the genome could alter radiation treatment effects will have a large impact on cancer therapy. Learning how to best use genomic tools in radiation therapy will lead to better patient outcomes.
Research topics of interest include:
For some tumors, treating with one modality is not enough. Combinations that include multiple modalities (radiation, surgery, chemotherapy, targeted therapy and immunotherapy) provide the best
option for success. There is still much to learn about what combinations are most effective for any given tumor. New data is emerging that radiation in combination with chemotherapy or immunotherapy provides a much safer and longer-lasting solution to eliminate cancer growth and metastasis.
The environment in which the tumor lives can have a large impact on tumor growth and metastasis and may alter responses to therapy. Understanding the influence of the tumor microenvironment, how the immune system controls tumor growth (the abscopal effect) and the impact of metabolism on radiation therapy outcomes is necessary to improve treatment efficacy and patient outcomes. Likewise, the study of radiation effects on normal tissue and on tissue vascularization will provide better understanding of how to eliminate or avoid toxicities.
Visualizing a tumor and accurately delivering radiation to the tumor site with better efficiency while avoiding damage to adjacent normal tissues is the goal of every radiation oncology
treatment. Improving technology and treatment modalities that increase the efficacy while decreasing the toxicity to normal tissues is a primary area of research focus.
Mutations found in each tumor are making individualized treatment options more common. This is changing the traditional format of clinical trials and bringing into the question traditional sample
sizes. Identifying new clinical trial designs and methods to utilize this new information while maximizing patient safety is a necessary focus. In addition, collecting, processing, storing and presenting clinical data on previously treated patients in a learning health system environment will be a powerful tool in our path toward precision medicine.