The 64th Annual Meeting of the American Society for Radiation Oncology
The annual meeting of the American Society for Radiation Oncology was held from Oct. 23 to 26 in San Antonio and attracted approximately 11,000 participants from around the world, including physicians, oncology nurses, radiation therapists, biologists, physicists, and other cancer researchers. The conference featured educational courses focusing on radiation, surgical, and medical oncology.
In a phase III randomized clinical trial, Tamim M. Niazi, M.D., of McGill University and Jewish General Hospital in Montreal, and colleagues found that in patients with high-risk prostate cancer, moderately hypofractionated radiation therapy combined with long-term androgen deprivation therapy is as effective as standard fractionated radiation therapy.
The authors assessed the role of standard fractionation versus moderately hypofractionated radiation therapy and long-term androgen deprivation therapy in high-risk prostate cancer. Patients were treated with radiation to the pelvic lymph nodes and the prostate plus or minus seminal vesicles and a boost either concomitantly (for the moderate hypofractionation arm) or sequentially (for the standard fractionation arm). The researchers found that moderately hypofractionated radiation therapy (68 Gy in 25 fractions) combined with long-term androgen deprivation therapy was as effective as standard fractionated radiation therapy (76 Gy in 38 fractions), with similar and clinically acceptable acute and delayed side effects.
“For high-risk prostate cancer patients considered for external beam radiation therapy and long-term androgen deprivation therapy, moderately hypofractionated radiation therapy and long-term androgen deprivation therapy should be considered a new standard of care,” Niazi said.
In a phase II clinical trial, Erin F. Gillespie, M.D., of the Memorial Sloan Kettering Cancer Center in New York City, and colleagues found that radiation therapy for high-risk, asymptomatic bone metastases may reduce painful complications and hospitalizations in individuals with metastatic cancer.
The authors identified 78 individuals with a metastatic solid tumor malignancy and more than five metastatic lesions, including at least one asymptomatic high-risk bone lesion. The researchers found that skeletal-related events (e.g., fracture, cord compression, surgery for instability, or radiation for bone pain) were decreased with radiation (29 versus 1.6 percent). In addition, hospitalizations for skeletal-related events occurred less often with radiation (11 versus 0 percent). Furthermore, pain-related quality of life was better at one year with radiation than without, and the side effects of radiation were minimal (no grade 3 toxicities and only 10 percent of patients reported grade 2 toxicities).
“This was somewhat unexpected, but there is rationale for it from prior randomized trials investigating early palliative care and proactive symptom assessment (such as patient-reported outcomes),” Gillespie said. “There is much enthusiasm for current practice change, though we have to remember this is a single phase II trial. Typically, you need at least a second confirmatory trial to justify broad practice change. That said, when a patient being seen by a radiation oncologist in current practice is already on the cusp of warranting treatment to prevent bone complications, this study may tip that balance.”
In a randomized, phase III clinical trial, Laura A. Dawson, M.D., of the University of Toronto and the Princess Margaret Cancer Centre/University Health Network in Toronto, and colleagues found that stereotactic body radiation therapy (SBRT) improves overall survival, progression-free survival, and time to tumor progression in patients with advanced hepatocellular carcinoma (HCC) compared with systemic therapy alone (sorafenib).
The authors performed a randomized study of sorafenib versus SBRT followed by half-dose sorafenib for one month, then escalated up to the standard dose if tolerated, in patients with locally advanced HCC. The trial was closed to accrual earlier than anticipated mainly due to a change in the standard systemic therapy for HCC, reducing the power for the original hypothesis from 80 to 65 percent. The researchers found that overall survival was longer for those receiving SBRT and sorafenib versus sorafenib alone (15.8 versus 12.3 months); the difference was statistically significant only after controlling for clinical prognostic factors. Median progression-free survival was prolonged (9.2 versus 5.5 months) and the median time to progression was longer (18.5 versus 9.5 months) with the combination of SBRT and sorafenib versus sorafenib alone. There was no concerning increase in toxicity observed with the addition of SBRT to sorafenib.
“SBRT is a new standard treatment in the tool box of therapies for the treatment of HCC, and should be considered in patients with macrovascular invasion, where the benefits of SBRT appear to be the strongest,” Dawson said.
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