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Seminars in Radiation Oncology

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https://read.qxmd.com/read/30827458/emerging-opportunities-for-digital-pet-ct-to-advance-locoregional-therapy-in-head-and-neck-cancer
#1
REVIEW
Chadwick L Wright, Iman R Washington, Aashish D Bhatt, Michael V Knopp
The purpose of this article is to present the recent imaging advancements enabled by digital photon counting positron emission tomography detector technology and discuss its potential applications in the clinical management of head and neck cancer (HNC) and nodal metastases. 18 F-fluorodeoxyglucose positron-emission tomography is a clinically useful biomarker for the detection, targeted biopsy, treatment planning, and therapeutic response assessment of HNC. This article highlights the current state of 18 F-fluorodeoxyglucose positron-emission tomography imaging in HNC management as well as the emerging capabilities of the recently introduced digital photon counting positron emission tomography/computed tomography platform for more effective molecular and functional HNC imaging...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827457/a-deep-dive-into-the-diagnosis-and-management-of-regional-lymph-node-metastases
#2
EDITORIAL
Evan J Wuthrick, Louis B Harrison
No abstract text is available yet for this article.
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827456/integrating-the-management-of-nodal-metastasis-into-the-treatment-of-nonmelanoma-skin-cancer
#3
REVIEW
Sue S Yom
The two types of nonmelanoma skin cancer most apt to metastasize to lymph nodes are cutaneous squamous cell carcinoma and Merkel cell carcinoma. The clinical impact of nodal metastases of these cancers is substantial, resulting in intensification of treatment and morbidity and worsened cancer outcomes. Exact best practices are challenging to define as many specific clinical scenarios remain incompletely catalogued, characterized, or studied. In general, the role of radiation therapy is indisputably established as part of the treatment of both of these diseases although its success depends on the best available assessment of extent of disease and appropriate integration into the multimodality care plan...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827455/do-not-forget-about-the-importance-of-loco-regional-therapy-in-melanoma-management
#4
REVIEW
Evan J Wuthrick, Priyanka Chablani
Immunotherapy agents have significantly changed the landscape of melanoma treatment over the past decade. Paradigm shifts in treatment require reanalysis of the treatment algorithms in melanoma. Despite surgical excision, certain high risk patients with desmoplastic melanoma remain at high risk for local recurrence and retrospective data suggests improvement in local control with adjuvant radiation therapy. Likewise, despite surgical excision and effective systemic therapy agents, patients with extracapsular extension and other high risk features are at substantial risk of nodal basin (regional) recurrence...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827454/management-of-nodal-disease-in-advanced-cervical-cancer
#5
REVIEW
Ina-Maria Jürgenliemk-Schulz, Sushil Beriwal, Astrid A C de Leeuw, Jacob Christian Lindegaard, Christel Nadine Nomden, Richard Pötter, Kari Tanderup, Akila N Viswanathan, Beth Erickson
During the last decade the adoption of image-guided adaptive brachytherapy has dramatically improved local control in patients with locally advanced cervical cancer (LACC) treated with radiotherapy and concomitant chemotherapy; however, nodal failure remains an obstacle. Metastatic lymph nodes can be detected by surgical and imaging approaches with different sensitivities and specificities, that improve the definition of relevant targets for macroscopic and microscopic nodal disease, and that influence our understanding of dose levels of external beam radiotherapy...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827453/the-evolving-and-multidisciplinary-considerations-in-nodal-radiation-in-breast-cancer
#6
REVIEW
Naamit K Gerber, Elisa Port, Manjeet Chadha
The therapeutic management of regional lymph nodes in breast cancer has seen a remarkable change in the past 2 decades. Clinical trials have refined our knowledge regarding the biology of the disease including the prognostic significance of disease in the regional lymph nodes. The contemporary management of lymph nodes is also influenced by advances in surgical technique, radiation oncology delivery systems, and effective systemic therapy regimens. This paper describes the role of regional nodal irradiation in the context of the de-escalation of axillary surgery, improved understanding of the molecular and pathologic features, and increasing use of neoadjuvant chemotherapy...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827452/postoperative-radiation-therapy-for-metastatic-cervical-adenopathy
#7
REVIEW
Adam S Garden, Jay P Reddy
The management of cancers of the head and neck focuses on primary site and regional (neck) disease control. Many patients are treated with surgery as the principal mode of treatment, and surgery often includes an elective or therapeutic neck dissection. Risk factors assessed for recurrence subsequent to neck dissection include nodal size, number, levels, and the presence of extranodal spread. Adjuvant radiation therapy (with or without chemotherapy) is offered to patients deemed at sufficient risk of recurrence based on assessment of these factors...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827451/anal-cancer-in-the-era-of-dose-painted-intensity-modulated-radiation-therapy-implications-for-regional-nodal-therapy
#8
REVIEW
Colton Ladbury, Karyn A Goodman, Tracey E Schefter, Jeffrey R Olsen
Since the initial development of 5-fluorouracil and mitomycin as a standard of care platform for definitive anal cancer chemoradiotherapy, multiple studies have evaluated the optimal chemotherapy regimen, and radiotherapy technique. Refinements in treatment technique have taken place during an era of improved diagnostic imaging, including incorporation of FDG-PET, with implications for a possible stage migration effect. This has introduced an opportunity to develop stage-specific recommendations for primary tumor, involved nodal, and elective nodal irradiation dose...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827450/regional-radiation-therapy-for-oropharyngeal-cancer-in-the-hpv-era
#9
REVIEW
Moses Tam, Kenneth Hu
Oropharyngeal carcinoma associated with the human papillomavirus is increasing in incidence and represents a unique head and neck disease with favorable treatment outcomes. This review evaluates the evolving role of radiotherapy in regional management with an overall goal of treatment de-escalation in the appropriate patient. Determining the optimal approach and selection factors for treatment de-escalation is under active investigation. Response to induction chemotherapy, refining adverse pathologic factors after a primary surgical approach, decreasing radiation dose with or without chemotherapy in the definitive or adjuvant settings as well as more selective nodal level irradiation all are current strategies for treatment de-escalation...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827449/novel-genomic-based-strategies-to-personalize-lymph-node-radiation-therapy
#10
REVIEW
Daniel E Oliver, Homan Mohammadi, Nicholas Figura, Jessica M Frakes, Kosj Yamoah, Bradford A Perez, Evan J Wuthrick, Arash O Naghavi, Jimmy J Caudell, Louis B Harrison, Javier F Torres-Roca, Kamran A Ahmed
Current standard radiotherapy doses have been derived from empiric methods rather than a scientific framework. Subclinical nodal dosing remains relatively uniform across most disease sites, despite heterogeneity in patient and tumor biology. It is now clear that there are subsets of patients who will benefit from genomically-informed radiotherapy planning, and there are increasing efforts toward prescribing radiation dose to match the radiosensitivity of the tumor. By using novel genomic biomarkers to personalize delivery of radiotherapy, there is an opportunity to improve loco-regional control and cure rates...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30827448/pathologic-evaluation-and-prognostic-implications-of-nodal-micrometastases-in-breast-cancer
#11
REVIEW
Sunil W Dutta, Ashley Volaric, John T Morgan, Zachary Chinn, Kristen A Atkins, Einsley-Marie Janowski
Using modern sentinel lymph node techniques, occult nodal metastases including micrometastases or isolated tumor cells are being increasingly discovered in up to 10% of early-stage breast cancers. Furthermore, the rate of nonsentinel lymph node involvement is approximately 10%. However, the impact of these findings on disease-free survival is low, particularly with regards to axillary recurrences. Current evidence suggests small-volume lymph node involvement in breast cancer patients is only one of several factors that should guide adjuvant therapy options...
April 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573188/imaging-metabolic-processes-to-predict-radiation-responses
#12
REVIEW
Sarwat Naz, Shun Kishimoto, James B Mitchell, Murali C Krishna
The aberrant vasculature in the tumor microenvironment creates hypoxic zones, poor perfusion, and high interstitial fluid pressure. Also, the tumor cell metabolic phenotype utilizes the aerobic glycolytic pathways for energy source and generation of cell mass. These physiologic and metabolic phenotypes in solid tumors are amenable for molecular imaging techniques to extract imaging biomarkers such as pO2 and enzyme kinetics reflecting glycolysis. The imaging biomarkers have value in diagnostic and prognostic purposes...
January 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573187/utilizing-superoxide-dismutase-mimetics-to-enhance-radiation-therapy-response-while-protecting-normal-tissues
#13
REVIEW
Kranti A Mapuskar, Carryn M Anderson, Douglas R Spitz, Ines Batinic-Haberle, Bryan G Allen, Rebecca E Oberley-Deegan
Symptomatic normal tissue injury is a common side effect following definitive therapeutic radiation and chemotherapy treatment for a variety of malignancies. These cancer therapy related toxicities may occur acutely during treatment resulting in reduced or missed therapy agent administration or after the completion of therapy resulting in significant chronic morbidities that significantly diminish patient quality of life. Radiation and chemotherapy induce the formation of reactive oxygen species (ROS) both in normal tissues and tumor cells...
January 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573186/soy-isoflavones-protect-normal-tissues-while-enhancing-radiation-responses
#14
REVIEW
Gilda G Hillman
Soy isoflavones have demonstrated chemopreventive and anticancer properties in epidemiology and biological studies, in addition to their function as antioxidants in prevention of cardiovascular disease. We have explored the potential of soy isoflavones, as a safe biological approach, to enhance the efficacy of radiotherapy for local tumor control and limit normal tissue damage in solid tumors. This review presents studies investigating the interaction between soy isoflavones and radiation in different malignancies, including prostate cancer, renal cell carcinoma, and nonsmall cell lung cancer...
January 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573185/targeting-nad-metabolism-to-enhance-radiation-therapy-responses
#15
REVIEW
Joshua E Lewis, Naveen Singh, Reetta J Holmila, Baran D Sumer, Noelle S Williams, Cristina M Furdui, Melissa L Kemp, David A Boothman
Nicotinamide adenine dinucleotide (NAD+ ) metabolism is integrally connected with the mechanisms of action of radiation therapy and is altered in many radiation-resistant tumors. This makes NAD+ metabolism an ideal target for therapies that increase radiation sensitivity and improve patient outcomes. This review provides an overview of NAD+ metabolism in the context of the cellular response to ionizing radiation, as well as current therapies that target NAD+ metabolism to enhance radiation therapy responses...
January 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573184/utilization-of-vitamin-e-analogs-to-protect-normal-tissues-while-enhancing-antitumor-effects
#16
REVIEW
Nukhet Aykin-Burns, Rupak Pathak, Marjan Boerma, Thomas Kim, Martin Hauer-Jensen
Despite advances in radiation delivery techniques, side effects of radiation therapy due to radiation exposure of normal tissues are common and can limit the deliverable dose to tumors. Significant interests lie in pharmacologic modifiers that may protect against normal tissue toxicity from cancer treatment while simultaneously enhancing the tumor response to therapy. While no such treatments are available in the clinic, this is an area of active preclinical and clinical research. This review summarizes research studies that provide evidence to indicate that tocotrienols, natural forms of vitamin E, are potent radiation protectors and may also have antitumor effects...
January 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573183/targeting-cancer-stem-cell-redox-metabolism-to-enhance-therapy-responses
#17
REVIEW
Ming Luo, Max S Wicha
Cancer has long been viewed as a disease of altered metabolism. Although it has long been recognized that the majority of cancer cells display increased dependence on glycolysis, the metabolism of "cancer stem-like cells" (CSCs) that drive tumor growth and metastasis is less well characterized. In this chapter, we review the current state of knowledge of CSC metabolism with an emphasis on the development of therapeutic strategies to exploit the metabolic vulnerabilities of these cells. We outline emerging evidence indicating distinct metabolic pathways active in the proliferative, epithelial- (E) and quiescent, mesenchymal-like (M) CSC states in triple negative breast cancer...
January 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573182/manipulation-of-glucose-and-hydroperoxide-metabolism-to-improve-radiation-response
#18
REVIEW
John M Floberg, Julie K Schwarz
Dysregulated glucose and redox metabolism are near universal features of cancers. They therefore represent potential selectively toxic metabolic targets. This review outlines the preclinical and clinical data for targeting glucose and hydroperoxide metabolism in cancer, with a focus on drug strategies that have the most available evidence. In particular, inhibition of glycolysis using 2-deoxyglucose, and inhibition of redox metabolism using the glutathione pathway inhibitor buthionine sulfoximine and the thioredoxin pathway inhibitor auranofin, have shown promise in preclinical studies to increase sensitivity to chemotherapy and radiation by increasing intracellular oxidative stress...
January 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573181/pharmacological-ascorbate-as-a-means-of-sensitizing-cancer-cells-to-radio-chemotherapy-while-protecting-normal-tissue
#19
REVIEW
Joshua D Schoenfeld, Matthew S Alexander, Timothy J Waldron, Zita A Sibenaller, Douglas R Spitz, Garry R Buettner, Bryan G Allen, Joseph J Cullen
Chemoradiation has remained the standard of care treatment for many of the most aggressive cancers. However, despite effective toxicity to cancer cells, current chemoradiation regimens are limited in efficacy due to significant normal cell toxicity. Thus, efforts have been made to identify agents demonstrating selective toxicity, whereby treatments simultaneously sensitize cancer cells to protect normal cells from chemoradiation. Pharmacological ascorbate (intravenous infusions of vitamin C resulting in plasma ascorbate concentrations ≥20 mM; P-AscH- ) has demonstrated selective toxicity in a variety of preclinical tumor models and is currently being assessed as an adjuvant to standard-of-care therapies in several early phase clinical trials...
January 2019: Seminars in Radiation Oncology
https://read.qxmd.com/read/30573180/exercise-as-adjunct-therapy-in-cancer
#20
REVIEW
Kathleen A Ashcraft, Allison Betof Warner, Lee W Jones, Mark W Dewhirst
Data from observational studies indicate that both physical activity as well as exercise (ie, structured physical activity) is associated with reductions in the risk of recurrence and cancer mortality after a diagnosis of certain forms of cancer. Emerging evidence from preclinical studies indicates that physical activity/exercise paradigms regulate intratumoral vascular maturity and perfusion, hypoxia, and metabolism and augments the antitumor immune response. Such responses may, in turn, enhance response to standard anticancer treatments...
January 2019: Seminars in Radiation Oncology
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