The Yin and Yang of Cytoreductive SBRT in Oligometastases and Beyond

Onderdonk, B.E.; Chmura, Steven J.

doi:10.3389/fonc.2019.00706

Cited by 11 publications

(7 citation statements)

References 47 publications

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“…The effectiveness of SBRT on LC is clearly associated with a doseresponse correlation; higher biologically equivalent dose (BED) leads to better tumor control (71,72). For lymph node metastases, 5year LC rates of uterine, cervical, and ovarian cancer range from 70 to 97%, and favorable disease-free survival and overall survival are reported in retrospective series (64,68,70,(72)(73)(74)(75)(76)(77).…”

Section: Omrgrt In the Management Of Oligometastatic Lymph Node Metastases From Gynecologic Malignanciesmentioning

confidence: 99%

Online Magnetic Resonance-Guided Radiotherapy (oMRgRT) for Gynecological Cancers

et al. 2021

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Radiation therapy (RT) is increasingly being used in gynecological cancer management. RT delivered with curative or palliative intent can be administered alone or combined with chemotherapy or surgery. Advanced treatment planning and delivery techniques such as intensity-modulated radiation therapy, including volumetric modulated arc therapy, and image-guided adaptive brachytherapy allow for highly conformal radiation dose delivery leading to improved tumor control rates and less treatment toxicity. Quality on-board imaging that provides accurate visualization of target and surrounding organs at risk is a critical feature of these advanced techniques. As soft tissue contrast resolution is superior with magnetic resonance imaging (MRI) compared to other imaging modalities, MRI has been used increasingly to delineate tumor from adjacent soft tissues and organs at risk from initial diagnosis to tumor response evaluation. Gynecological cancers often have poor contrast resolution compared to the surrounding tissues on computed tomography scan, and consequently the benefit of MRI is high. One example is in management of locally advanced cervix cancer where adaptive MRI guidance has been broadly implemented for adaptive brachytherapy. The role of MRI for external beam RT is also steadily increasing. MRI information is being used for treatment planning, predicting, and monitoring position shifts and accounting for tissue deformation and target regression during treatment. The recent clinical introduction of online MRI-guided radiation therapy (oMRgRT) could be the next step in high-precision RT. This technology provides a tool to take full advantage of MRI not only at the time of initial treatment planning but as well as for daily position verification and online plan adaptation. Cervical, endometrial, vaginal, and oligometastatic ovarian cancers are being treated on MRI linear accelerator systems throughout the world. This review summarizes the current state, early experience, ongoing trials, and future directions of oMRgRT in the management of gynecological cancers.

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Section: Omrgrt In the Management Of Oligometastatic Lymph Node Metastases From Gynecologic Malignanciesmentioning

confidence: 99%

Online Magnetic Resonance-Guided Radiotherapy (oMRgRT) for Gynecological Cancers

et al. 2021

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“…Other studies are investigating intratumoral virus injection together with radiotherapy for malignant gliomas or recurrent ependymomas [NCT02457845, NCT00634231], as well as adoptive cellular therapy with radiotherapy (with or without temozolomide) for patients with brainstem gliomas [NCT03396575]. Finally, based on pre-clinical and clinical data suggesting more robust systemic immune responses to combinations of focal radiotherapy and immunotherapy ( 107 – 113 ), a few early studies are evaluating this combination in extracranial solid tumors and lymphomas [NCT03445858].…”

Section: Role Of Radiotherapy With Advances In Targeted Systemic Therapiesmentioning

confidence: 99%

The Evolving Role of Radiotherapy for Pediatric Cancers With Advancements in Molecular Tumor Characterization and Targeted Therapies

Shen

Terezakis

2021

Front. Oncol.

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Ongoing rapid advances in molecular diagnostics, precision imaging, and development of targeted therapies have resulted in a constantly evolving landscape for treatment of pediatric cancers. Radiotherapy remains a critical element of the therapeutic toolbox, and its role in the era of precision medicine continues to adapt and undergo re-evaluation. Here, we review emerging strategies for combining radiotherapy with novel targeted systemic therapies (for example, for pediatric gliomas or soft tissue sarcomas), modifying use or intensity of radiotherapy when appropriate via molecular diagnostics that allow better characterization and individualization of each patient’s treatments (for example, de-intensification of radiotherapy in WNT subgroup medulloblastoma), as well as exploring more effective targeted systemic therapies that may allow omission or delay of radiotherapy. Many of these strategies are still under investigation but highlight the importance of continued pre-clinical and clinical studies evaluating the role of radiotherapy in this era of precision oncology.

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“…Several studies have suggested that the immune system plays an important role in the therapeutic effects of radiation by promoting tumor cell death in the radiation field (2,3). For example, in preclinical cancer models, the stimulation of granulocyte-macrophage colony formation after irradiation has been shown to promote the migration of myeloid-derived suppressor cells (MDSCs) into circulation and through inflamed tissues (4,5).…”

Section: Introductionmentioning

confidence: 99%

The characteristics of oncological clinical trials investigating the synergistic effect of radiotherapy and immune checkpoint inhibitors: a cross-sectional study

Chen¹,

Xu²,

Qi³

et al. 2023

Transl Cancer Res

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Background: The combined use of radiotherapy (RT) and immune checkpoint inhibitors (ICIs) is a promising strategy in the treatment of cancer patients. We sought to comprehensively summarize the characteristics of oncological trials investigating the synergistic effect of RT and ICIs registered at ClinicalTrials.gov. Methods:In this cross-sectional study, oncological trials investigating the synergistic effect of RT and ICIs registered at ClinicalTrials.gov from database inception to November 30, 2021 were retrieved. The characteristics of the included trials were assessed.Results: Overall, 403 registered trials were identified for analysis. Of these trials, 393 (97.5%) were interventional trials and 10 (2.5%) were observational trials. The top 3 most-studied conditions were gastrointestinal cancer (25.8%), head and neck cancer (18.6%), and non-small cell lung cancer (NSCLC) (17.9%). Approximately, 60.0% of the trials comprised ≤50 participants and 22.6% of the trials comprised >100 participants. More than half of the registered trials were prospective phase 2 trials (54.3%). In relation to trial location, 39.7% of the trials were conducted in the United States, which was the most common registered area, followed by China (33.7%) and Europe (19.4%). In relation to the radiation fractionation, the conventional fractionation size of 1.8-2.0 Gy was comparable to the ultra-hypofractionation size of ≥5 Gy (46.4% vs. 32.8%), and the most commonly used ultra-hypofractionation regimen was 24 Gy/3 Fx (24%), followed by 25 Gy/5 Fx (11%) and 30 Gy/5 Fx (11%). Additionally, the most commonly used ICI in the registered trials was pembrolizumab (20.1%), followed by durvalumab (11.4%) and nivolumab (9.2%). Among all the registered trials, only 4% of the trials had been completed, but 61.5% of the completed trials had reported their results on ClinicalTrials.gov. The conventional fractionation trials were more likely to be phase 3 trials, located in China, and performed in patients with head and neck cancer or gynecological cancer (all P values <0.05), while the ultra-hypofractionation trials were more likely to be phase 1 trials, stopped early, located in the United States, and performed in patients with lung cancer (all P values <0.05). Conclusions:The number of prospective trials investigating the synergistic effect of RT and ICIs registered at ClinicalTrials.gov has increased significantly over the past decade. The ultra-hypofractionation size of the registered trials varies, but the 24 Gy/3 Fx regimen is commonly used. The clinical results of registered trials examining the synergistic effect of RT in combination with ICIs, specifically in terms of ultra-hypofractionation, remain limited. Highlight box Key findings• Prospective oncological trials investigating the synergistic effect of RT and ICIs registered at ClinicalTrials.gov had been significantly increased, but most of these trials were small sample size, nonrandomized trials and were uncompleted. The fraction size of ultra-hypofractionation size used also varied. What...

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The Yin and Yang of Cytoreductive SBRT in Oligometastases and Beyond

Cited by 11 publications

References 47 publications

Online Magnetic Resonance-Guided Radiotherapy (oMRgRT) for Gynecological Cancers

Online Magnetic Resonance-Guided Radiotherapy (oMRgRT) for Gynecological Cancers

The Evolving Role of Radiotherapy for Pediatric Cancers With Advancements in Molecular Tumor Characterization and Targeted Therapies

The characteristics of oncological clinical trials investigating the synergistic effect of radiotherapy and immune checkpoint inhibitors: a cross-sectional study

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