ASTRO 2015
Raising the bar on radiation oncology excellence
Dr Bruce Haffty - Rutgers Cancer Institute of New Jersey, New Brunswick, USA
What are some of the research highlights of ASTRO 2015?
This year the Presidential Symposium is very interesting, it covers a wide range of gastrointestinal cancers of the oesophagus, stomach, rectal. Radiation really plays a key role in the management of the majority of gastrointestinal malignancies, oftentimes in combination with surgery and novel surgical techniques, chemotherapy, precision, genomically driven therapies and this is all rapidly evolving. So the Presidential Symposium today really covers all of gastrointestinal malignancies and a review of the latest information from a radiation perspective, surgical perspective and medical and systemic therapy.
What progress has been made in radiation oncology for treating breast cancer?
In breast cancer, as in all malignancies, as we move forward with our latest technologies the treatments become more refined. We’re learning that in breast cancer that radiation’s role in terms of treating the lymph nodes is critical for some patients with positive lymph nodes. We’re also learning shorter ways of delivering radiation and doing radiation in three to four weeks as opposed to six weeks. Also new techniques and novel methods of delivering partial breast irradiation. So, as with all malignancies whether it’s breast or GI malignancies, what we’re doing is refining our techniques so that the cure rates and the control rates are improved and the toxicities are decreased. As we move the field forward that really is the key to not only improve cure rates but decrease toxicities and side effects. As with any field, the advances in technology, in computer technology and imaging and other ways of really focussing radiation have really resulted in our ability to more or less decrease the side effects of treatment as well.
Are there tumour types that remain challenging to treat with radiation?
Pancreatic cancer is very difficult and cure rates of that are still far below what we’d like them to be. So in pancreatic cancer, in brain tumours, glioblastoma, again cure rates are far below what they could be. We have advanced with combination radiation and systemic therapies; we’ve improved a bit but there’s a long way to go.
Can you outline some of the research that you have recently been involved with?
I’m involved in a number of studies. Ongoing there are some national trials that are comparing radiation to axillary dissection; randomised trials comparing that in patients who have gotten previous chemotherapy for node positive breast cancer. So they have chemotherapy and then they have surgery of the breast, whether it’s a mastectomy or lumpectomy, and then the surgeons either do an axillary dissection or they just sample the nodes and do an axillary radiation. That’s one trial that I’m involved in; another similar trial that’s being done through the NRG group takes those patients who actually have had an excellent response and convert to node negative and trying to determine whether radiation is necessary to lymph nodes. So they’re being randomised to either have radiation to the lymph nodes or no radiation. So, again, these are questions that we don’t have the answer to so you need randomised trials to begin to say which is the right approach.
How long will the trials you mention run?
They’ll run three to five years. There were just published this year a couple of trials from Canada and Europe demonstrating that in patients who initially have node positive disease and are treated, have node positive breast cancer, do benefit from radiation to the lymph nodes after definitive surgery. So there are lots of things happening and, as I said, shorter ways of delivering radiation, there’s a trial being presented at this meeting looking at whole breast radiation versus partial breast radiation with radiation implants in the breast that deliver it over a few days as opposed to five or six weeks. That’s a randomised trial out of Europe and that will be presented at this meeting. So there are lots of things happening across all malignancies: prostate, lung, gastrointestinal, breast and brain.
What initiatives or programmes has ASTRO recently initiated?
Moving forward, one of the bigger programmes that we’re very actively involved in is called APEX, it’s our practice accreditation programme. That is where practices throughout the country can get accredited through a fairly rigorous process and that really raises the quality and the level of care by creating standards that each of the facilities needs to live up to and meet. That programme is just being launched. Another one which we’re very excited about is called our ROYALS programme and that’s a programme where hospitals and facilities throughout the country can submit data about not only errors but near errors that happen. The value of that is that they share the data; you don’t know where it happened because it’s blinded but you share it and so you know if you have a certain procedure or piece of equipment that is similar to another facility and they perhaps did something that could have caused an error that you can learn by that. Really prior to this there was really no mechanism for us understanding, if I’m in New Jersey and somebody in California has the same procedure, the same process and they have an error happen or a near happen and they say, ‘Oh, this could have happened and this is what we did to prevent it,’ then I can learn by that and make sure it doesn’t happen. So we’re very excited and proud of that because all of these efforts are again raising the standard of care and decreasing errors and potential errors and really delivering radiation in a more safe and effective way.
