Updates in radiation oncology from SIOG 2020

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Published: 30 Oct 2020
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Dr Lucinda Morris - Sutherland Hospital, Sydney, Australia

Dr Lucinda Morris speaks to ecancer about the updates in radiation oncology from the SIOG 2020 meeting.

She first talks about the recent trials in radiation oncology and how their results show a positive outcome for geriatric patients, since radiation is painless and more convenient for these patients.

She then talks about how the studies presented at this year’s SIOG can have an impact on the future of geriatric oncology.

I was really delighted this year to be able to present updates at the SIOG virtual conference around advancements in radiation therapy, particularly that benefit older adults with cancer in terms of improving their chance of cure and controlling their cancer as well as improving and maintaining their quality of life. The important background to the update is that we’ve known for a long time that radiation therapy is a highly effective vital form of cancer therapy that attributes up to half of all cancer cures. We know that one in two cancer patients will need radiation therapy at some point during their disease course.

In particular, for older adults, radiation therapy is a very acceptable and convenient treatment. It usually only takes a few minutes, it’s painless, 90% of our patients attend for treatment as an outpatient so they don’t need to be admitted to hospital. They often can drive themselves to and from treatment and get on with life as usual in the vast majority of cases. In particular for older adults, the fact that radiotherapy is a non-invasive local treatment with very limited systemic toxicity, it can often avoid the morbidity and mortality that can be associated with chemotherapy and surgery.

So the first major update this year in terms of exciting new advances that have come out is the results of the FAST-Forward trial. The FAST-Forward trial looked at treatment in breast cancer and in particular it investigated the role of a shorter, more convenient one-week treatment schedule for women with early breast cancer after they’ve had their operation. This is compared to the more traditional radiotherapy schedules in years gone by where women were having to attend for daily treatments from three, and sometimes up to five, weeks at a time. But very pleasingly, the FAST-Forward trial has shown that that shorter one-week treatment schedule is just as good at controlling the cancer as the longer treatment schedules but with no increase in toxicity. So for older women this is really good news because we know that for some older women attending daily treatments for three or four or five weeks can pose a real challenge in terms of logistics, psychosocial impact and the medical impact of having to attend so often. So having the option of a one-week treatment is really fantastic because it may mean the difference between some older women having radiotherapy or not. It also ensures that it gives older women an option to have a treatment that’s far more acceptable and tolerable in terms of convenience.

Secondly, we also saw the results of the SABR-COMET trial published this year. This trial really does represent a paradigm shift in the use of radiation therapy in people that have advanced cancer. What the SABR-COMET trial tested was the use of stereotactic ablative body radiotherapy, what we call SABR, which is a very focussed, very targeted high dose form of radiotherapy, in people with one to five oligometastases. Oligometastases are deposits of cancer that have spread from the primary site of disease. We often see these deposits in areas such as the bone or the lung. The great news from the SABR-COMET trial is that patients who had SABR demonstrated a 22 month improvement in terms of median overall survival as compared to standard of care. This trial had a good representation of older cancer patients. Certainly this is just a paradigm shift in the use of radiotherapy in advanced cancer. What it means for older people is that we can help them live longer, help them live better and avoid the systemic toxicity of palliative chemotherapy or surgery. So it’s really exciting news within the field of radiation oncology.

How will the papers presented at SIOG 2020 have an impact on the future of radiation oncology?

In summary, these two trials, amongst many others, really demonstrate what an attractive option radiation therapy is for older adults with cancer. It’s showing that radiotherapy is highly effective in terms of curing the cancer. We know that with modern technology and the sophisticated way that we deliver radiotherapy these days, which allows us to deliver hyperfrationated radiotherapy or SABR, means that the normal healthy tissues around a patient’s tumour are not affected and that means that they have less short-term and long-term side effects.

So, all in all, these developments really are demonstrating that radiotherapy is increasingly an absolutely vital part of cancer therapy, particularly for older adults.