Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.11.001
Gustav Y. Cederquist , Kathryn Tringale , Joachim Yahalom , Brandon S. Imber
The contemporary landscape of systemic therapy options for hematologic malignancies involving the central nervous system (CNS-HM) is rapidly evolving; a key question is how radiotherapy (RT) can be optimally integrated to improve patient outcomes. Historically, use of RT to treat CNS-HM was defined by broad fields and high doses. While effective, this approach raised concerns of potential neurotoxicity which significantly decreased RT utilization. RT was replaced by high-dose, CNS-penetrant, systemic therapies that offered durable control with lower perceived neurotoxic risk. But, as the therapeutic toolbox for CNS-HM expands, so too does the complexity and diversity of potential clinical scenarios where RT should be considered. In this review, we describe both well-established and emerging opportunities for RT integration, emphasizing how dose selection and field design could balance neurotoxicity risk and disease control. We propose an anatomical framework that captures the diverse utilization of RT for CNS-HM and serves as a practical guide for RT volume and dose design.
{"title":"The contemporary spectrum of radiotherapy for hematologic malignancies involving the central nervous system: From focal therapy to craniospinal","authors":"Gustav Y. Cederquist , Kathryn Tringale , Joachim Yahalom , Brandon S. Imber","doi":"10.1016/j.semradonc.2024.11.001","DOIUrl":"10.1016/j.semradonc.2024.11.001","url":null,"abstract":"<div><div>The contemporary landscape of systemic therapy options for hematologic malignancies involving the central nervous system (CNS-HM) is rapidly evolving; a key question is how radiotherapy (RT) can be optimally integrated to improve patient outcomes. Historically, use of RT to treat CNS-HM was defined by broad fields and high doses. While effective, this approach raised concerns of potential neurotoxicity which significantly decreased RT utilization. RT was replaced by high-dose, CNS-penetrant, systemic therapies that offered durable control with lower perceived neurotoxic risk. But, as the therapeutic toolbox for CNS-HM expands, so too does the complexity and diversity of potential clinical scenarios where RT should be considered. In this review, we describe both well-established and emerging opportunities for RT integration, emphasizing how dose selection and field design could balance neurotoxicity risk and disease control. We propose an anatomical framework that captures the diverse utilization of RT for CNS-HM and serves as a practical guide for RT volume and dose design.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 126-137"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.08.004
David J. Cutter , Berthe M.P. Aleman
Radiation therapy (RT) is an important modality in the modern management of lymphoma. RT has long been recognized as a cause of late toxicity in lymphoma survivors, including serious morbidity and increased mortality from second cancers and cardiovascular disease. Many studies have quantified the relationships between radiation dose to normal tissues and the risk of late toxicities. These relationships offer the opportunity to estimate future risks for patients on an individual basis. This knowledge has the potential to effect up-front management decisions regarding the use of RT, optimize radiotherapy planning for treatment, guide the evolution of future RT technologies and identify past and future patients whose risk of late toxicity is sufficient to warrant specific screening and surveillance strategies. Despite these potential applications the challenges around translating between radiation dose and accurate predictions of late toxicities are many and substantial. This article summarizes the current state of knowledge, the inherent challenges and possible directions for future research to address this area.
{"title":"Translating Between Radiation Dose and Late Toxicity for Lymphoma Survivors: Implications on Toxicity Counseling and Survivorship","authors":"David J. Cutter , Berthe M.P. Aleman","doi":"10.1016/j.semradonc.2024.08.004","DOIUrl":"10.1016/j.semradonc.2024.08.004","url":null,"abstract":"<div><div>Radiation therapy (RT) is an important modality in the modern management of lymphoma. RT has long been recognized as a cause of late toxicity in lymphoma survivors, including serious morbidity and increased mortality from second cancers and cardiovascular disease. Many studies have quantified the relationships between radiation dose to normal tissues and the risk of late toxicities. These relationships offer the opportunity to estimate future risks for patients on an individual basis. This knowledge has the potential to effect up-front management decisions regarding the use of RT, optimize radiotherapy planning for treatment, guide the evolution of future RT technologies and identify past and future patients whose risk of late toxicity is sufficient to warrant specific screening and surveillance strategies. Despite these potential applications the challenges around translating between radiation dose and accurate predictions of late toxicities are many and substantial. This article summarizes the current state of knowledge, the inherent challenges and possible directions for future research to address this area.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 27-39"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.08.003
Ritesh Kumar, Rahul R. Parikh
Lymphoma in elderly patients has unique treatment challenges due to baseline co-morbidities, nutrition status, impairment in functional capacities and fitness. While geriatric-specific assessment can be used to tailor treatment decisions, lack of adequate representation of elderly patients in lymphoma clinical trials impairs generalizability. Radiation treatment has traditionally been associated with high response and local control for lymphomas. The volume and dose of radiation in lymphomas has gradually decreased over the decades, which has led to improved compliance and lower toxicities. The use of radiation in Hodgkin and aggressive B-cell non-Hodgkin lymphomas has allowed for reduction in the number systemic therapy cycles, which is important in elderly patients who may be at high risk for treatment-related adverse events. Current strategies include a risk-adapted approach with minimal chemo-immunotherapy followed by radiation treatment, with dose adapted by response. Here, we provide a review of the literature regarding the role of radiation in the management of elderly patients with lymphoma, especially in follicular lymphoma, diffuse large cell lymphoma and Hodgkin lymphoma.
老年淋巴瘤患者由于合并基础疾病、营养状况、功能障碍和体能下降等原因，面临着独特的治疗挑战。虽然针对老年病的评估可用于调整治疗决策，但淋巴瘤临床试验中缺乏老年病人的充分代表会影响其普遍性。放射治疗历来与淋巴瘤的高反应性和局部控制有关。几十年来，淋巴瘤的放射治疗量和剂量逐渐减少，从而提高了依从性并降低了毒性。在霍奇金淋巴瘤和侵袭性 B 细胞非霍奇金淋巴瘤中使用放射治疗可减少系统治疗周期的次数，这对老年患者非常重要，因为他们可能是治疗相关不良事件的高危人群。目前的治疗策略包括风险适应疗法，即先进行最低限度的化疗免疫疗法，然后再进行放射治疗，并根据反应调整剂量。在此，我们回顾了有关放射治疗在老年淋巴瘤患者治疗中的作用的文献，尤其是滤泡淋巴瘤、弥漫大细胞淋巴瘤和霍奇金淋巴瘤。
{"title":"Role of Radiotherapy in the Management of Elderly Patients With Lymphoma","authors":"Ritesh Kumar, Rahul R. Parikh","doi":"10.1016/j.semradonc.2024.08.003","DOIUrl":"10.1016/j.semradonc.2024.08.003","url":null,"abstract":"<div><div>Lymphoma in elderly patients has unique treatment challenges due to baseline co-morbidities, nutrition status, impairment in functional capacities and fitness. While geriatric-specific assessment can be used to tailor treatment decisions, lack of adequate representation of elderly patients in lymphoma clinical trials impairs generalizability. Radiation treatment has traditionally been associated with high response and local control for lymphomas. The volume and dose of radiation in lymphomas has gradually decreased over the decades, which has led to improved compliance and lower toxicities. The use of radiation in Hodgkin and aggressive B-cell non-Hodgkin lymphomas has allowed for reduction in the number systemic therapy cycles, which is important in elderly patients who may be at high risk for treatment-related adverse events. Current strategies include a risk-adapted approach with minimal chemo-immunotherapy followed by radiation treatment, with dose adapted by response. Here, we provide a review of the literature regarding the role of radiation in the management of elderly patients with lymphoma, especially in follicular lymphoma, diffuse large cell lymphoma and Hodgkin lymphoma.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 57-66"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.10.003
Eric Simiele , Savita Dandapani , Chunhui Han , Jeffrey Wong , Susan M. Hiniker , Nataliya Kovalchuk
Total body irradiation (TBI) has been an important component of myeloablative and nonmyeloablative conditioning regimens for allogeneic hematopoietic stem cell transplantation (HSCT) for decades. Playing a dual role, both cytotoxic and immuno-suppressive, TBI eliminates residual disease while also impairing the immune system from rejecting the foreign donor cells being transplanted. Unlike chemotherapy, radiotherapy is not hampered by perfusion, diffusion, or the blood-barrier effect and can effectively treat sanctuary sites. However, radiotherapy is subject to radiobiological trade-offs between destroying cancer cells, preserving immune and hematopoietic stem cells, and causing various adverse effects in normal tissue. Optimizing the immuno- suppressive effect of fractionated TBI while sparing normal organs requires careful consideration of total dose, dose per fraction, dose rate, target dose coverage, and dose to organs. Prospective multi-institutional trials are required to elucidate this matter further. However, as various recent surveys across the world indicate, the heterogeneity of 2D TBI practices, inaccurate dose calculation and dosimetry, and differences in reporting across institutions makes conducting these multi-institutional studies of TBI challenging. Technological advancements in radiotherapy planning and delivery are prompting a transition to modern intensity modulated techniques such as Volumetric Modulated Arc Therapy (VMAT) TBI and helical TomoTherapyTM TBI, which can better spare normal organs and potentially reduce radiotherapy-related toxicities without compromising TBI effectiveness. This review discusses the present developments and outcomes and toxicity for modern TBI techniques as well as total marrow irradiation (TMI), and total marrow and lymphoid irradiation (TMLI).
{"title":"Radiation as an Immune Modulator: Where We Are With Modern Total Body Irradiation","authors":"Eric Simiele , Savita Dandapani , Chunhui Han , Jeffrey Wong , Susan M. Hiniker , Nataliya Kovalchuk","doi":"10.1016/j.semradonc.2024.10.003","DOIUrl":"10.1016/j.semradonc.2024.10.003","url":null,"abstract":"<div><div>Total body irradiation (TBI) has been an important component of myeloablative and nonmyeloablative conditioning regimens for allogeneic hematopoietic stem cell transplantation (HSCT) for decades. Playing a dual role, both cytotoxic and immuno-suppressive, TBI eliminates residual disease while also impairing the immune system from rejecting the foreign donor cells being transplanted. Unlike chemotherapy, radiotherapy is not hampered by perfusion, diffusion, or the blood-barrier effect and can effectively treat sanctuary sites. However, radiotherapy is subject to radiobiological trade-offs between destroying cancer cells, preserving immune and hematopoietic stem cells, and causing various adverse effects in normal tissue. Optimizing the immuno- suppressive effect of fractionated TBI while sparing normal organs requires careful consideration of total dose, dose per fraction, dose rate, target dose coverage, and dose to organs. Prospective multi-institutional trials are required to elucidate this matter further. However, as various recent surveys across the world indicate, the heterogeneity of 2D TBI practices, inaccurate dose calculation and dosimetry, and differences in reporting across institutions makes conducting these multi-institutional studies of TBI challenging. Technological advancements in radiotherapy planning and delivery are prompting a transition to modern intensity modulated techniques such as Volumetric Modulated Arc Therapy (VMAT) TBI and helical TomoTherapy<sup>TM</sup> TBI, which can better spare normal organs and potentially reduce radiotherapy-related toxicities without compromising TBI effectiveness. This review discusses the present developments and outcomes and toxicity for modern TBI techniques as well as total marrow irradiation (TMI), and total marrow and lymphoid irradiation (TMLI).</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 67-86"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.07.013
Mario Levis , Michael Oertel
The role of radiotherapy in the treatment of lymphoma is rapidly evolving. The development of modern systemic therapies and the adoption of FDG-PET-scanning as metabolic prognosticators are leading to a process of refinement of the treatment regimens. In this scenario, radiotherapy utilization is decreasing in several settings, including lower risk patients, to prevent the risk of long-term complications. Over the last decade, the most relevant changes in the treatment landscape are evident for advanced stage Hodgkin lymphoma and diffuse large B cell lymphoma. The main purpose of this paper is to review radiotherapy indications in these settings, to highlight pros and cons of a PET-guided strategy for radiotherapy recommendations, and to introduce future perspectives on the combination of radiotherapy and modern systemic therapies in both frontline and relapsed setting of advanced stage Hodgkin and diffuse large B cell lymphomas.
放射治疗在淋巴瘤治疗中的作用正在迅速发展。现代全身疗法的发展和 FDG-PET 扫描作为代谢预后指标的采用，正在促使治疗方案不断完善。在这种情况下，放疗在一些情况下的使用率正在下降，包括风险较低的患者，以防止长期并发症的风险。在过去十年中，晚期霍奇金淋巴瘤和弥漫大 B 细胞淋巴瘤的治疗方案发生了最明显的变化。本文的主要目的是回顾放疗在这些情况下的适应症，强调 PET 指导下的放疗推荐策略的利弊，并介绍在晚期霍奇金淋巴瘤和弥漫大 B 细胞淋巴瘤的一线治疗和复发治疗中放疗与现代系统疗法相结合的未来前景。
{"title":"Advanced Stage Hodgkin and Diffuse Large B-Cell Lymphomas: Is There Still a Role for Consolidation Radiotherapy in the PET Era?","authors":"Mario Levis , Michael Oertel","doi":"10.1016/j.semradonc.2024.07.013","DOIUrl":"10.1016/j.semradonc.2024.07.013","url":null,"abstract":"<div><div>The role of radiotherapy in the treatment of lymphoma is rapidly evolving. The development of modern systemic therapies and the adoption of FDG-PET-scanning as metabolic prognosticators are leading to a process of refinement of the treatment regimens. In this scenario, radiotherapy utilization is decreasing in several settings, including lower risk patients, to prevent the risk of long-term complications. Over the last decade, the most relevant changes in the treatment landscape are evident for advanced stage Hodgkin lymphoma and diffuse large B cell lymphoma. The main purpose of this paper is to review radiotherapy indications in these settings, to highlight pros and cons of a PET-guided strategy for radiotherapy recommendations, and to introduce future perspectives on the combination of radiotherapy and modern systemic therapies in both frontline and relapsed setting of advanced stage Hodgkin and diffuse large B cell lymphomas.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 16-26"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.10.002
Joanna C. Yang
Palliative RT is an effective tool in management and treatment of patients with hematologic malignancies. Even relatively low doses of palliative RT can quickly and effectively relieve pain and other symptoms impairing quality of life and function. As so many diseases are represented by the umbrella term, “hematologic malignancies,” and each disease has its own natural history and prognosis, the indications for palliative RT are heterogeneous. The following review provides a discussion of when palliative RT should be considered, as well as data-supported dose/fractionation schemes, for non-cutaneous lymphomas and leukemias. It also offers a suggested approach to the patient with a hematologic malignancy requiring palliative RT.
{"title":"The Role of Radiation Therapy for Palliation of Hematologic Malignancies","authors":"Joanna C. Yang","doi":"10.1016/j.semradonc.2024.10.002","DOIUrl":"10.1016/j.semradonc.2024.10.002","url":null,"abstract":"<div><div>Palliative RT is an effective tool in management and treatment of patients with hematologic malignancies. Even relatively low doses of palliative RT can quickly and effectively relieve pain and other symptoms impairing quality of life and function. As so many diseases are represented by the umbrella term, “hematologic malignancies,” and each disease has its own natural history and prognosis, the indications for palliative RT are heterogeneous. The following review provides a discussion of when palliative RT should be considered, as well as data-supported dose/fractionation schemes, for non-cutaneous lymphomas and leukemias. It also offers a suggested approach to the patient with a hematologic malignancy requiring palliative RT.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 11-15"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.10.005
David G. Wallington , Brandon S. Imber , Michael Scordo , Timothy J. Robinson
Chimeric antigen receptor (CAR) T-cell receptor therapy has transformed outcomes for patients with relapsed and refractory diffuse large B-cell lymphoma (R/R DLBCL). It is currently approved in the third line for all patients and in the second line for early relapsed or primary refractory disease. Although CAR T cell therapy offers the potential for improved outcomes, its use may also include logistical delays related to referral, medical, social, and financial clearance as well as manufacturing time; more than half of patients experience disease recurrence or progression while awaiting CAR T infusion. Bridging radiotherapy, defined as radiation delivered between the decision to pursue CAR T and infusion of CAR T cells, has become an attractive option for patients who would benefit from local disease control or palliation of symptoms. Additionally, patterns of failure analyses have revealed a dominant role of local disease progression, which has fueled investigations on bridging and early salvage radiation to improve long-term outcomes in patients, particularly those with localized or high-risk disease. Several potential mechanisms by which radiation therapy may improve CAR T efficacy have been proposed that include cytoreduction, tumor debulking, neutralization of immunosuppressive hypoxic and acidic tumor microenvironments, and immunologic and pro-apoptotic synergy between radiation and CAR T. Prospective clinical trials and translational work are ongoing and are needed to inform our conceptual understanding of potential mechanisms by which radiation therapy may improve CAR T efficacy and toxicity, identify which patients may be most likely to benefit, and confirm proposed clinical benefits.
嵌合抗原受体（CAR）T细胞受体疗法改变了复发和难治性弥漫大B细胞淋巴瘤（R/R DLBCL）患者的治疗效果。目前，该疗法已被批准用于所有患者的三线治疗，以及早期复发或原发性难治性疾病的二线治疗。尽管 CAR T 细胞疗法有可能改善疗效，但其使用也可能会导致转诊、医疗、社会和经济许可以及生产时间方面的后勤延误；一半以上的患者在等待 CAR T 输注期间会出现疾病复发或进展。桥接放疗是指在决定使用 CAR T 和输注 CAR T 细胞之间进行的放疗，对于那些可从局部疾病控制或症状缓解中获益的患者来说，桥接放疗已成为一种有吸引力的选择。此外，失败模式分析揭示了局部疾病进展的主导作用，这推动了对桥接和早期挽救性放疗的研究，以改善患者的长期预后，尤其是那些患有局部疾病或高风险疾病的患者。放疗可提高 CAR T 疗效的几种潜在机制已被提出，其中包括细胞还原、肿瘤剥脱、中和免疫抑制性缺氧和酸性肿瘤微环境，以及放疗与 CAR T 之间的免疫和促凋亡协同作用。前瞻性临床试验和转化工作正在进行中，我们需要了解放疗可提高 CAR T 疗效和毒性的潜在机制，确定哪些患者最有可能获益，并证实所提出的临床益处。
{"title":"The Role of Radiotherapy in Lymphoma Patients Undergoing CAR T Therapy: Past, Present, and Future","authors":"David G. Wallington , Brandon S. Imber , Michael Scordo , Timothy J. Robinson","doi":"10.1016/j.semradonc.2024.10.005","DOIUrl":"10.1016/j.semradonc.2024.10.005","url":null,"abstract":"<div><div>Chimeric antigen receptor (CAR) T-cell receptor therapy has transformed outcomes for patients with relapsed and refractory diffuse large B-cell lymphoma (R/R DLBCL). It is currently approved in the third line for all patients and in the second line for early relapsed or primary refractory disease. Although CAR T cell therapy offers the potential for improved outcomes, its use may also include logistical delays related to referral, medical, social, and financial clearance as well as manufacturing time; more than half of patients experience disease recurrence or progression while awaiting CAR T infusion. Bridging radiotherapy, defined as radiation delivered between the decision to pursue CAR T and infusion of CAR T cells, has become an attractive option for patients who would benefit from local disease control or palliation of symptoms. Additionally, patterns of failure analyses have revealed a dominant role of local disease progression, which has fueled investigations on bridging and early salvage radiation to improve long-term outcomes in patients, particularly those with localized or high-risk disease. Several potential mechanisms by which radiation therapy may improve CAR T efficacy have been proposed that include cytoreduction, tumor debulking, neutralization of immunosuppressive hypoxic and acidic tumor microenvironments, and immunologic and pro-apoptotic synergy between radiation and CAR T. Prospective clinical trials and translational work are ongoing and are needed to inform our conceptual understanding of potential mechanisms by which radiation therapy may improve CAR T efficacy and toxicity, identify which patients may be most likely to benefit, and confirm proposed clinical benefits.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 99-109"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.07.011
Sarah A. Milgrom , Andrea C. Lo
Hematologic cancers in pediatric, adolescent, and young adult populations include a diverse spectrum of malignancies. The cornerstone of treatment is multiagent chemotherapy. While radiation therapy (RT) is highly effective and played a pivotal role historically, its use has evolved. In classic HL, advancements in systemic therapy have allowed for reduced RT volumes and doses and careful patient selection. Similarly, NLPHL management has shifted toward observation after complete resection, or limited chemotherapy after incomplete resection with RT used only for partially responding disease sites. In primary mediastinal B-cell lymphoma, the role of RT is an area of active study, and treatment with chemotherapy alone has shown promise in adults. Frontline treatment of diffuse large B-cell lymphoma and Burkitt lymphoma relies on chemotherapy; evidence do not support a role for consolidative RT. In leukemia, the use of prophylactic cranial and testicular RT is declining in the setting of modern chemotherapy regimens. RT may play an important role in the salvage of relapsed/refractory lymphomas and leukemias. In addition, palliative RT is often integral to symptom relief and function preservation. Future research aims to refine risk stratification, personalize treatment approaches, and incorporate novel therapies to maintain or improve oncologic outcomes while mitigating late effects.
{"title":"The Role of Radiotherapy in Hematologic Malignancies in Children, Adolescents, and Young Adults","authors":"Sarah A. Milgrom , Andrea C. Lo","doi":"10.1016/j.semradonc.2024.07.011","DOIUrl":"10.1016/j.semradonc.2024.07.011","url":null,"abstract":"<div><div>Hematologic cancers in pediatric, adolescent, and young adult populations include a diverse spectrum of malignancies. The cornerstone of treatment is multiagent chemotherapy. While radiation therapy (RT) is highly effective and played a pivotal role historically, its use has evolved. In classic HL, advancements in systemic therapy have allowed for reduced RT volumes and doses and careful patient selection. Similarly, NLPHL management has shifted toward observation after complete resection, or limited chemotherapy after incomplete resection with RT used only for partially responding disease sites. In primary mediastinal B-cell lymphoma, the role of RT is an area of active study, and treatment with chemotherapy alone has shown promise in adults. Frontline treatment of diffuse large B-cell lymphoma and Burkitt lymphoma relies on chemotherapy; evidence do not support a role for consolidative RT. In leukemia, the use of prophylactic cranial and testicular RT is declining in the setting of modern chemotherapy regimens. RT may play an important role in the salvage of relapsed/refractory lymphomas and leukemias. In addition, palliative RT is often integral to symptom relief and function preservation. Future research aims to refine risk stratification, personalize treatment approaches, and incorporate novel therapies to maintain or improve oncologic outcomes while mitigating late effects.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 47-56"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.10.004
Samuel C. Zhang, Leslie K. Ballas
Survival outcomes for multiple myeloma (MM) have drastically improved over the past two decades with the advent of highly effective biologic agents and integration of autologous stem cell transplant (ASCT) for select patients. Despite these advances, MM remains an incurable disease and duration of remission decreases with each relapse. Palliative radiotherapy (RT) for MM, including treatment of pain, relief of compression, and prevention of fracture, is highly effective and generally well tolerated. Though RT can be delivered concurrently with biologic agents, caution should be exercised for potential added hematologic toxicity that may disrupt systemic therapy, especially in heavily pretreated patients, who have limited bone marrow reserve. In this review, we discuss the safety of RT with biologic agents (proteasome inhibitors, immunomodulators, monoclonal antibodies), review indications for palliative RT in MM, and present a framework for how to personalize RT based on goals of treatment, classification of uncomplicated versus complicated lesions, and patient and lesion characteristics. Additionally, we discuss the emerging role of bridging RT prior to chimeric antigen receptor (CAR) T-cell therapy.
{"title":"Radiation for Multiple Myeloma in the Era of Novel Agents: Indications, Safety, and Dose Selection","authors":"Samuel C. Zhang, Leslie K. Ballas","doi":"10.1016/j.semradonc.2024.10.004","DOIUrl":"10.1016/j.semradonc.2024.10.004","url":null,"abstract":"<div><div>Survival outcomes for multiple myeloma (MM) have drastically improved over the past two decades with the advent of highly effective biologic agents and integration of autologous stem cell transplant (ASCT) for select patients. Despite these advances, MM remains an incurable disease and duration of remission decreases with each relapse. Palliative radiotherapy (RT) for MM, including treatment of pain, relief of compression, and prevention of fracture, is highly effective and generally well tolerated. Though RT can be delivered concurrently with biologic agents, caution should be exercised for potential added hematologic toxicity that may disrupt systemic therapy, especially in heavily pretreated patients, who have limited bone marrow reserve. In this review, we discuss the safety of RT with biologic agents (proteasome inhibitors, immunomodulators, monoclonal antibodies), review indications for palliative RT in MM, and present a framework for how to personalize RT based on goals of treatment, classification of uncomplicated versus complicated lesions, and patient and lesion characteristics. Additionally, we discuss the emerging role of bridging RT prior to chimeric antigen receptor (CAR) T-cell therapy.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 87-98"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.semradonc.2024.08.005
Belinda A. Campbell , H. Miles Prince , Karin Thursky , Bouthaina Dabaja , Richard Hoppe , Lena Specht , Stephen Morris , Sandro V. Porceddu
Cutaneous T-cell lymphomas (CTCL) are a rare collection of diseases, frequently associated with diagnostic challenges and complex management dilemmas. The multidisciplinary team is vital for accurate clinico-pathological diagnoses and for collaborative therapeutic decisions throughout the management journey, which frequently involves multiple lines of therapy. Radiotherapy (RT) is a highly effective skin-directed therapy for CTCL, commonly delivered as localised fields or as total skin electron beam therapy (TSEBT). Mycosis fungoides (MF) is the most common of the CTCL, and patients typically experience high rates of morbidity and long natural histories of relapse and progression. Patients with MF typically present with incurable disease; in these patients, RT has an established role in symptom- and disease-control, achieving excellent response rates and proven therapeutic benefits. The role of RT continues to evolve, with modern practices favouring lower doses to reduce toxicity risks and allow for re-irradiation. Less commonly, there are situations where RT has an integral role in the potential cure of patients with MF: firstly, in the setting of unilesional MF where localised RT alone may be curative, and secondly, in the setting of preconditioning prior to curative-intent allogeneic hematopoietic stem cell transplant for patients with advanced MF/Sezary syndrome, where conventional-dose TSEBT is indicated as the most effective single agent for maximal debulking of skin disease. Radiotherapy also has an important role in the management of the less common CTCL, including the curative treatment of localised primary cutaneous anaplastic large cell lymphoma. Despite proven efficacy and quality of life benefits, disparity exists in access to RT and TSEBT. World-wide, stronger multidisciplinary collaborations and greater patient advocacy are required to increase access to RT and improve equity of care for our patients with CTCL.
{"title":"Breaking Down the Barriers for Patients With Cutaneous T-Cell Lymphoma: Current Controversies and Challenges for Radiation Oncologists in 2024","authors":"Belinda A. Campbell , H. Miles Prince , Karin Thursky , Bouthaina Dabaja , Richard Hoppe , Lena Specht , Stephen Morris , Sandro V. Porceddu","doi":"10.1016/j.semradonc.2024.08.005","DOIUrl":"10.1016/j.semradonc.2024.08.005","url":null,"abstract":"<div><div>Cutaneous T-cell lymphomas (CTCL) are a rare collection of diseases, frequently associated with diagnostic challenges and complex management dilemmas. The multidisciplinary team is vital for accurate clinico-pathological diagnoses and for collaborative therapeutic decisions throughout the management journey, which frequently involves multiple lines of therapy. Radiotherapy (RT) is a highly effective skin-directed therapy for CTCL, commonly delivered as localised fields or as total skin electron beam therapy (TSEBT). Mycosis fungoides (MF) is the most common of the CTCL, and patients typically experience high rates of morbidity and long natural histories of relapse and progression. Patients with MF typically present with incurable disease; in these patients, RT has an established role in symptom- and disease-control, achieving excellent response rates and proven therapeutic benefits. The role of RT continues to evolve, with modern practices favouring lower doses to reduce toxicity risks and allow for re-irradiation. Less commonly, there are situations where RT has an integral role in the potential cure of patients with MF: firstly, in the setting of unilesional MF where localised RT alone may be curative, and secondly, in the setting of preconditioning prior to curative-intent allogeneic hematopoietic stem cell transplant for patients with advanced MF/Sezary syndrome, where conventional-dose TSEBT is indicated as the most effective single agent for maximal debulking of skin disease. Radiotherapy also has an important role in the management of the less common CTCL, including the curative treatment of localised primary cutaneous anaplastic large cell lymphoma. Despite proven efficacy and quality of life benefits, disparity exists in access to RT and TSEBT. World-wide, stronger multidisciplinary collaborations and greater patient advocacy are required to increase access to RT and improve equity of care for our patients with CTCL.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 1","pages":"Pages 110-125"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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