Seminars in Radiation Oncology最新文献

Telemedicine allows providers and patients to communicate without being in the same room through video platforms or telephone. Like the increased use of telework for businesses, telemedicine exploded during the pandemic. While many workplaces and clinics have returned to some level of in-person interactions, the convenience and comfort have given telemedicine staying power. Patients can be seen from the comfort of their homes; family members can join from the same or a different location. Driving, obtaining childcare, or taking time off from work is unnecessary. Pediatric patients’ parents can pull them into the conversation at appropriate times and avoid the awkwardness of having them leave for portions of the discussion. Because virtual visits are more efficient for everyone, they can often be scheduled sooner than an in-person visit. While not every visit can be done without the patient physically with the provider, many can. This is particularly true for cancer patients, who often have several visits with multiple providers. For immunocompromised patients, there is an added benefit of avoiding exposure from travel and a hospital visit. Oncology and radiation oncology practices have widely adopted telemedicine. While legal and logistical barriers exist in some areas of the world, these are sure to be resolved to make this medicine feasible for all in the modern era.

Radiotherapy aims to achieve a high tumor control probability while minimizing damage to normal tissues. Personalizing radiotherapy treatments for individual patients, therefore, depends on integrating physical treatment planning with predictive models of tumor control and normal tissue complications. Predictive models could be improved using a wide range of rich data sources, including tumor and normal tissue genomics, radiomics, and dosiomics. Deep learning will drive improvements in classifying normal tissue tolerance, predicting intra-treatment tumor changes, tracking accumulated dose distributions, and quantifying the tumor response to radiotherapy based on imaging. Mechanistic patient-specific computer simulations (‘digital twins’) could also be used to guide adaptive radiotherapy. Overall, we are entering an era where improved modeling methods will allow the use of newly available data sources to better guide radiotherapy treatments.

The fusion of cutting-edge imaging technologies with radiation therapy (RT) has catalyzed transformative breakthroughs in cancer treatment in recent decades. It is critical for us to review our achievements and preview into the next phase for future synergy between imaging and RT. This paper serves as a review and preview for fostering collaboration between these two domains in the forthcoming decade. Firstly, it delineates ten prospective directions ranging from technological innovations to leveraging imaging data in RT planning, execution, and preclinical research. Secondly, it presents major directions for infrastructure and team development in facilitating interdisciplinary synergy and clinical translation. We envision a future where seamless integration of imaging technologies into RT will not only meet the demands of RT but also unlock novel functionalities, enhancing accuracy, efficiency, safety, and ultimately, the standard of care for patients worldwide.

Radiation oncology caregivers worldwide are dedicated to advancing cancer treatment with the ultimate goal of eradicating the disease. Recognizing the inherent complexity of cancer treatment using hypo-fractionation radiotherapy (HFRT), these caregivers are committed to exploring avenues for progress and providing personalized care to each patient. Strong teams and effective workflows are an essential component to implementing safe HFRT. Every patient presents unique challenges, and as a united team of clinical and administrative professionals, radiation oncology care teams strive to drive advancements and streamline complexities in their field, guided by continuous technological innovation.

There has long existed a substantial disparity in access to radiotherapy globally. This issue has only been exacerbated as the growing disparity of cancer incidence between high-income countries (HIC) and low and middle-income countries (LMICs) widens, with a pronounced increase in cancer cases in LMICs. Even within HICs, iniquities within local communities may lead to a lack of access to care.

Due to these trends, it is imperative to find solutions to narrow global disparities. This requires the engagement of a diverse cohort of stakeholders, including working professionals, non-governmental organizations, nonprofits, professional societies, academic and training institutions, and industry.

This review brings together a diverse group of experts to highlight critical areas that could help reduce the current global disparities in radiation oncology. Advancements in technology and treatment, such as artificial intelligence, brachytherapy, hypofractionation, and digital networks, in combination with implementation science and novel funding mechanisms, offer means for increasing access to care and education globally. Common themes across sections reveal how utilizing these new innovations and strengthening collaborative efforts among stakeholders can help improve access to care globally while setting the framework for the next generation of innovations.

Spatially-fractionated radiotherapy (SFRT) delivers high doses to small areas of tumor while sparing adjacent tissue, including intervening disease. In this review, we explore the evolution of SFRT technological advances, contrasting approaches with photon and proton beam radiotherapy. We discuss unique dosimetric considerations and physical properties of SFRT, as well as review the preclinical literature that provides an emerging understanding of biological mechanisms. We emphasize crucial areas of future study and highlight clinical trials that are underway to assess SFRT's safety and efficacy, with a focus on immunotherapeutic synergies. The review concludes with practical considerations for SFRT's clinical application, advocating for strategies that leverage its unique dosimetric and biological properties for improved patient outcomes.

Radiation treatment has been the cornerstone in cancer management. However, long term treatment-related morbidity always accompanies tumor control which has significant impact on quality of life of the patient who has survived the cancer. Spatially fractionated radiation has the potential to achieve both cure and to avoid dreaded long term sequelae. The first ever randomized study of mini-beam radiation treatment (MBRT) of canine brain tumor has clearly shown the ability to achieve this goal. Dogs have gyrencephalic brains functionally akin to human brain. We here report long term follow-up and final outcome of the dogs, revealing both tumor control and side effects on normal brain. The results augur potential for conducting human studies with MBRT.