Current concepts in clinical radiation oncology

Abstract

Based on its potent capacity to induce tumor cell death and to abrogate clonogenic survival, radiotherapy is a key part of multimodal cancer treatment approaches. Numerous clinical trials have documented the clear correlation between improved local control and increased overall survival. However, despite all progress, the efficacy of radiation-based treatment approaches is still limited by different technological, biological, and clinical constraints. In principle, the following major issues can be distinguished: (1) The intrinsic radiation resistance of several tumors is higher than that of the surrounding normal tissue, (2) the true patho-anatomical borders of tumors or areas at risk are not perfectly identifiable, (3) the treatment volume cannot be adjusted properly during a given treatment series, and (4) the individual heterogeneity in terms of tumor and normal tissue responses toward irradiation is immense. At present, research efforts in radiation oncology follow three major tracks, in order to address these limitations: (1) implementation of molecularly targeted agents and ‘omics’-based screening and stratification procedures, (2) improvement of treatment planning, imaging, and accuracy of dose application, and (3) clinical implementation of other types of radiation, including protons and heavy ions. Several of these strategies have already revealed promising improvements with regard to clinical outcome. Nevertheless, many open questions remain with individualization of treatment approaches being a key problem. In the present review, the current status of radiation-based cancer treatment with particular focus on novel aspects and developments that will influence the field of radiation oncology in the near future is summarized and discussed.

HSP90 inhibition as a means of radiosensitizing resistant, aggressive soft tissue sarcomas

“…Current approaches to improve the radiotherapeutic outcome of soft tissue sarcomas follow different strategies. These comprise combined-modality treatments with chemotherapy and hyperthermia as well as the implementation of novel irradiation qualities [32][33][34][35]. Whereas for heavy ion irradiation and hyperthermia in combination with photon irradiation the clinical results are promising [33,36], the efficacy of combined radiochemotherapy is controversially discussed and comes at the costs of accumulating side effects [37,38].…”

Priming anti-tumor immunity by radiotherapy: Dying tumor cell-derived DAMPs trigger endothelial cell activation and recruitment of myeloid cells

“…1 However, meanwhile it is well accepted that immune mechanisms contribute to the therapeutic outcome and that the mode of tumor cell death determines if and to which extent irradiation converts the tumor into an in situ vaccine. 2–4 Apart from tumor antigens which need to be made accessible to the immune system, the presence of adjuvants orchestrating the recruitment, differentiation, and activation of antigen-presenting cells (APCs) in the tumor microenvironment is of pivotal importance for the successful priming of anti-tumor immunity.…”

Cancer Therapy with Radiation: The Basic Concept of Radiotherapy and Its Development in Indonesia

“…Secara keseluruhan radiasi partikel memilliki Linear Energy Transfer (LET) yang lebih tinggi daripada radiasi foton, namun karena biaya produksinya yang mahal penggunaan jenis radiasi ini masih terbatas. 9,10 Jenis radioterapi Radioterapi dapat digunakan sebagai terapi kuratif, paliatif maupun profilaksis (preventif).…”

“…Terapi profilaksis (preventif) merupakan terapi yang bertujuan untuk mencegah kemungkinan metastasis atau kejadian berulang melalui penerapan radioterapi, contohnya adalah whole-barin radiotherapy untuk leukemia limfoblastik akut dan kanker paru-paru sel kecil. 10,11 Jurnal Farmasi Klinik Indonesia Volume 6, Nomor 4, Desember 2017…”