Moving Forward in the Next Decade: Radiation Oncology Sciences for Patient-Centered Cancer Care

Abstract

In a time of rapid advances in science and technology the opportunities for radiation oncology are undergoing transformational change. The linkage between and understanding of the physical dose and induced biological perturbations are opening entirely new areas of application. The ability to define anatomic extent of disease and the elucidation of the biology of metastases has brought a key role for radiation oncology for treating metastatic disease. That radiation can stimulate and suppress subpopulations of the immune response makes radiation a key participant in cancer immunotherapy. Targeted radiopharmaceutical therapy delivers radiation systemically with radionuclides and carrier molecules selected for their physical, chemical and biochemical properties. Radiation oncology usage of “big data” and machine learning/artificial intelligence adds the opportunity to markedly change the workflow for clinical practice while physically targeting and adapting radiation fields in real time. Future precision targeting requires multi-dimensional understanding of the imaging, underlying biology and anatomical relationship among tissues for radiation as spatial and temporal “focused biology”. Other means of energy delivery are available as are agents that can be activated by radiation with increasing ability to target treatments. With broad applicability of radiation in cancer treatment, it is a necessity for effective cancer care, opening a career path for global health serving the medically underserved in geographically isolated populations as a substantial societal contribution addressing health disparities. Understanding of risk and mitigation of radiation injury make it an important discipline for and beyond cancer care including energy policy, space exploration, national security and global partnerships.

Radiobiology of Combining Radiotherapy with Other Cancer Treatment Modalities

“…The compound goes into an excited state after neutron capture and undergoes a nuclear fission reaction to produce densely ionizing alpha particles. The range of these high LET particles in tissues is limited around 7.6 μm on an average (range 5-9 μm) [38,39]. Therefore, these particles lead to localized release of a substantial amount of energy within the tumor, sparing the normal tissues.…”

Evaluation of the ESMO-Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS v1.1) for adjuvant radiotherapy in breast cancer

“… 12 Indeed, during the last decade there has been accelerated development of technologies and techniques to enhance radiotherapy. 13 , 14 …”

Inter-agency perspective: Translating advances in biomarker discovery and medical countermeasures development between terrestrial and space radiation environments

“…Although dose prescriptions to a tumor or tissue are generally based on a population average, radiation therapy is now pursuing precision medicine and predictive oncology, where doses are individualized or stratified to a cohort ( Coleman et al, 2018 ). Since many patients suffer from adverse treatment effects, which could be acute, intermediate, or late ( Prasanna et al, 2012 ), the RRP has supported predictive biomarker development ( Prasanna et al, 2020 ; Prasanna et al, 2014 ), along with radioprotectors and mitigators to reduce treatment-related toxicities and improve patient outcomes ( Prasanna et al, 2015 ; Coleman et al, 2021 ). Cancer survivorship will expand with improvements in treatment, with one estimate suggesting >26 million cancer survivors by 2040 ( Bluethmann et al, 2016 ).…”