Podcasts about sbrt

In this episode of the Dr. Geo Prostate Podcast, we welcome Dr. Jonathan Lischalk, Director of Genitourinary Cancers at MedStar Georgetown University Hospital and former Medical Director at NYU's NYCyberKnife Center. Dr. Lischalk breaks down the evolution of radiation oncology and how cutting-edge imaging and targeted SBRT (Stereotactic Body Radiation Therapy) are reshaping prostate cancer treatment.We explore how imaging advances like MRI and PSMA PET scans are enabling unprecedented precision, the future of genetic-based personalization in prostate cancer therapy, and why fewer, more focused radiation sessions might soon become the new standard. From understanding the biology of radiation dosing to upcoming trials eliminating ADT in select patients, this is a must-listen for anyone looking to stay informed on the forefront of cancer care.

Last week the Edinburgh Cancer Centre begun treating prostate cancer patients within the framework of the so-called Precision Study. Patients receive only three radiation doses, with the Raypilot System used as a complement to ensure accurate motion control during treatment, thereby minimising potential side effects. The aim is to demonstrate that three sessions work as well as five in terms of both cancer eradication and the degree of side effects. The Pace-B study*, published in 2024, showed that SBRT** with five radiation sessions is just as effective in curing cancer as traditional treatment involving 20-40 sessions. The Precision Study aims to further streamline treatment while reducing side effects and improving patient convenience. The treatments in the study are carried out using the Raypilot System, which enables real-time monitoring of organ movement. This system allows for urethra-sparing techniques and tighter radiation margins - factors that both improve targeting accuracy and reduce the risk of side effects. Prostate Cancer Treatment Aiming for Improved Quality of Life The study includes 100 patients across multiple clinics in Europe and the US and is led by Professor Duncan McLaren at the Edinburgh Cancer Centre in Scotland. His aim is to make prostate cancer treatment more comfortable for patients and improving their quality of life post-treatment. "The goal of the Precision Study is to ensure that treatment with three radiation doses does not lead to greater side effects than those observed in the Pace-B study. I am confident that we can demonstrate effective cancer treatment with less side effects," says Professor McLaren. A Collaborative Effort for Improved Healthcare The study was initiated by researchers at various clinics using the Raypilot System. "Our customers are interested in developing and improving healthcare, always with patient quality of life in focus. At the same time, healthcare providers across the Western world are striving to reduce treatment times and enhance both quality and efficiency. This study could contribute to such progress, benefiting all stakeholders - healthcare providers reduce costs while improving care, and patients gain a better quality of life," says Thomas Lindström, MD at Micropos Medical AB, the company behind the Raypilot System. The first conclusions from the Precision Study are expected within one to two years, followed by a further five years of patient follow-up before final results can be presented. See more breaking stories here.

In this episode, Dr. Shana Coplowitz highlights the numerous benefits of Stereotactic Body Radiation Therapy (SBRT) and discusses which patients are ideal candidates. If you're seeking faster treatments with fewer trips to the clinic, this episode is packed with valuable information for anyone facing a prostate cancer diagnosis.

In this episode, Dr. Geo welcomes Dr. Jonathan Haas, Director of Radiation Oncology at NYU Grossman School of Medicine in Long Island, to discuss the latest advancements in stereotactic body radiation therapy (SBRT) for prostate cancer. Dr. Haas, a pioneer in CyberKnife radiation, shares the latest research, treatment options, and what's on the horizon for prostate cancer care.Episode Highlights:✔ SBRT & CyberKnife Technology – How high-dose, highly targeted radiation is replacing traditional 9-week radiation therapy.✔ New Developments – Research is underway to reduce SBRT treatment from five sessions to just two, making therapy even more convenient.✔ Prostate Motion & Radiation Accuracy – The prostate moves during treatment—learn how advanced imaging and AI-powered tracking compensate for movement to improve precision.✔ Androgen Deprivation Therapy (ADT) & SBRT – Not all patients may need ADT. New studies explore whether men with Gleason 4+3 can avoid hormone therapy.✔ Who is a Candidate? – Understanding the differences between Gleason 6, 7, 8, and 9 patients and who may benefit most from SBRT.✔ Side Effects & Risk Factors – Discussing common side effects like bladder bleeding (2%), rectal irritation (5%), erectile dysfunction (25% over 5 years), and strictures (2%).✔ Artificial Intelligence & Radiation Therapy – The RayStation AI system is now optimizing radiation planning, increasing precision, and making treatments more effective.✔ Choosing the Right Treatment Center – Why it's crucial to seek multidisciplinary care, get second opinions, and explore clinical trials for the best possible outcome.Takeaway: The landscape of prostate cancer treatment is evolving rapidly. If you or a loved one is considering radiation therapy, ask about SBRT, AI-driven imaging, and new clinical trials to ensure you receive the most advanced and effective care.Join Dr. Geo each week for expert insights, science-backed advice, and empowering conversations designed to help you live better with age. ----------------Thank you to our partnersThe ProLon 5-Day Fasting Mimicking Diet is a plant-based meal program designed to provide fasting benefits while allowing food intake. Developed by Dr. Valter Longo, it supports cellular renewal, fat loss, and metabolic health through low-calorie, pre-packaged meals that maintain the body in a fasting state.Special Offer: Thank you for listening, you can purchase the ProLon kit for just $148 by using this link.We'd also like to thank our partner AG1 by Athletic Greens. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, nervous system, immune system, energy, recovery, focus, and aging. All the essentials in one scoop. Enjoy AG1 by Athletic Greens.----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube...

Check out this week's QuadCast as we highlight the role of staging brain MRI in metastatic breast cancer, the link between acute and late toxicity in prostate cancer treatment, the benefits of liver SBRT over TACE, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

Check out this week's QuadCast as we highlight bone SBRT guidelines, best practice in the treatment of WHO grade II meningioma, frequency of partial breast IMRT treatment, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

Dr. Sue Yom, Editor in Chief, hosts guests Dr. Cristian Udovicich, a Fellow in Radiation Oncology at the University of Toronto's Sunnybrook Odette Cancer Centre, and Dr. Angela Jia, Assistant Professor and Assistant Residency Program Director at University Hospitals Cleveland Medical Center, who were the first and second authors of "Evolving Paradigms in Prostate Cancer: The Integral Role of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Primary Staging and Therapeutic Decision-Making." In addition, we review long-term SBRT results with Dr. Andrew Loblaw, Full Professor in the Department of Radiation Oncology and Institute of Health Policy, Management and Evaluation at Sunnybrook Health Science Center at the University of Toronto and supervising author of "Stereotactic Radiation Therapy for Localized Prostate Cancer: 10-Year Outcomes From Three Prospective Trials," and Dr. Constantinos Zamboglou, Deputy Medical Director at the German Oncology Center in Limassol, Cyprus and first author of an accompanying editorial, "Stereotactic Body Radiotherapy for Prostate Cancer is Getting Mature: 10-Year Outcomes From Three Prospective Trials."

Check out this week's QuadCast as we highlight spinal cord constraints for spine SBRT, published results of RTOG 1112 where liver SBRT shines, the role of prophylactic nodal RT in prostate SBRT, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

Shankar Siva joins the show to discuss the emerging role of stereotactic body radiotherapy (SBRT) in primary and metastatic RCC tumors.

Check out this week's QuadCast where we highlight the benefits of considering short course RT instead of years of endocrine therapy for low risk breast cancer patients, the superiority of SBRT over ablation for recurrent HCC, and much more! Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

ABOUT THIS EPISODEWhat is radiation oncology, and how is it used for neuroendocrine cancer? UCSF radiation oncologists Dr. Will Chen and Dr. Alexandra Hotca-Cho describe external radiation therapy (SBRT) and how, when, and where it may be used for select patients with neuroendocrine cancers. They address common concerns about the planning process, safety concerns, and treatment sequencing.TOP TEN QUESTIONS ABOUT EXTERNAL RADIATION THERAPY FOR NEUROENDOCRINE CANCERS:1. What is radiation oncology? How does it work? How is it different from other types of radiation?2. What are the types of radiation therapies used for neuroendocrine cancer? 3. Which neuroendocrine cancers are they used for, and when are they used? How do you decide who is a good candidate and if it will be effective?Where in the body can SBRT be used? (bone, liver, pancreas, rectal?) Where can it not be used in the body, and when is SBRT NOT used?Is there a number or size limit of the tumor(s)?4. For Bone: How do NETs affect the bones? Are they “on” or “in” the bone, and does the tumor tend to weaken it?If given to the bone, does SBRT weaken the bone? What are the chances of fracture with radiation to the bone? Does it matter which area of the bone/body is treated? What other factors influence fracture risk? (age, dose, number of treatments)? Should patients have a bone density scan before SBRT?If bone lesions are causing pain, how soon after treatment might a patient expect to have pain alleviated?How common is increased pain after treatment to the bone? What causes that?5. Safety: How much radiation is given with these procedures? Is there a concern about radiation safety following the procedures? (Do patients need to avoid others in the hours or days after the treatment?)Is there a lifetime limit to the amount of radiation one can receive, especially considering surveillance CT & PET scans?How often can these procedures be repeated? Does it damage other tissues or organs? How common are secondary cancers? What types and how treatable are they?Is there a risk with fertility?What other risks are there?6. How do these therapies compare to PRRT or radioembolization in terms of safety? If someone has had PRRT or radioembolization, can they also receive radiation therapy to the liver or bones? Is there increased risks if someone has had PRRT, radioembolization or CAPTEM or alkylating agents? 7. Is there an optimal sequence for treatments? 8. What is SBRT like for patients? What is the planning and preparation process? How do you determine how many treatments and what dose to give?9. What does the patient experience during and after the procedure? Does it hurt? What are the side effects? How much time do I need to take off of work? 10. How effective is SBRT in terms of managing symptoms? How effective is SBRT in controlling or destroying the tumor?  How do you know if the treatment “worked”?Bonus: What is the future of radiation therapy in neuroendocrine cancer treatment?For more information, visit LACNETS.org.

Check out this week's QuadCast where we highlight the reduced toxicity of reduced-margin MRI-guided prostate SBRT, the response rate of double hit lymphoma to radiation, the inappropriate radiation services denial rate of Medicare Advantage plans, and more! Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

In this edition of the On Target podcast, Dr Akila Viswanathan speaks with Dr Kristin Redmond about treating brain and spinal tumors and her research on stereotactic body radiation therapy (SBRT). Dr Redmond discusses some ongoing clinical trials using SBRT, a highly precise form of radiation therapy used to treat tumors in while minimizing damage to surrounding areas, that are exploring optimal doses and treatment techniques to improve patient outcomes. They also highlight the benefits of collaboration in multidisciplinary care at Johns Hopkins, where experts from radiation oncology, medical oncology, surgery, radiology and other fields work together to provide the best possible care for patients with complex cases, including rare tumors. Dr Redmond also touches on the innovative use of circulating tumor DNA to detect tumor recurrence early and her research on the neuropsychological effects of radiation on the brain.

Check out this week's QuadCast where we highlight the important results of the PACE-B trial for prostate SBRT, the utility of frozen section analysis of SLN bx in oral cavity cancer, dose de-escalation for gastric MALT lymphoma, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

Workup and management of Kidney Cancer in Radiation Oncology featuring guest Dr Riche Mohan

Check out this week's Quadcast as we highlight the first randomized trial of SBRT vs. Surgery for prostate cancer, the impact of pembrolizumab on survival in triple negative breast cancer, and the improved survival in limited stage small cell lung cancer with the addition of Durvalumab. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

Kidney Cancer & SBRT in the Management of RCC AUA Urology Core Curriculum: auau.auanet.org/core Host: Jay D. Raman, MD, FACS, FRCS(Glasg) Guest: Daniel Shapiro, MD Outline: Segment 1: History of radiation therapy in renal cell carcinoma Segment 2: Radiation use in the setting of primary kidney tumors Segment 3: Radiation use for locally advanced tumors including tumor thrombi Segment 4: Radiation therapy for metastatic disease Segment 5: Limitations of radiation therapy and selecting patients for radiation therapy

Check out this week's QuadCast as we highlight SBRT for oligometastatic pancreatic cancer, preoperative APBI, the role of post-lumpectomy mammograms prior to RT, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

Editor in Chief Sue Yom hosts a discussion of An Economic Analysis of SC.24: A Randomized Study of SBRT Compared with Conventional Palliative RT for Spinal Metastases. Guests are first and second author Dr. Marc Kerba, clinical associate professor in the Department of Oncology at the University of Calgary and radiation oncologist at the Tom Baker Cancer Centre, and Dr. Richard De Abreu Lourenco, Professor with the Centre for Health Economics Research and Evaluation at the University of Technology Sydney.

Check out this week's Quadcast where we highlight the role of FMISO PET to identify tumor hypoxia for attempts at dose de-escalation in HPV mediated HNSCC, ASTRO's new guidelines on bone metastasis treatment, SBRT for mediastinal LNs, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

Editor-in-Chief, Robert Amdur, MD, discusses using SBRT dose schedules to re-irradiate large volume recurrences of locally advanced Non-Small Cell Lung Cancer that has progressed following high-dose radiotherapy with conventional fractionation. The discussion is based on a paper published in the May 2024 issue of PRO titled "Thoracic Reirradiation with Stereotactic Body Radiation Therapy (SBRT) for Recurrent Advanced Non-Small Cell Lung Cancer (NSCLC)” (2024, Issue 3, May/June, PMID 38387781).

In this episode of the Oncology Brothers podcast, join Drs. Rahul and Rohit Gosain as they delve into the world of localized treatment options for gastrointestinal malignancies. They are joined by experts in the field, Drs. Nina Sanford, Jeffrey Ryckman, and Harris Chengazi, who provide insights into radiation oncology and interventional radiology modalities for treating liver cancer. The discussion covers the basics of radiation oncology terminology, including SRS, SBRT, and proton therapy, and how these modalities have evolved over the last decade. The experts also discuss the various tools available in the interventional radiology toolkit, such as ablation techniques, chemoembolization, and radioembolization. Listeners gain valuable insights into the considerations for referring patients with liver-confined hepatocellular carcinoma to radiation oncologists or interventional radiologists, depending on the size of the tumor and underlying liver function. The experts emphasize the importance of a multidisciplinary approach in cancer care to ensure the best treatment outcomes for patients. Tune in to learn about the side effects of SBRT, the nuances of combining different treatment modalities, and the significance of collaboration among oncology specialists. This episode highlights the importance of understanding and appreciating the diverse treatment options available for cancer patients. Don't miss out on this informative discussion on localized treatment options for gastrointestinal malignancies with the Oncology Brothers podcast.   Website: http://www.oncbrothers.com/ Twitter: https://twitter.com/oncbrothers Contact us at info@oncbrothers.com

Check out this week's Quadcast as we highlight SBRT for oligoprogressive prostate cancer, salvage SRS for high risk meningiomas, changes in breast cancer screening recommendations, and more! Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

At the end of last year, Dr. Jason Beckta published a docu-podcast about clinical supervision of radiotherapy services (parts one, two, and three). The series covers supervision terms, legal precedent, and dispels the misinformation shared by conflicted parties.  In this episode, The Accelerators (Drs. Matt Spraker and Simul Parikh) join up with Jason to interview the famous Dr. Todd Scarbrough, the radiation oncologist at the center of supervision lore.Todd shares his story and we discuss many aspects of supervision policy. Here are some links to things discussed in the show:TAP Episode with Simul, Jason, and Todd from ACRO 2022Jarvis et al., Initial Clinical Experience of Cherenkov Imaging in External Beam Radiation Therapy Identifies Opportunities to Improve Treatment DeliveryPrice et al., Washington University in St. Louis experience with remote SBRT coverage and adaptive radiotherapy coverageThe Accelerators Podcast is a production of Photon Media, a division of the Cold Light Legacy Company.If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

Editor-in-Chief, Robert Amdur, MD, reviews the evidence for treating Low-Intermediate Risk prostate cancer with Ultra Hypofractionated SBRT. This discussion was stimulated by a paper published in the November/December 2023 issue of PRO titled “Long-Term Outcomes of a Prospective Study on Highly Hypofractionated Intensity Modulated Radiation Therapy for Localized Prostate Cancer for 3 Weeks” with PMID 37414247. However, the majority of the podcast will focus on data supporting 5 Fraction SBRT, including the most recent report from the PACE-B trial (Abstract only from the 2023 ASTRO annual Meeting).

Editor-in-Chief Sue Yom hosts Dr. Karin Lindberg, a Clinical Oncologist at the Karolinska Institute in Sweden and the supervising author of a new paper this month, "Expanded HILUS trial - a pooled analysis of risk factors for toxicity from SBRT of central and ultra-central lung tumors," and Dr. David Palma, a Radiation Oncologist at the London Health Sciences Centre who co-authored the accompanying editorial, "Beyond the HILUS Trial: How Can We Improve the Safety of SABR for Ultra-Central Thoracic Tumors?" Dr. Palma also describes the design and findings of the new clinical trial SUNSET, which he presented in the Multidisciplinary Thoracic Cancer Symposium plenary session simultaneously with this podcast release.

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Esseim Sharma, MD, of University Hospitals Cleveland, and Paul C Zei, MD, PhD, FHRS, of Brigham and Women's Hospital to discuss One-Year Outcomes Following Stereotactic Body Radiotherapy for Refractory Ventricular Tachycardia. Cardiac stereotactic body radiotherapy (SBRT) has emerged as a promising noninvasive treatment for refractory ventricular tachycardia (VT). The objective is to describe the safety and effectiveness of SBRT for VT in refractory to extensive ablation. For a select group of high-risk patients with VT refractory to standard therapy, SBRT is associated with a reduction of in VT and appropriate ICD therapies.   https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(23)02782-0/fulltext    Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): E. Sharma: No relevant financial relationships with ineligible companies to disclose.  P. Zei: Honoraria/Speaking/Consulting Fee: Varian Medical Systems, Biosense Webster, Inc., Abbott; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc.; Stocks (Publicly Traded): Affera, Inc.

Episode two of the Radiation Therapy podcast series discusses treatment of Oligometastatic disease, re-irradiation and role of palliative radiation, utilization of SBRT, introduction to proton therapy and mitigation of radiation-associated toxicities. Host: Mian M. Shahzad, MD, PhD (Gynecologic Oncologist; H. Lee Moffitt Cancer Center)Guest Speaker: Michael Montejo, MD (Radiation oncologist; H. Lee Moffitt Cancer Center) Sound engineered and produced by Tanya Colomb on behalf of the Society of Gynecologic Oncology.

This week on BackTable Urology, Dr. Aditya Bagrodia (UCSD), medical oncologist Dr. Rana McKay (UCSD) and radiation oncologist Dr. Shankar Siva (University of Melbourne) discuss the growing role of radiation therapy in kidney cancer treatment. --- SHOW NOTES Shankar first explains the original historical studies that provided evidence of the limited efficacy of low dose conventional radiation therapy (RT) in treating kidney cancer. However, he and Rana discuss how stereotactic body radiation therapy (SBRT), a newer technology which delivers a higher dose per fraction more accurately, has shown better outcomes in clinical trials than conventional RT. They also explain the associated risks with SBRT and how neoadjuvant therapies can be combined with radiation. They also consider the use of SBRT in bulky tumors and those with IVC thrombus. All three doctors agree that radiation therapy needs to be incorporated into a multimodal approach to kidney cancer. They also discuss the potential of radiation therapy in the cytoreductive setting and its role in delaying systemic therapy in patients with oligometastases. Finally, they explore the possibility of using PET imaging to detect oligometastatic disease. Although prostate-specific membrane antigen positron emission tomography (PSMA PET/CT) imaging is mostly used to stage prostate cancer, other solid tumors like renal cell carcinoma (RCC) may also express PSMA. For this reason, they agree that a next generation PSMA PET/CT equivalent for RCC could be revolutionary. Lastly, they predict what the future of RCC could hold by examining newer therapies, such as radioligand therapy and cyberknife. --- RESOURCES Kidney Cancer Association: 2023 International Kidney Cancer Symposium (Nov. 9-11) https://www.kidneycancer.org/ikcs/2023-ikcs-north-america/ Decipher by Veracyte https://decipherbio.com/ WellPrept https://wellprept.com/

Check out this week's QuadCast as we highlight some of the most important data from ASTRO 2023, including SBRT for Renal Cell Carcinoma, SRS for small cell, RT instead of transplant for relapsed Hodgkin lymphoma, and more!

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today's episode, our guests will discuss new research advances in treating non-small cell lung cancer, small cell lung cancer, and mesothelioma.  Dr. Charu Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, Pennsylvania. She is also the 2023 Cancer.Net Associate Editor for Lung Cancer. Dr. Melina Marmarelis is an assistant professor at the University of Pennsylvania, the Medical Director of the Penn Medicine Mesothelioma Program, and the co-director of the Molecular Tumor Board at the University of Pennsylvania. She is also the 2023 Cancer.Net Specialty Editor for Mesothelioma. Dr. Kristin Higgins is a radiation oncologist, Professor and Vice Chair in Clinical Research in the Department of Radiation Oncology at Emory University School of Medicine and medical director of radiation oncology of The Emory Clinic at Winship Cancer Institute's Clifton campus location. She is also a 2023 Cancer.Net Advisory Panelist for Lung Cancer. You can view disclosures for Dr. Aggarwal, Dr. Marmarelis, and Dr. Higgins at Cancer.Net. Dr. Aggarwal: Hello and welcome to this Cancer.Net Research Round Up podcast. Today, we will be talking about the latest research from the Annual Meeting of the American Society of Clinical Oncology from June 2023, and I'm joined today by 2 experts in the field of lung cancer. Before I introduce them, I'd like to introduce myself. I'm Dr. Charu Aggarwal. I'm an associate professor for lung cancer excellence at the University of Pennsylvania's Abramson Cancer Center. I'd now like to introduce Dr. Melina Marmarelis. Dr. Marmarelis: Hi, so happy to be here. I'm Melina Marmarelis. I'm an assistant professor at the University of Pennsylvania and the medical director of the Penn mesothelioma program. Dr. Aggarwal: And Dr. Kristin Higgins. Dr. Higgins: Hi, everyone. I'm Kristin Higgins. I am a thoracic radiation oncologist at Winship Cancer Institute of Emory University. I'm a professor and vice chair for clinical research for radiation oncology. Dr. Aggarwal: Fantastic. So today, we'll talk about relevant research as it applies to practical implications in the clinic for practitioners, but most importantly, patients with lung cancer. I'd like to start off by discussing 2 key studies, and I would love for perspectives from our faculty here. The first study I want to highlight is the ADAURA trial. This is a trial that has already sort of changed practice in most recent years when the study was presented at the Annual Meeting of the American Society of Clinical Oncology in 2020, but we have new updates on this study as of 2023. So, in brief, this was a study that looked at the value of administering an oral pill called osimertinib that is a tyrosine kinase inhibitor against the EGFR, or the epidermal growth factor receptor, in patients with non-small cell lung cancer. We know that non-small cell lung cancer is quite a heterogeneous disease with some subsets of patients having mutations that may render them increasingly sensitive to the effects of these tyrosine kinase inhibitors. In fact, these pills have been used in the metastatic setting for several years based on an improvement in overall survival. What the ADAURA study tried to do was ask the question if this pill would add an incremental advantage after receiving curative-intent surgical resection in those with early-stage lung cancer. So this study enrolled patients with stage IB to IIIA non-small cell lung cancer after surgical resection and focused only on those patients that had sensitizing EGFR mutations with EGFR exon 19 deletion or L858R mutations. Patients could receive chemotherapy after having the surgery and then were basically randomized into 2 groups, one of whom received osimertinib at a dose of 80 milligrams once daily for a total of 3 years. Patients were followed up for recurrence. We already know from the earlier results that patients who received osimertinib had a better chance of delaying the recurrence of disease. However, what we found at the Annual Meeting this year is that the administration of this osimertinib also improved overall survival, which is really what we all look for in the oncology world. If you're administering a therapy, especially for a long duration, we want to be able to see a survival benefit, and that's what we saw. In fact, in patients who received osimertinib, there was a 49% less likelihood of dying from lung cancer compared to those who did not receive osimertinib. This, I think, is practice-affirming. It may not be practice-changing because some of the practitioners started using osimertinib after its FDA approval in December of 2020, but I think it just confirms our practice as it delivers an overall survival advantage in these patients. One thing that's increasingly important is to identify patients who have this mutation, so now we have efforts underway locally as well as nationally to perform molecular genotyping on all patients with lung cancer so that we can adequately and appropriately treat those with early-stage lung cancer following curative resection or following surgery. Melina and Kristin, what are your thoughts? Dr. Marmarelis: Well, I think these results are really important because it did, as you say, affirm kind of what we're already doing, but I think the most convincing part of this for me is the prevention of spread of disease to the brain. This is not comparing osimertinib after surgery versus osimertinib ever, which I think is a difficult part about interpreting this trial. But I think the fact that it prevented disease from going to the brain is really meaningful to everyone, to patients, to the physicians that are caring for them, so I think that's a really important endpoint. Dr. Higgins: I agree with Melina. I think this is really exciting for our patients. It's exciting to have more treatment options for early-stage lung cancer. I think patients that are diagnosed with early-stage lung cancer are highly motivated to do everything they can to improve their likelihood of being cured. So I tend to have a lot of conversations about side effects and toxicities with patients that have questions and are sort of wondering how it will affect their quality of life, and of course, that is an important piece of it because patients that do have curable lung cancer are probably starting off with a better overall quality of life, but I think generally speaking, our patients have tolerated it well. I'm also kind of excited from a radiation oncology point of view. We treat patients with stereotactic body radiation therapy [SBRT] that are medically inoperable. And we have another trial with a cohort looking at osimertinib for those patients that have EGFR mutations, too, and that's ongoing, again, applying the same concept of trying to really use these SBRTs that work really well in the advanced setting, moving them into earlier stages of disease to help us care for more patients. So overall, I think it's really exciting, and I think it's a huge win for the clinical research community. Dr. Aggarwal: Well, that's wonderful. And I think this certainly advances the field as this is the first targeted therapy approved for patients with early-stage non-small cell lung cancer. I should add that AstraZeneca, the company that makes this drug, has provided institutional research funding to my institution, and I also serve as an advisor to them, but I was not involved personally in the research of this clinical trial. I'd like to move on but stay within the field of early-stage lung cancer and talk about another study called the KEYNOTE-671 study, and this is important because it really applies the idea of using immunotherapy before and after surgical resection in patients with early-stage lung cancer. Just to give a little bit of background to our listeners, we now have 3 approvals for the use of immunotherapy in patients with early-stage lung cancer. Two of those are in the adjuvant setting, meaning that if a patient undergoes surgical resection or surgery for early-stage lung cancer, they can receive either atezolizumab or pembrolizumab following that surgery, and that has been shown to improve outcomes in terms of reducing the chances of recurrence. We also have another approval, which is the third approval in early-stage lung cancer, where 3 cycles of chemotherapy and immunotherapy are administered prior to surgery, also called as the neoadjuvant chemo-immunotherapy approach. This drug that has been approved in combination with chemotherapy is nivolumab, and this approval came from a clinical trial called CheckMate 816 that showed both that patients who received this neoadjuvant chemo-immunotherapy approach had a higher proportion of patients who had complete response or pathologic complete response in their tumors at the time of surgery and also showed that the chances of the disease coming back after surgical resection was much lower amongst those that had received this intervention. The current study, the KEYNOTE-671 study, builds upon this concept and adds both a before-surgery intervention as well as an after-surgery intervention. So what this study did was it enrolled patients with early-stage, stage II to IIIB non-small cell lung cancer, and patients in the intervention arm received 4 cycles of chemotherapy in combination with pembrolizumab, underwent surgery, and then received immunotherapy with pembrolizumab for up to 13 cycles. Patients in the control arm received only chemotherapy prior to surgery and then placebo for up to 13 cycles after. This was a large study with about 786 patients randomized, and what we found was that those patients that received the intervention had a much higher likelihood of remaining disease-free or event-free following surgical resection as well as in the early analysis, an improvement in overall survival with about a 27% reduction in the risk of death. So I do think that this is the first study that shows us that use of both neoadjuvant as well as adjuvant. So sort of this perioperative approach of using immunotherapy before and after surgical resection can actually lead to improved outcomes. This is ultimately what we want for our patients, improvement in overall survival, improvement in cure rates, etc. The study has been silent on the use of radiation therapy, although it has gone into details in terms of the kinds of surgery that was done. Kristin, what are your views about this? Dr. Higgins: I think postoperative radiation after resection for non-small cell lung cancer has sort of started to fall out of favor because of the Lung ART trial that was published in Europe, a randomized phase III trial that showed no differences in disease-free survival or overall survival. And that's not to say that there aren't more study questions on ways to give it safer and ways to incorporate radiation in with the chemo-IO approach, and there are some novel ways to do that, and we're going to see some data presented at the World Lung Cancer Conference looking at some of those novel approaches. But standardly, when patients receive neoadjuvant chemo-immunotherapy followed by surgery, we typically would not offer radiation. There are instances, though, when patients have positive margins, for example, and in that situation, it's sort of a discussion on a case-by-case basis. But ideally, we're hoping that most of these patients that go to surgery are able to get a complete resection, and that's really the key component of the decision-making for deciding if patients are eligible for this approach. Dr. Aggarwal: I agree. Melina, any additional thoughts on this trial? Dr. Marmarelis: I think it's an exciting trial for the reasons that you mentioned. I think it does bring up a number of questions about whether both neoadjuvant and adjuvant immunotherapy are needed. I tend to like the idea of having immunotherapy present when the tumor is present before surgery, so I like kind of having that on board, but I think we still don't know which is more important. Dr. Aggarwal: So it certainly raises many more questions, which hopefully will be answered in the future. KEYNOTE-671 trial was conducted by Merck that produces the drug Keytruda, or pembrolizumab. We have received institutional research funding for other trials. I was not personally involved in this clinical trial. I do serve as an advisor for Merck. I think we'll bring you more research from the ASCO Annual Meeting. And I'll turn it over to Dr. Marmarelis to discuss some more exciting research. Dr. Marmarelis: Thanks, Charu. So perhaps it's not surprising that one of the exciting things I picked from ASCO has to do with mesothelioma. And I just want to put into context a little bit about why this trial was important. This is IND227. It was a cooperative group trial done across Canada, France, and Italy, and this was chemotherapy plus or minus pembrolizumab in patients with pleural mesothelioma that did not undergo surgery. So this was their first treatment, and they were not undergoing surgery. And the reason this trial was important is that in the last few years, we had results from CheckMate 743, which was looking at IPI/NIVO, so a combination of immunotherapies versus chemotherapy. And there was an improvement in survival for those that received double immunotherapy, and that improvement was most pronounced in the non-epithelioid population, which is actually a smaller subset of pleural mesotheliomas. And so as we've seen in the lung when we look at immunotherapy versus chemo, it raises the question of whether combination immunotherapy plus chemotherapy would actually be better for all and, in particular, for all histologies in pleural mesothelioma. So this was looking at that concept. It took the standard chemotherapy, carboplatin-pemetrexed or cisplatin-pemetrexed, and then combined it with one immunotherapy, so slightly less than the combo immunotherapy seen in CheckMate 743, and that was pembrolizumab. And what they saw was that there was a small overall survival improvement in the group that got pembrolizumab. Again, that was most pronounced in patients in the non-epithelioid group, so those with sarcomatoid or biphasic histology. And this is really a prelude to several other trials that are coming out in mesothelioma, namely the DREAM3R trial, which is looking at chemotherapy plus or minus durvalumab. That control arm also includes IPI/NIVO, so that will be really important to be able to compare those, and then also the BEAT-meso trial, which is looking at chemotherapy-immunotherapy but also with an anti-VEGF agent, bevacizumab. So I think this was an important trial. It's a little bit of proof of concept, but there's still a lot that we're looking forward to. It's not quite practice-changing in the clinic, although I think it's certainly an option that people are using, but I'm looking for more data going forward. Dr. Aggarwal: It's incredible to see how far we've come in mesothelioma within the last decade. We are introducing immunotherapy. We're introducing novel agents in the first-line setting. Dr. Marmarelis: The other trial that I was interested in was KEYNOTE-789, which is looking also at patients with EGFR mutations and those that had the original osimertinib as their first-line treatment or another tyrosine kinase inhibitor and then had disease progression on that TKI. And this is an area of huge need. We have patients that do really well on targeted therapies, and then they have disease progression, and we're looking for additional targeted options, but we're also looking for effective chemotherapy options. And one of the questions that has risen from this is whether there's a role for immunotherapy. We know that immunotherapy alone in patients with EGFR mutations is not very effective when you look at a broad population, but in combination with chemotherapy, it's possible that it can add some benefit. So this trial looked at those that had EGFR mutations, had disease progression after a targeted therapy, and then it randomized them to chemotherapy plus or minus pembrolizumab, so chemotherapy plus or minus immunotherapy, and interestingly, it had no difference in the progression-free survival or the overall survival. So the 2 arms were really similar in terms of outcomes. There was also no difference in the overall response rates of the amount that the drug actually shrinks the tumor. So it really doesn't look like immunotherapy is adding much to chemotherapy for these patients. I think we still need to look a little bit closer because there are probably some patients with EGFR mutations that could benefit from immunotherapy, but we're really not very good at identifying those. One of the questions that comes up in this space is whether to add anti-VEGF treatment in addition to chemotherapy and immunotherapy. So there are some upcoming trials looking at that. Dr. Aggarwal: I think this was a trial that was actually very important and again, practice-affirming that this idea of continuing chemotherapy without adding immunotherapy, patients are not losing much. In fact, they're not gaining anything by adding immunotherapy as shown in this clinical trial. I think continuing immunotherapy, so continuing osimertinib, may be important in this setting also because we know that osimertinib can cross the blood-brain barrier. It can provide that CNS [central nervous system] protection. Dr. Marmarelis: Yeah, I think that's a great point that the comparison here is not chemotherapy plus osimertinib. It's chemotherapy alone. So I agree that the control arm is not quite what some of us do. I agree. I do the same as you do. I also just want to mention that the KEYNOTE trial and the previous trial about mesothelioma used pembrolizumab, which is made by Merck. We have received institutional funding, and I've served as an advisor as well as received honorarium from Merck.   Dr. Aggarwal: Melina, those were 2 very important studies and certainly, I think, answer some very relevant questions in clinic in the management of patients with EGFR-mutant lung cancer, for example. And then I think we look forward to more practice-changing data in mesothelioma. Kristin, I would love to hear research from ASCO from you. What caught your interest? Dr. Higgins: So I have a special interest in small cell lung cancer. And I think there was one important small cell lung cancer trial that I wanted to review with everyone. It was SWOG S1929. And SWOG is the Southwest Oncology Group, and it's a cooperative group that conducts clinical trials in cancer funded by the National Cancer Institute. And this is a randomized phase II trial of atezolizumab and chemotherapy followed by randomization to continuing the maintenance of atezolizumab with a PARP inhibitor. Now, we know from prior data that PARP inhibition is attractive for small cell lung cancer because PARP is expressed frequently in small cell lung cancer, and there is a biomarker called Schlafen-11 that preclinical data and prior data has shown can predict response to PARP inhibition. And this trial was sort of a proof-of-concept trial, a small, randomized phase II trial testing whether or not that Schlafen-11 biomarker could be used to direct therapy. Now, in this trial, there were 309 patients that were registered. They then had to have their tumor samples sent for central testing for the Schlafen-11 expression. One thing that I think is important to bring up is that in small cell lung cancer, there's this belief that it's really hard to get tissue samples from small cell lung cancer and it's a difficult thing logistically because it's just a lot harder to access these tumors. But interestingly, in this trial, 80% of patients had tumors that were evaluable for the biomarker, and the median time to the test result was only 7 days. So patients were able to get their tumor tested, get it sent out, get results in a rapid manner, and then be randomized based on these results. The primary endpoint for this trial was progression-free survival, and the primary endpoint was met. Progression-free survival was 4.2 months versus 2.8 months. Now, I think many people will say the magnitude of benefit here is not very much, but it's small cell lung cancer, and we don't have a lot of positive trials in this space, and we also don't have many trials that have used a biomarker to direct therapy. So I think for those reasons, it's really exciting to see these results. It was also conducted within a cooperative group with multiple different sites across the United States, and the fact of the matter is that we can do trials like this in small cell lung cancer patients, and I think it will sort of serve as a precedent for future trial design. Now, the overall survival for the trial is still premature. It didn't look that much different with the PARP inhibitor, but that doesn't mean that, again, things could change with more follow-up. And I really like the approach of this trial design, and I'm excited to see biomarker-driven trials in small cell lung cancer. Charu and Melina, what do you guys think about this study? And what do you think about our small cell lung cancer patients and our ability to conduct future trials like this? Dr. Aggarwal: I think this is certainly an advance. As you pointed out, Kristin, it shows us that we can conduct trials in the space. I think it offers a lens into the potential of personalized therapy in small cell lung cancer, which has eluded us for a very long time. The standard of small cell lung cancer has not changed significantly for a very long time, so I think this is very exciting and can't wait to see more things come in the future. Dr. Marmarelis: Yeah, I agree. I think we've always been asking for additional biomarkers, especially in such a difficult disease like small cell. And so this is really exciting to see potential biomarkers and that it was feasible to actually pose that question and study it. So that part's really exciting. Dr. Higgins: Great. And I should also say I was not involved in the study, and I'm not associated with any of the pharmaceutical companies that were involved in the study for S1929. And the final study that we wanted to talk about was the phase III LUNAR study, and this is sort of a different type of trial in the setting of advanced non-small cell lung cancer. It was studying tumor treatment fields with standard of care in metastatic non-small cell lung cancer after progression with platinum-based therapies. And first, I just want to step back and explain what tumor treating fields are. Tumor treating fields are applied to a patient with a transducer that's placed on the skin, and what it does is it applies an electrical field, and that disrupts mitosis when the cancer cells are trying to divide. And the mechanism of cell death is a little bit unclear. There are sort of many mechanisms that are postulated, one of which is immunogenic cell death, but we don't really know, I think, what's happening. But there have been studies that show improved results with tumor treating fields and other diseases. For example, particularly in glioblastoma multiforme, tumor treating fields are used in combination with surgery, radiation, and temozolomide (Temodar). So it's something that's being used in other disease sites, and this is some of the early data that we've seen in metastatic non-small cell lung cancer. And so in this trial, 276 patients were randomized to tumor treating fields plus standard of care or standard of care alone. Now, I should mention that this trial began enrolling patients in 2016, and so the standard of care was very different. After platinum-based therapies, the standard was considered docetaxel. Of course, platinum-based therapy alone for frontline treatment of advanced non-small cell lung cancer is also not the standard of care anymore. And so I think with that in the background, it does make interpretation of these results somewhat difficult, and that's probably the major caveat to this study. But nonetheless, patients were randomized, 276 patients. The primary endpoint of the study was overall survival. They were looking at progression-free survival and overall response rates as secondary endpoints as well as overall survival in patients that received immunotherapy versus just chemotherapy alone. And the trial was positive. Overall survival was improved. The median overall survival was 13.2 months for patients that received tumor treating fields with standard of care versus 9.9 months for standard of care alone. If you look at 3-year survival, it was 18% versus 7%. I think this is a new type of therapy for our patients with non-small cell lung cancer. It is somewhat of a difficult thing to wear the transducer, and you have to wear it for many, many hours. So that is one thing that I think can be difficult for patients that are using this treatment, but nonetheless, it is something new for advanced non-small cell lung cancer. I do know that the technology of tumor treating fields is being studied in other settings for non-small cell lung cancer, for stage III non-small cell lung cancer, for example, and also in the frontline setting. I think this trial kind of speaks to the fact that the landscape of advanced non-small cell lung cancer is changing so rapidly, and when we're studying something novel, we have to make sure that we make these trials feasible for enrollment so that we can get them completed rapidly, and we can get a readout and it doesn't become obsolete based on this shift in the standard of care. So I think it just really kind of drives home that we need to make sure that we're taking that into account with trial design. It's not standard of care changing right now, but it'll be interesting to see how the data evolves over time. Melina, I'm interested to hear your point of view because I know that these can be used in mesothelioma, maybe not that frequently. What is your experience with tumor treating fields, if any? Dr. Marmarelis: Tumor treating fields are approved as a device in pleural mesothelioma in the first-line setting in combination with chemotherapy. They have been used off-label in other settings, but that's the device approval. The trial that looked at tumor treating fields in mesothelioma was a single-arm trial, so there was no control arm, and it was really actually just looking at the safety of the device. So I have not used it personally in mesothelioma, although I know of patients and I know of real-world studies looking at its use, and I think it's potentially an interesting modality of treatment, especially in combination with immunotherapy, given that it really doesn't have a lot of additive toxicity. But I think the question is really, which patients are benefiting from it, and which patients are able to actually wear the vest in the case of mesothelioma? Dr. Higgins: Yeah. Any thoughts, Charu? Dr. Aggarwal: I agree, and I think this is going to be largely driven by patient experience. I think this is going to be quite onerous to wear this, carry the suitcase, so I would be very interested in patient reported outcomes as well as patient experiences and stories, which will really drive our use here. Dr. Higgins: Yeah, that's a great point. I should say that this trial was sponsored by Novocure. My institution does have other Novocure studies underway, and we receive research funding, but I was not involved in the study, and I did not personally receive any research funding. Dr. Aggarwal: Thank you, Kristin. This has been a wonderful review of practice-changing and some promising research that came out of the ASCO Annual Meeting. I hope our listeners enjoyed it, and we'll be sure to update you with the next annual research conference. Thank you, everyone. ASCO: Thank you, Dr. Aggarwal, Dr. Marmarelis, and Dr. Higgins. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

On this episode of Oncology Unscripted, patient advocates Julie Johnson and Katie Coleman and radiation oncologist Dr. Matt Spraker continue The Insider's Guide to Radiation Therapy! This four episode series will cover radiation 101, stereotactic body radiation therapy (SBRT), and proton therapy!In this episode, we discuss SBRT, alternatively called stereotactic ablative body radiotherapy (SABR). We also discuss a related treatment, stereotactic radiosurgery (SRS).Here are some links to things we discussed during the show:Rare Cancer Research FoundationPattern.orgCount Me InJAMA Oncology SBRT/SABR patient pageCyberKnife information from the manufacturer (Accuray)GammaKnife information from the manufacturer (Eleckta)The patient-led Remove the Mask CampaignHere are some clinical and scientific publications mentioned during this show:Original Timmerman study of SBRT for early stage lung cancerDiscovery of the SBRT "No Fly Zone" in the chestInternational Radiosurgery Consortium of the Kidney (IROCK) meta-analysis of SBRT for primary kidney cancer (renal cell carcinoma).Here are some resources that may be of interest, but were not discussed in this episode:An excellent video on Stereotactic Radiosurgery (SRS) versus Whole Brain Radiotherapy (WBRT) for brain metastases from our friends at PRIMRRTOG 1112 Trial: Benefit of adding SBRT to Sorafenib in locally advanced liver cancer (hepatocellular carcinoma). (conference abstract only)TRENDY Trial: Suggests that SBRT is superior to trans-arterial chemoembolization (TACE) for early liver cancer (haptocellular carcinoma).MD Anderson Cancer Center Phase II Trial: Suggests that SBRT may be used to defer systemic therapy in patients with oligometastatic kidney cancer (renal cell carcinoma) Oncology Unscripted is a Photon Media production. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.Additional content from Katie Coleman can be found at her website, https://www.katiekickscancer.com/. This show and our opinions are meant for general informational purposes and are not medical advice. We encourage you to reach out to your doctors to discuss your individual case. 

Editor-in-Chief, Robert Amdur, MD, explains the main values used to evaluate conformality and dose gradient in treatment plans with high intensity hypofractionated dose schedules as are used in radiosurgery or stereotactic body radiotherapy. The basis for the discussion is a paper published in the September 2023 issue of PRO titled "Benchmarking Tests of Contemporary SRS Platforms: Have Technological Developments Resulted in Improved Treatment Plan Quality?" (2023, Issue 5, September/October, PMID: 37290672).

On this episode of Oncology Unscripted, patient advocates Julie Johnson and Katie Coleman and radiation oncologist Dr. Matt Spraker continue The Insider's Guide to Radiation Therapy! This four episode series will cover radiation 101, stereotactic body radiation therapy (SBRT), and proton therapy!In this episode, we complete radiation 101, covering 2 more important points to understand radiotherapy:1. How are radiation plans created and delivered, and how has this improved over decades?2. Who are the workers in the Radiation Oncology department and what is the workflow that patients experience when getting treatment?Here are some other things we discussed during the show:Explanation of Intensity Modulated Radiation Therapy (IMRT), UCLA HealthMultileaf Collimator (MLC) video, Phoenix CyberknifePercentage depth dose curveAn "old" radiotherapy block, Vishal Majithia on FlikrOncology Unscripted is a Photon Media production. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.Additional content from Katie Coleman can be found at her website, https://www.katiekickscancer.com/. This show and our opinions are meant for general informational purposes and are not medical advice. We encourage you to reach out to your doctors to discuss your individual case. 

On this episode of Oncology Unscripted, patient advocates Julie Johnson and Katie Coleman and radiation oncologist Dr. Matt Spraker kick of The Insider's Guide to Radiation Therapy! This four episode series will cover radiation 101, stereotactic body radiation therapy (SBRT), and proton therapy!  Radiation 101 covers the basics you need to know in order to understand how oncologists think about and use radiotherapy to kill cancer. In this episode we discuss two important points:What is radiation and how does it kill cancer (and affect other tissues)?How is radiation therapy used in medicine?Here are some links to things mentioned in the show:Matt on "Ask Me Anything" - Radiation Therapy for Sarcoma (YouTube)Electromagnetic energy figureA nice written history of radiotherapy - cancer.orgSpoon of Sugar Podcast - a very nice, detailed overview of radiation therapyHow Do X-Rays Work? - HowStuffWorks.comOncology Unscripted is a Photon Media production. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.Additional content from Katie Coleman can be found at her website, https://www.katiekickscancer.com/. This show and our opinions are meant for general informational purposes and are not medical advice. We encourage you to reach out to your doctors to discuss your individual case. 

In this episode of the Cancer Advances podcast, Dale Shepard, MD, PhD is joined by Shlomo Koyfman, MD, Director of Head and Neck and Skin Radiation at Cleveland Clinic to discuss the use of stereotactic body radiation therapy (SBRT) for head and neck cancer treatment. Dr. Koyfman shares insights from his experience highlighting the role of SBRT in re-irradiation cases as a primary therapy option. This informative conversation sheds light on the innovative techniques and advancements in radiation oncology that are improving outcomes for patients with head and neck cancer.

Accelerators co-host Dr. Matt Spraker hosts Radiation Oncologists Drs. Krish Jethwa, Neil Newman, and Jeff Ryckman for part 2 of our discussion on radiotherapy for liver tumors. We kick off with Neil reviewing his Twitter thread comparing TACE and SBRT for liver tumors. We discuss the data supporting SBRT as superior therapy, especially in patients who have recurrence after TACE. We further share some talking points for your tumor board. Then discuss one of our faves, a randomized trial of sorafenib with or without SBRT (NRG/RTOG 1112). This leads to more discussion about how to approach large/unresectable liver tumors in your tumor board and possible future studies for these patients. Here are some things we discussed in the episode:Barcelona Liver StagingSapir et al., Stereotactic Body Radiation Therapy as an Alternative to Transarterial Chemoembolization for Hepatocellular CarcinomaComito et al., SBRT versus TACE/TAE for recurrence after TACEAkarapatima et al., TACE versus BSC for HCCXiang et al., TACE versus BSC for HCCLlovet et al., TACE/TAE versus BSC for HCC TRENDY trial., TACE versus SBRT for HCCBush et al., proton radiotherapy versus TACE for HCCVerbus et al., SBRT versus TACE as bridging therapy in HCC Hong et al., phase II trial of proton radiotherapy for unresectable cholangiocarcinomaRTOG 1112 survival curvesPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Accelerators co-host Dr. Matt Spraker hosts Radiation Oncologists Drs. Krish Jethwa, Neil Newman, and Jeff Ryckman for romp through the exciting world of radiotherapy for liver tumors! In the first of this two part episode, we Krish, Neil, and Jeff explore how liver tumors are treated in practice. We learn that Jeff can tell your Child-Pugh score by looking at your finger nails and other tips that can help with patient selection. Then we have a fantastic data-driven discussion on treatment planning. We also cover motion management and delivery. Toward the end, we approach the topic that inspired this episode, comparing SBRT with catheter-based therapies. Like Krish, we all want to know: will Neil "let it fly" on why SBRT should be the therapy of choice? Tune in next week to find out.Here are some things that were discussed doing the show:Dr. Newman's epic Twitter thread on TACE versus SBRT for HCCThe liver has a body - a Cook's tour by Adrien RubenDr. Zaorsky's Liver Anatomy Explained Using Your Right FistBujold et al., phase I and II studies of SBRT for HCCRitter et al., Application of Critical Volume-Dose Constraints for SBRT in NRG TrialsDawson et al., Individualized image guided iso-NTCP based liver cancer SBRTDawson et al., Partial Irradiation of the LiverPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

In this episode of ASCO Educational podcasts, we'll explore how we interpret and integrate recently reported clinical research into practice. The first scenario involves a 72-year old man with high-risk, localized prostate cancer progressing to hormone-sensitive metastatic disease.  Our guests are Dr. Kriti Mittal (UMass Chan Medical School) and Dr. Jorge Garcia (Case Western Reserve University School of Medicine). Together they present the patient scenario (1:12), review research evidence regarding systemic and radiation therapy for high-risk localized disease (5:45), and reflect on the importance of genetic testing and (10:57) and considerations for treatment approaches at progression to metastatic disease (16:13).  Speaker Disclosures Dr. Kriti Mittal:  Honoraria – IntrinsiQ; Targeted Oncology; Medpage; Aptitude Health; Cardinal Health  Consulting or Advisory Role – Bayer; Aveo; Dendreon; Myovant; Fletcher; Curio Science; AVEO; Janssen; Dedham Group  Research Funding - Pfizer Dr. Jorge Garcia:  Honoraria - MJH Associates: Aptitude Health; Janssen Consulting or Advisor – Eisai; Targeted Oncology Research Funding – Merck; Pfizer; Orion Pharma GmbH; Janssen Oncology;  Genentech/Roche; Lilly  Other Relationship - FDA Resources  ASCO Article: Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019 ASCO Course: How Do I Integrate Metastasis-directed Therapy in Patients with Oligometastatic Prostate Cancer? (Free to Full and Allied ASCO Members) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Dr. Kriti Mittal: Hello and welcome to this episode of the ASCO Education Podcast. Today we'll explore how we interpret and integrate recently reported clinical research into practice, focusing on two clinical scenarios: localized prostate cancer progressing to hormone-sensitive metastatic disease; and a case of de novo metastatic hormone-sensitive prostate cancer progressing to castration-resistant disease.   My name is Kriti Mittal and I am the Medical Director of GU Oncology at the University of Massachusetts. I am delighted to co-host today's discussion with my colleague, Dr. Jorge Garcia. Dr. Garcia is a Professor of Medicine and Urology at Case Western Reserve University School of Medicine. He is also the George and Edith Richmond Distinguished Scientist chair and the current chair of the Solid Tumor Oncology Division at University Hospital's Seidman Cancer Center. Let me begin by presenting the first patient scenario.  Case 1: A 72-year-old male was referred to urology for evaluation of hematuria. A rectal exam revealed an enlarged prostate without any nodules. A CT urogram was performed that revealed an enlarged prostate with bladder trabeculations. A cystoscopy revealed no stones or tumors in the bladder, but the prostatic urethra appeared to be abnormal looking. Transurethral resection of the prostate was performed. The pathology revealed Gleason score 4+5=9 prostate cancer, involving 90% of the submitted tissue. PSA was performed one week later and was elevated at 50. Patient declined the option of radical prostatectomy and was referred to radiation and medical oncology.   So I guess the question at this point is, Dr. Garcia, in 2023, how do you stage patients with high-risk localized prostate cancer and how would you approach this case? Dr. Jorge Garcia: That's a great question and a great case, by the way, sort of what you and I in our practice will call ‘bread and butter'. Patients like this type of case that you just presented come from different places to our practice.  So either they come through urology or oftentimes they may come through radiation oncology. And certainly, it depends where you practice in the United States, at ‘X', US, they may come through medical oncology.   So I think that the first question that I have is in whatever role I'm playing in this case, where the patient has seen a urologist or a rad onc or me first, I think it's important for us in medical oncology, at least in the prostate cancer space, to talk about how do we think of their case and put those comments into context for the patient. It's very simple for you to tell a patient you can probably have surgery, radiation therapy, but at the end of the day, how do you counsel that patient as to the implications of the features of his disease is going to be really important. I use very simple examples that I relate to my patients, but really this patient is a patient that has very high-risk prostate cancer based upon the NCCN guidelines and how we actually stratify patients into what we call low-risk, intermediate-, and high-risk, and between those very low and very high risk.  So his PSA is high, very high, I would argue. His Gleason score, now, what we call group grading is high. He has high-volume disease. So the first question that I would have is, what are the choices for treatment for a patient like this? But even before you and I may talk about treatment options, we really want to understand the volume of their disease and whether or not they have localized prostate cancer with high-risk features or whether or not they have locally advanced or hopefully not metastatic disease. So back in the days prior to the FDA approval for PSMA PET imaging, we probably will have a Technetium-99 whole-body bone scan, and/or we probably will actually use CT scanning. Most people in the past, we used to do just a CT of the abdomen and pelvic region. As you know, with the movement of oral agents in the advanced setting, I think most of us will do a chest CT, abdomen and pelvic region, and certainly we also probably will have a Technetium-99 bone scan.  Now, with the utility and the use of PET imaging, I think most people like him will probably undergo PET PSMA, where you use F-18 PSMA or Gallium-68 PSMA. I think the importance depends on how you look at the approval of these two technologies. I think that PET PSMA imaging is here to stay. It's probably what most of us will use. And based upon that, we will define yet the truest stage of this patient. So right now, what we know is he has high-risk features. Hopefully, their disease is localized. We'll probably put the patient through an imaging technology. If you don't have access to a PET, then obviously CT and a bone scan will do. But if you do, the PET will actually help us define if the patient has disease outside of the prostate region, in the pelvic area, or even if they have distant metastases. Dr. Kriti Mittal: I would agree with that approach, Dr. Garcia. I think in the United States, we've been late adopters of PSMA scans. I think this patient with high-risk localized disease, if insurance allows at our institution, would get a PSMA for staging. There are still some patients where insurance companies, despite peer-to-peer evaluations, are not approving PSMAs. And in those situations, the patient would benefit from conventional CTs and a bone scan. So let's say this patient had a PSMA and was found not to have any regional or distant metastases. He decided against surgery, and he is seeing you as his medical oncologist together with radiation. What would your recommendations be?  Dr. Jorge Garcia: I think the bigger question is, do we have any data to suggest or to demonstrate that if in the absence of metastatic disease with conventional imaging or with emerging technologies such as PSMA PET, there is no evidence of distant disease, which I think you probably agree with me, that would be sort of unlikely with a patient with these features not to have some form of PSMA uptake somewhere in their body. But let's assume that indeed then the PSMA PET was negative, so we're really talking about high-risk localized prostate cancer. So I don't think we can tell a patient that radical prostatectomy would not be a standard of care. We never had a randomized trial comparing surgery against radiation therapy. This patient has already made that decision and surgery is not an option for him. If he, indeed, had elected radiotherapy, the three bigger questions that I ask myself are where are you going to aim the beam of that radiation therapy? What technology, dose, and fractionation are you going to use? And lastly, what sort of systemic therapy do you need, if any, for that matter? Where we do have some data maybe less controversial today in 2023 compared to the past? But I think the question is, do we do radiation to the prostate only or do we expand the field of that radiation to include the pelvic nodes?  Secondly, do we use IMRT? Do you use proton beam or not? Again, that's a big question that I think that opens up significant discussions. But more important, in my opinion, is the term of hypofractionation. I think the field of radiation oncology has shifted away from the old standard, five, seven weeks of radiation therapy to more hypofractionation, which in simple terms means a higher dose over a short period of time. And there was a concern in the past that when you give more radiation on a short period of time, toxicities or side effects would increase. And I think that there is plenty of data right now, very elegant data, demonstrated that hypofractionation is not worse with regards to side effects. I think most of us will be doing or supporting hypofractionation. And perhaps even to stretch that, the question now is of SBRT. Can we offer SBRT to a selected group of patients with high-risk prostate cancer? And again, those are discussions that we will naturally, I assume, in your practice, in your group, you probably also have along with radiation oncology.  Now, the bigger question, which in my mind is really not debatable today in the United States, is the need for systemic therapy. And I think we all will go back to the old data from the European EORTC data looking at the duration of androgen deprivation therapy. And I think most of us would suggest that at the very least, 24 months of androgen deprivation therapy is the standard of care for men with high-risk prostate cancer who elect to have local definitive radiation therapy as their modality of treatment. I think that whether or not it's 24 or 36, I think that the Canadian data looking at 18 months didn't hit the mark. But I think the radiation oncology community in the prostate cancer space probably has agreed that 24 months clinically is the right sort of the sweetest spot.  What I think is a bit different right now is whether or not these patients need treatment intensification. And we have now very elegant data from the British group and also from the French group, suggesting, in fact, that patients with very high-risk prostate cancer who don't have evidence of objective metastasis may, in fact, benefit from ADT plus one of the novel hormonal agents, in this case, the use of an adrenal biosynthesis inhibitor such as abiraterone acetate. So I think in my practice, what I would counsel this patient is to probably embark on radiotherapy as local definitive therapy and also to consider 24 months of androgen deprivation therapy. But I would, based upon his Gleason score of group grading, his high-volume disease in the prostate gland, and his PSA, to probably consider the use of the addition of abiraterone in that context. Dr. Kriti Mittal: That is in fact how this patient was offered treatment. The patient decided to proceed with radiation therapy with two years of androgen deprivation. And based on data from the multi-arm STAMPEDE platform, the patient met two of the following three high-risk features Gleason score >8, PSA >40, and clinical >T3 disease. He was offered two years of abiraterone therapy. Unfortunately, the patient chose to decline upfront intensification of therapy. In addition, given the diagnosis of high-risk localized prostate cancer, the patient was also referred to genetic counseling based on the current Philadelphia Consensus Conference guidelines. Germline testing should be considered in patients with high-risk localized node-positive or metastatic prostate cancer, regardless of their family history. In addition, patients with intermediate-risk prostate cancer who have cribriform histology should also consider germline genetic testing.  Access to genetic counseling remains a challenge at several sites across the US, including ours. There is a growing need to educate urologists and medical oncologists to make them feel comfortable administering pretest counseling themselves and potentially ordering the test while waiting for the results and then referring patients who are found to have abnormalities for a formal genetics evaluation. In fact, the Philadelphia Consensus Conference Guideline offers a very elegant framework to help implement this workflow paradigm in clinical practice. And at our site, one of our fellows is actually using this as a research project so that patients don't have to wait months to be seen by genetics. This will have implications, as we will see later in this podcast, not only for this individual patient as we talk about the role of PARP inhibitors but also has implications for cascade testing and preventative cancer screening in the next of kin. Dr. Jorge Garcia: Dr. Mittal, I think that we cannot stress enough the importance of genetic testing for these patients. Oftentimes I think one of the challenges that our patients are facing is how they come into the system. If you come through urology, especially in the community side, what I have heard is that there are challenges trying to get to that genetic counsel. Not so much because you cannot do the test, but rather the interpretation of the testing and the downstream effect as you're describing the consequences of having a positive test and how you're going to counsel that patient. If you disregard the potential of you having an active agent based upon your genomic alteration, is the downstream of how your family may be impacted by a finding such as the DNA repair deficiency or something of that nature. So for us at major academic institutions because the flow how those patients come through us, and certainly the bigger utilization of multi-disciplinary clinics where we actually have more proximity with radiation oncology urology, and we actually maybe finesse those cases through the three teams more often than not, at least discuss them, then I think that's less likely to occur. But I think the bigger question is the timing of when we do testing and how we do it.  So there are two ways -- and I'd love to hear how you do it at your institution -- because there are two ways that I can think one can do that. The low-hanging fruit is you have tissue material from the biopsy specimen. So what you do, you actually use any of the commercial platforms to do genomic or next-generation sequencing or you can do in-house sequencing if your facility has an in-house lab that can do testing. And that only gets you to what we call ‘somatic testing', which is really epigenetic changes over time that are only found in abnormal cells. It may not tell you the entire story of that patient because you may be missing the potential of identifying a germline finding. So when you do that, did you do germline testing at the same time that you do somatic testing or did you start with one and then you send to genetic counseling and then they define who gets germline testing? Dr. Kriti Mittal: So at our site, we start with germline genetic testing. We use either blood testing or a cheek swab assay and we send the full 84-gene multigene panel. Dr. Jorge Garcia: Yeah, and I think for our audience, Dr. Mittal, that's great. I don't think you and I will be too draconian deciding which platform one uses. It's just that we want to make sure that at least you test those patients. And I think the importance of this is if you look at the New England Journal paper from many years ago, from the Pritchard data looking at the incidence of DNA repair deficiency in men with prostate cancer in North America, that was about what,  around 10% or so, take it or leave it. So if you were to look only for germline testing, you only will, in theory, capture around 10% of patients. But if you add somatic changes that are also impacting the DNA pathway, then you may add around 23%, 25% of patients. So we really are talking that if we only do one type of testing, we may be missing a significant proportion of patients who still may be candidates, maybe not for family counseling if you had a somatic change, rather than germline testing, the positivity, but if you do have somatic, then you can add into that equation the potential for that patient to embark on PARP inhibitors down the road as you stated earlier. It may not change how we think of the patient today, or the treatment for that matter. But you may allow to counsel that patient differently and may allow to sequence your treatments in a different way based upon the findings that you have. So I could not stress the importance of the NCCN guidelines and the importance of doing genetic testing for pretty much the vast majority of our patients with prostate cancer. Dr. Kriti Mittal: Going back to our patient, three years after completion of his therapy, the patient was noted to have a rising PSA. On surveillance testing, his PSA rose from 0.05 a few months prior to 12.2 at the time of his medical oncology appointment. He was also noted to have worsening low back pain. A PSMA scan was performed that was noteworthy for innumerable intensely PSMA avid osseous lesions throughout his axial and appendicular skeleton. The largest lesion involved the right acetabulum and the right ischium. Multiple additional sizable lesions were seen throughout the pelvis and spine without any evidence of pathologic fractures. So the question is, what do we do next? Dr. Jorge Garcia: The first question that I would have is, the patient completed ADT, right? So the patient did not have treatment intensification, but at the very least he got at least systemic therapy based upon the EORTC data. And therefore, one would predict that his outcome will have been improved compared to those patients who receive either no ADT or less time on ADT. But what I'm interested in understanding is his nadir PSA matters to me while he was on radiation and ADT. I would like to know if his nadir PSA was undetectable, that's one thing. If he was unable to achieve an undetectable PSA nadir, that would be a different thought process for me.   And secondly, before I can comment, I would like to know if you have access to his testosterone level. Because notably, what happens to patients like this maybe is that you will drive down testosterone while you get ADT, PSAs become undetectable. Any of us could assume that the undetectability is the result of the radiation therapy. But the true benefit of the combination of radiation and ADT in that context really comes to be seen when the patient has got off the ADT, has recovered testosterone, and only when your testosterone has normalized or is not castrated, then we'll know what happens with your serologic changes. If you rise your PSA while you recover testosterone, that is one makeup of patient. But if you rise your PSA while you have a testosterone at the castrated level, that would be a different makeup of a patient. So do we have a sense as to when the patient recovered testosterone and whether or not if his PSA rose after recovery?  Dr. Kriti Mittal: At the time his PSA rose to 12, his testosterone was 275. Dr. Jorge Garcia: Okay, perfect. You and I would call this patient castration-naive or castration-sensitive. I know that it's semantics. A lot of people struggle with the castration-naive and castration-sensitive state. What that means really to me, castration-naive is not necessarily that you have not seen ADT before. It's just that your cancer progression is dependent on the primary fuel that is feeding prostate cancer, in this case, testosterone or dihydrotestosterone, which is the active metabolite of testosterone. So in this case, recognizing the patient had a testosterone recovery and his biochemical recurrence, which is the rising of his PSA occur when you have recovery of testosterone, makes this patient castration-sensitive. Now the PET scan demonstrates now progression of his disease. So clearly he has a serologic progression, he has radiographic progression. I assume that the patient may have no symptoms, right, from his disease?  Dr. Kriti Mittal: This patient had some low back pain at the time of this visit. So I think we can conclude he has clinical progression as well. Dr. Jorge Garcia: Okay, so he had the triple progression, serologic, clinical, and radiographic progression. The first order of business for me would be to understand the volume of his disease and whether we use the US CHAARTED definition of high volume or low volume, or whether we use the French definition for high volume from Latitude, or whether we use STAMPEDE variation for definition, it does appear to me that this patient does have high-volume disease. Why? If you follow the French, it's a Gleason score of >8, more than three bone metastases, and the presence of visceral disease, and you need to have two out of the three. If you follow CHAARTED definition, we did not use Gleason scoring, the US definition. We only use either the presence of visceral metastases or the presence of more than four bone lesions, two of which had to be outside the appendicular skeleton. So if we were to follow either/or, this patient would be high-volume in nature.  So the standard of care for someone with metastatic disease, regardless of volume, is treatment intensification, is you suppress testosterone with androgen deprivation therapy. And in this case, I'd love to hear how you do it in Massachusetts, but here, for the most part, I would actually use a GnRH agonist-based approach, any of the agents that we have. Having said that, I think there is a role to do GnRH antagonist-based therapy. In this case, degarelix, or the oral GnRH antagonist, relugolix, is easier to get patients on a three-month injection or six-month injection with GnRH agonist than what it is on a monthly basis. But I think it's also fair for our audience to realize that there is data suggesting that perhaps degarelix can render testosterone at a lower level, meaning that you can castrate even further or have very low levels of testosterone contrary to GnRH agonist-based approaches.  And also for patients maybe like this patient that you're describing, you can minimize the flare that possibly you could get with a GnRH agonist by transiently raising the DHT before the hypothalamic-pituitary axis would shut it down. So either/or would be fine with me. Relugolix, as you know, the attraction of relugolix for us right now, based upon the HERO data, is that you may have possibly less cardiovascular side effects. My rationale not to use a lot of relugolix when I need treatment intensification is quite simple. I'm not aware, I don't know if you can mitigate or minimize that potential cardiovascular benefit by adding abiraterone or adding one of the ARIs, because ARIs and abiraterone by themselves also have cardiovascular side effects. But either/or would be fine with me. The goal of the game is to suppress your male hormone.  But very important is that regardless of volume, high or low, every patient with metastatic disease requires treatment intensification. You can do an adrenal biosynthesis inhibitor such as abiraterone acetate. You can pick an androgen receptor inhibitor such as apalutamide or enzalutamide if that's the case. The subtleties in how people feel comfortable using these agents, I think, none of us – as you know, Dr. Mittal - can comment that one oral agent is better than the other one. Independently, each of these three oral agents have randomized level 1, phase III data demonstrating survival improvement when you do treatment intensification with each respective agent. But we don't have, obviously, head-to-head data looking at this.  What I think is different right now, as you know, is the data with the ARASENS data, which was a randomized phase III trial, an international effort looking at triple therapy, and that is male hormone suppression plus docetaxel-based chemotherapy against testosterone suppression plus docetaxel-based chemotherapy plus the novel androgen receptor inhibitor known as darolutamide. This trial demonstrated an outcome survival improvement when you do triple therapy for those high-volume patients. And therefore, what I can tell you in my personal opinion and when I define a patient of mine who is in need of chemotherapy, then the standard of care in my practice will be triple therapy. So if I know you are a candidate for chemotherapy, however, I make that decision that I want you to get on docetaxel upfront. If you have high-volume features, then the standard of care would not be ADT and chemo alone, it would be ADT, chemo, and darolutamide.  What I don't know, and what we don't know, as you know, is whether or not triple therapy for a high-volume patient is better, the same, equivalent, or less than giving someone ADT plus a novel hormonal agent. That is the data that we don't have. There are some meta-analyses looking at the data, but I can tell you that at the very least, if you prefer chemo, it should be triple therapy. If you prefer an oral agent, it certainly should be either apalutamide, abiraterone acetate, and/or enzalutamide. But either/or, patients do need treatment intensification, and what is perplexing to me, and I know for you as well, is that a significant proportion of our patients in North America are still not getting treatment intensification, which is really sub-optimal and sub-standard for our practice.  Dr. Kriti Mittal: Thank you, Dr. Garcia, for a terrific discussion on the application of recent advances in prostate cancer to clinical practice. In an upcoming podcast, we will continue that discussion exploring management of de novo metastatic prostate cancer.   The ASCO Education Podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncologists' well-being and professional development. If you have an idea for a topic or a guest you'd like to see on the ASCO Education Podcast, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

On this episode of BackTable Urology, Dr. Aditya Bagrodia, Dr. Daniel Costa (UT Southwestern), and Dr. Xiaosong Meng (UT Southwestern) discuss patient selection and procedure for TULSA-PRO, a new transurethral ultrasound ablation system that incorporates real-time MR imaging, as a focal treatment option for prostate cancer. --- CHECK OUT OUR SPONSOR Profound Medical TULSA-PRO https://profoundmedical.com/ --- SHOW NOTES First, the doctors discuss the benefits of using MRI with transurethral ultrasound ablation (TULSA), which include direct visualization of anatomy, margins, and boundaries. They compare TULSA to other forms of focal management, such as cryoablation, brachytherapy, stereotactic body radiation therapy (SBRT). Compared to these methods, TULSA has lower risk of rectourethral fissures and preserves the posterior plane better, making salvage procedures more viable. Then, the doctors discuss ideal candidates for TULSA therapy, which include patients with intermediate risk and localized disease, patients with lesions in lateral or anterior portion of prostate, patients with medium sized prostates, low risk patients with lower urinary tract symptoms (LUTS) who do not want to undergo active surveillance. Patients with large calcifications may not be ideal candidates for TULSA, as the calcifications can be a shield for the ultrasound beam. The doctors recommend ordering a CT/MRI scan first to identify if calcifications are present to assess their sizes and locations. During imaging, it is also important to make sure the tumor is not close to key anatomical elements, such as the neurovascular bundle. When deciding between different focal therapies, it is important to balance oncological outcomes and quality of life preservation. Thus, the treatment decision should be a collaboration between patients, their families, the radiologist, and the urologist. The doctors also discuss special considerations for salvage therapy patients, brachytherapy patients, patient with urethral strictures, and patients with a prior history of TURP. Next, the doctors explain how to prepare patients for TULSA. The patient's colon has to be emptied in order to reduce MRI noise during the procedure. Additionally, the doctors help patients understand the immediate side effects of the procedure, which can include reduced semen volume, urgency incontinence from bladder and prostate irritation, and temporary erectile dysfunction, and semen retention. After the procedure, the urinary catheter will have to be left inside for five days to two weeks, depending on the volume of the prostate removed. There is a 20-25% chance of recurrence. Finally, they discuss specifics of the TULSA procedure. Dr. Costa and Dr. Meng perform these procedures at the university hospital, as they need access to MRI and anesthesia. They discuss the optimal MRI window for the procedure, patient positioning, as well as their two sweep method. The total procedure time is dependent on the volume of ablation and number of sweeps, but the average total time is 3 hours. Patients are discharged on the same day, and no narcotics are prescribed. Finally, they discuss the progress of a new prospective multi-center randomized trial comparing focal TULSA therapy to surgery for intermediate risk prostate cancer patients. --- RESOURCES TULSA Procedure https://tulsaprocedure.com/tulsa-procedure/about-tulsa-procedure/ Profound Medical https://profoundmedical.com/

The latest QuadCast episode discusses the status of Pluvicto, breast conservation therapy for patients with multifocal breast cancer, the reason that whole brain radiation has neurocognitive impact, impressive results of immunotherapy for dMMR endometrial cancer, the timing of prostate SBRT, and newly approved Narcan nasal spray. Be sure to tune in! QuadShot Website

Dr Kishan discusses the use of MRI-guided SBRT in prostate cancer to reduce acute genitourinary and gastrointestinal toxicity; findings from the MIRAGE study; and how MRI-guided SBRT allows for tighter planning margins, thereby reducing both physician-reported and patient-reported bowel and bladder toxicities.

Dr. Ehsan Balagamwala joins this episode of Butts and Guts during National Colorectal Cancer Awareness Month to discuss everything you need to know about how stereotactic body radiotherapy (SBRT) can be used to treat colorectal cancer. Listen to learn more about this type of treatment, how it differs from other radiation therapies, and who qualifies to receive it.

Andreas Rimner, MD, Memorial Sloan Kettering Cancer Center, joins us for a conversation about radiation oncology and currently available clinical trials. He discussed various ways patients can benefit from radiation therapy, including an overview of different types of radiation and different modes of treatment. Radiation therapy can be applied alone, or in combination with other treatments such as surgery, chemotherapy, or immunotherapy. Dr. Rimner is a radiation oncologist who specializes in caring for people with cancers of the chest, known as thoracic cancers. These include non-small cell and small cell lung cancers, pleural mesotheliomas, thymomas, lung metastases, sarcomas, and other rare tumors of the chest. He works closely with a highly skilled team of experts from many areas — including surgeons, medical oncologists, radiologists, medical physicists, and radiation therapists — to determine the best treatment options for his patients. HIs team uses the most advanced radiation techniques, including stereotactic body radiation therapy (SBRT) or stereotactic ablative body radiation (SABR), stereotactic radiosurgery (SRS), intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), intensity-modulated pleural radiation therapy (IMPRINT), MR-guided radiation therapy, and proton radiation to precisely target cancers while limiting damage to normal tissues. MesoTV is a program by the Mesothelioma Applied Research Foundation. This program is made possible by our generous sponsors: Maune Raichle Hartley French & Mudd, LLC (MRHFM); Bristol Myers Squibb; Novocure, Merck, The Gori Law Firm, TCR2, AstraZeneca, Early Lucarelli Sweeney & Meisenkothen. Search our previous episodes for topics/speakers of interest to you at www.curemeso.org/mesotv.

The Accelerators (Drs. Anna Brown, Matt Spraker, and Simul Parikh) are back with Drs. Alison Tree (The Royal Marsden NHS, UK), Vedang Murthy (Tata Memorial Centre Mumbai, India), and Himanshu Nagar (New York Presbyterian Weill Cornell and Brooklyn Methodist, NYC). We pick up our international discussion of prostate cancer by further discussing Radiation Oncology training and research in India, the UK, and the US. Then we move to discuss more practical matters, such as the remarkable variation in prostate SBRT techniques across the world. We also discuss the future. We close this episode with a discussion of our favorite Indian dishes. Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

As part of the 2022 Prostate Cancer Patient Conference, Dr. Felix Feng discusses metastasis-directed therapy and SBRT for prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Education] [Show ID: 38570]

The Accelerators (Dr. Anna Brown, Matt Spraker, and Simul Parikh) host radiation oncologist Dr. Amar Kishan and Brett Sloman, Product Sales Director at Viewray, Inc.On this episode, we discussed the newly resulted MIRAGE trial, a single-center phase III study of prostate target reduction using MR-guided stereotactic body radiotherapy (SBRT) versus standard CT-guided SBRT.Amar kicks off this in depth interview by reviewing the results, then we cover a range of topics and critiques that arose on the release of this trial. What is the impact of industry influence? Can we shrink prostate target size using other technologies? Given that the outcomes included quality of life measures, should this have been a blinded study?  Are commutes in LA really easier if you listen to The Accelerators Podcast? Here are some things that were mentioned during the show:Siva et al. editorial on the MIRAGE TrialThe SMART Trial for locally advanced pancreas cancerParikh et al. SMART Trial ASCO resultsViewray multi-center LAP-ABLATE trial for locally advanced pancreas cancerPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

Today, we are happy to introduce Dr. Bob Dess, a radiation oncologist from the University of Michigan, to our listeners!  Dr. Dess is joining us to discuss another type of radiation therapy called Stereotactic Body Radiation Therapy (SBRT). SBRT can be a faster and more efficient form of radiation therapy than conventional prostate cancer treatments.  Dr. Dess is an Assistant Professor in the Department of Radiation Oncology at the University of Michigan. He has published extensively in peer-reviewed journals on prostate cancer. He has collaborated to create novel prognostic models to characterize prostate cancer disease aggressiveness, to analyze racial outcomes, differences, and settings in which disparities are minimized, and to advance more convenient forms of treatment, including Stereotactic Body Radiation Therapy, and characterize the long-term quality of life post-treatment. Dr. Dess's guiding principle is to deliver the right treatment to the right patient at the right time. He is interested in maximizing efficiency, minimizing burden, and understanding the long-term toxicity risks of treatment.  Stay tuned to find out how SBRT compares with more conventional treatments for prostate cancer. Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show highlights: Dr. Dess explains what Stereotactic Body Radiotherapy is. How SBRT compares with the longer courses of radiation. Who would be good candidates for SBRT? The benefits of choosing SBRT as a treatment for prostate cancer. Dr. Dess talks about hypofractionation, an intermediate treatment for prostate cancer that gets delivered with the same technology and image guidance as SBRT. The potential risks and side-effects of SBRT. Why Dr. Dess prefers to use MRIs along with SBRT. Links:  Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link here, on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up for our bonus video content.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here.

While radiation is a common cancer treatment, few people actually know what it is and how it affects patients. In this episode, Dr. Richard Pearlman shares with listeners his expertise in radiation oncology.  Episode At A Glance: Whether we battle it ourselves or walk through it with friends and family, cancer touches almost everyone. This week, Dr. Richard Pearlman joins The SavvyCast to educate listeners on radiation oncology. Dr. Pearlman is a radiation oncologist with Alliance Cancer Care. In this episode, he shares what radiation oncology is, who can benefit from it, as well as what treatment looks like.  Who is Dr. Richard Pearlman?  Dr. Pearlman was born and raised in Birmingham, Alabama. He attended Birmingham-Southern College in Birmingham, Alabama. He received his medical doctorate from the University of South Alabama College of Medicine in Mobile, Alabama. Following medical school, he completed his internship at Brookwood Baptist Health in Birmingham, Alabama. Additionally, he completed his residency in radiation oncology at Wayne State University in Detroit, Michigan, where he served as Chief Resident in his final year. Dr. Pearlman has experience in several radiation therapy treatments, including stereotactic body radiation therapy (SBRT), stereotactic radiosurgery (SRS), intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and high dose-rate brachytherapy (HDR brachytherapy). In addition to his education and medical training, Dr. Pearlman has been awarded numerous honors and has authored several articles in peer-reviewed medical publications. He is married to Dr. Hailey Park, who is a dentist in Muscle Shoals, Alabama. Questions Answered In This Episode:  How did Dr. Pearlman get into radiation oncology? What is the difference between radiology and radiation oncology? When is radiation the best option? What is radiation oncology? How does radiation treat breast cancer? What are some of the differences between radiation treatment and chemotherapy? Does insurance typically cover radiation treatment? What diseases does Dr. Pearlman treat the most? What are the side effects of radiation, especially for head and neck cancer patients? How many treatments a week are typical? What are most radiation treatments like? I hope you enjoyed this episode! As always, if you have time to rate, review, and subscribe to The SavvyCast on Apple Podcasts, it would be SO appreciated!!! If you like this podcast, be sure to check these out: Men can get Breast Cancer Too: Talking with a Male Breast Cancer Survivor Let's Talk: Surviving Cancer When You're Given Two Months To Live  

Hosted by Ralph Weichselbaum, MD, Chair of the Department of Radiation and Cellular Oncology, University of Chicago, this episode tackles the burgeoning world of radiopharmaceuticals and features two radiation oncologists: Jeff Michalski, MD, MBA, Washington University in St. Louis and president of ASTRO, and Freddy Escorcia, MD, PhD, National Cancer Institute and National Institutes of Health. They kick it off by giving background context on isotope therapy and the current data for these therapies in different malignancies, including an update into peptides and SBRT; provide commentary on how randomized controlled trials account for the complexities of radiopharmaceuticals in their design (especially pertaining to selection criteria and dosage); and share how a radiation department is structured and staffed to account for all patient needs, including a push for a novel patient-centered approach that involves the nuclear medicine department. Check out Chadi's website for all Healthcare Unfiltered episodes and other content. www.chadinabhan.com/ Watch all Healthcare Unfiltered episodes on Youtube. www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA