Key news from the American Society of Therapeutic Radiation Oncology (ASTRO) Meeting 2019

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Dan Ford

What are the latest advances in radiotherapy? Consultant Clinical Oncologist Dan Ford assesses key news from the American Society of Therapeutic Radiation Oncology (ASTRO) Meeting 2019.

What was the major talking point?

The recent meeting of ASTRO in Chicago acknowledged and showcased the recent advances in the field of radiotherapy and other areas of disease management and treatment. The developing role of Stereotactic Ablative Radiotherapy (SABR) in patient care was one of the big talking points, with the presidential debate asking whether it should be standard of care for patients, or if more data and data was needed before it is adopted as standard of care. The data surrounding new treatment techniques will always take time to establish and mature. In contrast, there will always be a drive from clinicians and patients to be early adopters of techniques such as SABR which seemingly have so much to offer, with what in many cases will be limited side effects.

What is the evidence?

So, what data with regards to SABR was presented at ASTRO 2019? The PACE trial is UK led and looking at whether localised radiotherapy to the prostate gland can be delivered in 5 treatments or fractions over a week and a half rather than 20 over 4 weeks which in most cases is the current standard of care. Within the trial, both schedules are being compared. To deliver the treatment over a shorter time frame a higher daily dose is required, which runs the risk of causing significant side effects to the surrounding tissues. Although the data with regards to cancer outcome was not mature enough to present, the side effect profiles of both treatments was demonstrated to be broadly similar.

Clearly these are encouraging results and add to the already growing long term data surrounding the effectiveness and safety of giving localised radiotherapy in 5 fractions to the prostate gland. There is a drive to take this further with data emerging on treating with fewer fractions and potentially even single treatments in the long term.

Real time adaption of treatment during radiotherapy: the MRLinac

The ability to accurately focus radiotherapy on the area needing treatment (in this case the prostate) and reduce the dose to the surrounding normal tissues is crucial to delivering treatment with fewer fractions. A major advancement in this area will be the arrival of new technologies such as MRLinac with GenesisCare. This allows the accurate visualisation of the target and surrounding tissues with real time adaptation of treatment during radiotherapy. We will be able to offer BPC patients access to the MRLinac with GenesisCare Oxford before the end of the year.

Options for oligometastatic disease

Data was also presented in the setting of oligometastatic disease (cases where cancer has recurred or spread to a limited number of areas away from the initial cancer site). SABR to such areas allows the delivery of high doses of radiotherapy in a limited number of treatments (typically 3-5) generally with limited toxicity and side effects. Trials are varied, both in terms of which cancer types are treated, how many sites are treated and what other treatments are combined with SABR. This has meant that we are still awaiting definitive conclusions, but initial results are encouraging. With the number of trials currently recruiting and the adoption of new technologies, it is clear that SABR for oligometastatic disease is here to stay.

GenesisCare: delivering cutting edge treatments

It is the ability to access cutting edge radiotherapy technologies such as MRLinac for local and metastatic SABR as well as leading diagnostics (3T MRI and PSMA PET scans) and exciting theranostic options ( 177Lutetium PSMA therapy) all with GenesisCare which means that we are able to offer our patients at the BPC state of the art and cutting edge treatments for their disease. The extensive and wide-ranging options for patients delivered through GenesisCare and BPC is unrivalled.


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