University of North Carolina Lineberger Comprehensive Cancer Center researchers presented a number of studies at the American Society for Radiation Oncology’s 2017 Annual Meeting, which took place this week in San Diego and was expected to draw more than 11,000 people.
The research published in nearly 30 abstracts highlights the strength of the UNC School of Medicine Department of Radiation Oncology’s research, education and clinical programs, said UNC Lineberger’s Lawrence Marks, MD, department chair and the Dr. Sidney K. Simon Distinguished Professor of Oncology Research.
“We have tremendously-good leveraging of synergies between our educational, research, and our clinical programs,” Marks said. “Our faculty and residents are researching important clinical problems.”
Marks said the studies reflect the multidisciplinary and translational nature of the department’s research, and incorporated basic science research, industrial engineering, and clinical and translational work.
Studies of treatment side effects could help prostate cancer patients choose
A study led by Ronald C. Chen, MD, MPH, UNC Lineberger member and associate professor in radiation oncology, compared side effects of multiple prostate cancer treatments after four years. The data presented were presented in a special session of late-breaking abstracts at ASTRO, and was an update of a study published in the Journal of the American Medical Association that tracked patients two years after treatment.
Patients with early prostate cancer have multiple treatment options ranging from active surveillance to surgery to radiotherapy. The findings could help prostate cancer patients who are facing treatment make decisions about the treatment that is best for them.
“The longer-term data more thoroughly show how quality of life changes over time,” Chen said.
Researchers saw that patients who had radical prostatectomy, compared to activate surveillance, had worse short-term and long-term sexual function, as well as urinary incontinence. Radiation treatment was linked to worse bowel symptoms at three months, but not after. At four years, they found no clinically meaningful difference in quality of life between radiation and active surveillance in terms of urinary, bowel and sexual function.
“These additional data help patients better understand the short-term and long-term quality of life impact of different treatments they may be considering,” Chen said.
A study presented by Brandon Mullins, MD, a radiation oncology resident, compared sexual dysfunction after different types of radiation and surgery. This study found that radiation alone was associated with the best sexual function, followed by radiation with hormone therapy, then nerve-sparing radical prostatectomy. Non-nerve-sparing radical prostatectomy had the worst sexual function after treatment.
By imaging tumor blood vessels, researchers detect can detect treatment response
A new imaging technology can detect radiation treatment failure faster than conventional methods, according to preliminary research findings.
A preclinical study by UNC Lineberger researchers S.X. Chang, PhD, and P.A. Dayton, PhD, used a potential new imaging technique called “acoustic angiography” to gauge whether radiation treatment was working in preclinical models of fibrosarcoma.
In this imaging technique, “microbubbles” attach to the surface of blood vessels after injection. These non-toxic and U.S. Food and Drug Administration bubbles vibrate at frequency that can be detected by ultrasound.
They saw in the study that radiation treatment can change blood vessel density, and the changes are closely correlated with tumor control or failure. By measuring changes in blood vessel density, their imaging technology consistently predicted treatment failure before the tumor volume started to change, Chang said.
“We have shown that we could detect treatment failure as much as 50 percent earlier than the conventional method widely used in the clinic,” Chang said. “This is great news for patients who do not respond well to treatment, as it enables their doctors to modify their treatment for a better outcome.”
There is a need to better track the outcomes of radiation treatment since tumors can respond slowly after treatment. “Using ultrasound to monitor blood vessel density may be a way of assessing tumor response to help you customize the treatment,” Marks said. “Often you can see changes in ultrasound in the vascular density, and that you might use this information to better tailor the treatment.”
Improving the therapeutic ratio
Several studies were designed to improve the therapeutic ratio of radiation treatment to minimize toxicities while improving treatment efficacy. For example, Kyle Wang, MD, examined the question of how to minimize the side effect of xerostomia, or dry mouth, in patients with whole-brain radiation.
“We are always looking to improve the therapeutic ratio of what we do,” Marks said. “Radiation therapy is a very potent anti-cancer agent – it’s arguably the most potent anti-cancer agent that exists. It’s also potentially toxic to normal tissues.”
Other highlights from the meeting included:
Bhisham Chera, MD, Oral Presentation: “Quantification of HPV-16 in Circulating Tumor DNA During De-intensified Chemoradiation Therapy for Favorble-Risk HPV-Associated Oropharyngeal Squamous Cell Carcinoma”
Leith Rankine, MS, DABR, Oral Presentation: “Is Lung Ventilation Imaging a Reasonable Surrogate for Gas Exchange? Implications for Functionally Guided Radiation Therapy Planning”
David Fried, PhD, Poster presentation: “Does Immunotherapy Alter the Dose/Volume/Outcome Relationship in the Normal Brain?”
Poster: “Predictors of Short Term Death After Stereotactic Radiation for Brain Metastases”
Orit Kaidar-Person, MD, Poster: “Discrepancies Between Biological Markers of Primary Breast Cancer and Their Brain Metastases: An International Multicenter Study”
Brandon Mullins, MD, Oral Presentation: “Patient-reported sexual quality of life (QOL) after different types of radical prostatectomy (RP) and radiation treatments, analysis of a population-based prospective cohort.”
Greg Judy, MD, Poster presentation: “Preservation of Swallowing Function with De-intensified Chemoradiotherapy for HPV-Associated Oropharyngeal Squamous Cell Carcinoma”
Poster presentation: “Near Miss or Safety Incident in Patients Treated with Radiotherapy: What are the Contributing Factors?”
Lukasz Mazur, PhD, Poster Presentation: “Using Simulation-based Training to Enhance Procedural Compliance of Radiation Oncology Professionals”
Dominic Moon, MD, Oral presentation: “Phase Ib/II study of neoadjuvant chemoradiotherapy with CRLX101 and capecitabine for locally advanced rectal cancer”
Poster presentation: “prospective study of the safety and efficacy of liver stereotactic body radiotherapy in patients with prior liver-directed therapy.”
Gaorav Gupta, MD, PhD, Oral presentation: “A CRISPR Screen to Systematically Identify DNA Repair Gene Alterations that Modulate Sensitivity to DNA Damaging Agents”
Daniel Lindsay, MD, Oral presentation: “Nanotechnology-based Quantification of Circulating Tumor Cells in Oligometastatic Patients Undergoing Definitive Radiation Therapy”
Kyle Wang, MD, Oral presentations: “Abstract Title: Pitfalls of PET Surveillance in Patients with HPV-associated Oropharynx Cancer Treated on a Multi-institutional De-intensification Trial”
“Heart Dosimetric Analysis of Three Types of Cardiac Toxicity in Patients Treated on Dose-Escalation Trials for Stage III Non-Small-Cell Lung Cancer”
“Xerostomia is an Unrecognized Complication of Whole Brain Radiotherapy and may be Related to Parotid Dose: A Prospective Observational Trial”
Poster: “Dosimetric Correlations With Patient-reported Urinary and Bowel Symptoms After Stereotactic Body Radiotherapy (SBRT) for Prostate Cancer”
Sha Chang, PhD, Presentation: “Early assessment of tumor response to radiation therapy using high-resolution quantitative microvascular ultrasound imaging”
Kevin Pearlstein, MD
Poster: “Correlation between bladder dosimetry and patient-reported acute urinary quality of life during modern post-prostatectomy image-guided IMRT”
Poster: “Survival of healthy prostate cancer patients after radical prostatectomy (RP) vs radiotherapy (RT), a population-based analysis”
Ronald Chen, MD, MPH
Poster: “PSA characteristics post-heterogeneous SBRT: results from a multi-institutional Phase II trial.”
Brittaney-Belle Elizabeth Gordon
Poster: “Treatments received by and timeliness of treatment for African American (AA) and Caucasian (CA) pancreatic cancer patients across the US.”
In addition, several other professional societies within the field of radiation oncology had meetings in San Diego that ran concurrent with ASTRO.
At the American Society of Radiologic Technologists, Robert Adams, EdD, MPH, FASRT, FAAMD, assistant professor and director of the UNC Radiation Therapy and Medical Dosimetry Education Programs, spoke about the future of radiation therapist clinical practice patterns.
At the meeting of the Society of Radiation Oncology Administrators, Alison Amos, PhD, assistant professor and member of the Division of Healthcare Engineering, spoke about the challenges to maintaining clinical flow in the radiation oncology department in a presentation called “Patient Flow Analysis in Outpatient Radiation Oncology Clinic: Improving the Patient’s Experience.”