Session Content Resources

Breast cancer is one of the most common malignancies treated by radiation oncologists. Indications for radiation in patients with breast cancer are increasingly dependent on advances in surgery and systemic treatments and improved understanding of tumor biology. Recent clinical trials indicate a variety of fractionation regimens involving whole breast or partial breast treatment are equally effective in patients with early stage breast cancer. This educational session will review the latest evidence supporting hypofractionated and ultrashort hypofractionated treatment regimens as well as indications for post-mastectomy and regional nodal irradiation. We will also discuss clinical scenarios where radiation may be withheld. Radiation techniques will be discussed. Lastly, novel systemic and targeted therapies are being rapidly approved in patients with breast cancer, and this session will increase awareness regarding potential interactions between radiation and these treatments.   

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Discuss a variety of equally effective radiation treatment options for patients with early stage breast cancer and determine the best option for the individual patient through shared decision making.
• Determine when and how to perform regional nodal irradiation.
• Determine the best radiation technique for delivering treatment to an individual patient.

References

• Brunt et al. Ten-year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer. JCO 2020; 38 (28); 3261-3272.  
• Meattini et al. Accelerated Partial-Breast Irradiation Compared with Whole-Breast Irradiation for Early Breast Cancer: Long-Term Results of the Randomized Phase III APBI-IMRT-Florence Trial. JCO 2020; 38(35): 4175-4183.
• Kunkler et al. Breast Conserving Surgery with or without Irradiation in Early Breast Cancer.  N Engl J Med 2023; 388:585-594.
• Torres et al. Postmastectomy and Regional Nodal Irradiation for Breast Cancer. JCO 2020; 38 (20): 2299-2309.

Potential Challenges/Barriers to Change

• Lower reimbursement for hypofractionated regimens may limit changes in practice.
• Lack of advanced technology and reimbursement for these technologies prevent access to certain types of radiation.
• Lack of knowledge/expertise regarding novel systemic and targeted therapies may inadvertently increase adverse events in patients.

The session will review the current clinical management of the most common malignant and benign adult CNS tumors. This review will provide an overview of the current clinical practice in the treatment of brain metastases. We will review the evolving role of stereotactic radiosurgery in combination with novel therapeutic agents in the treatment of brain metastases. We will discuss in depth the roles of surgery, radiotherapy and chemotherapy in the management of each of these tumors.

Multidisciplinary approach is required in the management of CNS tumors with an emphasis on new molecular prognostic and predictive biomarkers that allow for appropriate treatment selection. Recent updates of the 5th edition WHO Classification of CNS tumors in 2021 include new tumor types that will be summarized. The importance of neuroimaging in helping clinicians improve diagnosis, treatment and response assessment for CNS tumors will be emphasized. This session highlights the importance for a multidisciplinary treatment approach in the management of CNS tumors.  

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Discuss the role of each modality, including surgery, radiotherapy and chemotherapy in managing the major malignant and benign adult primary CNS tumors.
• Describe the new updates of the 5th edition of the WHO Classification of Tumors of the CNS 2021. Substantial heterogeneity exists within these tumor types. Discuss the prognostic and predictive variables that allow for the selection of the appropriate therapy.
• Discuss key imaging modalities and features to differentiate recurrent tumor and treatment effect.

References

• Louis DN, Wesseling P, Aldape K, et al. cIMPACT-NOW update 6: new entity and diagnostic principle recommendations of the cIMPACT-Utrecht meeting on future CNS tumor classification and grading. Brain Pathol. 2020 Jul;30(4):844-8562.
• Wen PY, Weller M, Lee EQ, et al. Glioblastoma in adults: a Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol. 2020;22(8):1073-1113. doi:10.1093/neuonc/noaa106.
• Mohile NA, Messersmith H, Gatson NT, et al. Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline. J Clin Oncol. 2022;40(4):403-426. doi:10.1200/JCO.21.02036.

Potential Challenges/Barriers to Change

• Complexity of evolving data.
• Lack of access to multidisciplinary CNS expertise.
• Lack of access to novel treatment technologies.
• Difficulty with insurance reimbursement and resources to perform genomic testing.  

The goal is this session is to teach attendees the practical aspects of liver contouring. Attendees will be able to practice contouring liver tumors and relevant organs at risk (OAR) both prior to the session and after to evaluate self-improvement. We will review the challenges in identifying the gross target volumes and OARs, as well as common pitfalls.
 
Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Correctly identify organs-at-risk in the upper abdomen including those not routinely contoured, such as the common bile duct.
• Delineate the gross tumor volume (GTV) for different types of tumors including hepatocellular carcinoma and liver metastases.
• Identify the common pitfalls in upper abdominal contouring and how to avoid them.

References

• RTOG 1112 (abstract presented at: ASTRO 2022, GI ASCO 2023)
• HE.1 (abstract presented at: GI ASCO 2023
• Uhlig J, Lukovic J, Dawson LA, Patel RA, Cavnar MJ, Kim HS. Locoregional therapies for colorectal cancer liver metastases: options beyond resection. ASCO Ed Book 2021; 41:133-146.
• Palma D, et al. Long term results of the SABR-COMET Phase II Randomized trial. J Clin Oncol. 2022; 38(35): 2830-2838.

Potential Challenges/Barriers to Change

• The main barrier to the implementation of a liver SBRT program is lack of knowledge/expertise to implement as well as potential lack of resources (e.g., the ability to perform daily image guidance).

This eContouring session will review best practices for lung cancer contouring, including the integration of 4DCT imaging and PET/CT. The cases covered will include a centrally located, early stage NSCLC and a locally advanced NSCLC. Participants will review generation of ITV from 4DCT data, best practices for CTV and PTV margins, and contouring of critical normal structures. They will also review how to incorporate findings from pathologic staging such as EBUS into treatment planning for locally advanced disease and best practices for nodal target volume delineation. The session will include 2 practice cases.

Program Objectives

Upon completion of this live activity, attendees should be able to do the following:

• Accurately contour a centrally located, early stage NSCLC case planned for SBRT, including critical structures such as the proximal bronchial tree.
• Accurately integrate radiographic and pathologic staging data to contour a locally advanced NSCLC case.
• Integrate 4DCT data into their lung cancer contouring.

References

• Daly ME, Singh N et al. Management of Stage III Non–Small-Cell Lung Cancer: ASCO Guideline. JCO 2022.
• Videtic G et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Practical Radiation Oncology 2017.

Potential Challenges/Barriers to Change

• Lack of access to 4DCT
• Lack of access to PET/CT simulator
• Limited time for contouring in busy clinical practice

We will start with a brief review of anatomy in CT and MRI followed by a brief discussion of how to deliver a boost based on the FLAME trial. Then we will follow with a review of the postoperative contouring guidelines and the update to the pelvic lymph nodes contouring guidelines. We will then finish reviewing contours for previously assigned cases.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Apply changes in the contouring of pelvic lymph nodes based on the most recent contouring guidelines.
• Contour volumes for patients undergoing radiation therapy in the postoperative setting.
• Implement the use of MRI for contouring of volumes in patients with intact prostate cancer.

References

• Hall et al. NRG Oncology Updated International Consensus Atlas on Pelvic Lymph Node Volumes for Intact and Postoperative Prostate Cancer. IJROBP. 2021;109(1):174-185.
• Michalski et al. Development of RTOG Consensus Guidelines for the Definition of the Clinical Target Volume for Postoperative Conformal Radiation Therapy for Prostate Cancer. IJROBP. 2010 Feb 1; 76(2): 361–368.

Potential Challenges/Barriers to Change

• Lack of access to imaging modalities such as MRI.

Upper GI
This activity will provide an overview of the current state of management of upper GI cancers. Specifically it will focus on esophageal, gastric and pancreatic tumors. Recently published clinical trials and ongoing trials will be reviewed in detail.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Summarize recent important published trials in pancreatic cancer, gastric cancer and esophageal cancer.
• Discuss the ongoing trials in the space of upper GI cancers along with unanswered questions.
• Identify current new technologies (CT and MR based adaptive therapy) and how these many help patients.

References
Will provide during presentation.

Potential Challenges/Barriers to Change

• Lack of resources.    
• Lack of reimbursement.
• Lack of clinical trials staff.

Lower GI
This lecture will cover contemporary management of rectal and anal cancer. For rectal cancer, contemporary trials using total neoadjuvant therapy and non-operative management will be reviewed with specific emphasis on various approaches, merits of different sequencing options and future trials. Management of anal cancer will focus on modern radiation therapy techniques as well as current efforts aimed at toxicity mitigation or treatment de-intensification/intensification for favorable/unfavorable risk patients respectively.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Identify various sequencing strategies for radiation as part of total neoadjuvant therapy in rectal cancer and pros/cons of various approaches.
• Implement modern radiation therapy techniques for management of anal cancer.

References

• Wo et al. Radiation Therapy for Rectal Cancer: Executive Summary of an ASTRO Clinical Practice Guideline. Practical Radiation Oncology. 2021.

Potential Challenges/Barriers to Change

• Institutional paradigms for rectal cancer may not reflect best practices.
• Lack of experience with non-operative management for rectal cancer may be a barrier to implementation.

This refresher course will provide an overview of the treatment of prostate cancer with an emphasis on the role of radiation therapy in the treatment of localized disease, nodal disease, recurrent disease after prostatectomy and treatment of the primary in the setting of oligometastatic disease. It will include discussion of optimal systemic therapy to administer with radiation treatment, incorporating predictive biomarkers into practice, normal tissue constraints and comparative outcomes between radiation, surgery and active surveillance.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Recognize which patients may benefit from microboost, brachytherapy boost and nodal treatment as part of their definitive prostate radiation treatment.
• Identify the optimal systemic therapy to deliver with salvage radiation treatment.
• Describe the data supporting the treatment of the prostate with radiation therapy in the setting of metastatic disease.

Potential Challenges/Barriers to Change

• Not having access to required technology.
• Lack of expertise to implement.
• Not covered by patient’s insurance.

Cervical Cancer
This session will focus on providing updates in the management of cervical cancer. It will focus on the use of modern imaging and treatment techniques which are rapidly being adopted. This will include discussions of intensity modulated radiation therapy in the post-operative and definitive settings as well as how to integrate image guided adaptive brachytherapy. In addition we will review updated guidelines for target and organ at risk suggested doses for definitive cervical cancer treatment.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Describe of the factors associated with local failure after definitive chemo-RT for cervical cancer.
• Describe the morbidities after definitive chemo-RT and how to reduce them.
• Describe indications for post-operative treatment following surgery for earlier staged cervical cancer.

References

• Schmid M, Lindegaard J, Mahantshetty, et al. Risk factors for local failure following chemoradiation and magnetic resonance image-guided brachytherapy in locally advanced cervical cancer: results from the EMBRACE-I study. JCO. 2023.
• Vittrup A, Kirchheiner K, Potter R, et al. Overall severe morbidity after chemo-radiotherapy and MRI guided adaptive brachytherapy in locally advanced cervical cancer: results from the EMBRACE-I study. IJROBP. 2023.
• Suvaal I, Kirchheiner K, Nour R, et al. Vaginal changes, sexual functioning and distress of women with locally advanced cervical cancer treated in the EMBRACE vaginal morbidity substudy. Gynecol Oncol. 2023.

Potential Challenges/Barriers to Change

• Some practices may not see many cervical cancer cases yearly.
• The resources needed to develop/sustain an image guided brachytherapy program may not be available.
• The skillset of the radiation oncologist might not include feeling comfortable with placing needles using a hybrid type applicator.

Endometrial Cancer
This educational activity will address the recent knowledge acquired in endometrial cancer mainly the indications for adjuvant RT and chemotherapy and the role of concurrent chemoradiation in high risk and locally advanced disease as well as the optimal sequencing approach when both modalities are used. In addition, the interpretation and potential impact of molecular markers will be discussed given the recent publication of the European guidelines which based their recommendations on molecular markers. Last, the interpretation and optimal management of sentinel LN biopsy, isolated tumor cells findings and MELF will be addressed. Recently published prospective trials and ongoing clinical trials will be reviewed.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Determine the indications for systemic therapy and radiation therapy in non-metastatic endometrial cancer.
• Determine the role of molecular markers and their potential impact on adjuvant therapy.
• Interpret the significance and interpretation of sentinel LN biopsy and isolated tumor cells in LN.
• Determine the role of MELF in decision making.
• Assess QOL after concurrent chemoradiation.

References

• ASTRO EC guidelines
• GOG 258, PORTEC 3
• QoL after GOG 258

Potential Challenges/Barriers to Change

• Lack of overall survival benefit in GOG 258 comparing chemoRT vs chemo alone in locally advanced disease which contradicts the findings of PORTEC 3 and complicate interpretation of data.
• Lack of randomized trials to establish the optimal sequencing approach of adjuvant chemotherapy and radiation therapy.
• Paucity of studies establishing the impact of molecular markers on clinical practice and challenge in determining treatment algorithms.
• Impact of ITCs on adjuvant therapy remains controversial and is mostly based on retrospective studies.

This is a lecture-based educational format designed to update attendees on the latest evidence-based practice recommendations for head and neck cancer radiation therapy. Scientific updates that inform practice as well as technological advances that are relevant to best outcomes for patients will be addressed.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Select appropriate radiation dose and fractionation schedules for early and advanced-stage nasopharynx, oropharynx, larynx and hypopharynx cancer patients.
• Coordinate surgery timing and chemotherapy if needed into the management of oral cavity, larynx and hypopharynx cancer patients who will require postoperative radiation therapy.
• Perform target delineation for intensity modulated radiation therapy planning according to standard guidelines.

References

• Mody MD, Rocco JW, Yom SS, Haddad RI, Saba NF. Head and neck cancer. Lancet. 2021 Dec 18;398(10318):2289-2299. doi: 10.1016/S0140-6736(21)01550-6. Epub 2021 Sep 22. PMID: 34562395.
• Grégoire V, Evans M, Le QT, Bourhis J, Budach V, Chen A, Eisbruch A, Feng M, Giralt J, Gupta T, Hamoir M, Helito JK, Hu C, Hunter K, Johansen J, Kaanders J, Laskar SG, Lee A, Maingon P, Mäkitie A, Micciche' F, Nicolai P, O'Sullivan B, Poitevin A, Porceddu S, Składowski K, Tribius S, Waldron J, Wee J, Yao M, Yom SS, Zimmermann F, Grau C. Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO, TROG consensus guidelines. Radiother Oncol. 2018 Jan;126(1):3-24. doi: 10.1016/j.radonc.2017.10.016. Epub 2017 Nov 24. PMID: 29180076.
• Margalit DN, Sacco AG, Cooper JS, Ridge JA, Bakst RL, Beadle BM, Beitler JJ, Chang SS, Chen AM, Galloway TJ, Koyfman SA, Mita C, Robbins JR, Tsai CJ, Truong MT, Yom SS, Siddiqui F. Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria. Head Neck. 2021 Jan;43(1):367-391. doi: 10.1002/hed.26490. Epub 2020 Oct 23. PMID: 33098180; PMCID: PMC7756212.

Potential Challenges/Barriers to Change

• Lack of clinical knowledge or expertise about this specialized area of medicine.
• Lack of access to guidelines and other published materials on best practices.
• Lack of technical knowledge to implement planning and dosimetric improvements.

The treatment approaches for lung cancer are rapidly evolving and include integration of new systemic therapies (e.g., immunotherapy and targeted therapies) into combined modality approaches for non-metastatic disease and ablative radiation therapy approaches for oligometastatic disease. This session will review recent literature and guidelines for the treatment of lung cancer and provide insights into tailoring of different combined modality therapy options for patients.  

Attendees will learn about the clinical outcomes and toxicity risks and how to coordinate these new, complex multidisciplinary treatment approaches.

Furthermore, this session will review recent insights into toxicity risks for both conventional radiation therapy (especially in the postoperative setting and related to cardiac injury) and stereotactic body radiation therapy (especially for ultracentral tumors), and the implications of radiation therapy toxicity on newer combined modality approaches.  

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Discuss the literature supporting novel combined modality therapy approaches that include immunotherapy, chemotherapy, surgery and/or radiation therapy in non-metastatic lung cancer.
• Discuss the pros and cons of different modalities of local therapy (surgery versus radiation) for each stage of lung cancer and appropriate situations to consider dual local therapy.
• Describe risk factors for severe radiation-related toxicity, including cardiac injury and central mediastinal structure injury for SBRT, and methods to mitigate these risks.

References

• Checkmate 816: https://www.nejm.org/doi/10.1056/NEJMoa2202170
• 5-year results of PACIFIC trial: https://ascopubs.org/doi/full/10.1200/JCO.21.01308
• Nordic HILUS trial of ultracentral lung SBRT: https://pubmed.ncbi.nlm.nih.gov/33823286/

Potential Challenges/Barriers to Change

• Communication and coordination of care between disciplines may be more difficult when there is not a consensus on the optimal treatment approach.
• Lack of risk stratification and/or decision support tools to help clinicians personalize treatment optimally.
• Lack of resources and knowledge on how to manage emerging toxicities.

This presentation will help inform listeners about the multidisciplinary care of patients with lymphoma, the use of contemporary treatment fields (e.g., INRT, ISRT), appropriate use of technology (i.e., IMRT, VMAT, deep inspiration breath hold, proton beam therapy), new targeted therapies, immunotherapy and treatment guidelines. The goal is to provide participants with updates on current clinical and translational initiatives in hematologic malignancies that are relevant to daily clinical practice. Additionally, attendees will be updated on the appropriate integration of these advancements in their daily practice, including indication, patient selection and combinations of different therapeutic modalities and management of common toxicities.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Discuss the current guideline-based clinical practice in hematologic malignancies.
• Discuss PET/CT response adaptive radiation therapy protocols for Hodgkin lymphoma and non-Hodgkin lymphoma.
• Explain the application of involved-site radiation therapy (ISRT) for all disease sites, including Hodgkin lymphoma and non-Hodgkin lymphoma.
• Discuss the importance of multidisciplinary care in hematologic malignancies and how to best apply it for optimal outcomes.
• Describe key advances in immunotherapy and targeted therapy in hematologic malignancies.
• Discuss recent advances in new technology integration (i.e., IMRT, VMAT, deep inspiration breath hold, proton therapy) and how and when to integrate them.
• Discuss late effect of radiation therapy and how to best utilize current knowledge for decision-making.

References

• Hoppe BS, Hoppe RT.  “Expert radiation oncologist interpretation of involved-site radiation therapy guidelines in the management of Hodgkin lymphoma” IJROBP 2015.
• Piva C, Genovesi D, Filippi AR…Ricardi U.  “Interobserver variability in clinical target volume delineation for primary mediastinal B-cell lymphoma” PRO 2015.
• Aznar MC, Girinsky T, Berthelsen AK, …Specht L.  “Interobserver delineation uncertainty in INRT for early-stage Hodgkin lymphoma: On behalf of the RT Committee of the EORTC lymphoma group.  Acta Oncol. 2017.

Potential Challenges/Barriers to Change

• Lack of coverage/reimbursement for advanced techniques.
• Lack of knowledge on appropriate utilization of advanced techniques into clinical practice.
• Resistance to change based on historical practice patterns influenced by referring physicians in hematology oncology.

The purpose of this educational lecture will be to review recent data on treatment of oligometastases and to discuss practical approaches to treatment at different locations.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Describe the evidence supporting the existence of an oligometastatic state.
• Identify new randomized data assessing the use of ablative therapies in the treatment of metastases.
• Design a safe approach to treatment of oligometastases in practice.

References

• Several guidelines for treatment with SABR exist, this is one example: Guidelines for safe practice of stereotactic body (ablative) radiation therapy https://onlinelibrary.wiley.com/doi/full/10.1111/1754-9485.12336.

Potential Challenges/Barriers to Change

• Lack of exposure to patients with oligometastases.
• Lack of peer/mentor support in evaluating difficult radiation plans.
• Uncertainty regarding benefits of SABR.

This one-hour refresher will highlight existing standards of care in pediatric radiation oncology, review recent updates to the standard of care, comment on new radiation techniques unique to pediatric radiation oncology, and discuss some of the current controversies in the application of radiotherapy in various clinical scenarios.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Reevaluate their existing knowledge surrounding the appropriate workup and risk stratification of pediatric malignancies and demonstrate an understanding of the potential influence of these findings on disease outcomes.
• Demonstrate new knowledge of molecularly defined pediatric cancer subsets and how to navigate the ongoing controversies surrounding the optimal therapeutic approach.
• Integrate new radiation techniques unique to pediatric radiation oncology into their daily practice to minimize treatment related morbidity.

References

• Halperin, Edward C., et al. Pediatric Radiation Oncology. N.p., Wolters Kluwer Health, 2012.
• Kortmann, Role-Fieter., Merchant, Thomase E. Pediatric Radiation Oncology. Germany, Springer International Publishing.
• Macdonald, Shannon M., Terezakis, Stephanie A. Target Volume Delineation for Pediatric Cancers. (2019). Switzerland: Springer International Publishing.

Potential Challenges/Barriers to Change

• Disagreement regarding the optimal standard of care for a given set of patient disease characteristics.
• Site specific lack of appropriate infrastructure to successfully characterize the extent of and/or molecular characteristics of a disease.
• Lack of required radiotherapy and or ancillary resources necessary to provide the optimal standard of care (i.e., pediatric anesthesia, proton therapy, child life, on-site oncology support, etc.).

In this course, we provide an overview of biomarker definitions and potential use in the management of cancer patients. We then describe the historical evolution of efforts by NRG Oncology to develop and validate tissue-based molecular biomarkers to direct management of GU cancers treated with radiation. Topical examples will be provided that punctuate these efforts to realize the goal of precision radiation medicine.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Describe the different types of biomarkers and how they impact treatment of cancer patients.
• Identify molecular biomarkers that are in development and those that are available as standard of care to help guide management of GU cancer patients treated with radiation therapy.

References

• PMID 35676445
• PMID 35657158
• PMID 36001857

Potential Challenges/Barriers to Change

• Lack of knowledge/expertise in biomarker fundamentals.
• Lack of knowledge/expertise in available tissue-based molecular biomarkers to guide precision radiation medicine for GU cancer patients treated with radiation.
• Lack of regulatory approval and insurance reimbursement for some tissue-based molecular biomarkers to be used to guide precision radiation medicine for GU cancer patients treated with radiation.

Radiopharmaceuticals are an increasingly utilized therapeutic option for the treatment of malignancies. This session will focus on clinical indications and basics of medical physics and radiobiology (along with Robert Hobbs, PhD, DABR). Specifically, Radium-223, Lutetium-177 dotatate and Lutetium-177 PSMA-617 will be discussed. The purpose of the Radiopharmaceuticals Refresher is to increase physician, physicist, and trainee understanding on how to effectively and safely develop a radiopharmaceutical program at their respective institutions.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Discuss the relevant principles of physics and radiobiology for radiopharmaceutical therapies (RPTs).
• Identify clinical indications for RPTs that are currently approved for clinical use.
• Identify barriers and logistical steps for implementing RPT use in their own practice.

References

• Strosberg J et al. Phase 3 trial of 177Lu-dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017.
• Parker C et al.  Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 2013.
• FDA approves iobenguane I-131 for rare adrenal gland tumors. www.fda.gov. July 2018.
• Hofman MS et al. 177Lu-PSMA-617 radionuclide treatment in patients with metastatic castration-resistant prostate cancer (LuPSMA trial): a single-centre, single-arm, phase 2 study. Lancet Onc. 2018.
• Zukotynski et al.  Targeted Radionuclide Therapy: Practical Applications and Future Prospects.  Biomark Cancer. 2016.

Potential Challenges/Barriers to Change

• Lack of background knowledge regarding RPTs
• Lack of practical knowledge / experience in RPT usage.
• Lack of financial/reimbursement models and staffing requirements for running an RPT program.

This session will review the basic concepts of staging, overall treatment paradigm, radiation specific recommendations, radiation simulation, planning and treatment aspects, and literature regarding extremity and retroperitoneal soft tissue sarcomas. This session will also review literature regarding hypofractionation for extremity soft tissue sarcomas and provide guidance on how best to incorporate this into practice. This session will also review literature regarding the role of radiation therapy for retroperitoneal soft tissue sarcomas and how best to incorporate radiation therapy into practice.

Program Objectives
Upon completion of this live activity, attendees should be able to do the following:

• Develop and implement the treatment paradigm as it relates to radiation therapy for extremity and retroperitoneal soft tissue sarcomas.
• Select patients with sarcoma who may benefit from hypofractionated regimens.
• Establish safe and effective techniques (fractionation, target design, etc.) supported by the prospective data on hypofractionated radiation therapy for sarcoma.

References

• Guadagnolo et al. Hypofractionated, 3-week, preoperative radiotherapy for patients with soft tissue sarcomas (HYPORT-STS): a single-centre, open-label, single-arm, phase 2 trial. Lancet Oncology. 2022
• Bedi et al. Could Five Be the New Twenty-Five? Long-term Oncologic Outcomes from a Phase II, Prospective, 5-Fraction Pre-operative Radiation Therapy Trial in Patients with Localized Soft Tissue Sarcoma. Advances in Radiation Oncology. 2022.
• Bonvalot S, Gronchi A, Le Péchoux C, et. al. Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2020 Oct;21(10):1366-1377.
• Callegaro D, Raut CP, Ajayi T, et. al. Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma: EORTC-62092 Trial (STRASS) Versus Off-trial (STREXIT) Results. Ann Surg. 2022.

Potential Challenges/Barriers to Change

• Reluctance to deviate from comfortable techniques used for decades.
• Fear of side effects associated with hypofractionation.
• Uncertainty of how best to incorporate radiation therapy in the treatment of retroperitoneal sarcomas.