Session highlights advances in radiation therapies offering improved patient experience, quality of life and high rates of cancer control for a variety of cancers
By Laura Williamson, Science Writer
Research presented in the plenary session focused on advancements in radiation therapy that improve the patient experience and quality of life, expanding treatment options to people with a variety of cancers. The session was moderated by Kenneth Rosenzweig, MD, FASTRO of the Icahn School of Medicine at Mount Sinai in New York City and by Farzan Siddiqui, MD, PhD, of Henry Ford Health/Henry Ford Hospital in Detroit, Michigan.
The session’s first presentation was given by Matthew M. Poppe, MD, FASTRO from the University of Utah in Salt Lake City.
Dr. Poppe presented “A Randomized Trial of Hypofractionated Post-Mastectomy Radiation Therapy (PMRT) in Women with Breast Reconstruction (RT CHARM, Alliance A221505).” In this large, multi-institution study, investigators confirmed that patients who wanted to undergo any type of breast reconstruction following mastectomy could safely and effectively cut their radiation treatment time nearly in half, also potentially lessening complications. He said the findings would make post-mastectomy radiation a more viable option for people for whom long absences from work, family and home were cost-prohibitive or otherwise challenging.
“Radiation after mastectomy saves lives,” Dr. Poppe said. “Patients should not have to choose between radiation and no radiation based on their desire for reconstruction or because they can’t take five or six weeks out of their lives for treatment. The results of this trial show we can safely reduce treatment time for these patients to three weeks, without compromising their reconstruction.”
Kathleen Horst, MD, of Stanford University, served as discussant for Dr. Poppe’s study, concluding that moderate hypofractionation is safe and effective after mastectomy with reconstruction and that reconstruction complication rates are similar regardless of fractionation schedule. Dr. Horst encouraged “multidisciplinary discussions” with the plastic surgery teams. “I would advocate that patients should be seen by radiation oncology before surgery to discuss these risks and trade-offs even prior to decisions being made,” remarked Dr. Horst.
Next, Jason A. Efstathiou, MD, of Massachusetts General Hospital and Harvard Medical Center in Boston, Massachusetts, presented “Prostate Advanced Radiation Technologies Investigating Quality of Life (PARTIQoL): Phase III Randomized Clinical Trial of Proton Therapy vs. IMRT for Localized Prostate Cancer.”
In this multi-center, phase III randomized trial, researchers found low- and intermediate-risk prostate cancer patients treated with proton beam therapy (PBT) or intensity modulated radiation therapy (IMRT) experienced equally high progression-free survival rates and no difference in patient-reported bowel, urinary or sexual function.
“We tested two contemporary, advanced forms of external beam radiation for a very common cancer, and we demonstrated that both are very safe, effective treatments that give patients excellent outcomes in terms of both quality of life and cancer control,” Dr. Efstathiou said. Dr. Efstathiou mentioned that there was an accompanying Red Journal article and podcast to accompany the results presented in his presentation.
Curtiland Deville, MD, FASTRO, of Johns Hopkins University served as discussant for this study. Dr. Deville remarked on the study’s sound methodology and explained the Expanded Prostate Cancer Index Composite (EPIC). The discussion delved into the rationale of using proton therapy for the treatment of PCa, highlighting that patients fared very well in this trial regardless of treatment modality. Dr. Deville called for further results from this trial to help inform practice. “Is this practice informing? Yes. Is it practice changing? In my opinion, not quite.”
Kristin Higgins, MD, of City of Hope Cancer Center Atlanta, presented “Concurrent Chemoradiation +/- Atezolizumab (atezo) in Limited-Stage Small Cell Lung Cancer (LS-SCLC): Results of NRG Oncology/Alliance LU005.”
This international, phase III randomized trial showed timing matters when adding immunotherapy to radiation therapy for people with limited-stage small cell lung cancer. While prior research found immunotherapy given after chemotherapy and radiation were completed could extend overall survival, this study showed delivering those treatments at the same time did not confer the same benefit.
“This seemingly small difference in the timing of when the drug is delivered has a very significant impact on the results,” Dr. Higgins said. “At the same time, we found that changing the way you deliver radiation — giving it twice daily — improved survival rates compared to the once daily approach.”
Further examining Dr. Higgins’ study, discussant Robert Samstein, MD, PhD, Icahn School of Medicine at Mount Sinai stated, “Unfortunately, in the results of the study that Dr. Higgins showed, there was no benefit observed in overall survival, progression-free survival, distant metastasis-free survival or local failure as well as in subset analysis, clearly demonstrating that in this setting there was no benefit of the addition of atezoluzumab to standard of care chemoradiation. We need to strongly reconsider approaches with concurrent immunotherapy and radiation, particularly in the setting of significant lymph node or blood volume dose.”
“Interim Futility Results of NRG-HN005, a Randomized, Phase II/III Non-Inferiority Trial for Non-Smoking, p16+ Oropharyngeal Cancer Patients” was presented by Sue S. Yom, MD, PhD, FASTRO of the University of California, San Francisco in California.
In this phase II randomized trial, researchers tested two lower-intensity radiation treatments for people with HPV-associated, local, regionally advanced oropharyngeal squamous cell carcinomas against standard of care chemoradiation. The trial was halted when patients in the traditional arm reached a two-year estimated progression-free survival rate of 98.1%, and there were excessive failures in the dose-reduced arms.
“Deintensification of radiation treatment for HPV-associated oropharyngeal cancers is of very high interest to patients and researchers, but our study makes clear that these approaches should remain very experimental,” Dr. Yom said. “I think this study is a good reminder that patients with this disease have really outstanding cure rates after we treat them with contemporary chemoradiation. At this point, neither of the deintensification options we tested would be appropriate for standard of care use, because you would actually be reducing some patients’ chance for a cure.”
Closing out the session, Sewit Teckie, MD, MBA, of New York City Health and Hospitals, served as discussant of Dr. Yom’s study. “I think we can all agree that for patients and for us physicians, the goal is cure. Patients want to preserve their function, and they want to live pain free.” Dr. Teckie further stated, “We had previously accepted that in phase II trials, the progression pre-survival rate of 90% at two years was acceptable. I want to argue with these results that that number is no longer acceptable.” Dr. Teckie further concluded that the standard of care should remain 70 Gy and cisplatin.
ASTRO staff Beth Bukata, Lisa Braverman, PhD, Amanda Helms, and Diane Kean, PMP, contributed to this article.
Additional resources on the Plenary studies:
Red Journal Podcast featuring the PARTIQoL trial
The NRG Podcast - Special ASTRO24 Episode: NRG-LUU005 and NRG-HN005 Results. The NRG Podcast interviews Drs. Kristin Higgins and Dr. Sue Yom on the results of NRG-LU005 (chemo +/- atezo in limited-stage small cell lung cancer) and NRG-HN005 (de-intensified RT for Early-stage p16+ oropharyngeal cancer) presented during the 2024 ASTRO Plenary Session.
