Academy Add-ons

Activity Description

Radiopharmaceuticals are an increasingly utilized therapeutic option for the treatment of malignancies. This activity focuses on clinical indications, difficult cases, medical physics considerations, development of standard operating procedures for clinical implementation, billing and safe theranostic delivery practices. Specifically, Radium-223, Lutetium-177 dotatate and Lutetium-177 PSMA-617 are discussed.

The activity includes didactic presentations from physician experts from radiation oncology, nuclear medicine, medical oncology and medical physicists, with question and answer sessions to discuss practice implementation in various clinical settings (i.e., academic hospital vs. community practice, nuclear medicine vs. radiation oncology).

Objectives:

• Evaluate radiation treatment options for patient use such as radiopharmaceutical therapies.
• Safely and effectively administer the new and growing list of active radiopharmaceuticals.
• Actively establish and develop radiopharmaceutical therapy programs for patient care.

Activity Description

There is considerable research in preclinical and clinical domains that has investigated therapeutic interactions between radiation therapy and immunotherapies, and these treatment modalities are increasingly being used in conjunction with each other. There is a critical need for clinicians and researchers to stay up to date with these developments in order to safely and effectively provide patient care and advance translational research objectives. Participants of this activity learn the rationale for combining radiation therapy with different types of immunotherapy, as well as the factors that need to be considered as they may affect the efficacy of the treatment, including the radiation dose and field, and sequencing of radiation with immunotherapy. Learners gain an understanding of the current status of knowledge of the mechanisms of action of combinations of immunotherapeutic agents and radiation that can inform treatment decisions. Examples of specific clinical situations and clinical cases are discussed. This activity was originally recorded at the 2024 ASTRO Annual Meeting.

Objectives:

• Implement an optimal radiation delivery for patients treated with immunotherapy.
• Discuss combination treatment options for patients that may benefit from radiation and immunotherapy.
• Identify disease sites and stages that require special consideration in how radiation is delivered in combination with immunotherapy.

Activity Description

This program is designed to address the needs of a community practice physician and includes disease site reviews, interactive case-based discussions, a business fundamentals review and a radiopharmaceuticals overview.

The Practical Radiation Oncology (PRO) Program 2024 includes all PRO sessions originally recorded at the 2024 ASTRO Annual Meeting. Learn more about the presentations and presenters for each PRO session listed below.

PRO Sessions:

• Advances in Breast Cancer Management: Early-Stage Disease, Post-Neoadjuvant Radiation Therapy and IMRT for Breast Cancer
• Brain Metastases Radiotherapy while Mitigating Radionecrosis and Neurotoxicity
• Business of Radiation Oncology for Clinicians
• Benign Radiotherapy: Back to the Future
• Patient Guided Radiotherapy: Tools to Help Providers Support Patients when the "Right Choice" Isn't Always Clear
• Prevention and Management of Toxicity in Organs at Risk (OAR)
• Gynecologic Tumor Board - Case-Based Discussion of the Molecular and Treatment Approach Updates for the Management of Endometrial, Vulvar and Cervical Cancers
• Implementation of a Prostate SBRT Program in the Community Setting
• Head and Neck Cancer - Prevention and Management of Radiation Therapy Toxicity
• Introduction to Theranostics for the Community Radiation Oncologist

The Challenging Cases Package includes two sessions recorded at the 2024 ASTRO Annual Meeting. Both course descriptions and learning objectives appear below.

1) Challenging Cases in Palliative Care: Novel Therapeutics, Radioresistant Histology and Treatment Delivery

Activity Description

This activity uses case vignettes to discuss (1) thinking through the application of novel therapeutics with radiation treatment for metastatic cancer (e.g., which agents to hold, how much volume to treat, what dose to deliver); (2) handling treatment decisions (e.g., dose, fractionation, technique, timing) for patients whose clinical condition may be uncertain/changing and who have a radioresistant histology; and (3) practical aspects of treatment delivery for palliative RT patients including sim-less RT work flows and similar, that can reduce work burdens of radiation oncologists caring for palliative patients. Common practice patterns for these challenging scenarios are discussed along with available treatment options and strategies for implementing them into practice. The unique challenges associated with treating geriatric patients with advanced cancer are discussed as well.

Objectives

• Understand the nuanced decision making processes underlying combining novel therapeutics with radiation for metastatic disease.
• Become familiar with sim-less radiation workflows.
• Apply a 2x2 matrix decision tool for treatment decision making in cases where there is a radioresistant histology.

2) Challenging Cases in the Management of Squamous Cell Carcinoma of the Skin

Activity Description

This activity highlights some complex cases that require thoughtful integration of multidisciplinary care to achieve optimal tumor control, function and QoL. We present four to five challenging cases of squamous cell carcinoma of the skin. A moderator presents the preselected challenging cases and guides the panel discussion. This is a joint activity between the Cutaneous/Sarcoma disease site and the Head and Neck disease site. We present 2-3 body skin SCC cases and 2-3 H&N SCC cases. Panelists include a H&N surgeon, Surg/Onc, Med/Onc and Rad/Onc all specializing in the management of skin cancers. Through the various cases we explore: Surgical management of cutaneous SCC, including when nodal evaluation is indicated. Use of systemic therapy (standard chemotherapy, immunotherapy, targeted therapy). Sequencing of therapy (neoadjuvant vs. adjuvant strategies) and the role of radiation therapy (definitive, neoadjuvant, post-operative and palliative).

Objectives

• Determine the best course of action when faced with a challenging cutaneous SCC as it relates to sequencing of therapy (surgery first vs. a neoadjuvant strategy - and what advantages the latter can provide).
• Identify clinical scenarios and risk factors that should motivate recommendation of RT in the definitive and post-operative settings.

Activity Description

This series provides an overview of historical and contemporary indications for radiation therapy in the treatment of nononcological conditions such as ventricular tachycardia, plantar fasciitis, Dupuytren's and Ledderhose diseases, osteoarthritis, and functional brain disorders. The presenters review data supporting the use of radiation therapy for these conditions, describe the biological mechanisms of efficacy, and provide practical instructions on how to treat.

Topics Covered

• What Goes Around Comes Around: Radiation Therapy of Nonmalignant Disorders
• Cardiac Radioablation for Ventricular Tachycardia
• A Pain in the Foot: Radiotherapy for Plantar Fasciitis
• An Overview of the Multidisciplinary Management of Dupuytren's and Ledderhose Diseases
• Low Dose Radiotherapy for Osteoarthritis
• A Functional Radiosurgery Renaissance - Historical Perspectives and Future Applications

Objectives

• Classify potential indications for radiotherapy of benign diseases.
• Identify trends and knowledge gaps in radiotherapy of benign diseases.
• Estimate the risk of treatment toxicity.
• Describe the key elements required to define a cardiac radioablation target volume.
• Describe expected efficacy and toxicity outcomes following cardiac radioablation.
• Describe plantar fasciitis, and know that it is common, and that traditional treatments can be ineffective.
• Discuss the evidence and mechanisms behind the use of radiotherapy for plantar fasciitis.
• Use radiotherapy effectively to treat plantar fasciitis.
• Describe and understand the unique pathophysiology of Dupuytren’s and Ledderhose Disease.
• Analyze current data on the role of radiotherapy in the management of Dupuytren's and Ledderhose Disease.
• Discuss the role of the radiation oncologist in the multidisciplinary management of Dupuytren's and Ledderhose Disease.
• Articulate the evidence showing benefit of low dose radiotherapy (LDRT) for osteoarthritis as well as limitations.
• Identify appropriate patients who might benefit from LDRT and identify strategies for educating referring providers to develop thriving service line.
• Increase familiarity with the historical background of functional radiosurgery.
• Describe current applications of functional radiosurgery.
• Share a vision for future potential applications of functional radiosurgery.