Session Content Resources

This course is designed to provide clinicians in practice and trainees with a comprehensive review and update of the clinical practice parameters across most sub-disciplines of radiation oncology, including sarcomas and the role of radiotherapy in the multidisciplinary management of cancer patients. The course will review key evidence that forms the basis for current clinical practice guidelines and trends in new approaches. In addition, the course will cover implementation of hypofractionation in key disease sites as well as treatment of oligometastases and use of SBRT to improve outcomes for patients with metastatic disease. It will also provide hands-on experience in contouring for upper GI, breast and lymphomas. It will also inform on the radiobiology of benign disease and a physics session will discuss protons and heavy ions. 

Below is session planning content that will help attendees extend and enhance learning as well as reinforce changes in practice. View more information on the overall program.

View the disclosures of all presenters (potential conflicts of interest have been reviewed and managed).
 

Breast

This session will provide a global overview of breast radiotherapy indications, approaches and techniques, informed by the latest clinical trials and relevant research. By the completion of the session, attendees should be able to identify which patients are suitable for omission of radiation therapy for early stage breast cancer, what kinds of genomic tests have been explored for risk stratification, and what techniques and dose/fractionation schemes demonstrate appropriate efficacy and toxicity profiles for definitive early-stage and locally-advanced breast cancer.

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

  • Appropriately identify patients suitable for omission of adjuvant radiation therapy in early-stage breast cancer.
  • Utilize hypofractionation techniques, when applicable, in early-stage and post-mastectomy settings.
  • Understand the relative value and limitations of tumor biology and genomic signatures in risk stratification for breast radiotherapy.

References

  • Kunkler et al. SUPREMO Trial, San Antonio Breast Cancer Symposium, December 2024.
  • ​Meattini et al. EUROPA Trial, San Antonio Breast Cancer Symposium, December 2024.
  • Poppe et al. RT-CHARM Trial, ASTRO Annual Meeting, September 2024.

Potential Challenges/Barriers to Change

  • Lack of knowledge/expertise
  • Implications to physician/departmental compensation
  • Lack of resources
Central Nervous System

This session will update participants on emerging trends in central nervous system radiation oncology, with special attention to high grade and low grade gliomas and brain metastases. Additionally, various benign tumors will be reviewed. Focus will be on trends in the last five years, as well as the types of therapies and techniques that we could be seeing in the next few years as clinical trials develop and report.

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

  • Describe recent advancements in the treatment of high grade glioma and low grade glioma with radiotherapy.
  • Describe recent advancements in the treatment of brain metastases with radiotherapy.

References

  • Wei RL, Colbert LE, Jones J, Racsa M, Kane G, Lutz S, Vapiwala N, Dharmarajan KV. Palliative care and palliative radiation therapy education in radiation oncology: A survey of US radiation oncology program directors. Pract Radiat Oncol. 2017 Jul-Aug;7(4):234-240. doi: 10.1016/j.prro.2016.11.009. Epub 2016 Dec. 1. PMID: 28222994.

Potential Challenges/Barriers to Change

  • Appropriate radiotherapy technology at the treating center
  • Novel drug FDA approval
eContouring for Upper GI

This session will evaluate contouring of Upper GI tumors and may include a discussion about esophageal cancers, stomach cancers, pancreatic, hepatobiliary and liver cancers.

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

  • Evaluate CTV delineations for esophageal cancer and pancreatic cancer.
  • Design volumes and doses for hepatocellular carcinoma.

References

  • Sanford NN, Narang AK, Aguilera TA, et al. NRG Oncology International Consensus Contouring Atlas on Target Volumes and Dosing Strategies for Dose-Escalated Pancreatic Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys. Published online November 6, 2024. doi:10.1016/j.ijrobp.2024.10.026. 
  • Goodman KA, Regine WF, Dawson LA, et al. Radiation Therapy Oncology Group consensus panel guidelines for the delineation of the clinical target volume in the postoperative treatment of pancreatic head cancer. Int J Radiat Oncol Biol Phys. 2012;83(3):901-908. doi:10.1016/j.ijrobp.2012.01.022.
  • Hong TS, Bosch WR, Krishnan S, et al. Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: radiation therapy oncology group consensus guidelines. Int J Radiat Oncol Biol Phys. 2014;89(4):804-813. doi:10.1016/j.ijrobp.2014.03.041.

Potential Challenges/Barriers to Change

  • Improve contouring knowledge for upper GI cancers based on available data
  • Improve knowledge of doses and planning constraints for upper GI cancers
eContouring for Breast

This session will focus on evidence-based breast cancer contouring practices. We will cover accelerated partial breast irradiation, whole breast contouring with considerations for different fractionation schedules, breast boost volumes including simultaneous integrated boosts, regional nodal irradiation volumes including internal mammary nodal boosts, and how volumes may differ when IMRT versus 3-D photon vs. electron techniques are used.

Program Objectives

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

  • Identify resources for breast cancer contouring.
  • Describe and perform contouring for accelerated partial breast and regional nodal cases.
  • Describe and perform contouring for simultaneous integrated boost cases.

References

  • Shaitelman SF, Anderson BM, Arthur DW, Bazan JG, Bellon JR, Bradfield L, Coles CE, Gerber NK, Kathpal M, Kim L, Laronga C, Meattini I, Nichols EM, Pierce LJ, Poppe MM, Spears PA, Vinayak S, Whelan T, Lyons JA. Partial Breast Irradiation for Patients With Early-Stage Invasive Breast Cancer or Ductal Carcinoma In Situ: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2024 Mar-Apr;14(2):112-132. doi:10.1016/j.prro.2023.11.001. Epub 2023 Nov 15. Erratum in: Pract Radiat Oncol. 2024 Nov-Dec;14(6):613. doi:10.1016/j.prro.2024.06.011. PMID: 37977261.
  • Loganadane G, Truong PT, Taghian AG, Tesanovic D, Jiang M, Geara F, Moran MS, Belkacemi Y. Comparison of Nodal Target Volume Definition in Breast Cancer Radiation Therapy According to RTOG Versus ESTRO Atlases: A Practical Review from the TransAtlantic Radiation Oncology Network (TRONE). Int J Radiat Oncol Biol Phys. 2020 Jul 1;107(3):437-448. doi:10.1016/j.ijrobp. 2020.04.012. Epub 2020 Apr 22. PMID: 32334035.

Potential Challenges/Barriers to Change

  • Lack of availability of deep inspiratory breath hold
  • Lack of knowledge about new contouring techniques
eContouring for Lymphomas

This session will review the evolution of field design in lymphoma radiation treatments, as well as offer case-based hands-on practice in contouring GTV, CTV and PTV in a variety of types of lymphomas. This session will also review how to optimize modern simulation and planning techniques to minimize unwanted radiation dose to organs at risk.

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

  • Describe how radiation fields for the treatment of lymphomas has evolved.
  • Describe how to optimally employ different radiation treatment techniques to treat lymphomas and minimize dose to organs at risk.
  • Implement contouring techniques practiced in the session in clinical practice.

References

  • Specht L, Yahalom J, Illidge T, Berthelsen AK, Constine LS, Eich HT, Girinsky T, Hoppe RT, Mauch P, Mikhaeel NG, Ng A; ILROG. Int J Radiat Oncol Biol Phys. 2014 Jul 15;89(4):854-62. doi:10.1016/j.ijrobp.2013.05.005. Epub 2013 Jun 18.
  • Illidge T, Specht L, Yahalom J, Aleman B, Berthelsen AK, Constine L, Dabaja B, Dharmarajan K, Ng A, Ricardi U, Wirth A; International Lymphoma Radiation Oncology Group. Modern radiation therapy for nodal non-Hodgkin lymphoma-target definition and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):49-58. doi: 10.1016/j.ijrobp.2014.01.006.
  • Dabaja BS, Ng AK, Terezakis SA, Plastaras JP, Yunes M, Wilson LD, Yang J, Gunther JR, Specht L, Yahalom J. ILROG Lymphoma Mini-Atlas Part II, Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys. 2020 Nov 15;108(4):977-978. doi:10.1016/j.ijrobp.2020.05.063. Epub 2020 Aug 4.

Potential Challenges/Barriers to Change

  • Referral patterns
  • Insurance reimbursement
Gastrointestinal

This talk will provide a review of the current role of radiation therapy in the multidisciplinary management of esophageal, gastric, pancreatic, hepatobiliary, rectal and anal cancers focusing on the key data supporting current clinical practice and use of technologies, and studies that have impacted the standard of care in the past year. 

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

  • Apply key studies to clinical decision making for patients with GI malignancies.
  • Analyze new data for GI oncology patients and adapt practice accordingly.

References

  1. Radiation Therapy for Rectal Cancer: An ASTRO Clinical Practice Guideline Focused Update, PRO 2024.

Potential Challenges/Barriers to Change

  • Lack of access to technology
  • Need to identify collaborating team members
Genitourinary

This session will review clinical radiation oncology for the management of genitourinary cancers.

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

  • Discuss evaluation of genitourinary cancers relevant to radiation oncology.
  • Discuss treatment of genitourinary cancers relevant to radiation oncology.

References

  • NCCN Guidelines
  • ASTRO Guidelines

Potential Challenges/Barriers to Change

  • Lack of information about recommended evaluation
  • Lack of information about current studies evaluating treatment
Gynecologic - Endometrial and Cervical

This session will review the indications for radiation therapy for endometrial and cervical cancer, the indications for surgery and systemic therapy for endometrial and cervical cancer, as well as describe the ideal radiation techniques and doses for endometrial and cervical cancer. 

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

  • Identify patients that qualify for definitive or post-operative radiation for cervical or endometrial cancers. 
  • Discuss with surgical and hematologic/oncology colleagues the optimal surgery or systemic therapy for your patients, and how they should be used in conjunction with radiation.
  • Use the correct radiation techniques and doses for radiation for patients with cervical and endometrial cancer, including choosing correct brachytherapy applicators. 

References

  • Hathout L. (2023). Can Immunotherapy Replace Radiation in Locally Advanced Endometrial Cancer?: Treatment for Advanced Endometrial Cancer. Practical Radiation Oncology, 13(6):551-557.

Potential Challenges/Barriers to Change

  • Lack of appropriate brachytherapy applicators
  • Lack of knowledgeable staff to provide brachytherapy to patients
  • Lower insurance reimbursement for gynecological treatments and procedures compared to other disease sites
Gynecologic - Vulvar and Vaginal

This refresher course aims to provide an overview of the treatment of vulvar and vaginal cancer, review current data regarding the role of radiation therapy in the treatment of localized disease and nodal disease, and explore current treatment paradigms. This session will include a discussion of current treatment paradigms, modern radiation treatment techniques, systemic therapies, incorporating predictive molecular studies into practice, and multidisciplinary approaches to optimize outcomes. A brief discussion of supportive care and normal-tissue toxicity will also be included.

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

  • Implement modern radiation techniques and coordinate multidisciplinary care for the definitive management of vulvar and vaginal cancer.
  • Incorporate predictive molecular studies into practice.
  • Support patients through treatment to minimize delays in treatment completion.

References

  • Parker JE, Yoshida EJ, Glen LT, Slomovitz BM, Nagel C. Vulvar cancer management and wrangling recurrent disease: A report from the society of gynecologic oncology journal club. Gynecol Oncol Rep. 2023;50:101310. PMID: 10716003.

Potential Challenges/Barriers to Change

  • Limited gynecologic oncology specialists
  • Limited pathology resources
  • Limited nursing support
Head and Neck

The session will provide a comprehensive update on the multidisciplinary management of head and neck cancers, focusing on advancements in radiotherapy. It will begin with an overview of the epidemiology and risk factors for oropharyngeal, laryngeal, hypopharyngeal, nasopharyngeal and cutaneous malignancies. It will highlight global trends such as the rising incidence of HPV-associated oropharyngeal cancer and the global variations in head and neck cancer subtypes.

The role of radiotherapy will be highlighted in each disease site, emphasizing key management principles by incorporating the most recent data to guide evidence-based decisions. A general overview summarizing the key fractionation and systemic therapy trials will precede the individual disease sites. For oropharyngeal cancers, recent results from de-escalation studies will be discussed to guide contemporary standards of care. Patient selection for upfront surgery or radiation will also be a key learning objective. For laryngeal and hypopharyngeal cancers, discussions will address the integration of chemotherapy and radiation to preserve voice and swallowing function. Updates on nasopharyngeal cancer will focus on recent advancements in radiotherapy dosing, contouring and planning, and the role of systemic therapy. The management of cutaneous malignancies will cover emerging data on adjuvant radiotherapy for high-risk tumors and its integration with immunotherapy.

Throughout, the lecture will emphasize patient-centered care, incorporating quality-of-life considerations and survivorship challenges into treatment decision making. Insights into optimizing radiation therapy planning and delivery will also be highlighted. This session is essential for clinicians aiming to provide cutting-edge, evidence-based care to patients with head and neck cancers.

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

  • Discuss the latest evidence-based recommendations for head and neck cancer.
  • Implement the latest evidence-based recommendations into head and neck practice.

References

  • Margalit DN, Anker CJ, Aristophanous M, Awan M, Bajaj GK, Bradfield L, Califano J, Caudell JJ, Chapman CH, Garden AS, Harari PM, Helms A, Lin A, Maghami E, Mehra R, Parker L, Shnayder Y, Spencer S, Swiecicki PL, Tsai JC, Sher DJ. Radiation Therapy for HPV-Positive Oropharyngeal Squamous Cell Carcinoma: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2024 Sep-Oct;14(5):398-425. doi: 10.1016/j.prro.2024.05.007. Epub 2024 Jun 18. PMID: 39078350.

Potential Challenges/Barriers to Change

  • Time constraints
  • Established practices and treatment paradigms
Lung

This session will provide clinicians in practice and trainees with a comprehensive review and update of the clinical practice parameters in the multidisciplinary management of patients with lung cancer. We will discuss the management of non-small cell lung cancer and small cell lung cancer, focusing on the role of radiotherapy in early-stage, locally advanced and metastatic disease. We will review key evidence that forms the basis for current clinical practice guidelines and emerging trends in practice patterns. 

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

  • Implement radiotherapy in the management of patients with non-small cell lung cancer following evidence-based practices. 
  • Implement radiotherapy in the management of patients with small cell lung cancer following evidence-based practices. 

References

  1. Riely, Gregory J., et. al. "Non-small cell lung cancer, version 4.2024, NCCN clinical practice guidelines in oncology." Journal of the National Comprehensive Cancer Network 22.4 (2024): 249-274. 
  1. Ganti, Apar Kishor P., et al. "Small cell lung cancer, version 2.2022, NCCN clinical practice guidelines in oncology." Journal of the National Comprehensive Cancer Network 19.12 (2021): 1441-1464.

Potential Challenges/Barriers to Change

  • Insurance reimbursement
  • Lack of knowledge among referring providers
Lymphomas

In this session we will review current principles and data supporting the utilization of radiation therapy for patients with hematologic malignancies. We will explore current treatment paradigms as well as modern radiation treatment techniques that are utilized in this patient population. We will examine the indications for cellular therapies and how radiation therapy can serve as a therapeutic partner for the treatment of refractory disease.

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

  • Understand the indications for consolidative radiation therapy for patients with early stage Hodgkin lymphoma and Diffuse large B-cell lymphoma.
  • Have knowledge of targeted and cellular therapies used currently for patients with hematologic malignancies and how radiation therapy can serve as a therapeutic partner in several settings.
  • Understand current treatment approaches for indolent B-cell lymphoma.

References

  • Dabaja BS, Ng AK, Terezakis SA, Plastaras JP, Yunes M, Wilson LD, Specht L, Yahalom J. Making Every Single Gray Count: Involved Site Radiation Therapy Delineation Guidelines for Hematological Malignancies. Int J Radiat Oncol Biol Phys. 2020 Feb 1;106(2):279-281. doi: 10.1016/j.ijrobp.2019.10.029. PMID: 31928641.
  • Fang PQ, Gunther JR, Wu SY, Dabaja BS, Nastoupil LJ, Ahmed S, Neelapu SS, Pinnix CC. Radiation and CAR T-cell Therapy in Lymphoma: Future Frontiers and Potential Opportunities for Synergy. Front Oncol. 2021 Mar 25;11:648655. doi: 10.3389/fonc.2021.648655. PMID: 33842363; PMCID: PMC8027336.
  • Wirth A, Mikhaeel NG, Aleman BMP, Pinnix CC, Constine LS, Ricardi U, Illidge TM, Eich HT, Hoppe BS, Dabaja B, Ng AK, Kirova Y, Berthelsen AK, Dieckmann K, Yahalom J, Specht L. Involved Site Radiation Therapy in Adult Lymphomas: An Overview of International Lymphoma Radiation Oncology Group Guidelines. Int J Radiat Oncol Biol Phys. 2020 Aug 1;107(5):909-933. doi: 10.1016/j.ijrobp.2020.03.019. Epub 2020 Apr 7. PMID: 32272184.

Potential Challenges/Barriers to Change

  • Lack of knowledge to implement changes in daily practice
  • Lack of insurance reimbursement for certain types of radiation therapy delivery approaches
  • Lack of referrals of appropriate patients
Oligometastatic Cancers and SBRT

This session will delve into the biological rationale behind SBRT for oligometastatic disease, review emerging clinical evidence supporting its use, and discuss patient selection criteria. Attendees will gain insights into how SBRT fits within the broader treatment paradigm, including its integration with systemic therapies and immunotherapy. Additionally, the session will address challenges such as toxicity management, optimal dose-fractionation schedules, and ongoing clinical trials that may further refine treatment strategies. 

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

  • Evaluate the rationale and clinical evidence supporting the use of SBRT in the management of oligometastatic cancers, including its potential impact on disease progression and patient survival.
  • Identify appropriate patient selection criteria for SBRT, understand its integration with systemic therapies, and recognize key considerations for optimizing treatment planning and toxicity management.

References

  • Guckenberger M, Lievens Y, Bouma AB, et al. "Towards precision radiotherapy for oligometastatic cancer: biological insights and clinical strategies." Lancet Oncology 2020;21(2):e18-e28.

Potential Challenges/Barriers to Change

  • Patient selection challenges - Identifying true oligometastatic disease remains difficult due to current diagnostic limitations and evolving understanding of tumor biology.
  • Integration with systemic therapy - Unclear guidelines on sequencing SBRT with immunotherapy and other treatments create uncertainty in clinical practice.
Pediatrics

The purpose of this session is to provide a contemporary overview of the role of radiation therapy in the treatment of pediatric malignancies. The session will review the diseases in which radiation therapy is used including the disease presentations, workups, treatment algorithms and radiation treatment details. The session will cover fields, doses, fractionations, common short term side effects, and subacute and late risks of treatment. The session will briefly discuss in which disease proton therapy should be considered.

Program Objectives

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

  • Compare and contrast the fields, dose, and fractionation of radiation therapy for localized infratentorial ependymoma vs. average risk medulloblastoma.
  • Outline the treatment schema, radiation fields, radiation dose and radiation fractionation for parameningeal rhabdomyosarcoma.
  • List at least two pediatric cancer scenarios in which photon radiation is often preferable to proton radiation.

References

  1. CA Cancer J Clin 2017; 67:7-30.

Potential Challenges/Barriers to Change

  • Lack of sufficient clinical experience with pediatric cases in residency
  • Insufficient pediatric-specific resources such as pediatric anesthesia
  • Lack of sufficient case numbers to justify investment in pediatric-specific resources
Physics

The well-defined range of a particle therapy beam may allow users to create a more targeted radiation dose distribution than is possible from an x-ray beam, but careful application of particle beams requires consideration of several uncertainties that are relatively trivial in photon therapy. This presentation will describe some of the chief differences between particle therapy and x-ray treatments, including robust optimization, consideration of tumor depth during image guidance, off-line plan verification and adaptation, and attention to biologic dose. Some emerging trends in particle therapy will also be discussed, such as the development of online adaptive proton therapy and progress toward the first heavy ion therapy facility in the United States.

Quality assurance is crucial for new and rapidly evolving technologies, such as proton and heavy ion radiation therapy, which require accurate application to be effective.

In this session, the critical role of peer review audits in particle therapy will be demonstrated, underscoring their importance in ensuring the accuracy and safety of cancer treatments. Peer review audits serve as a vital checkpoint, catching potential errors in treatment planning and delivery that could otherwise compromise patient (and clinical trial) outcomes. Several real-world examples of particle therapy treatment planning and delivery errors identified through peer review audits will be presented, illustrating the types of issues that can arise and the impact of these audits in catching and correcting them. Additionally, practical techniques for rectifying such errors will be shared, providing valuable insights for practitioners.

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

  • Explain the different sources of uncertainties unique to proton therapy.
  • Describe a workflow for online adaptive proton therapy.
  • Identify the physical and biological advantages of heavy ion therapy.
  • Describe the goal of peer review quality assurance.
  • Explain the types of peer review audits and the radiation dosimetry employed.
  • Identify common errors caught in particle therapy peer review audits. 

References

  • Hu YH, Harper RH, Deiter NC, Evans JD, Mahajan A, Kruse JJ, Mundy DW. Analysis of the Rate of Re-planning in Spot-Scanning Proton Therapy. Int J Part Ther. 2022 Fall; 9(2):49-58 Epub 2022 June 28.
  • Albertini F, Matter M, Nenoff L, Zhang Y, Lomax A. Online daily adaptive proton therapy. Br J Radiol. 2020 Mar;93(1107):20190594. doi:10.1259/bjr.20190594. Epub 2019 Nov 11. PMID: 31647313; PMCID: PMC7066958.
  • Taylor PA, Kry SF, Followill DS. Pencil Beam Algorithms Are Unsuitable for Proton Dose Calculations in Lung. Int J Radiat Oncol Biol Phys. 2017 Nov 1;99(3):750-756. doi:10.1016/j.ijrobp.2017.06.003. Epub 2017 Jun 13. PMID: 28843371; PMCID: PMC5729062.
  • Taylor PA, Lowenstein J, Followill D, Kry SF. The Value of On-Site Proton Audits. Int J Radiat Oncol Biol Phys. 2022 Mar 15;112(4):1004-1011. doi:10.1016/j.ijrobp.2021.10.145. Epub 2021 Nov 13. PMID: 34780973; PMCID: PMC8863623.
  • Mehrens H, Taylor P, Alvarez P, Kry S. Analysis of Performance and Failure Modes of the IROC Proton Liver Phantom. Int J Part Ther. 2023 Jul 14;10(1):23-31. doi:10.14338/IJPT-22-00043.1. PMID: 37823015; PMCID: PMC10563664.

Potential Challenges/Barriers to Change

  • Lack of resources (staff, financial) - careful application of proton therapy requires an expensive facility and a large staff
  • Lack of knowledge - precise modeling of the biologic effectiveness of proton and heavy ion beams is not available yet
  • Pressure for profit - particle therapy medical physicists may be encouraged to focus on clinical throughput rather than machine and process quality assurance
  • Lack of knowledge/expertise in proton and heavy ion therapy - new centers may be staffed by medical physicists with no prior experience with particle therapy
Radiobiology for Benign Disease

This session will explore the role of Low Dose Radiotherapy (LDRT) in treating osteoarthritis (OA), a prevalent and debilitating condition affecting millions worldwide. Despite its widespread use in Europe, LDRT remains underutilized in the United States. Recent international studies have demonstrated significant improvements in pain relief and mobility for OA patients treated with LDRT, highlighting its potential as a cost-effective, non-invasive alternative to traditional therapies. The session may include educational discussions of the pathophysiology of OA and the background of the current treatment landscape of OA, emphasizing the limitations of existing therapies. The session can include a radiobiology focus on the anti-inflammatory mechanisms of low-dose radiotherapy, as well as delve into the historical and modern applications of LDRT, examining and reviewing recent clinical evidence that supports its efficacy and safety. The discussion will address the controversies surrounding LDRT, including the potential risk of secondary malignancies, and provide guidance on treatment planning, including dose fractionation and energy considerations. Attendees will gain insights into the benefits of integrating LDRT into OA management protocols and explore future research directions necessary to solidify its role in clinical practice. This session aims to foster a renewed interest in LDRT among U.S. practitioners and encourage collaborative efforts to re-evaluate its application in benign musculoskeletal disorders.

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

  • Analyze the efficacy and safety of LDRT in osteoarthritis management. 
  • Implement LDRT treatment protocols in clinical practice.
  • Discuss the risks and benefits of LDRT with patients and colleagues.

References

  • Ott O.J., Nischwitz, M., Jakel, O., et al. (2019). Radiation Therapy for Benign Diseases: Patterns of Care in Germany. Strahlentherapie und Onkologie, 195(12), 1072-1082.
  • Seegenschmiedt, M.H., Keilholz, L., and Martus, P. (1999). Radiotherapy for arthritis: Systematic review and meta-analysis. Rheumatology International, 19(5), 181-186.
  • Mintz, A., & Khanna, R. (2018). Radiotherapy for Osteoarthritis: Current and Emerging Applications. Journal of Medical Imaging and Radiation Oncology, 62(1), 1-6.

Potential Challenges/Barriers to Change

  • Lack of insurance reimbursement and coverage
  • Limited clinical knowledge and expertise
  • Institutional resource constraints 
Sarcomas

We will review the literature for key aspects of soft tissue sarcoma management in adults. The goal will be to provide evidence base to guide clinicians on practice for management of these rare tumors.

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

  • Understand the rationale for combined modality local therapy for soft tissue sarcomas.
  • Understand the risk and benefits of preoperative vs. postoperative RT and radiotherapy planning considerations for both.
  • Understand the current state of the data regarding hypofractionation for STS.

References

  • Salerno KE, Alektiar KM, Baldini EH, et al. Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2021;11(5):339-351. doi:10.1016/j.prro.2021.04.005.
  • Haas RLM, Delaney TF, O’Sullivan B, et al. Radiotherapy for management of extremity soft tissue sarcomas: why, when, and where? Int J Radiat Oncol Biol Phys. 2012;84(3):572-580. doi:10.1016/j.ijrobp.2012.01.062.
  • Guadagnolo BA, Baldini EH.Are We Ready for Life in the Fast Lane? A Critical Review of Preoperative Hypofractionated Radiotherapy for Localized Soft Tissue Sarcoma. Semin Radiat Oncol. 2024 Apr;34(2):180-194. doi:10.1016/j.semradonc.2023.12.003. PMID: 38508783

Potential Challenges/Barriers to Change

  • These are rare tumors so opportunity to implement may be infrequent
  • Patients face logistical and financial barriers to multiple weeks of radiotherapy
  • STS is comprised of ~60 histologies, so nuances of management may be difficult to implement outside of a sarcoma expert center

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