Radiotherapy articles within Nature Reviews Clinical Oncology

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  • Review Article |

    Radiotherapy has several key attributes that make it an attractive combination partner for immunotherapy; however, numerous clinical trials investigating the combination of these two treatment modalities have failed to demonstrate clear improvements in patient outcomes. In this Review, Galluzzi and colleagues discuss the evidence indicating that radiotherapy administered according to standard schedules and target volumes might impair immune fitness and, therefore, propose that adaptation of the radiotherapy regimens to immunotherapy (and not vice versa) might synergistically enhance the antitumour immune response to achieve meaningful clinical benefits.

    • Lorenzo Galluzzi
    • , Molykutty J. Aryankalayil
    •  & Silvia C. Formenti

  • Review Article |

    Although radiotherapy affects multiple cellular pathways, treatments are generally planned with the assumption that all tumours respond similarly to radiation. The authors of this Review summarize the effect of various pathways activated by radiotherapy on tumour responses to radiotherapy and present the current knowledge on genomic classifiers designed to inform treatment decisions.

    • James M. Price
    • , Asmithaa Prabhakaran
    •  & Catharine M. L. West

  • Perspective |

    FLASH radiotherapy involves delivering ultra-high dose rates of radiation, which enables sustained tumour control with reduced toxicity to surrounding tissues. The authors of this Perspective describe the principles underlying FLASH radiotherapy, present the available evidence from preclinical studies testing this modality and discuss the challenges for its application in routine clinical practice.

    • Marie-Catherine Vozenin
    • , Jean Bourhis
    •  & Marco Durante

  • Review Article |

    Radiotheranostics enables the clinician to image and then target lesions using the same probe. Despite this appealing potential, interest in the field of radiotheranostics has long been constrained by a lack of expertise, high infrastructure costs and the availability of non-radioactive alternative approaches. Nonetheless, several recent successes have led to renewed research interest. In this Review, the authors summarize the current challenges and opportunities in this rapidly emerging area.

    • Lisa Bodei
    • , Ken Herrmann
    •  & Jason S. Lewis

  • Review Article |

    In the past decade, treatment devices that combine imaging with targeted irradiation have been developed to deliver MRI-guided radiotherapy (MRIgRT). This treatment modality uses motion management and biological targeting to improve local control rates whilst reducing the radiation delivered to non-malignant tissues. The authors of this Review describe the current state of MRIgRT, and the opportunities and challenges of this radiotherapy approach.

    • Paul J. Keall
    • , Caterina Brighi
    •  & Brendan Whelan

  • Review Article |

    Chimeric antigen receptor T cells have revolutionized the treatment of patients with certain haematological malignancies. Nonetheless, an optimal approach to lymphodepleting chemotherapy and/or bridging therapies has yet to be defined in patients receiving these agents. In this Review, the authors describe the various lymphodepletion and/or bridging therapy strategies used, and highlight the need for prospective comparisons in order to determine the safest and most effective approach.

    • Leila Amini
    • , Sara K. Silbert
    •  & Mohamed Abou-el-Enein

  • News & Views |

    Patients with pancreatic ductal adenocarcinoma (PDAC) usually have a dismal prognosis, and even after curative resection most patients will have disease relapse and ultimately die. Nonetheless, adjuvant chemotherapy has considerably improved the outcomes of patients who are able to undergo surgery. The PREOPANC trial provides some evidence supporting the use of neoadjuvant therapy for patients with borderline resectable PDACs but not, as claimed, for those with resectable tumours.

    • Christoph Springfeld
    •  & John P. Neoptolemos

  • Review Article |

    The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing rapidly in most developed countries. In this Review, the authors provide an overview of the epidemiology, molecular biology and treatment of HPV-positive OPSCC, including discussions of the role of treatment de-escalation and emerging novel therapies.

    • Matt Lechner
    • , Jacklyn Liu
    •  & Tim R. Fenton

  • Review Article |

    Patients receiving cytotoxic therapies for cancer have an increased risk of cognitive and functional decline that is usually associated with ageing. In this Review, the authors describe how cancer therapies can enhance physiological ageing processes and highlight the potential for interventions that could potentially ameliorate these long-term adverse events in patients receiving active treatment for cancer and in cancer survivors.

    • Judith E. Carroll
    • , Julienne E. Bower
    •  & Patricia A. Ganz

  • Review Article |

    Targeted therapies have improved the outcomes of many patients with cancer, although many more lack targetable alterations or do not derive clinical benefit for other reasons. Radiotherapy can also provide benefit to many patients, although radioresistance often limits the effectiveness of this intervention. Here, the authors describe the potential for radiotherapy to promote non-oncogene dependence on targetable signalling pathways, thus extending the benefits of both targeted therapy and radiotherapy to greater numbers of patients.

    • Giulia Petroni
    • , Lewis C. Cantley
    •  & Lorenzo Galluzzi

  • Consensus Statement |

    Patients with early-stage rectal cancer might potentially benefit from treatment with an organ-sparing approach, which preserves quality of life owing to avoidance of the need for permanent colostomy. Trials conducted to investigate this have so far been hampered by considerable inter-trial heterogeneity in several key features. In this Consensus Statement, the authors provide guidance on the optimal end points, response assessment time points, follow-up procedures and quality of life measures in an attempt to improve the comparability of clinical research in this area.

    • Emmanouil Fokas
    • , Ane Appelt
    •  & Claus Rödel

  • News & Views |

    Artificial intelligence and machine learning have the potential to make cancer care more accessible, efficient, cost-effective and personalized. However, meticulously planned prospective deployment strategies are required to validate the performance of these technologies in real-world clinical settings and overcome the human trust barrier.

    • Issam El Naqa

  • News & Views |

    Advances in cancer immunotherapy have led to clinical trials of immunotherapy-based neoadjuvant treatments for early stage non-small-cell lung cancer. Evidence for priming of the immune system using both preoperative short-course radiotherapy and immunotherapy in this setting has now emerged from a randomized phase II study incorporating pathological and immunological end points.

    • Famke L. Schneiders
    •  & Suresh Senan

  • Review Article |

    Nasopharyngeal carcinoma (NPC) is an Epstein–Barr virus (EBV)-associated malignancy endemic to southern China, southeast Asia and north Africa. The authors of this Review present a comprehensive overview of advances from the past three decades on the pathogenic role of EBV, and the genomic, epigenomic and immune landscape of NPC, which have led to the development of new biomarkers, therapeutic targets and improved treatment approaches for patients with NPC.

    • Kenneth C. W. Wong
    • , Edwin P. Hui
    •  & Anthony T. C. Chan

  • Comment |

    Precision oncology is predicated on information derived from high-quality tissue samples. Despite almost half of all patients with cancer receiving radiotherapy, samples from these patients are much less commonly available for use in biomarker studies. Biobanks that include material from radiotherapy studies do exist; the challenge is increasing their visibility and accessibility to researchers to continue our efforts to improve outcomes for our patients.

    • Duncan C. Gilbert
    •  & Valerie Speirs

  • Perspective |

    The possible uses of artificial intelligence (AI) in radiation oncology are diverse and wide ranging. Herein, the authors discuss the potential applications of AI at each step of the radiation oncology workflow, which might improve the efficiency and overall quality of radiation therapy for patients with cancer. The authors also describe the associated challenges and provide their perspective on how AI platforms might change the roles of radiation oncology medical professionals.

    • Elizabeth Huynh
    • , Ahmed Hosny
    •  & Raymond H. Mak

  • News & Views |

    SABR-COMET was the first randomized controlled trial to demonstrate an overall survival benefit with the use of stereotactic ablative body radiotherapy (SABR) for the treatment of oligometastatic cancer. Considering the recently reported long-term follow-up data from SABR-COMET, we review the outcomes and limitations of this study in the context of other emerging information on therapy for oligometastatic disease.

    • Tyler P. Robin
    •  & Jeffrey R. Olsen

  • Review Article |

    Photodynamic and photothermal therapies hold promise in the local treatment of cancer although, arguably, their full potential has not yet been achieved. Herein, the authors review the current clinical progress of these phototherapies and discuss the bioengineering approaches that are being explored to overcome challenges and thereby improve such treatments.

    • Xingshu Li
    • , Jonathan F. Lovell
    •  & Xiaoyuan Chen

  • Comment |

    Radiotherapy can be safely delivered during the coronavirus disease 2019 (COVID-19) pandemic, often through use of hypofractionated regimens, which minimize the number of visits to treatment centres while also avoiding potentially detrimental delays in the delivery of cancer care.

    • Himanshu Nagar
    •  & Silvia C. Formenti

  • Comment |

    During the COVID-19 global pandemic, the cancer community faces many difficult questions. We will first discuss safety considerations for patients with cancer requiring treatment in SARS-CoV-2 endemic areas. We will then discuss a general framework for prioritizing cancer care, emphasizing the precautionary principle in decision making.

    • Timothy P. Hanna
    • , Gerald A. Evans
    •  & Christopher M. Booth

  • Review Article |

    Brain metastases are a frequent manifestation of several common solid tumour types, including lung cancer, breast cancer and melanoma. Although the presence of brain-metastatic disease continues to be associated with poor outcomes, advances in surgery, radiotherapy and systemic therapies that can permeate the blood–brain barrier are beginning to improve patient outcomes. In this Review, the authors provide an overview of contemporary advances in the management of brain metastases over the past decade.

    • John H. Suh
    • , Rupesh Kotecha
    •  & Eric L. Chang

  • News & Views |

    Interval invasive breast cancers diagnosed after a normal mammogram but before the next screening examination have a different tumour biology from that of screen-detected breast cancers, and thus are not detected on mammography. Understanding the genetics and biology of interval invasive cancers could inform better approaches to detection.

    • Yiwey Shieh
    • , Elad Ziv
    •  & Karla Kerlikowske

  • News & Views |

    The identification of biomarkers and the development of genomics-based assays predictive of outcomes following radiotherapy, in an effort to help guide the treatment of patients with cancer, is an area of increasing research interest. Here, we discuss the validity of one such classifier, ARTIC, in the context of complementary genomic approaches designed to predict both tumour response and the susceptibility of nonmalignant tissues to toxicities resulting from radiotherapy.

    • David Azria
    •  & Barry S. Rosenstein

  • Review Article |

    Systemic hormone therapies and chemotherapy are the cornerstones of treatment for patients with de novo metastatic prostate cancer, with a currently limited role for local treatments. Herein, the authors outline the pathobiological and immunological rationale for local cytoreductive treatment of the primary tumour and/or metastases in patients with this disease. They also review the preclinical and clinical evidence for the use of radical prostatectomy, prostate radiotherapy, minimally invasive ablative therapies, and metastasis-directed therapy (predominantly with stereotactic ablative radiotherapy) in this population.

    • Martin J. Connor
    • , Taimur T. Shah
    •  & Hashim U. Ahmed

  • News & Views |

    In the past few years, efforts have been made to combine two approaches — immune-checkpoint inhibition and locally ablative radiation therapy — to treat patients with metastatic non-small-cell lung cancer. Herein we discuss the implications of two studies that support the existence of a systemic therapy augmented by radiotherapy (STAR) effect in this setting.

    • Jordan A. Torok
    •  & Joseph K. Salama

  • Review Article |

    Despite their promise, immunotherapy–radiotherapy combinations could be limited by the patient-specific nature of radiation-induced immune responses. This Review discusses methods of assessing the immune response to radiotherapy and approaches to predict the synergy between immunotherapy and radiotherapy for personalized medicine.

    • Clemens Grassberger
    • , Susannah G. Ellsworth
    •  & Jay S. Loeffler

  • Review Article |

    The authors of this Review discuss treatments currently available for patients with head and neck squamous cell carcinomas (focusing in those of the oral cavity, oropharynx, hypopharynx and larynx). Advances in surgical and non-surgical approaches (mainly combinations of radiotherapy and chemotherapy) are discussed, including the first immunotherapeutic agents approved for these malignancies.

    • John D. Cramer
    • , Barbara Burtness
    •  & Robert L. Ferris

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