Radiotherapy articles within Nature Reviews Clinical Oncology

Featured

  • Perspective |

    Many clinical trials are testing the safety and/or efficacy of combining radiotherapy with immunotherapy, nearly all using a single-site irradiation (or ‘abscopal’) approach, but emerging evidence suggests that this approach likely produces suboptimal results. The authors of this Perspective provide a biological rationale supporting the abandonment of the abscopal approach, and instead advocate exploring comprehensive irradiation of multiple/all lesions.

    • Eric D. Brooks
    •  & Joe Y. Chang

  • Review Article |

    The combination of radiotherapy and immune-checkpoint inhibition (ICI) has generated considerable excitement among oncologists, and numerous clinical trials are currently exploring the efficacy of this approach; however, the safety and tolerability of this combination remains incompletely understood. In this Review, the authors describe the available data on safety considerations in patients receiving radiotherapy in combination with ICI.

    • William L. Hwang
    • , Luke R. G. Pike
    •  & Jay S. Loeffler

  • Review Article |

    Clinical trials are an essential aspect of drug development; however, in patients with non-castrate prostate cancer, the long natural history of the disease provides a major barrier to the introduction of new therapies. In this Review, the authors describe the potential of a novel, multi-arm, multistage, clinical trial project, with surrogate end points designed to fully reflect the effects of treatments, in transforming the treatment of patients with early stage prostate cancer, before the development of castration-resistant disease.

    • Min Yuen Teo
    • , Matthew J. O'Shaughnessy
    •  & Howard I. Scher

  • Review Article |

    Conventional radiotherapy with X-rays is being replaced by radiotherapy with high-energy charged particles, an approach that better spares healthy tissue from radiation but is associated with higher costs. Evidence supporting the cost-effectiveness of either modality can only come from the results of randomized clinical trials. The authors of this Review discuss ongoing randomized trials of charged-particle therapies as well as aspects related to radiobiology, which need to be taken into account in order to fully exploit the therapeutic potential of charged particles.

    • Marco Durante
    • , Roberto Orecchia
    •  & Jay S. Loeffler

  • Review Article |

    The interaction between radiotherapy and the host immune system has uncovered new mechanisms that can be exploited to improve the efficacy of radiotherapy. In this article, the authors highlight data providing new explanations for the success or failure of radiotherapy, and postulate, using radiation-induced tumour equilibrium (RITE) as an example, how the combination of immune-modulation and radiation could tip the balance of the host immune response to promote cure.

    • Ralph R. Weichselbaum
    • , Hua Liang
    •  & Yang-Xin Fu

  • Year in Review |

    In the past year, clinical trials have provided important information on strategies to decrease treatment-associated toxicities in patients with head and neck cancer. In addition, the FDA approved the first immunotherapeutic agents for patients with recurrent and/or metastatic disease, based on the observation of durable responses to pembrolizumab in a phase Ib trial, and demonstration of improved survival and quality of life with the use of nivolumab versus chemotherapy in a phase III trial.

    • Alain P. Algazi
    •  & Jennifer R. Grandis

  • Opinion |

    A multidisciplinary approach is essential for the optimization of patient care in oncology, especially in the current landscape, in which standard-of-care approaches to cancer treatment are evolving towards highly targeted treatments, precise image guidance and personalized cancer therapy. Herein, the authors discuss current career development pathways for oncologists, suggesting strategies to improve clinical training and research, with specific emphasis on the involvement of trainees in multidisciplinary teams.

    • Alison C. Tree
    • , Victoria Harding
    •  & Ricky A. Sharma

  • News & Views |

    Active surveillance has been proposed as a management option that reduces the risk of overtreatment in patients diagnosed with early stage prostate cancer. However, up until now, this approach has not been tested in a prospective, randomized fashion. The PROTECT study confirms that patients diagnosed with prostate cancer through prostate-specific antigen (PSA)-based screening are at a very low risk of cancer-related mortality, but patients undergoing active surveillance do have an increased risk of disease progression and metastases compared with those managed with upfront therapy.

    • Fred Saad

  • Opinion |

    Autophagy is fundamental to cellular homeostasis and also has a central role in the development and progression of cancer. However, autophagy is also required for optimal immune system function, including the development of an anticancer immune response. In this Perspective, the authors present the available preclinical and clinical evidence that autophagy might enhance the effectiveness of both immunogenic chemotherapy and radiotherapy, as opposed to the general view of inhibition of autophagy as an antitumour strategy.

    • Lorenzo Galluzzi
    • , José Manuel Bravo-San Pedro
    •  & Guido Kroemer

  • News & Views |

    Most patients with cancer who develop brain metastases have a very poor prognosis, especially those with brain metastases from non-small-cell lung cancer. The short life-expectancy of these patients, which is typically measured in weeks or a few months, raises an important question: do they benefit from whole-brain radiotherapy, or are they appropriately treated with best supportive care alone? A recent randomized trial sought to answer this question.

    • Dirk Rades
    •  & Steven E. Schild

  • News & Views |

    Eaton et al. report a very strong association between institutional clinical trial accrual volume and the survival of patients with stage III NSCLC. The observed volume effect might have been exaggerated by artefact. More work is required to quantify the volume effect and understand its causes, before rushing to centralize care.

    • William J. Mackillop
    •  & Christopher M. Booth

  • News & Views |

    A theoretical radiobiological rationale supports the use of hypofractionated radiotherapy (higher radiation doses per fraction over a shorter period of time compared with conventional fractionation) for the treatment of prostate cancer. The investigators of two recently published phase III clinical trials with different designs have come to opposing conclusions regarding whether hypofractionated radiotherapy should be considered a new standard of care.

    • Alan Pollack
    •  & Matthew Abramowitz

  • Review Article |

    Distant metastasis remains a common cause of death in patients with solid tumours, even after treatment with surgery, radiotherapy and/or chemotherapy. Treatment itself can sometimes cause or promote metastasis by increasing the number of circulating tumour cells. The authors of this article discuss preclinical and clinical data concerning cancer treatments, circulating tumour cell mobilization and other factors that might promote metastasis.

    • Olga A. Martin
    • , Robin L. Anderson
    •  & Michael P. MacManus

  • News & Views |

    The results of a number of studies have demonstrated the promise of adding intrahepatic arterial selective internal radiotherapy (SIRT) to chemotherapy for patients with liver metastases from colorectal cancer; however, the frequent progression of extrahepatic metastases observed in patients treated with SIRT in the SIRFLOX trial call the potential overall benefit of this approach into question.

    • Josep Tabernero
    •  & Ramon Salazar

  • Consensus Statement
    | Open Access

    The National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad) includes academia, industry, patient groups and regulatory bodies representatives. In this Consensus Statement, recommendations are provided with the aim of increasing the number of novel drugs being successfully registered in combination with radiotherapy in clinical trials for patients with cancer.

    • Ricky A. Sharma
    • , Ruth Plummer
    •  & Stephen R. Wedge

  • Review Article |

    Local and systemic treatments for advanced or metastatic cancer are rarely curative. Innate and/or acquired resistance can reduce therapy responsiveness, with studies highlighting the contribution of therapy-induced physiological changes in host tissues and cells that reduce the antitumour effects of therapy. These unwanted host effects can promote tumour-cell repopulation and malignant aggressiveness. In this Review, the author discusses ways to suppress these host-response effects as a possible new approach to improving local and systemic cancer therapies.

    • Yuval Shaked

  • Opinion |

    Substantial interest exists in the effects of immunotherapy; however, radiation therapy also has the potential to stimulate an antitumour immune response. In this Perspectives, the authors describe the rationale for combining immunotherapy with stereotactic ablative radiotherapy based on the available clinical data, and provide recommendations for the future testing of approaches using this combination of treatments.

    • Michael B. Bernstein
    • , Sunil Krishnan
    •  & Joe Y. Chang

  • Opinion |

    The general effectiveness of radiotherapy has improved over time, owing to improvements in technology which have enabled, among others, image-guided and intensity-modulated approaches to be used. In this Perspectives article, the authors describe how these advances can be best implemented for treatment of squamous-cell carcinoma of the anus.

    • Rob Glynne-Jones
    • , David Tan
    •  & Peter Hoskin

  • Year in Review |

    In 2015, academic-led trials provided evidence for safe de-escalation of adjuvant treatment in early stage breast cancer and answered important questions related to adjuvant regional irradiation and optimal first-line chemotherapy in advanced-stage disease. Furthermore, the development of novel therapies and potential tools for treatment tailoring will offer new hope to patients with breast cancer.

    • Martine J. Piccart
    •  & Isabelle Gingras

  • Review Article |

    Use of radiotherapy or chemotherapy generally increases the survival of women with breast cancer; however, the use of radiotherapy, chemotherapy agents, such as the anthracycline doxorubicin, or anti-HER2 agents, such as trastuzumab, confer an increased risk of adverse cardiovascular events in these patients. In this Review, the authors describe the incidence and management of treatment-induced cardiac disease in women with breast cancer, and highlight strategies that might be used to minimize this risk.

    • Timothy M. Zagar
    • , Daniela M. Cardinale
    •  & Lawrence B. Marks

  • Review Article |

    Neurotoxicity caused by treatment is widely recognized in patients with cancer. This Review addresses the main neurotoxicities of cancer treatment with a focus on the newer therapeutics. Recognition of these patterns of toxicity is important because drug discontinuation or dose adjustment might prevent further neurological injury. Familiarity with the neurological syndromes associated with cancer treatments enables clinicians to use the appropriate treatment for the underlying malignancy while minimizing the risk of neurological damage, which might preserve patient quality of life.

    • Jacqueline B. Stone
    •  & Lisa M. DeAngelis

  • News & Views |

    On the basis of an Early Breast Cancer Trialists' Collaborative Group meta-analysis, it has been suggested that the controversy over post-mastectomy radiotherapy (PMRT) for women with 1–3 involved lymph nodes should end. However, the meta-analysis lacks appropriate sample size, stratification, and uses outdated systemic regimens. Thus, the debate should continue.

    • Caspian Oliai
    •  & Sara A. Hurvitz

  • Review Article |

    Although dramatic changes in the delivery of radiation therapy have occurred, the impact of radiobiology on the clinic has been far less substantial. New advances are uncovering some of the mechanistic processes that underlie the differences between the tumour and host tissue characteristics. The authors of this Review focus on how these processes might be targeted to improve the outcome of radiotherapy for patients.

    • Dörthe Schaue
    •  & William H. McBride

  • Review Article |

    Transarterial therapies in the setting of primary and secondary liver malignancies are an essential part of the oncology landscape. Most patients are not amenable to curative surgical intervention, which necessitates the use of alternative treatments that preserve quality of life whilst providing clinical benefit. The authors of this Review discuss intra-arterial techniques in light of the current levels of evidence to support their appropriate use in various clinical settings.

    • Ali Habib
    • , Kush Desai
    •  & Riad Salem

  • News & Views |

    In patients with oesophageal cancer, the effect of lymphadenectomy on survival remains unclear. A recent retrospective cohort study suggests that extensive lymphadenectomy does not improve survival and might even hamper it in patients with early T-stage tumours. The available data show conflicting results and the introduction of neoadjuvant chemoradiotherapy might decrease any positive effect of extensive lymphadenectomy on survival.

    • Bo Jan Noordman
    •  & J. Jan B. van Lanschot

Browse broader subjects

Browse Radiotherapy across other nature.com journals