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Highlights from the 2024 American Society for Radiation Oncology Annual Meeting
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| The Space-Time Continuum in Metastatic Castration-Sensitive Prostate Cancer: The Final Frontier?
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| Phuoc Tran, MD, PhD
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| Phuoc Tran discussed the evolving concept of the "space-time continuum" in metastatic castration-sensitive prostate cancer (mCSPC), emphasizing how space (metastatic burden) and time (timing of metastases) impact treatment outcomes. Oligometastatic disease, a state between localized and widespread metastasis, may benefit from local therapies like radiotherapy in combination with systemic treatments.
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| Precision in Practice: Optimizing Prostate Radiation with MRI-Defined Microboost |
| Brandon Mahal, MD |
| Brandon Mahal discusses the use of MRI-defined microboost to enhance precision in prostate radiation therapy. The technique, shown to improve biochemical disease-free survival in trials like FLAME, delivers targeted radiation to MRI-visible tumors, reducing local recurrence without significantly increasing toxicity. Although not yet proven to improve overall survival, MRI-defined microboost offers a promising approach for patients with high-risk prostate cancer, with ongoing advancements in imaging and treatment planning expected to further optimize outcomes. |
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| Initial Results of a Phase 2 Trial of Stereotactic Body Radiation Therapy, Hormone/Androgen Deprivation Therapy and Radium 223 Dichloride for Oligometastatic Castrate Sensitive Prostate Cancer (SHARP)
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| Savita Dandapani, MD, PhD
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| Savita Dandapani presents initial results from the SHARP Phase 2 trial, which evaluated the combination of stereotactic body radiation therapy, androgen deprivation therapy, and Radium-223 in patients with oligometastatic castrate-sensitive prostate cancer. The trial showed a median progression-free survival of 21.7 months, with better outcomes in de novo oligometastatic patients (34.3 months PFS) compared to those with oligoprogressive disease.
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| A Prospective Pilot Study Investigating 18F rhPSMA-7.3 PET/MRI to Detect Recurrent Disease and Guide Radiotherapy Planning in Patients with Biochemically Recurrent Prostate Cancer Post-Prostatectomy
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| Devaki Shilpa Surasi, MD, MBBS
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| Devaki Shilpa Surasi presents a pilot study investigating the use of F-18 rhPSMA-7.3 PET/MRI for detecting recurrent prostate cancer (PCa) post-prostatectomy. The study focused on men experiencing biochemical recurrence, aiming to guide salvage radiotherapy (RT) planning. Traditional imaging struggles with detecting small metastatic disease in these cases, but PET/MRI combines metabolic and spatial data to improve accuracy.
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| Short-Term Androgen Deprivation Therapy and High-Dose Radiotherapy in Intermediate- and High-Risk Localized Prostate Cancer: Results from the GETUG 14 Randomized Phase III Trial
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| Nicolas Demogeot, MD |
| Nicolas Demogeot presented findings from the GETUG 14 trial, which assessed the efficacy of short-term androgen deprivation therapy combined with high-dose radiotherapy in intermediate- and high-risk localized prostate cancer. The study enrolled 376 patients, and results showed that ST-ADT significantly improved disease-free survival. |
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| Impact of Prior Local Therapy on Treatment Response and Survival of Men with Metastatic Castrate Resistant Prostate Cancer: A Pooled Analysis of COU-AA-302 and ACIS Trials
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| Omar Azem, MD
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| A pooled analysis of the COU-AA-302 and ACIS trials examined the impact of prior local therapy, such as radiation or surgery, on the treatment response and survival of men with metastatic castration-resistant prostate cancer. The study found no significant differences in overall survival or radiographic progression-free survival between patients with and without prior LT when treated with androgen receptor pathway inhibitors.
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| Radiotherapy of the Primary Tumor and All Metastatic Lesions in Oligometastatic Prostate Cancer: 5-Year Results of Prolong Study
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| Qi Xin, MD, MS
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| Qi Xin presents the 5-year results of the Prolong Study, which evaluated the survival outcomes of radiotherapy targeting both the primary tumor and all metastatic lesions in oligometastatic prostate cancer. The study followed 395 patients who received radiotherapy combined with androgen deprivation therapy and androgen receptor pathway inhibitors. Results showed promising overall survival rates, particularly for HSPC patients, with a 5-year overall survival of 79.5%.
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| Post-Prostatectomy Linac-Based Ultrahypofractionated Radiotherapy for Patients with Localized Prostate Cancer: Toxicity and Quality-of Life Results from a Prospective Trial
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| Chia-Lin Tseng, MD
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| Chia-Lin Tseng presents the results from a prospective trial investigating post-prostatectomy ultrahypofractionated radiotherapy (SBRT) for patients with localized prostate cancer. The study demonstrated that SBRT to the prostate bed, with or without nodal irradiation, was well-tolerated, with no grade ≥3 acute toxicities.
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| Bladder Preservation - A Modern Choice for Patients
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| Leslie Ballas, MD, FASTRO
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| Leslie Ballas's presentation at the 2024 American Society for Radiation Oncology (ASTRO) annual meeting emphasized the evolving role of bladder preservation as a modern treatment choice for muscle-invasive bladder cancer. Historically, radical cystectomy (bladder removal) has been the standard of care, but trimodality therapy, combining maximal transurethral resection of the bladder tumor (TURBT), chemotherapy, and radiotherapy, offers a viable alternative.
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| Bladder Cancer - The Dawn or Era of More Personalized Radiotherapy
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| Ananya Choudhury, PhD, MA, MRCP, FRCR
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| Ananya Choudhury discusses the need for personalized radiotherapy in bladder cancer, emphasizing the underutilization of radical treatments, especially among older and lower socioeconomic status patients. She presented findings from the RAIDER study, highlighting the effectiveness of adaptive radiotherapy and hypofractionation while addressing the importance of identifying biomarkers for tailoring treatments.
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| Integrating Novel Therapeutics with Trimodal Therapy (TMT) |
| Gopakumar Iyer, MD |
| Gopakumar Iyer presents on integrating novel therapeutics, like immune checkpoint inhibitors and antibody-drug conjugates, with trimodal therapy (TMT) for muscle-invasive bladder cancer (MIBC). He highlighted ongoing clinical trials, such as Keynote 992 and SWOG S1806, that focus on bladder preservation strategies and the promising role of predictive biomarkers like ERCC2 and circulating tumor DNA (ctDNA) in treatment outcomes. |
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| Bladder Adjuvant RadioTherapy (BART): Acute and Late Toxicity from a Phase III Multicenter Randomized Controlled Trial |
| Vedang Murthy, MD, DNB, DipEP |
| Vedang Murthy presented results from the phase III Bladder Adjuvant RadioTherapy (BART) trial, evaluating the safety of post-cystectomy radiotherapy in high-risk bladder cancer patients. The trial found that radiotherapy increased acute grade 2 toxicity but caused fewer grade 3/4 events. Late grade 2 toxicity was also higher in the radiotherapy group. However, radiotherapy reduced the risk of locoregional recurrence, and follow-up for survival outcomes is ongoing. |
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| SABR for Primary RCC – Is It Ready for Primetime?
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| Shankar Siva, PhD, MBBS, FRANZCR
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| Shankar Siva discusses the potential for stereotactic ablative radiotherapy (SABR) to become a mainstream treatment for primary renal cell carcinoma (RCC). While surgery remains the standard of care for RCC, SABR presents a viable option for inoperable patients. Historically, RCC was considered radioresistant, but newer studies show that high doses of radiation, like those used in SABR, can effectively target RCC cells.
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