At SIOG I was delighted to be able to give an update in radiation oncology and how recent trials and advances in technology around radiation oncology have benefitted older adults with cancer.
Are there any studies related to this topic that you would like to discuss?
The most important work, I think, that’s happened lately is actually around data in terms of older adults and their access and their use of radiation therapy. Our investigator group based here in Australia, led by Penny Mackenzie, published a systematic review in the Journal of Geriatric Oncology which showed that the use of radiotherapy decreases with age across almost all tumour sites. Which, when we know that radiotherapy can often be an excellent choice for older adults with cancer, is a worrying finding and something that definitely warrants more research.
What were some of the highlights at SIOG?
One of the most exciting things that’s happened in radiation oncology is advances in terms of the technology that we use to deliver radiation therapy. Over the last decade or so there have been a number of advances in terms of radiation therapy in terms of what we call the conformality of radiotherapy. We are now able to sculpt the radiation beam to millimetre accuracy to exactly match that of the tumour. We’ve also been able to utilise what we call image guidance, so the use of MRI, PET scans and on-board CT scans to see the tumour during treatment, between treatments and before treatment and track it. That has improved our ability to precisely target the tumour.
There have been other personalised strategies that we’ve been able to use as well. For instance, in prostate cancer the use of gold fiducial markers within the prostate so we can track that prostate cancer with millimetre accuracy. And other strategies such as the insertion of hydrogel just behind the prostate gland which means that we’ve been able to move the rectum away from the treatment field and spare patients toxicity from the radiation therapy itself.
What all these strategies have meant is that we have been able to deliver much higher doses of radiation to the tumour but really spare those healthy, normally-functioning organs around the tumour. That means that cure rates from radiation therapy are higher than ever before but side effects are much lower. The other advantage, particularly for older adults is that these techniques have meant that we’ve been able to shorten treatment time, not only individual treatment times but the treatment course length. So, for instance, men who had prostate cancer in the past have had to come for many, many weeks of radiation therapy, every day, Monday to Friday, up to five or six weeks. We can now cure prostate cancer in as little as five treatments delivered over two weeks. So this really has meant that radiation therapy as a treatment option for older adults has become much more tolerable, much more acceptable and convenient and also offers a chance of cure, in many cases without the need for surgery such as in prostate cancer and early lung cancer.
Please discuss radiation therapy within breast cancer
The advances in radiation therapy have certainly benefitted women, older women, with breast cancer. Really good, high-level, randomised data has come through in the last few years from the FAST-Forward trial which has shown that we can treat women with breast cancer effectively in as little as five treatments given over a week. For older women who may not have the physical reserves or psychosocial supports to come in for many weeks of treatment, such as three weeks or five weeks, this has been a game changer. Often a short course of very well-tolerated radiotherapy, as I said, with very few side effects and very effective, also can represent a very good alternative to many, many years of endocrine therapy. So certainly these advances in radiation therapy have benefitted older women who have been diagnosed with breast cancer.
