This issue offers a concise overview of the major trends in radiation therapy. This is timely as some of these advances are already altering treatment in a major way.
From the patient's point of view, one of the significant problems with radiation therapy was the time commitment: treatment took up to 8 weeks. Several approaches have been tested to reduce the time needed for treatment. The best-established alternative is stereotactic radiation, which takes less than a week. This approach is discussed by Dr. Zelefsky, who has played a major role in the development of this technique.
Imaging of normal and cancerous tissue plays a critical role in radiation therapy. Clearly delineating the extent of the cancer in relation to surrounding normal tissue aids treatment planning, resulting in better odds of cancer control and minimizing normal tissue damage. The PSMA scan represents a major advance in our ability to identify small metastatic prostate cancer lesions. While this is likely to revolutionize radiation therapy of oligometastatic disease, much work remains to be done on the details of who is most likely to benefit.
Hormonal therapy of metastatic prostate cancer has been revolutionized by abiraterone and the newer androgen receptor blockers. Clinical trials in progress are testing whether these agents might also improve adjuvant hormonal during radiation therapy.
Finally, molecular tools provide us with an increasingly clear understanding of the mechanisms that determine the behavior of cancer cells. These tools are now being tested do their capacity to guide radiation therapy. One such approach, the Decipher panel, is undergoing extensive evaluation.
Charles E. Myers, Jr., MD