Opportunities Abound for Radiation Oncology in the Era of Personalized Medicine

Richard Dargan

Radiation oncology will lead the way into the future of personalized medicine by improving survival and quality of life for cancer patients, according to a renowned authority who delivered the Annual Oration in Radiation Oncology on Wednesday.

Haas-Kogan

In her address, Daphne A. Haas-Kogan, MD, chair of the Department of Radiation Oncology at Dana-Farber Cancer Institute, Brigham and Women's Hospital and Boston Children's Hospital, all in Boston, highlighted some of the ways that radiation oncology is improving the odds for patients.

A growing body of research shows that radiation therapy bolsters the effectiveness of immunotherapy, or treatment that enlists and strengthens the power of a patient's immune system to attack tumors, now widely regarded as the "fifth pillar" of cancer treatment.

Radiation therapy and immunotherapy make good partners, Dr. Haas-Kogan said, because radiation works quickly while immunotherapy takes longer to kick in.

"Immunotherapy provides fuel to an existing fire, but how do we generate the spark, the initial immune response against the tumor?" she asked. "That is where radiation comes into play."

Prospective trials are emerging, Dr. Haas-Kogan said, including a recent New England Journal of Medicine study that found superior results for patients with non-small-cell lung cancer who had undergone chemotherapy and radiation therapy prior to treatment with the immunotherapy drug durvalumab.

Dr. Haas-Kogan, a member of the Blue Ribbon Panel appointed to inform the scientific direction and goals of the National Cancer Institute's Cancer Moonshot, pointed out that 45 years after President Richard Nixon declared war on cancer, successful courses of radiation therapy and immunotherapy allowed President Jimmy Carter to discontinue treatment for melanoma that had metastasized to his brain and liver.

A major paradigm shift in radiation oncology is underway, Dr. Haas-Kogan said, toward MRI-guided radiation therapy. The higher soft tissue resolution MRI provides can improve target delineation, allowing more precise radiation therapy that is able to spare surrounding normal tissues, reduce toxicities and improve outcomes for many cancer patients.

"Just as the 2-dimensional x-rays we relied on in the 1980s were replaced by CT-guided radiotherapy, so will MR-guided radiation technology render CT-guided radiation obsolete," she said.

A new class of molecules called micro­RNAs is also expected to have an increasingly prominent role in radiation therapy by helping predict the risk of long-term radiation damage and serve as what Dr. Haas-Kogan called "functional dosimeters of radiation."

As she closed her address, Dr. Haas-Kogan discussed how the philosophy of personalized medicine has had particular resonance in her life. In 1997, she was under consideration for an RSNA Research Scholar award, but her plans to travel to Chicago for the interview were interrupted by the birth of her third child, a son, who was in the audience Wednesday. Undaunted, Dr. Haas-Kogan made copies of her slides and shipped them overnight to Chicago. She then completed her presentation over the phone and won the grant, which she credits for jumpstarting her career and changing her life.

"This is the most important kind of personalized care that we can engage in as radiologists, radiation oncologists and healthcare professionals: the personal touch devoted to education and mentorship," she said. "I owe much of what I've accomplished to all of you and to RSNA, and I thank you from the bottom of my heart."