SAN FRANCISCO — Radiotherapy is poised to offer opportunities beyond cancer treatment, according to three presentations delivered September 28 at the American Society for Radiation Oncology meeting.
In a talk delivered during the Presidential Symposium and titled “Radiotherapy Beyond Cancer: A New Dawn?”, presenter Jarad Martin, MD, a radiation oncologist at Calvary Mater Newcastle Hospital in Australia outlined a plethora of reasons for treatment’s use in patient care, ranging from its long history and biological rationale to the range of indications for radiotherapy treatment, scalability, and low acute toxicity.
“We’re talking big opportunities and new challenges,” he told session attendees. “[Radiotherapy] is an effective means to stop cellular proliferation … [is] non invasive … [and can be delivered in low doses].”
Radiotherapy for osteoarthritis
In his presentation, Martin began with a focus on the use of radiotherapy for osteoarthritis, citing research that investigated the use of radiotherapy for painful osteoarthritis that found improvement in patient symptoms (one study found that, out of a 60 patient cohort, the majority experienced analgesic benefit, while another found favorable pain mitigation at low doses [0.3 Gy]) — although he did caution that these studies had limitations that must be kept in mind.
He also outlined recommendations from the Royal College of Radiologists (RCR) regarding indications for radiotherapy, which include Dupuytren’s contracture (a disease that affects the hands), plantar fasciitis, ossification of the hip, keloid scarring, head and neck paraganglioma, Graves’ orbitopathy, and total lymphatic irradiation.
Martin didn’t shrink from describing challenges to the field, listing the following:
- Generally low-level evidence,
- Insufficient expertise in clinical domains,
- Lack of research funding,
- Medicolegal exposure, and
- Long term risk quantification.
But he also noted ways to address these challenges, including identifying evidence practice gaps; conducting quality clinical trials; expanding funding resources; collecting real-world data; ramping up training curricula; and establishing multidisciplinary/intersocietal collaborations.
“There’s a whole universe of possible indications [for radiotherapy],” he said. “I personally find [the field] rewarding, and your patients will love you for helping them.”
In a talk that followed Martin’s, Heidi Prather, DO, a physiatrist at New York Presbyterian in New York City, spoke further on using radiotherapy for osteoarthritis, urging researchers to subgroup osteoarthritis populations and categorize by metabolic load and biopsychosocial pain risk factors. Prather founded and runs an osteoarthritis program at the Hospital for Special Surgery, also in New York.
Heidi Prather, DO
“Low-dose radiotherapy is a passive intervention that addresses a root cause of disease without harming cartilage cells and gut biome,” she said. “Because [it] impacts inflammation, [it shows] potential for symptom reduction, improved function, and improved quality of life.”
“Functional” radiotherapy
In a related presentation titled “Translating Oncology Lessons Beyond Cancer”, Gopal Bajaj, MD, a radiation oncologist at Inova Schar Cancer Institute in Fairfax, VA, introduced the term “functional radiation medicine” and listed a number of uses for it, including conditions such as fibroproliferative, inflammatory, dermatologic, vascular, neurologic, cardiac, and iatrogenic
“Each wave of innovation in radiation oncology — from IMRT [intensity-modulated radiation therapy] to IGRT [image-guided radiation therapy] to SBRT [stereotactic body radiation therapy] — was fueled by rigorous data,” he said. “The same must guide our expansion into functional radiotherapy.”
Gopal Bajal, MD
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The future of the field could manifest as “functional radiotherapy programs inside and outside major cancer centers, embedded cross-collaborative RT pathways in orthopedics, dermatology, [physical medicine and rehabilitation], rheumatology, and pain management,” Bajaj concluded.