Home

Cover Story

Table of Contents

E-Newsletter

Article Archive

Editorial Calendar

Datebook

Writers' Guidelines

Orgs/Links

Opinion Polls

Reprints

Forum

December 4, 2006

Reporter’s Notebook — ASTRO
Radiology Today
Vol. 7 No. 24 P. 18

Editor’s Note: These reports are based on press information provided at the 48th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) held November 5 to 9 in Philadelphia.

Lipid Screening Extends Lives of Hodgkin’s Survivors
Hodgkin’s lymphoma survivors who have lipid screenings every five years to detect high cholesterol will live one half year longer than patients who don’t have the screening and the intervention is cost-effective, according to a study presented last month at ASTRO’s 48th Annual Meeting in Philadelphia.

“Although physicians are aware that Hodgkin’s lymphoma survivors are at increased risk of heart disease, it hasn’t been well-established how to best monitor these patients,” said Aileen Chen, MD, MPP, lead author of the study and a radiation oncologist at the Dana-Farber Cancer Center in Boston. The presentation was titled “Cost-effectiveness of Lipid Screening in Hodgkin’s Disease Survivors.”

“Our study shows that lipid screening in Hodgkin’s survivors is cost-effective and provides physicians with a guideline on how frequently they should be screening for high cholesterol, an important risk factor for heart disease,” said Chen.

Hodgkin’s lymphoma survivors who received chest radiation therapy to cure their cancer are at an increased risk of heart disease compared with the general population because the heart receives a small amount of radiation when the nearby lymph nodes are treated. Hodgkin’s survivors who have high cholesterol are more likely to develop heart disease.

Lipid screening tests are simple blood tests that check the level of lipids or cholesterol in the blood. A high level of cholesterol increases the chance of having heart disease, which can lead to heart attacks. If caught early, this condition can be treated with cholesterol-lowering medications.

Chen’s study compared lipid screening every five years starting five years after treatment vs. no lipid screening in a cohort of 25-year-old Hodgkin’s survivors treated with chest radiation. Patients who screened positive for high cholesterol were treated with statins, which have been shown to reduce the risk of heart attacks and death from heart disease. The study found that patients who had lipid screening, with statin therapy, if needed, lived six months longer than those who did not.

Radiation After Surgery Doubles Survival Time for Some Lung Cancer Patients
Patients with lung cancer that has spread to mediastinal lymph nodes (between the chest, breastbone, and spine) who receive radiation after surgery and chemotherapy live twice as long—47 vs. 24 months—as patients who do not receive radiation after surgery, according to an international study presented November 6 at ASTRO.

“This is the first time that a clinical trial has examined the effectiveness of radiation after surgery for lung cancer,” said Jean-Yves Douillard, MD, PhD, lead author of the study and a medical oncologist at the Centre Rene Gauducheau in St. Herblain, France. “The results show that radiation treatment should be considered for resected non-small cell lung cancer with involved mediastinal lymph nodes in addition to chemotherapy. The data observed in this study, however, needs to be confirmed in a prospective randomized trial of radiation, in addition to chemotherapy.”

Douillard presented study results in a presentation titled “Impact of Radiation on Survival After Complete Resection of Non Small Cell Lung Cancer: Descriptive Analysis In the Randomized Adjuvant Chemotherapy Trial ANITA 1.” The work is part of a larger randomized study, ANITA 1 (Adjuvant Navelbine International Trialist Association), which examined the effectiveness of chemotherapy after surgery in 840 non-small cell lung cancer patients.

The researchers found that additional chemotherapy after surgery improves overall survival in cancer that has spread to the lymph nodes. In the study, radiation was neither randomized nor mandatory but only recommended for patients whose disease had spread to the lymph nodes. A total of 232 lung cancer patients received radiation after undergoing surgery to remove their tumor with or without chemotherapy.

Researchers found that additional radiation after surgery alone or surgery and chemotherapy benefited patients whose cancer had spread to mediastinal lymph nodes. At that stage, those who underwent chemotherapy and radiation after surgery lived nearly two years longer than those patients who had only chemotherapy after surgery.

PSA Spike After Rad Therapy Not Linked to Prostate Cancer Recurrence
A temporary rise in prostate-specific antigen (PSA) levels after radiation therapy does not increase patients’ risk of cancer recurring more than patients who don’t have that temporary rise, according to research from the largest study on the subject presented at ASTRO’s annual meeting in Philadelphia last month.

External beam radiation therapy and radiation seed implants are two of the main treatments for prostate cancer. Since these treatments are minimally invasive, have short recovery periods, and often help men preserve their sexual and urinary function, many men with prostate cancer prefer radiation over other treatments, including surgery. The PSA bounce is common in one half of all men who have radiation treatment for prostate cancer. Increased levels of PSA, which is a protein produced by the prostate, may be a sign of prostate cancer.

“I believe the results of our study should help reduce the stress and uncertainty for men who experience a PSA bounce after radiation knowing that this doesn’t represent a recurrence or put them at increased risk for cancer coming back later on,” said Eric M. Horwitz, MD, lead author of the study and clinical director of the radiation oncology department at Fox Chase Cancer Center in Philadelphia. “This study significantly impacts the clinical practice for both radiation oncologists and urologists. Clinicians should consider additional PSA tests after the initial bounce to see if the PSA levels return to normal before concluding that cancer has recurred and recommending additional treatment.”

Horwitz’s presentation, “The Post-Treatment PSA Bounce for Prostate Cancer Patients Treated with External Beam RT or Permanent Brachytherapy Alone Is Not Biochemically or Clinically Significant: A Multi-Institutional Pooled Analysis of More Than 7,500 Patients,” reported data from a study involving more than 7,500 men in 19 institutions who were treated for prostate cancer with either external beam radiation therapy or radiation seed implants. Findings show that over a 10-year period, there was no difference in cancer recurrence between those who had a PSA bounce and those who did not.

IMRT Reduces Skin Burns in Breast Cancer Treatment
Breast cancer patients who undergo intensity-modulated radiation therapy (IMRT) after surgery are three times less likely to have severe skin reactions from the treatment than patients who received standard radiation therapy, according to a study presented at the plenary session November 6 at ASTRO’s 48th Annual Meeting in Philadelphia. The study is the first of its kind to show how recent dramatic improvements in radiation treatments directly benefit patients.

“Using IMRT, we are able to dramatically reduce the painful side effects of radiation, thereby improving the patient’s quality of life,” said Jean-Philippe Pignol, MD, PhD, lead author of the study and a radiation oncologist at Sunnybrook and Women’s College Health Sciences Centre in Toronto, Canada. “Patients should be aware that breast IMRT has fewer side effects than standard radiation therapy and is now widely available.”
Pignol discussed results from the study in a presentation titled “Phase III Randomized Study of Intensity Modulated Radiation Therapy vs. Standard Wedging Adjuvant Breast Radiotherapy.”

The current standard of care for breast cancer is surgical removal of the cancer, followed by radiation to the breast to kill any remaining cells. The standard radiation technique uses two opposite radiation beams on the whole breast to target the cancer and can cause excess amounts of radiation to certain areas of the breast, increasing the risk of the patient developing sensitive, red, weepy skin that may blister and peel. Approximately 80% of severe skin burns occur on the breast crease, located between the bottom of the breast and the chest wall.

Using IMRT, however, radiation oncologists can control the intensity of each beam as it moves around the breast to better spare nearby healthy tissue and minimize the risk of too much radiation causing severe skin reactions on the breast. The treatment significantly reduced this occurrence in women with large breasts, who are more likely to have severe skin reactions.

In the study, 358 patients were randomly assigned to receive either the standard breast radiation treatment or breast IMRT and were observed during treatment and for six weeks afterward.

Intravenous Chemoradiation Offers Easier, Effective Option for Inoperable Head and Neck Cancer Patients
Intravenous chemoradiation (radiation and chemotherapy given at the same time) is as effective as treatment given directly to the tumor through a tube inserted into an artery in the tumor for patients with inoperable head and neck cancer, according to a randomized study presented at ASTRO’s annual meeting last month in Philadelphia.

“We were surprised about the findings because previous studies that were not randomized found that intra-arterial chemoradiation was more effective than intravenous treatment,” said Coen Rasch, MD, PhD, lead author of the study and a radiation oncologist at the Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis in Amsterdam. “Since intravenous chemoradiation is an easier treatment procedure for patients and doctors, it should be considered the standard of care for inoperable head and neck cancer.”

Rasch’s presentation, “Intra-arterial vs. Intravenous Chemoradiation for Advanced Head and Neck Cancer, Early Results of a Multi-institutional Trial,” reviewed data from a study that compared intra-arterial with intravenous chemoradiation in 240 patients with inoperable head and neck cancer. Patients were assigned to one of the treatment procedures by chance. The chemoradiation was a combination of radiation and cisplatin, a chemo drug that is especially effective when combined with radiation. Results found that both treatment methods were equally effective at controlling cancer growth.

Misconceptions Drive Men With Prostate Cancer Away From Radiation
Negative perceptions about radiation therapy can strongly influence a prostate cancer patient’s choice to avoid external beam radiation therapy, even though studies have proven the treatment to be as safe and effective as other treatments for the disease, according to a study presented at ASTRO’s annual meeting last month.

“The study shows that patients base their treatment choice not only on technical information but also on cultural and personal prejudices,” said Riccardo Valdagni, MD, an author of the study and head of the Prostate Programme at the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy. “It’s important for patients to express their fears about radiation treatment to their doctors and for doctors to consider these worries and address any misconceptions about this therapy so that patients can make the best, most informed decision about their treatment.”

Men with prostate cancer often choose between external beam radiation therapy, radiation seed implants, and surgery to treat their cancer. To minimize radiation side effects, treatment is given five days per week for several weeks. Many men with prostate cancer choose external beam radiation over other treatments because it is noninvasive, has a short recovery period, and often helps men preserve their sexual and urinary function.

However, Valdagni’s study shows that some men with prostate cancer have definite fears about radiation treatment, with the greatest worries related to false beliefs on how the x-rays would affect them. For example, some patients believe radiation cannot be controlled because it is invisible, that it will harm surrounding unprotected organs, and that it is dangerous for family members to physically be near them when undergoing radiation treatment. Some patients also said the terminology used in radiation therapy, such as the phrase hitting the target, evoked feelings more related to war than to a cure. In addition, while some patients experienced technology as reassuring, many others believed the technologically advanced computer equipment used during radiation treatment provoked anxiety.

The study was carried out by a multidisciplinary team of doctors at the National Cancer Institute-Milan Prostate Cancer Program from March 2005 to March 2006. The team interviewed 257 men with prostate cancer to determine their perceptions about radiation therapy. The ASTRO presentation was titled “Patient’s Fantasies and Worries about Radiation Therapy for Prostate Cancer during the Decision Making Phase.”