GRACE :: Radiation Oncology

Can a drug reduce risk of cognitive side effects from whole brain radiation therapy?

Last week, I wrote a post highlighting a relatively new blog and a review article about whole brain radiation therapy (WBRT) by my friend, Moffitt Cancer Center-based radiation oncologist Dr. Jacob Scott.   I found the review article to be among the very best I’ve ever encountered on this very important subject, but it only made passing reference to an important trial called RTOG (for Radiation Therapy Oncology Group) 0614, which randomized patients to WBRT with or without the agent memantine (Namenda), a medication for Alzheimer’s disease.  Memantine works by blocking glutamate receptors in the brain, which can excite brain cells, but at high levels of transmission, the effect can be harmful on memory formation and brain function.  Radiation oncologists developed the study to ask whether the this agent that can have a (modestly) beneficial effect on cognitive function on Alzheimer’s disease might also be beneficial in reducing cognitive deficits in patients who undergo WBRT.

I asked Dr. Scott for his thoughts on the recently reported preliminary results of the RTOG 0614 trial, which was among the most important results presented at the big radiation oncology conference in October of last year, called ASTRO (American Society for Radiation Oncology — I think the T is sometimes said to abbreviate “Therapeutic”, sometimes acknowledged as gratuitous to make an elegant abbreviation).  As described in a very nice follow-up post by Dr. Scott, the results suggested a borderline statistically significant result, with a p value just above our magic threshold of 0.05 that makes us more convinced that it should change our practice patterns.  

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Great review article on whole brain radiation therapy, highly recommended

  Dr. Jacob Scott, a friend who is a radiation oncologist at Moffitt Cancer Center in Tampa, FL wrote a terrific review article on whole brain radiation therapy (WBRT) that is available to the general public.  Though written for physicians, I would say that the language is accessible enough that patients and caregivers can also understand most or all of it and would find it very helpful. It covers the historical development of WBRT as a standard therapy for brain metastases, the evidence on acute and longer term side effects, the questions on how it should be integrated with stereotactic radiosurgery (SRS), and studies of adding systemic therapies with WBRT.  Since these questions come up very often, I would recommend this article as a great source of information.

   As a bit of colorful background, I met the talented and very interesting Dr. Scott at TEDMED last year, where he spoke eloquently on his recommendation for the changing role of doctors in a new era of medicine.  At that meeting, we had a very enjoyable discussion where we learned that not only was he from Cleveland like me, but he attended the same school, where his mother was also a teacher…and in fact she was my kindergarten teacher.  I know…wild. You can’t make this stuff up.


Is it safe to give Tarceva with whole brain radiation for lung cancer patients with brain metastases?

This question of the safety of giving Tarceva (erlotinib) along with brain radiation comes up in our clinics.  In general, cancer docs tend to be conservative about giving anti-cancer therapies concurrent with brain radiation unless we have a good sense of its safety.  This video talks about the question and the findings from a series of 40 patients from MD Anderson who provide an answer that can help guide us in the future.


Brief Video: Systemic Therapy Alternative to Radiation for Multiple Brain Metastases?

In most situations where a patient is diagnosed with multiple brain metastases in the setting of a new lung cancer, the recommended treatment will be radiation, often whole brain radiation (WBR).  But even if that’s the general rule, there are sometimes cases in which there’s good reason to consider making an exception.  Here’s my brief discussion of a case scenario in which I consider it a strong option to try systemic therapy before initiating brain radiation, and why I consider it to be an exception:

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The full series of podcasts from Dr. Mehta’s webinar on radiation oncology developments in lung cancer

Here’s the links to each of the six parts of the podcast series by Dr. Vivek Mehta, radiation oncology expert, on emerging new technological developments and techniques for improving radiation therapy in lung cancer. 

Part 1: Radiation Therapy — A Historical Perspective

Part 2: The Rationale for Stereotactic Body Radiation Therapy (SBRT)

Part 3: Early Successes and Open Questions with SBRT

Part 4: Defining a Role for SBRT in Lung Cancer

Part 5: New Technologies in Radiation for Lung Cancer

Part 6: Moving New Approaches into Metastatic Lung Cancer


Dr. Mehta on New Technologies in Radiation for Lung Cancer

Somehow I posted the last podcast from Dr. Mehta’s presentation on New Developments in Radiation Oncology for Lung Cancer but overlooked part 5 that should have preceded it. Here’s that longer portion that covers several new advances in the technologies now being incorporated into radiation therapy for lung cancer.

Here’s the video and audio versions of his podcast, along with the associated transcript and figures.

Mehta Refining RT for LC Pt 5 New Technologies Audio Podcast

Mehta Refining RT for LC Pt 5 New Technologies Transcript

Mehta Refining RT for LC Pt 5 New Technologies Figures

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Dr. Mehta on Moving Radiation Developments into Metastatic Lung Cancer

 

Finishing his presentation on new techniques in radiation oncology being applied to lung cancer, Dr. Vivek Mehta turns to the setting of metastatic lung cancer and the potential though still debatable utility of focused radiation to treat oligometastatic disease (metastatic, but with very limited spread of the cancer). Here’s the last podcast from his presentation, in both video and audio formats, along with the associated transcript and figures.

Mehta Refining RT for LC Pt 6 Moving Developments into Metastatic LC Audio Podcast

Mehta Refining RT for LC Pt 6 Moving Developments into Metastatic LC Transcript

Mehta Refining RT for LC Pt 6 Moving Developments into Metastatic LC Figs

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Defining a Role for Sterotactic Radiosurgery in Lung Cancer: Podcast 4 by Dr. Mehta

Here’s part 4 of the presentation by Swedish Cancer Institute radiation oncologist Dr. Vivek Mehta, in which he provides additional data supporting a growing role for stereotactic radiosurgery, also referred to as stereotactic body radiation therapy (SBRT) in lung cancer.  There is discussion of the data supporting its role in medically inoperable patients and also consideration of extending its use to patients able to tolerate surgery, so now asking whether SBRT can substitute for the historical “gold standard” of surgery in patients who would otherwise undergo resection. 

Below you’ll find the video and audio versions of the podcast, along with the transcript and figures.

Mehta Refining RT for LC Pt 4 Defining Role for SBRT Audio Podcast

Mehta Refining RT for LC Pt 4 Defining Role for SBRT Transcript

Mehta Refining RT for LC Pt 4 Defining Role for SBRT Figures

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Dr. Mehta on Early Successes and Open Questions with SBRT

Here’s the third part of Dr. Vivek Mehta’s webinar presentation on refining radiation for lung cancer. This podcast focuses on some of the early encouraging work with stereotactic body radiation therapy, or SBRT, along with discussion of some current open questions on this technology.

Here are the video and audio versions of the podcast, along with the associated transcript and figures for it.

Mehta Refining RT for LC Pt 3 SBRT Early Work Audio Podcast

Mehta Refining RT for LC Pt 3 SBRT Early Work Transcript

Mehta Refining RT for LC Pt 3 SBRT Early Work Figures

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Dr. Mehta on Refining Radiation for Lung Cancer: The Rationale for Stereotactic Body Radiation Therapy (SBRT)

We continue Dr. Mehta’s webinar presentation with a discussion of the potential mechanisms by which we may be able to improve the efficacy and safety of radiation for lung cancer.  This leads to a discussion of the rationale for stereotactic body radiation therapy (SBRT), which is very focal radiation administered over just a few treatments at a relatively high dose each time, rather than several weeks of lower dose radiation over a broader area.  

Here are the video and audio versions of the podcast on this part of the webinar, along with the transcript and figures for the program:

Mehta Refining RT for LC Pt 2 Rationale for SBRT Audio Podcast

Mehta Refining RT for LC Pt 2 Rationale for SBRT Transcript

Mehta Refining RT for LC Rationale for SBRT Figures

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