John Christodouleas, SVP at Elekta, Medical Affairs and Attending Radiation Oncologist at Hospital of the University of Pennsylvania, shared on X:
“My top 3 ‘most exciting’ clinical observations from Day 2 of the MR-Linac Consortium meeting:
1. Prostate cancer: Intermediate-risk disease may be disrupted (again).
HERMES and TURBO, two MRL RCTs investigating 2 vs 5 fx, provide encouraging evidence that 2 fx can be very well tolerated.
Now RMH, NKI, Sunnybrook, MSKCC and CHUM are accruing to DESTINATION-2.
Mature cancer control and late AE outcomes will be critical, but the long-term HDR experience provides good reason to 2 fx are adequate.
Now add Direct-to-Unit workflows. Treating prostate cancer in two ~30-min visits doesn’t seem that far away.
Trigger warning: such a paradigm could even compete with active surveillance with respect to long term outcomes and health system costs.
2. Rectal cancer: Increasing reason to believe that many pts with low-lying, locally advanced rectal cancer, not just early-stage dz, may ultimately be able to avoid colostomy.
Tumor kinetics during the first 2 weeks of long-course RT is now a prospectively validated prognostic biomarker.
Add longitudinal measures of hypoxia, diffusion and perfusion, and perhaps our ability to discriminate responders from nonresponders gets even better.
Multiple MRL trials are testing these concepts.
3. Pancreas cancer: The reported 2- and 3-year OS and AE outcomes with ablative SBRT are striking.
What’s next?
Combined RT with emerging KRAS inhibitor regimens being explored cautiously given the potential for overlapping GI toxicity and limited experience.
Could PULSAR-like spacing, allowing acute RT effects to subside between fx, offer a way to mitigate some of that risk?”
Other articles from John Christodouleas on OncoDaily.