Advances in cellular and molecular radiation oncology

Of what use is molecular biology to the practicing radiation oncologist?

BACKGROUND AND PURPOSE

We are in a period of rapid advance in understanding the basic mechanisms behind the induction and progression of cancer. The relevance of this new knowledge to the daily clinical practice of radiation oncology may not necessarily be readily apparent. Familiarity with a few of the concepts of molecular biology and biochemistry are necessary to fully appreciate the clinical relevance of the new biology.

METHODS AND RESULTS

To illustrate how the new knowledge affects the practice of radiation oncology, examples of the use of molecular biology are presented for different clinical aspects of clinical oncology, i.e. screening and prevention, prognostic factors, predictive factors, treatment decision, novel therapy and follow-up. A number of the molecular biology techniques are illustrated.

CONCLUSIONS

The advances from molecular biology directly impact the role of radiation oncologists in the clinic. While major new therapies are still in development in the laboratory, these will likely have a very significant role in patient care and cancer prevention in the not-too-distant future. Given the central role of radiation oncologists in cancer management, a basic knowledge of molecular biology techniques and their application is essential so that we can be current with our colleagues and patients and as a specialty, participate actively in improving the outcome of patients with or at risk of developing cancer.

New approaches in the use of radiation therapy in the treatment of infiltrative transitional-cell cancer of the bladder

Organ preservation using primary radical radiation therapy (RT) is a viable treatment option for many patients with invasive bladder cancer, and there is no evidence that survival is compromised by this approach. However, the survival and local control rates in patients with bladder cancer currently treated with radical RT are not optimal. Combined modality therapy, altered radiation-fractionation approaches, and exciting new approaches such as the application of gene therapy and the use of hypoxic cell sensitisers, among others, may well improve the results of treatment in the future. Ongoing clinical research, including prospective randomised trials, will be required to evaluate these new approaches to therapy.