1
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Abdel-Wahab M, Coleman CN, Eriksen JG, Lee P, Kraus R, Harsdorf E, Lee B, Dicker A, Hahn E, Agarwal JP, Prasanna PGS, MacManus M, Keall P, Mayr NA, Jereczek-Fossa BA, Giammarile F, Kim IA, Aggarwal A, Lewison G, Lu JJ, Guedes de Castro D, Kong FMS, Afifi H, Sharp H, Vanderpuye V, Olasinde T, Atrash F, Goethals L, Corn BW. Addressing challenges in low-income and middle-income countries through novel radiotherapy research opportunities. Lancet Oncol 2024; 25:e270-e280. [PMID: 38821101 PMCID: PMC11382686 DOI: 10.1016/s1470-2045(24)00038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 06/02/2024]
Abstract
Although radiotherapy continues to evolve as a mainstay of the oncological armamentarium, research and innovation in radiotherapy in low-income and middle-income countries (LMICs) faces challenges. This third Series paper examines the current state of LMIC radiotherapy research and provides new data from a 2022 survey undertaken by the International Atomic Energy Agency and new data on funding. In the context of LMIC-related challenges and impediments, we explore several developments and advances-such as deep phenotyping, real-time targeting, and artificial intelligence-to flag specific opportunities with applicability and relevance for resource-constrained settings. Given the pressing nature of cancer in LMICs, we also highlight some best practices and address the broader need to develop the research workforce of the future. This Series paper thereby serves as a resource for radiation professionals.
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Affiliation(s)
- May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Lee
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ryan Kraus
- Department of Radiation Oncology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Ekaterina Harsdorf
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Becky Lee
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA; Department of Radiation Oncology, Summa Health, Akron, OH, USA
| | - Adam Dicker
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ezra Hahn
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, ON, Canada
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Keall
- Image X Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nina A Mayr
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiotherapy, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul, South Korea; Seoul National University, College of Medicine, Seoul, South Korea
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grant Lewison
- Institute of Cancer Policy, King's College London, London, UK
| | - Jiade J Lu
- Shanghai Proton and Heavy Ion Centre, Fudan University School of Medicine, Shanghai, China
| | | | - Feng-Ming Spring Kong
- Department of Clinical Oncology, HKU-Shenzhen Hospital and Queen Mary Hospital, Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region, China
| | - Haidy Afifi
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Hamish Sharp
- Institute of Cancer Policy, King's College London, London, UK
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology and Nuclear Medicine, Korlebu Teaching Hospital, Accra, Ghana
| | | | - Fadi Atrash
- Augusta Victoria Hospital, Jerusalem, Israel
| | - Luc Goethals
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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2
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Norman Coleman C, Mayr N. Tribulations and Trials: The Implementation of Biologically Dependent Radiation Therapy Technologies. Int J Radiat Oncol Biol Phys 2022; 113:701-704. [PMID: 35595576 DOI: 10.1016/j.ijrobp.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/09/2022] [Indexed: 11/19/2022]
Affiliation(s)
- C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Nina Mayr
- College of Human Medicine, Michigan State University, East Lansing, Michigan
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3
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Buchsbaum JC, Espey MG, Obcemea C, Capala J, Ahmed M, Prasanna PG, Vikram B, Hong JA, Teicher B, Aryankalayil MJ, Bylicky MA, Coleman CN. Tumor Heterogeneity Research and Innovation in Biologically Based Radiation Therapy From the National Cancer Institute Radiation Research Program Portfolio. J Clin Oncol 2022; 40:1861-1869. [PMID: 35245101 DOI: 10.1200/jco.21.02579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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4
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Buchsbaum JC, Jaffray DA, Ba D, Borkon LL, Chalk C, Chung C, Coleman MA, Coleman CN, Diehn M, Droegemeier KK, Enderling H, Espey MG, Greenspan EJ, Hartshorn CM, Hoang T, Hsiao HT, Keppel C, Moore NW, Prior F, Stahlberg EA, Tourassi G, Willcox KE. Predictive Radiation Oncology - A New NCI-DOE Scientific Space and Community. Radiat Res 2022; 197:434-445. [PMID: 35090025 DOI: 10.1667/rade-22-00012.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
Abstract
With a widely attended virtual kickoff event on January 29, 2021, the National Cancer Institute (NCI) and the Department of Energy (DOE) launched a series of 4 interactive, interdisciplinary workshops-and a final concluding "World Café" on March 29, 2021-focused on advancing computational approaches for predictive oncology in the clinical and research domains of radiation oncology. These events reflect 3,870 human hours of virtual engagement with representation from 8 DOE national laboratories and the Frederick National Laboratory for Cancer Research (FNL), 4 research institutes, 5 cancer centers, 17 medical schools and teaching hospitals, 5 companies, 5 federal agencies, 3 research centers, and 27 universities. Here we summarize the workshops by first describing the background for the workshops. Participants identified twelve key questions-and collaborative parallel ideas-as the focus of work going forward to advance the field. These were then used to define short-term and longer-term "Blue Sky" goals. In addition, the group determined key success factors for predictive oncology in the context of radiation oncology, if not the future of all of medicine. These are: cross-discipline collaboration, targeted talent development, development of mechanistic mathematical and computational models and tools, and access to high-quality multiscale data that bridges mechanisms to phenotype. The workshop participants reported feeling energized and highly motivated to pursue next steps together to address the unmet needs in radiation oncology specifically and in cancer research generally and that NCI and DOE project goals align at the convergence of radiation therapy and advanced computing.
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Affiliation(s)
| | - David A Jaffray
- The University of Texas, MD Anderson Cancer Center, Houston, Texas 77030
| | - Demba Ba
- Harvard University, Cambridge, Massachusetts 02138
| | - Lynn L Borkon
- Frederick National Laboratory for Cancer Research, Frederick, Maryland, 21701
| | | | - Caroline Chung
- The University of Texas, MD Anderson Cancer Center, Houston, Texas 77030
| | | | | | | | | | - Heiko Enderling
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612
| | | | | | | | - Thuc Hoang
- U.S. Department of Energy, Washington, DC 20585
| | - H Timothy Hsiao
- American Society for Radiation Oncology (ASTRO), Arlington, Virginia 22202
| | | | - Nathan W Moore
- Sandia National Laboratories, Albuquerque, New Mexico 87123
| | - Fred Prior
- University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Eric A Stahlberg
- Frederick National Laboratory for Cancer Research, Frederick, Maryland, 21701
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5
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Wahl RL, Sgouros G, Iravani A, Jacene H, Pryma D, Saboury B, Capala J, Graves SA. Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns. J Nucl Med 2021; 62:23S-35S. [PMID: 34857619 DOI: 10.2967/jnumed.121.262751] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/15/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - George Sgouros
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Amir Iravani
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | | | - Daniel Pryma
- Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jacek Capala
- National Institutes of Health, Bethesda, Maryland
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6
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Prasanna PG, Citrin DE, Hildesheim J, Ahmed MM, Venkatachalam S, Riscuta G, Xi D, Zheng G, Deursen JV, Goronzy J, Kron SJ, Anscher MS, Sharpless NE, Campisi J, Brown SL, Niedernhofer LJ, O'Loghlen A, Georgakilas AG, Paris F, Gius D, Gewirtz DA, Schmitt CA, Abazeed ME, Kirkland JL, Richmond A, Romesser PB, Lowe SW, Gil J, Mendonca MS, Burma S, Zhou D, Coleman CN. Therapy-Induced Senescence: Opportunities to Improve Anticancer Therapy. J Natl Cancer Inst 2021; 113:1285-1298. [PMID: 33792717 PMCID: PMC8486333 DOI: 10.1093/jnci/djab064] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Cellular senescence is an essential tumor suppressive mechanism that prevents the propagation of oncogenically activated, genetically unstable, and/or damaged cells. Induction of tumor cell senescence is also one of the underlying mechanisms by which cancer therapies exert antitumor activity. However, an increasing body of evidence from preclinical studies demonstrates that radiation and chemotherapy cause accumulation of senescent cells (SnCs) both in tumor and normal tissue. SnCs in tumors can, paradoxically, promote tumor relapse, metastasis, and resistance to therapy, in part, through expression of the senescence-associated secretory phenotype. In addition, SnCs in normal tissue can contribute to certain radiation- and chemotherapy-induced side effects. Because of its multiple roles, cellular senescence could serve as an important target in the fight against cancer. This commentary provides a summary of the discussion at the National Cancer Institute Workshop on Radiation, Senescence, and Cancer (August 10-11, 2020, National Cancer Institute, Bethesda, MD) regarding the current status of senescence research, heterogeneity of therapy-induced senescence, current status of senotherapeutics and molecular biomarkers, a concept of "one-two punch" cancer therapy (consisting of therapeutics to induce tumor cell senescence followed by selective clearance of SnCs), and its integration with personalized adaptive tumor therapy. It also identifies key knowledge gaps and outlines future directions in this emerging field to improve treatment outcomes for cancer patients.
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Affiliation(s)
| | | | | | | | | | | | - Dan Xi
- National Cancer Institute, NIH, Bethesda, MD, USA
| | - Guangrong Zheng
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | - Jorg Goronzy
- Department of Medicine, Stanford University, Stanford, CA, USA
| | | | | | | | | | | | - Laura J Niedernhofer
- Institute on the Biology of Aging and Metabolism, Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Ana O'Loghlen
- Epigenetics & Cellular Senescence Group; Blizard Institute; Barts and The London School of Medicine and Dentistry; Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Alexandros G Georgakilas
- DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou, 15780, Athens, Greece
| | - Francois Paris
- Universite de Nantes, INSERM, CNRS, CRCINA, Nantes, France
| | - David Gius
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Mohamed E Abazeed
- Johannes Kepler University, 4020, Linz, Austria
- Department of Radiation Oncology, Northwestern, Chicago, IL, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Ann Richmond
- Department of Pharmacology and Department of Veterans Affairs, Vanderbilt University, Nashville, TN, USA
| | - Paul B Romesser
- Translational Research Division, Department of Radiation Oncology and Early Drug Development Service, Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott W Lowe
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, and Howard Hughes Medical Institute, New York, NY, USA
| | - Jesus Gil
- MRC London Institute of Medical Sciences (LMS), and Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, Du Cane Road, London, W12 ONN, UK
| | - Marc S Mendonca
- Departments of Radiation Oncology & Medical and Molecular Genetics, Indiana University School of Medicine, IUPUI, Indianapolis, IN 46202, USA
| | - Sandeep Burma
- Departments of Neurosurgery and Biochemistry & Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Daohong Zhou
- College of Pharmacy, University of Florida, Gainesville, FL, USA
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7
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Abstract
Radiation therapy benefits the majority of patients across the spectrum of cancer types. However, both local and distant tumor recurrences limit its clinical success. While departing from the established tenet of fractionation in clinical radiotherapy, ablative-intensity hypofractionated radiotherapy, especially stereotactic radiosurgery and stereotactic ablative radiotherapy, has emerged as an alternative paradigm achieving unprecedented rates of local tumor control. Direct tumor cell killing has been assumed to be the primary therapeutic mode of action of such ablative radiation. But with increasing recognition that tumor responses also depend on the immunostimulatory or immunosuppressive status of the tumor microenvironment, the immunologic effect of ablative radiotherapy is emerging as a key contributor to antitumor response. More recently, novel radiation modalities, such as spatially fractionated radiotherapy and ultrahigh dose rate FLASH irradiation, that venture even further from conventional paradigms have shown promise of increasing the therapeutic index of radiation therapy with the potential of immunomodulation. Here, we review the immunomodulatory impact of novel radiation therapy paradigms, heretofore considered radiobiological heresies, a deeper understanding of which is imperative to realizing fully their potential for more curative cancer therapy.
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8
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Prasanna PG, Rawojc K, Guha C, Buchsbaum JC, Miszczyk JU, Coleman CN. Normal Tissue Injury Induced by Photon and Proton Therapies: Gaps and Opportunities. Int J Radiat Oncol Biol Phys 2021; 110:1325-1340. [PMID: 33640423 PMCID: PMC8496269 DOI: 10.1016/j.ijrobp.2021.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 12/16/2022]
Abstract
Despite technological advances in radiation therapy (RT) and cancer treatment, patients still experience adverse effects. Proton therapy (PT) has emerged as a valuable RT modality that can improve treatment outcomes. Normal tissue injury is an important determinant of the outcome; therefore, for this review, we analyzed 2 databases: (1) clinical trials registered with ClinicalTrials.gov and (2) the literature on PT in PubMed, which shows a steady increase in the number of publications. Most studies in PT registered with ClinicalTrials.gov with results available are nonrandomized early phase studies with a relatively small number of patients enrolled. From the larger database of nonrandomized trials, we listed adverse events in specific organs/sites among patients with cancer who are treated with photons and protons to identify critical issues. The present data demonstrate dosimetric advantages of PT with favorable toxicity profiles and form the basis for comparative randomized prospective trials. A comparative analysis of 3 recently completed randomized trials for normal tissue toxicities suggests that for early stage non-small cell lung cancer, no meaningful comparison could be made between stereotactic body RT and stereotactic body PT due to low accrual (NCT01511081). In addition, for locally advanced non-small cell lung cancer, a comparison of intensity modulated RTwith passive scattering PT (now largely replaced by spot-scanned intensity modulated PT), PT did not provide any benefit in normal tissue toxicity or locoregional failure over photon therapy. Finally, for locally advanced esophageal cancer, proton beam therapy provided a lower total toxicity burden but did not improve progression-free survival and quality of life (NCT01512589). The purpose of this review is to inform the limitations of current trials looking at protons and photons, considering that advances in technology, physics, and biology are a continuum, and to advocate for future trials geared toward accurate precision RT that need to be viewed as an iterative process in a defined path toward delivering optimal radiation treatment. A foundational understanding of the radiobiologic differences between protons and photons in tumor and normal tissue responses is fundamental to, and necessary for, determining the suitability of a given type of biologically optimized RT to a patient or cohort.
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Affiliation(s)
- Pataje G Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland.
| | - Kamila Rawojc
- The University Hospital in Krakow, Department of Endocrinology, Nuclear Medicine Unit, Krakow, Poland
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Justyna U Miszczyk
- Department of Experimental Physics of Complex Systems, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
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9
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Buchsbaum JC, Coleman CN, Bernhard EJ, Espey MG, Vikram B. Overview and Lessons From the Preclinical Chemoradiotherapy Testing Consortium. Int J Radiat Oncol Biol Phys 2021; 111:1126-1130. [PMID: 34348172 DOI: 10.1016/j.ijrobp.2021.07.1709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE In the current molecular-targeted cancer treatment era, many new agents are being developed so that optimizing therapy with a combination of radiation and drugs is complex. The use of emerging laboratory technologies to further biological understanding of drug-radiation mechanisms of action will enhance the efficiency of the progression from preclinical studies to clinical trials. In 2017, the National Cancer Institute (NCI) solicited proposals through PAR 16-111 to conduct preclinical research combining targeted anticancer agents in the Cancer Therapy Evaluation Program's portfolio with chemoradiation. METHODS AND MATERIALS The Preclinical Chemo-Radiotherapy Testing Consortium (PCRTC) was formed with 4 U01 programs supported to generate validated high-quality preclinical data on the effects of molecular therapeutics when added to standard-of-care therapies with a concentration on cancers of the pancreas, lung, head and neck, gastrointestinal tract, and brain. RESULTS The PCRTC provides a rational basis for prioritizing NCI-supported investigational new drugs or agents most likely to have clinical activity with chemoradiotherapy and accelerate the pace at which combined modality treatments with greater efficacy are identified and incorporated into standard treatment practices. CONCLUSIONS Herein, we introduce and summarize the course of the PCRTC to date and report 3 preliminary observations from the consortium's work to date.
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Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Eric J Bernhard
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael G Espey
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Buchsbaum JC, Coleman CN, Espey MG, Prasanna PGS, Capala J, Ahmed MM, Hong JA, Obcemea C. FLASH Radiation Therapy: New Technology Plus Biology Required. Int J Radiat Oncol Biol Phys 2021; 110:1248-1249. [PMID: 33548337 DOI: 10.1016/j.ijrobp.2021.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael G Espey
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mansoor M Ahmed
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Julie A Hong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ceferino Obcemea
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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11
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Coleman CN, Buchsbaum JC, Prasanna PGS, Capala J, Obcemea C, Espey MG, Ahmed MM, Hong JA, Vikram B. Moving Forward in the Next Decade: Radiation Oncology Sciences for Patient-Centered Cancer Care. JNCI Cancer Spectr 2021; 5:pkab046. [PMID: 34350377 PMCID: PMC8328099 DOI: 10.1093/jncics/pkab046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
In a time of rapid advances in science and technology, the opportunities for radiation oncology are undergoing transformational change. The linkage between and understanding of the physical dose and induced biological perturbations are opening entirely new areas of application. The ability to define anatomic extent of disease and the elucidation of the biology of metastases has brought a key role for radiation oncology for treating metastatic disease. That radiation can stimulate and suppress subpopulations of the immune response makes radiation a key participant in cancer immunotherapy. Targeted radiopharmaceutical therapy delivers radiation systemically with radionuclides and carrier molecules selected for their physical, chemical, and biochemical properties. Radiation oncology usage of “big data” and machine learning and artificial intelligence adds the opportunity to markedly change the workflow for clinical practice while physically targeting and adapting radiation fields in real time. Future precision targeting requires multidimensional understanding of the imaging, underlying biology, and anatomical relationship among tissues for radiation as spatial and temporal “focused biology.” Other means of energy delivery are available as are agents that can be activated by radiation with increasing ability to target treatments. With broad applicability of radiation in cancer treatment, radiation therapy is a necessity for effective cancer care, opening a career path for global health serving the medically underserved in geographically isolated populations as a substantial societal contribution addressing health disparities. Understanding risk and mitigation of radiation injury make it an important discipline for and beyond cancer care including energy policy, space exploration, national security, and global partnerships.
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Affiliation(s)
- C Norman Coleman
- Correspondence to: C. Norman Coleman, MD, Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, MSC 9727, Bethesda, MD 20892-9727, USA (e-mail: )
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ceferino Obcemea
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael G Espey
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mansoor M Ahmed
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Julie A Hong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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12
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Buchsbaum JC, Vikram B. NCI support for pediatric radiation therapy: Past, present, and future. Pediatr Blood Cancer 2021; 68 Suppl 2:e28689. [PMID: 32939959 DOI: 10.1002/pbc.28689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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13
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Demaria S, Guha C, Schoenfeld J, Morris Z, Monjazeb A, Sikora A, Crittenden M, Shiao S, Khleif S, Gupta S, Formenti SC, Vikram B, Coleman CN, Ahmed MM. Radiation dose and fraction in immunotherapy: one-size regimen does not fit all settings, so how does one choose? J Immunother Cancer 2021; 9:jitc-2020-002038. [PMID: 33827904 PMCID: PMC8031689 DOI: 10.1136/jitc-2020-002038] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 12/12/2022] Open
Abstract
Recent evidence indicates that ionizing radiation can enhance immune responses to tumors. Advances in radiation delivery techniques allow hypofractionated delivery of conformal radiotherapy. Hypofractionation or other modifications of standard fractionation may improve radiation’s ability to promote immune responses to tumors. Other novel delivery options may also affect immune responses, including T-cell activation and tumor-antigen presentation changes. However, there is limited understanding of the immunological impact of hypofractionated and unique multifractionated radiotherapy regimens, as these observations are relatively recent. Hence, these differences in radiotherapy fractionation result in distinct immune-modulatory effects. Radiation oncologists and immunologists convened a virtual consensus discussion to identify current deficiencies, challenges, pitfalls and critical gaps when combining radiotherapy with immunotherapy and making recommendations to the field and advise National Cancer Institute on new directions and initiatives that will help further development of these two fields. This commentary aims to raise the awareness of this complexity so that the need to study radiation dose, fractionation, type and volume is understood and valued by the immuno-oncology research community. Divergence of approaches and findings between preclinical studies and clinical trials highlights the need for evaluating the design of future clinical studies with particular emphasis on radiation dose and fractionation, immune biomarkers and selecting appropriate end points for combination radiation/immune modulator trials, recognizing that direct effect on the tumor and potential abscopal effect may well be different. Similarly, preclinical studies should be designed as much as possible to model the intended clinical setting. This article describes a conceptual framework for testing different radiation therapy regimens as separate models of how radiation itself functions as an immunomodulatory ‘drug’ to provide alternatives to the widely adopted ‘one-size-fits-all’ strategy of frequently used 8 Gy×3 regimens immunomodulation.
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Affiliation(s)
- Sandra Demaria
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York, USA
| | - Chandan Guha
- Radiation Oncology, Pathology and Urology, and Institute of Onco-Physics, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Jonathan Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Zachary Morris
- Human Oncology, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Arta Monjazeb
- Radiation Oncology, UC Davis, Davis, California, USA
| | - Andrew Sikora
- Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marka Crittenden
- Department of Radiation Oncology, Providence Portland Medical Center, Portland, Oregon, USA
| | - Stephen Shiao
- Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samir Khleif
- The Loop Immuno-Oncology Laboratory, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Seema Gupta
- The Loop Immuno-Oncology Laboratory, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Silvia Chiara Formenti
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York, USA
| | - Bhadrasain Vikram
- Radiation Research Program, National Cancer Institute Division of Cancer Treatment and Diagnosis, Bethesda, Maryland, USA
| | - C Norman Coleman
- Radiation Research Program, National Cancer Institute Division of Cancer Treatment and Diagnosis, Bethesda, Maryland, USA
| | - Mansoor M Ahmed
- Radiation Research Program, National Cancer Institute Division of Cancer Treatment and Diagnosis, Bethesda, Maryland, USA
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14
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Coleman CN, Eke I, Makinde AY, Chopra S, Demaria S, Formenti SC, Martello S, Bylicky M, Mitchell JB, Aryankalayil MJ. Radiation-induced Adaptive Response: New Potential for Cancer Treatment. Clin Cancer Res 2020; 26:5781-5790. [PMID: 32554542 PMCID: PMC7669567 DOI: 10.1158/1078-0432.ccr-20-0572] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/24/2020] [Accepted: 06/11/2020] [Indexed: 12/20/2022]
Abstract
Radiotherapy is highly effective due to its ability to physically focus the treatment to target the tumor while sparing normal tissue and its ability to be combined with systemic therapy. This systemic therapy can be utilized before radiotherapy as an adjuvant or induction treatment, during radiotherapy as a radiation "sensitizer," or following radiotherapy as a part of combined modality therapy. As part of a unique concept of using radiation as "focused biology," we investigated how tumors and normal tissues adapt to clinically relevant multifraction (MF) and single-dose (SD) radiation to observe whether the adaptations can induce susceptibility to cell killing by available drugs or by immune enhancement. We identified an adaptation occurring after MF (3 × 2 Gy) that induced cell killing when AKT-mTOR inhibitors were delivered following cessation of radiotherapy. In addition, we identified inducible changes in integrin expression 2 months following cessation of radiotherapy that differ between MF (1 Gy × 10) and SD (10 Gy) that remain targetable compared with preradiotherapy. Adaptation is reflected across different "omics" studies, and thus the range of possible molecular targets is not only broad but also time, dose, and schedule dependent. While much remains to be studied about the radiation adaptive response, radiation should be characterized by its molecular perturbations in addition to physical dose. Consideration of the adaptive effects should result in the design of a tailored radiotherapy treatment plan that accounts for specific molecular changes to be targeted as part of precision multimodality cancer treatment.
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Affiliation(s)
- C Norman Coleman
- Radiation Oncology Branch and Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.
| | - Iris Eke
- Radiation Oncology Branch and Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Adeola Y Makinde
- Radiation Oncology Branch and Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Sunita Chopra
- Radiation Oncology Branch and Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Sandra Demaria
- Radiation Oncology and Pathology, Weill Cornell Medicine, New York, New York
| | - Silvia C Formenti
- Radiation Oncology and Pathology, Weill Cornell Medicine, New York, New York
| | - Shannon Martello
- Radiation Oncology Branch and Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Michelle Bylicky
- Radiation Oncology Branch and Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - James B Mitchell
- Radiation Oncology Branch and Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Molykutty J Aryankalayil
- Radiation Oncology Branch and Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
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15
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Coleman CN. Sixteenth Annual Warren K. Sinclair Keynote Address: Frontiers in Medical Radiation Science. HEALTH PHYSICS 2020; 118:349-353. [PMID: 32039927 DOI: 10.1097/hp.0000000000001240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
On the occasion of the 90 anniversary of National Council on Radiation Protection and Measurements (NCRP) and its 55 anniversary since being Congressionally Chartered, the theme of "Providing Best Answers to Your Most Pressing Questions about Radiation" is most appropriate. The question proposed here is, "What are the new frontiers for the NCRP with its breadth of talent and expertise in the rapidly evolving era of precision medicine?" Three closely related themes are presented for new applications of radiation science for research and career opportunities: (1) introduction of the new concept of defining radiation dose in biological perturbations in addition to physical dose, particularly for cancer treatment; (2) assessment of early biomarkers of radiation injury for mass casualty exposure (biodosimetry) to guide triage and for clinical application to guide radiation therapy; and (3) proposal to expand opportunities for radiation professionals, including consideration of a new training program within NCRP's "Where are the radiation professionals?" initiative that trains radiation oncologists as molecular radiation epidemiologists.
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16
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Implementation of New Biology-Based Radiation Therapy Technology: When Is It Ready So "Perfect Makes Practice?". Int J Radiat Oncol Biol Phys 2020; 105:934-937. [PMID: 31748143 DOI: 10.1016/j.ijrobp.2019.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 11/21/2022]
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17
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Vapiwala N, Thomas CR, Grover S, Yap ML, Mitin T, Shulman LN, Gospodarowicz MK, Longo J, Petereit DG, Ennis RD, Hayman JA, Rodin D, Buchsbaum JC, Vikram B, Abdel-Wahab M, Epstein AH, Okunieff P, Goldwein J, Kupelian P, Weidhaas JB, Tucker MA, Boice JD, Fuller CD, Thompson RF, Trister AD, Formenti SC, Barcellos-Hoff MH, Jones J, Dharmarajan KV, Zietman AL, Coleman CN. Enhancing Career Paths for Tomorrow's Radiation Oncologists. Int J Radiat Oncol Biol Phys 2019; 105:52-63. [PMID: 31128144 PMCID: PMC7084166 DOI: 10.1016/j.ijrobp.2019.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Neha Vapiwala
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Surbhi Grover
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; University of Botswana, Gaborone, Botswana
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute, University of New South Wales, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centre, Western Sydney University, Campbelltown, Australia; School of Public Health, University of Sydney, Camperdown, Australia
| | - Timur Mitin
- Department of Radiation Medicine Director, Program in Global Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Lawrence N Shulman
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary K Gospodarowicz
- Department of Radiation Oncology, University of Toronto, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John Longo
- Department of Radiation Oncology Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel G Petereit
- Department of Radiation Oncology, Rapid City Regional Cancer Care Institute, Rapid City, South Dakota
| | - Ronald D Ennis
- Clinical Network for Radiation Oncology, Rutgers and Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey C Buchsbaum
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Clinical Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - May Abdel-Wahab
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Alan H Epstein
- Uniformed Service University of the Health Sciences, Bethesda, Maryland
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida Health Cancer Center, Gainesville, Florida
| | - Joel Goldwein
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Elekta AB, Stockholm, Sweden
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California; Varian Medical Systems, Palo Alto, California
| | - Joanne B Weidhaas
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California; MiraDx, Los Angeles, California
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clifton David Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reid F Thompson
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Andrew D Trister
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York City, New York
| | | | - Joshua Jones
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kavita V Dharmarajan
- Department of Radiation Oncology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - C Norman Coleman
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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18
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Abhyankar YS, Dev S, Sarun OS, Saxena A, Joshi R, Darbari H, Sajish C, Sonavane UB, Gavane V, Deshpande A, Dixit T, Harsh R, Badwe R, Rath GK, Laskar S, Faddegon B, Perl J, Paganetti H, Schuemann J, Srivastava A, Obcemea C, Nath AK, Sharma A, Buchsbaum J. Monte Carlo Processing on a Chip (MCoaC)-preliminary experiments toward the realization of optimal-hardware for TOPAS/Geant4 to drive discovery. Phys Med 2019; 64:166-173. [PMID: 31515016 DOI: 10.1016/j.ejmp.2019.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/21/2019] [Accepted: 06/29/2019] [Indexed: 01/23/2023] Open
Abstract
Amongst the scientific frameworks powered by the Monte Carlo (MC) toolkit Geant4 (Agostinelli et al., 2003), the TOPAS (Tool for Particle Simulation) (Perl et al., 2012) is one. TOPAS focuses on providing ease of use, and has significant implementation in the radiation oncology space at present. TOPAS functionality extends across the full capacity of Geant4, is freely available to non-profit users, and is being extended into radiobiology via TOPAS-nBIO (Ramos-Mendez et al., 2018). A current "grand problem" in cancer therapy is to convert the dose of treatment from physical dose to biological dose, optimized ultimately to the individual context of administration of treatment. Biology MC calculations are some of the most complex and require significant computational resources. In order to enhance TOPAS's ability to become a critical tool to explore the definition and application of biological dose in radiation therapy, we chose to explore the use of Field Programmable Gate Array (FPGA) chips to speedup the Geant4 calculations at the heart of TOPAS, because this approach called "Reconfigurable Computing" (RC), has proven able to produce significant (around 90x) (Sajish et al., 2012) speed increases in scientific computing. Here, we describe initial steps to port Geant4 and TOPAS to be used on FPGA. We provide performance analysis of the current TOPAS/Geant4 code from an RC implementation perspective. Baseline benchmarks are presented. Achievable performance figures of the subsections of the code on optimal hardware are presented; Aspects of practical implementation of "Monte Carlo on a chip" are also discussed.
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Affiliation(s)
| | - Sachin Dev
- Open Health Systems Laboratory (OHSL), USA
| | - O S Sarun
- Centre for Development of Advanced Computing (C-DAC), Pune, India
| | - Amit Saxena
- Centre for Development of Advanced Computing (C-DAC), Pune, India
| | - Rajendra Joshi
- Centre for Development of Advanced Computing (C-DAC), Pune, India
| | - Hemant Darbari
- Centre for Development of Advanced Computing (C-DAC), Pune, India
| | - C Sajish
- Centre for Development of Advanced Computing (C-DAC), Pune, India
| | - U B Sonavane
- Centre for Development of Advanced Computing (C-DAC), Pune, India
| | - Vivek Gavane
- Centre for Development of Advanced Computing (C-DAC), Pune, India
| | - Abhay Deshpande
- Society for Applied Microwave Electronics Engineering & Research (SAMEER), Mumbai, India
| | - Tanuja Dixit
- Society for Applied Microwave Electronics Engineering & Research (SAMEER), Mumbai, India
| | - Rajesh Harsh
- Society for Applied Microwave Electronics Engineering & Research (SAMEER), Mumbai, India
| | | | - G K Rath
- All India Institute of Medical Sciences (AIIMS), Delhi, India
| | | | | | - Joseph Perl
- SLAC National Accelerator Laboratory, Menlo Park, USA
| | - Harald Paganetti
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Jan Schuemann
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | | | - Asheet K Nath
- Centre for Development of Advanced Computing (C-DAC), Pune, India
| | - Ashok Sharma
- All India Institute of Medical Sciences (AIIMS), Delhi, India
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19
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Falls KC, Sharma RA, Lawrence YR, Amos RA, Advani SJ, Ahmed MM, Vikram B, Coleman CN, Prasanna PG. Radiation-Drug Combinations to Improve Clinical Outcomes and Reduce Normal Tissue Toxicities: Current Challenges and New Approaches: Report of the Symposium Held at the 63rd Annual Meeting of the Radiation Research Society, 15-18 October 2017; Cancun, Mexico. Radiat Res 2018; 190:350-360. [PMID: 30280985 PMCID: PMC6322391 DOI: 10.1667/rr15121.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The National Cancer Institute's (NCI) Radiation Research Program (RRP) is endeavoring to increase the relevance of preclinical research to improve outcomes of radiation therapy for cancer patients. These efforts include conducting symposia, workshops and educational sessions at annual meetings of professional societies, including the American Association of Physicists in Medicine, American Society of Radiation Oncology, Radiation Research Society (RRS), Radiosurgery Society, Society of Nuclear Medicine and Molecular Imaging, Society for Immunotherapy of Cancer and the American Association of Immunology. A symposium entitled "Radiation-Drug Combinations to Improve Clinical Outcomes and Reduce Normal Tissue Toxicities" was conducted by the NCI's RRP during the 63rd Annual Meeting of the RRS on October 16, 2017 in Cancun, Mexico. In this symposium, discussions were held to address the challenges in developing radiation-drug combinations, optimal approaches with scientific evidence to replace standard-of-care, approaches to reduce normal tissue toxicities and enhance post-treatment quality-of-life and recent advances in antibody-drug conjugates. The symposium included two broad overview talks followed by two talks illustrating examples of radiation-drug combinations under development. The overview talks identified the essential preclinical infrastructure necessary to accelerate progress in the development of evidence and important challenges in the translation of drug combinations to the clinic from the laboratory. Also addressed, in the example talks (in light of the suggested guidelines and identified challenges), were the development and translation of novel antibody drug conjugates as well as repurposing of drugs to improve efficacy and reduce normal tissue toxicities. Participation among a cross section of clinicians, scientists and scholars-in-training alike who work in this focused area highlighted the importance of continued discussions to identify and address complex challenges in this emerging area in radiation oncology.
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Affiliation(s)
- Kelly C. Falls
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Carver College of Medicine, Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, Iowa 52242
- Scholar-in-Training, Radiation Research Society
| | - Ricky A. Sharma
- NHR University College of London Hospitals Biomedical Research Center, UCL Cancer Institute, University College London, United Kingdom
| | - Yaacov R. Lawrence
- Center for Translational Research in Radiation Oncology, Department of Radiation Oncology, Sheba Medical Center affiliated with Tel Aviv University, Tel HaShomer 5265601, Israel
| | - Richard A. Amos
- Proton and Advanced Radiotherapy Group, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sunil J. Advani
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, Moores Cancer Center, La Jolla, California 92093
| | - Mansoor M. Ahmed
- National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program, Bethesda, Maryland 20892
| | - Bhadrasain Vikram
- National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program, Bethesda, Maryland 20892
| | - C. Norman Coleman
- National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program, Bethesda, Maryland 20892
| | - Pataje G. Prasanna
- National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program, Bethesda, Maryland 20892
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