Not All Patients Have Easy Access to Radiation Therapy, and More From ASTRO

Scientists gathered online October 22 through 29 for the annual meeting of the American Society for Radiation Oncology (ASTRO), held virtually this year and accessible on the organization's website through November 30. Here are some of the top stories from day 2 of the meeting.

Many Patients Live Far From Radiation Oncology Treatment Centers

About 5 percent of Americans live 50 miles or more from the closest facility that offers radiation therapy for cancer, according to a study presented October 27 at the annual meeting of ASTRO.

The survey, from researchers at the University of Texas MD Anderson Cancer Center in Houston, showed that the number of radiation therapy facilities in the United States has grown by 17 percent over the last 15 years — improving access to radiation treatments for many Americans.

But it also found that many patients living in remote regions still face hardships in accessing that care. At least half of all cancer patients receive radiation therapy as part of their treatment regimen. Radiation therapy is often administered over many sessions, which can require separate daily trips.

“Radiation therapy is a key part of the treatment paradigm for most patients with cancer,” said the lead author of the study, Sean Maroongroge, MD, MBA, a radiation oncology resident at MD Anderson Cancer Center. “It’s also unique among cancer treatment modalities because patients often have to come back for multiple treatments.”

Having to travel to receive radiation therapy is a significant issue and increases the financial hardship cancer patients face, a review of studies published in December 2015 in The Oncologist showed. Moreover, that review showed that having to travel can make patients less likely to receive or complete radiation treatment, impacting cancer outcomes.

Dr. Maroongroge and his colleagues used data from state agencies to map radiation clinic locations. They found that the number of centers has increased from 1,987 nationwide in 2005 to 2,332 in 2020. The authors estimated that about 70 percent of Americans live within 12.5 miles of a radiation treatment center. There was slower growth in geographical areas that already lacked radiation facilities, however.

The study found that those who live in geographically remote areas may also face special challenges to receiving the most innovative radiation modalities, such as stereotactic radiotherapy or proton therapy.

That is important, because there is greater focus today on precision radiation technologies and their ability to improve cancer outcomes, says Karen Winkfield, MD, PhD, an associate professor of radiation oncology at Wake Forest University in Winston-Salem, North Carolina, an associate director for community outreach and engagement, and the director of the office of cancer health equity at Wake Forest Baptist Comprehensive Cancer Center. Dr. Winkfield was not involved in the newstudy.

Opening a radiation oncology facility requires both financial resources and a trained and qualified workforce to staff the center. That poses problems for adding more radiation clinics in rural areas. More effort may be needed to help patients who live far from clinics manage and pay for travel to those centers, Maroongroge said.

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A Single Stereotactic Radiation Treatment Benefits Patients With Oligometastases

Stereotactic body radiation therapy (SBRT) for cancer that has begun to spread throughout the body was equally effective whether the treatment was delivered in one treatment or four treatment sessions, according to a multicenter trial conducted in Australia and New Zealand.

SBRT is typically delivered over several treatment sessions because of fears that a single higher-dose treatment might result in toxicity and severe side effects.

The study adds support for the use of SBRT for multiple metastases — a condition known as oligometastatic cancer. The phase 2 randomized trial included patients with up to three lung metastases who received either one treatment or an equivalent regimen consisting of four treatment sessions.

The study found cancer control in 93 percent of patients who received a single SBRT treatment after one year of follow-up compared with 95 percent for those who received four treatments. Overall survival rates were 95 percent and 93 percent, respectively.

The study shows that SBRT may be a more appealing option for patients compared with drug therapies or surgery, especially if SBRT can be delivered in one treatment, said the lead author of the study, Shankar Siva, MBBS, PhD, an associate professor of radiation oncology and head of the SBRT program at the Peter MacCallum Cancer Centre in Melbourne, Australia.

"I think the future of radiation oncology could be these ultra-short treatments," Dr. Siva said.

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Minorities Are Underrepresented in Radiation Clinical Trials

A review of the racial composition of radiation clinical trials shows that both Black Americans and Asians are underrepresented compared with whites. The study, by researchers at the Medical College of Wisconsin in Milwaukee, highlights the continuing challenges in addressing disparities in cancer care.

“We recognize racial disparities as a public health emergency,” said Emily H. Bero, a medical student at the Medical College of Wisconsin in Milwaukee and the lead author of the study. “Structural racism, systemic bias, and related barriers consistently limit inclusion of patients from underrepresented minority groups in clinical trials.”

The study showed that Black Americans make up 12 percent of radiation clinical trial enrollment, although they represent 13 percent of the U.S. population. Black Americans, however, have disproportionately higher rates of some types of cancer, such as prostate cancer, colon cancer, stomach cancer, and cervical cancer. Moreover, Black Americans have the highest cancer death rates of any racial or ethnic group for all cancers combined and for many of the most common cancers, the study authors said.

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