ESTRO 2024 - Abstract Book

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Invited Speaker

ESTRO 2024

11. van Kesteren et al., 2022; doi.org/10.1016/S0167-8140(22)02788-8. 12. Veldman et al., 2023; doi:10.1016/j.ijrobp.2023.06.2251.

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Breur Award Lecture: Bridging the care gap - A fascinating new era for radiotherapy in the treatment of haematological malignancies

Umberto Ricardi

University of Turin, Oncology, Turin, Italy

Abstract:

Avoiding toxicity to improve survival has been the key to promote a revolutionary development in the application of radiation therapy for the treatment of many hematological malignancies Current optimal treatment is individualized and highly conformal, delivering a homogeneous dose to well-defined target volume, with as low dose as possible to normal tissues. In most situations, the concept of involved site radiotherapy (ISRT) should be applied. ISRT has replaced involved field radiotherapy (IFRT) and means treatment of the original tissue volume which contained lymphoma before systemic therapy, adjusted to changes in anatomy and differences in patient position on imaging as per ILROG guidelines. In lymphomas, the main benefit from this “modern radiotherapy”, meaning lower radiation volumes, lower radiation doses and high gradient techniques, would be to reduce dose to organs at risk, without compromising dose to the target, with the aim of decreasing the risk of late effects whilst maintaining disease control. In spite of this safer and more accurate way to deliver radiotherapy, there is a tendency to omit radiotherapy, especially in the era of PET driven radiotherapy, even if at the price of more systemic therapeutic burden, to improve outcomes of patients minimizing the risk of long-term toxicities attributable to radiotherapy. Different clinical scenario belonging to this area of investigation will be discussed, with updated results from clinical trials. Advances in cancer immunotherapy and recent advances in cell-based therapies are heralding unprecedented successes in the treatment of hematological malignancies; the addition of radiotherapy to immunotherapy could further strengthen this approach through radiation’s ability to activate the immune system, able to subsequently recognize and kill tumor cells. The safe introduction of radiation in combination with CAR T-cell therapy, even if still requiring better understanding of the complexity of adoptive cell therapy interactions, is another exciting example of this new era. We are facing a revolutionary change regarding the role of radiotherapy in treating hematologic malignancies, with a shift, at least in part, from the intent to directly kill cancer cells to the goal of priming antitumor immune response, then attacking both irradiated and non-irradiated tumors. Data and evidence regarding this pro-immunogenic role of radiotherapy will be presented, together with discussion on how radiotherapy can facilitate the effectiveness of cellular immunotherapies. Since systemic treatment choices are moving towards a “chemo-free” era, we potentially might be witnesses of a fascinating time, where we are really opening the door for novel uses of radiotherapy in hematological malignancies.

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