ESTRO 2024 - Abstract Book

S62

Invited Speaker

ESTRO 2024

3422

Managing treatment-related toxicities in radiation oncology

Antonella Camilleri

Ministry for Health and Active Ageing - Sir Anthony Mamo Oncology Centre, Radiotherapy Department, Msida, Malta

Abstract:

Radiation therapy remains a vital component in the arsenal against various malignancies, offering remarkable efficacy in local disease control and improved survival rates. However, this therapeutic modality is often accompanied by treatment-associated toxicities that can significantly impair the patients' quality of life and treatment outcomes. The range of radiation-induced toxicities encompasses acute effects, manifesting during or shortly after treatment, as well as late effects that can emerge months to years later. Acute toxicities commonly includefatigue, pain, skin reactions, mucositis, gastrointestinal and urinary changes. Late toxicities may involve fibrosis, organ dysfunction, and secondary malignancies. Managing these toxicities effectively necessitates a multidisciplinary approach, involving radiation oncologists, medical physicists, radiation therapists, and supportive care teams. The latter may include members from the speech and language pathology, physiotherapy, occupational therapy, dietetics and nutritional care, social work, psycho-oncology, and dental care teams. Advanced radiation delivery and imaging techniques, such as volumetric modulated arc therapy (VMAT) and image guided radiation therapy (IGRT) particularly the recent developments in magnetic resonance-guided radiotherapy (MRgRT), offer improved sparing of healthy tissues, thereby reducing the incidence and severity of acute toxicities. Pre-treatment evaluation is also essential in identifying individuals at higher risk of developing toxicities, allowing for tailored interventions and patient education aimed at mitigating potential adverse effects. The two main approaches to addressing acute toxicities are supportive care and symptomatic relief. Medications, topicals, nutritional support, and lifestyle changes are frequently employed to reduce symptoms and increase a patient's tolerance to treatments. Additionally, interventions targeting specific toxicities, such as specialized skincare regimens for radiation-induced dermatitis; oral care and hygiene for upper gastro-intestinal mucositis; dietary assessments; and minor changes in nutritional and fluid intake for lower gastro-intestinal and urinary toxicities, can significantly improve patients' quality of life during treatment. Addressing late toxicities presents unique challenges due to their delayed onset and potential for cumulative damage. Long-term surveillance and proactive management strategies are essential for early detection and intervention. The implementation of prehabilitation and rehabilitation programs early on can also lead to enhanced outcomes, potentially postponing or preventing the development of specific acute and late toxicities. The addition of concurrent treatment with other modalities, including chemotherapy, immunotherapy and targeted agents, introduces additional complexities in managing treatment-related toxicities. Although there are promising opportunities for these modalities to work in combination with radiation therapy, they also have distinct toxicity profiles resulting in the need for specialised management techniques. To optimise therapeutic outcomes and reduce side effects, it is essential to comprehend how various modalities interact and how that affects toxicities. In radiation oncology, there are still a number of obstacles to overcome in the management of treatment-related toxicities. Prominent areas of concern continue to include limited prediction tools, inter-patient variability, and the need for additional research to define the best management techniques. In order to customise interventions more