Far-reaching PSA Guidelines Affect Radiation Oncologists

OncLive Chairman,

Mike Hennessy

This second issue of Contemporary Radiation Oncology covers radiation oncology issues focused on genitourinary cancer and head and neck cancers. The lead article, “Changes in Prostate Cancer Presentation for Radiation Oncology Care” by Su and colleagues addresses the 2008 decision by the US Preventive Services Task Force (USPSTF) to recommend against prostate-specific antigen (PSA) screening for men over the age of 75, and the agency’s follow-up in 2012, which recommended against PSA screening for all men. How these guidelines have affected patient presentation to radiation oncology remains unclear. The researchers note that the USPSTF guidelines may have decreased the number of patients presenting with prostate cancer for radiation oncology care, particularly those with low-risk disease, without a short-term increase in higher-risk disease. However, they recommend that future research assess the longer-term impact of these guidelines nationally.

The second genitourinary cancer manuscript focuses on the debate about organ preservation versus extirpative cystectomy. “Are Surgery and Chemotherapy Sufficient to Treat Locally Advanced Bladder Cancer?” says there is a paucity of clinical research directed toward the locoregional tumor eradication rate following surgery. The authors note that both awareness about pelvic failure following contemporary cystectomy has been raised and clinical trials to pursue the amelioration of this problem have commenced.

Head and neck cancers make this month’s issue with studies involving glottis cancer and parotid gland cancer. The authors of “Therapeutic Ratio of Hypofractionation in Early Glottic Cancer: A Topic Worth Revisiting?” state that optimal fractionation for this cancer is unclear. The study addresses the researchers’ experience at the Sylvester Comprehensive Cancer Center at the University of Miami using the therapeutic ratio of 2.25 Gy versus 2 Gy in this cancer. They found that treatment of early glottic cancer with 2.25 Gy/fraction may result in greater acute toxicity than 2 Gy/fraction without improved efficacy.

A study to determine the frequency and clinical characteristics of parotid gland metastasis and the criteria for elective inclusion of parotidean nodes in the radiotherapy clinical target volume marks the second head-and-neck cancer manuscript. “Parotid Node Metastases in Locally Advanced Nasopharyngeal and Oropharyngeal Cancer: Implications for Radiotherapy Target Volume Delineation” concluded that the ipsilateral parotidean nodes may be at risk for metastatic involvement when bulky ipsilateral level II metastases and multilevel nodal disease are co-existent, possibly due to retrograde lymphatic drainage. Inclusion of the ipsilateral parotid gland in the clinical target volume should be considered in such cases. This month’s Strategic Alliance Partnership articles highlight activities at the University of Arizona’s Center for Applied NanoBioscience and Medicine and the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale University.

The Center for Applied NanoBioscience and Medicine has developed expertise in creating new platform technologies that integrate genomic and proteomic biomarker signatures into assay platforms for molecular-based biodosimetry. These platforms can assess toxicity and tissue radio-sensitivity in order to gain knowledge about the biological mechanisms that could guide precise therapies. Researchers from COPPER collaborate across a wide spectrum of translational cancer research projects, employing expertise in clinical epidemiology, comparative effectiveness, and health services research. In addition to performing original research, COPPER provides training and mentorship to the next generation of cancer policy and outcomes researchers.