Data-Based Radiation Oncology: Design of Clinical Trials in the Toxicity Biomarkers Era

Frontiers in Oncology
David AzriaBarry S Rosenstein

Abstract

The ability to stratify patients using a set of biomarkers, which predict that toxicity risk would allow for radiotherapy (RT) modulation and serve as a valuable tool for precision medicine and personalized RT. For patients presenting with tumors with a low risk of recurrence, modifying RT schedules to avoid toxicity would be clinically advantageous. Indeed, for the patient at low risk of developing radiation-associated toxicity, use of a hypofractionated protocol could be proposed leading to treatment time reduction and a cost-utility advantage. Conversely, for patients predicted to be at high risk for toxicity, either a more conformal form or a new technique of RT, or a multidisciplinary approach employing surgery could be included in the trial design to avoid or mitigate RT when the potential toxicity risk may be higher than the risk of disease recurrence. In addition, for patients at high risk of recurrence and low risk of toxicity, dose escalation, such as a greater boost dose, or irradiation field extensions could be considered to improve local control without severe toxicities, providing enhanced clinical benefit. In cases of high risk of toxicity, tumor control should be prioritized. In this review, toxicity biomarkers ...Continue Reading

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Citations

May 17, 2019·Journal of the National Cancer Institute·Sarah L KernsCatharine M L West
Dec 1, 2019·Nature Reviews. Clinical Oncology·David Azria, Barry S Rosenstein
Apr 21, 2018·Frontiers in Oncology·David AzriaCeline Bourgier
May 14, 2018·JCO Precision Oncology·Sophia C Kamran, Kent W Mouw
Feb 27, 2021·Deutsches Ärzteblatt International·Ulrike HoellerTheodor Hans Eich
Mar 18, 2021·World Neurosurgery·Amr M N El-ShehabySameh R Tawadros
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May 25, 2021·Deutsches Ärzteblatt International·Ulrike HoellerHans Theodor Eich
Jun 11, 2021·Acta Oncologica·Sahar AhangariAdam Espe Hansen

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Methods Mentioned

BETA
genotyping

Software Mentioned

REQUITE
TAILORED
STROGAR
CONSORT

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