2025 ACRO Summit Shows ‘Amazing Prospects’ in Radiation Oncology

Brandon Mancini, MD, MBA, FACRO, medical director at BAMF Health and clinical associate professor at the Michigan State University College of Human Medicine

Brandon Mancini, MD, MBA, FACRO, medical director at BAMF Health and clinical associate professor at the Michigan State University College of Human Medicine, spoke with CancerNetwork® about takeaways from the 2025 American College of Radiation Oncology (ACRO) Summit following his attendance of the meeting. He also discussed challenges and prospects related to the field of radiation oncology, particularly those related to theranostics and radiopharmaceuticals, of which Mancini specializes in.

Mancini initially discussed challenges that healthcare professionals in the radiation oncology field are facing, emphasizing cost-cutting measures for patients and proving radiation oncology’s feasibility. He additionally highlighted clinical developments in combining radiation therapy with systemic therapies, as well as novel technologies impacting the delivery of radiation in patients.

Highlighting the applicability of the presentations given at ACRO, Mancini espoused the ability of these sessions in providing advanced techniques to community oncologists that they can bring to their practice immediately. He further discussed his own contributions to ACRO, touching upon his involvement in program-building for newer practitioners as well as his involvement in ACRO Sharing Excellence Among Leaders (SEAL) to inform colleagues about radiopharmaceutical delivery and the prospect of theranostics.

Mancini then touched upon treatment or research he believed could transform clinical practice, highlighting the specificity and adaptability of radiation oncology, the emergence and ongoing development of theranostics, and a dedicated session to benign diseases presented at ACRO. Mancini concluded by reiterating the potential of theranostics and radiopharmaceuticals to enhance patient outcomes.

CancerNetwork®: What are some challenges related to radiation oncology that healthcare professionals are currently facing?

Mancini: One of the major challenges, which is not specific to radiation oncology but [one that] gets brought up every year, is the potential for Medicare cost cutting for reimbursement. The value of radiation oncology in treating patients with cancer is quite high, and to do so, fair reimbursement is important across that space.

From a clinical perspective, radiation oncology has its unique focus within the oncologic care of a patient. There are [many] instances where certain trials or treatment regimens are trying to minimize the use of radiation therapy for certain disease entities to mitigate [adverse] effects that patients might experience and to ensure that we are not overtreating cancers or creating problems that could manifest in the future. One of the concerns in radiation oncology is continuing to prove its worth and demonstrate its safety, efficacy, and usefulness across an array of cancers and benign conditions as medicine in general and oncologic care continue to evolve in that precision-based, personalized focus for patients moving forward.

What ongoing clinical trials evaluating radiation-based therapies in patients with cancer appear promising?

Mancini: Much of the focus within radiation therapy at the present time is participating in the personalization of therapy, whether that [involves] combinations with targeted therapies, immunotherapies, or other systemic [agents]. Whether that is utilizing genomic or genetic tests to understand how much radiation therapy someone needs....There is the utilization of genomic classifiers to assist with better personalizing the treatment algorithm for patients undergoing curative intent radiation therapy.

There are investigations into different technologies that we use [such as] ongoing trials within proton and photon radiotherapy and opportunities for using types of linear accelerators or radiation therapy delivery hardware to see if CT- or MRI-based delivery of care can be different. [These trials may show] whether MRI aids in the specificity that either improves outcomes or decreases [adverse] effects. Combination therapy personalization tends to be the theme for many of the trials that are within this space. It is all for the betterment of the patient as new therapies come out from a systemic treatment perspective within the field of medical oncology and beyond. Then, it is incorporating those with radiation therapy to understand how that compares to what we know is [currently] standard of care. [It is] exciting in the sense of personalization, specification, getting better with our treatment, better outcomes, [fewer adverse] effects, and [improving] patient curability [and] long-term [outcomes] from these therapies.

Were there any points brought up while attending the ACRO Summit that resonated with you?

Mancini: ACRO does an outstanding job at creating experiences that are immediately applicable to everyday life and practice within the field of radiation oncology. A few interesting topics include things like SFRT, which is something that is quite new and not commonly delivered across most centers. That is being investigated as a useful tool for large or radio-resistant tumors. It is a different approach than what we are classically doing in radiation therapy, where you are intentionally treating tumors with a non-uniform dose. It is creating opportunities for the usefulness of treatment that may allow long-term improvement in outcomes for patients.

Other things that came up were combination therapies. Like in the clinical trial space where combination therapies, immunotherapy, and different systemic treatments are coming into play, how those interact with radiation and the overview of the latest and greatest trials within every disease site is important, whether that is small cell lung cancer, cervical cancer, or beyond. All the presenters did an incredible job at [reviewing] where the field has been, where it currently is, and where it is going. They gave the tips and tricks on how to directly apply the knowledge that was delivered throughout these presentations to someone's practice when they return to work the next day.

Within the space, [clinicians are] trying to get people more comfortable with partial breast irradiation, for example, where you are improving in your [delivery of] safe treatment in fewer visits than what women are accustomed to in breast radiation therapy. That has evidence in support of it for certain patient populations but has not been as fast to be implemented. This was a practical presentation that said, “Do not be scared of this. This is something that is good. Here are the data. Here is how you do it,” to galvanize the individuals to enable community radiation oncologists and beyond to deliver the same care, so they have the same knowledge base [and] same expertise as physicians who dedicate their whole lives in an academic setting to these disease statuses. [Quite] exciting, practical, and impactful information every day.

Was there any research presented at ACRO that you were a part of? What were the most important takeaways from that work?

Mancini: At ACRO, [many] of my contributions this year focused on new practitioners, which are physicians who are a few years out [of school] and starting to practice on their own. I primarily utilize theranostics or radiopharmaceutical therapy in my practice. Participating and delivering a talk or presentation to those individuals on what theranostics is and where it is going, as well as discussing unique career opportunities within radiation oncology and beyond for people who are trained in therapeutic radiology and radiation oncology, brought up a lot of good discussion.

I was also able to participate in the ACRO SEAL portion of the conference, where I delivered a presentation on theranostics in the sense of setting up a program––certain important attributes of a radiopharmaceutical program that can be directly implemented into multiple different clinics or centers across the country. I had an outstanding panel with a physicist and administrator, going into the weeds of how to do appropriate radiopharmaceutical treatment delivery, the important aspects to consider when building a program, and how to assist both the near-term and long-term prospects of theranostics as a part of a radiation oncology clinic and center.

What other developments in radiation oncology treatment or research have the potential to transform clinical practice?

Mancini: From a transformation perspective of clinical practice, the ability to continue to hone our practice from a specificity of therapy and safety is incredible. There are a number of techniques that are at different stages of development, but MRI-guided radiation therapy is something unique and has been shown to have an improved [adverse] effect profile so far in prostate cancer and other disease sites. Another exciting development is adaptive radiation therapy, which was also a part of ACRO, which is literally changing the plan or [treatment delivery method], potentially on a daily basis for an individual, based on changing tumor size, anatomy, and different factors.

[Another exciting aspect] is the field of theranostics, [which relate to] targeted radiation medicines that are injected peripherally as a systemic therapy. There are 2 FDA-approved products in prostate cancer and neuroendocrine tumors, but the utility of those therapies are going to continue to expand with a large number of patients going to be eligible for those treatments in the near future.^1,2 Because radiopharmaceutical treatments are something that our field has historically participated extensively in, energizing individuals to continue to have interest in that field and play a part is exciting.

Another buzz field or phrase within radiation oncology is the treatment of benign diseases like osteoarthritis. There has been a lot of excitement in the field on that, specifically. ACRO did a great job of incorporating that into this meeting by having a dedicated session on the data that exist and then how to implement those in clinical practice immediately.

[ACRO] is a great organization in the sense that you are getting exposure to all of that from a practical standpoint. There are so [many] amazing prospects within radiation oncology moving forward.

Is there anything related to the conference or radiation oncology as a field that you would like to highlight?

Mancini: At this time, I am more biased because of that transition into the theranostics space, but it is incredibly exciting. Most of what we do is external beam radiation therapy or brachytherapy, so something that we plan from the outside-in. [It involves] radiation beams crossing tissues and getting to where they need to go to create positive outcomes or physically implanting brachytherapy seeds or catheters to get radiation to where it needs to go.

Theranostics in radiopharmaceutical therapy is exciting because of the unique attributes of the radiation biology, the physics that go into it, the image review of patient-specific PET scans in [ensuring] qualification, and the fact that this is something brand new for the US, specifically in the prostate cancer space, which is just 3 years old here. The anticipation for change in the years and decades ahead is enormous, and that should make [many] radiation oncologists excited to participate in that. Even for patients who do have stage IV malignancies or metastatic disease, we can still play a role with our thorough oncologic training and our knowledge of radiation biology and physics. We can still [play a solid] role, not only in external beam palliation of symptomatic lesions, but in creating meaningful quality and quantity of time for patients by using these targeted radiopharmaceuticals as a part of our practice.

One of the most valuable aspects of that is the longevity that you have with the patient. Then, from a relationship perspective, you [can] play that bigger role for longer. There is so much research within that space. There are endless clinical trials; there is disease site expansion to [many] different tumors. It is incredibly exciting because it is not frequent that something new and innovative [suddenly] hits a home run in the sense of an offering in oncologic care that radiation oncologists are a part of. It is something with a ton of potential opportunity within the space, and we should all be excited for that.

References

1. FDA approves Pluvicto for metastatic castration-resistant prostate cancer. News release. FDA. March 23, 2022. Accessed March 25, 2025. https://tinyurl.com/ypshufms
2. FDA approves new treatment for certain digestive tract cancers. News release. FDA. January 26, 2018. Accessed March 25, 2025. https://tinyurl.com/kzsbn4hj