Optimizing Opportunities to Deliver Personalized Radiation Oncology Care

During a visit to Sibley Memorial Hospital, part of Johns Hopkins Medicine, CancerNetwork^® spoke with Rachit Kumar, MD, and Curtiland Deville Jr., MD, about the radiotherapy modalities their institution offers to improve outcomes among patients with different types of cancer.

Kumar, assistant professor of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins School of Medicine, highlighted the availability of external photon radiation, proton therapy, brachytherapy, and other options to treat patients. Additionally, he emphasized using the “right technology” on the “right patient” as part of ensuring individualized treatment plans.

Deville Jr., medical director of the Johns Hopkins Proton Therapy Center and clinical director of Radiation Oncology at Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital, described the benefits of these technologies as they particularly relate to prostate cancer management. He also discussed the use of radiopharmaceutical agents and prostate-specific membrane antigen (PSMA)-based therapy to improve outcomes for certain prostate cancer populations.

Transcript:

Kumar: We have the privilege and the benefit of [having] a variety of different options for our patients. Those would include standard external photon radiation, which is probably the most common way that photon radiation is delivered. Additionally, we have a technology called proton radiation, which is the use of a particle to deliver radiation therapy. Additionally, we use what’s called brachytherapy, which is internal radiation as opposed to external radiation, which comes from the outside-in. These different tools that we have can be used in some combination of one or the other. Sometimes we use them together. It depends on the cancer type and the cancer stage; how extensive is the cancer? What’s the purpose of what we’re doing?

What we want to do, as obvious as it may sound is try to use the right technology on the right patient. Many patients will come in and say, "I’ve read about this great technology. Can I use this? Does this apply to me?" Part of the important task that we have is to help break that down for patients and to say, "Yes, we have a variety of different options, but of those different options, here is the best one for you, and here’s why."

Deville Jr.: [Radiotherapy modalities include] proton therapy, stereotactic radiation, brachytherapy, and our use of both low-dose rate and high-dose rate—there’s an increasing trend towards more high-dose-rate—brachytherapy. The benefits for something like prostate cancer are that they can treat more [patients with] advanced disease who may have an invasion of the seminal vesicles. [In patients who are] more high risk, the dosing can be better controlled in some cases when delivery is done. Then, most importantly, the patient does not go home with radiation in their body. They don’t have implanted seeds, so there’s fewer radiation precautions. [The use of] that is increasing, and we do offer that treatment here now at Sibley.

Another main treatment for radiation is the use of radiopharmaceuticals. There is a treatment called radium-223 and now lutetium therapy—PSMA-based therapy—which we use for patients on the other end of the spectrum where they have not localized disease but metastatic disease that has become systemic and spread through the body. PSMA therapy was approved in the US very recently, a few years ago, and we’re pleased to be able to offer it here now for patients with metastatic prostate cancer that is progressing through other therapies like chemotherapy and hormonal therapy. There are many studies that are now studying it earlier in the disease course spectrum, so we may soon be offering it for patients, not just when they progress through other therapies, but upfront earlier on. There are very promising data coming out, so there’s more to come in the use of our radiopharmaceutical treatments.