Education & History in Radiation Oncology

Panel 27 - (INTERACTIVE) When Conventional Wisdom Leads Us Astray

Moderator(s)

• DH

  Daphne Adele Haas-Kogan, MD, FASTRO

  Dana-Farber Cancer Institute

There are many examples of where conventional wisdom has led us astray as a field in radiation oncology. In evaluating such examples, three recurring themes emerge. First, treatment intensification and de-intensification with the purpose of improving outcomes can lead to surprising, sometimes inferior results. Examples include dose de-escalation in the search for lesser treatment toxicity trials in rhabdomyosarcoma and medulloblastoma in pediatric oncology. On the other hand, examples in non-small lung cancer illustrate that dose escalation and treatment intensification can also lead to inferior outcomes. A second theme is the pitfalls that can arise in the application of new technologies. The initial experiences of IMRT in mesothelioma illustrate the risks of applying new technology to patient care, and the need for caution in such endeavors. This theme continues to be important as the use of particle therapy expands globally. Third, issues with the design or misinterpretation of clinical trials represents another recurrent theme where conventional wisdom has led us astray. An example of this is the use of surrogate endpoints, as seen in early phase trials of bevacizumab in glioblastoma, which demonstrated a robust progression-free survival benefit in part due to treatment-associated changes in imaging without anti-tumor effect.

Learning Objectives:

• Describe examples of treatment intensification or deintensification that has led to inferior patient outcomes in radiation oncology
• Explain the need for caution in applying new technological advances towards patient care in radiation oncology
• Critically analyze the design, methods and interpretation of clinical trials to better contextualize results of a given trial

Presentations:

• 1:15 PM - 1:20 PM

  Introduction
  Speaker: Daphne Adele Haas-Kogan, MD, FASTRO – Dana-Farber Cancer Institute
  
• 1:20 PM - 1:35 PM

  Imprudent attempts of treatment intensification and de-intensification
  Speaker: Stephanie Terezakis, MD – University of Minnesota
  
• 1:35 PM - 1:50 PM

  Pitfalls in the application of new technology in radiation oncology
  Speaker: Jona Hattangadi-Gluth, MD – University of California, San Diego
  
• 1:50 PM - 2:05 PM

  Missteps in the design or analysis of clinical trials
  Speaker: Rifaquat Rahman, MD, BA – Brigham and Women's Hospital
  
• 2:05 PM - 2:20 PM

  Wrap-up: Learning from the past to inform the future
  Speaker: Daphne Adele Haas-Kogan, MD, FASTRO – Dana-Farber Cancer Institute
  
• 2:20 PM - 2:30 PM

  Audience Q&A
  Speaker: Daphne Adele Haas-Kogan, MD, FASTRO – Dana-Farber Cancer Institute