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Scientists at Yale School of Medicine design a virus to treat ovarian cancer

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Marisa Peryer, Senior Photographer

A new Yale study showed that certain genetically modified viruses can cure ovarian cancer in mice. It may be of use in the treatment of ovarian cancer in humans.

Researchers at the Yale School of Medicine have tested a chimeric virus — containing genes from two different viruses — that can selectively infect and kill ovarian cancer cells in mice. Their findings represent a potential breakthrough in the long-term treatment of ovarian cancer in humans. The study was published in the journal Virology on Nov. 12, two weeks after the death of the paper’s lead author Anthony Van den Pol, former professor of neurosurgery and psychiatry at Yale.

“Every year, around 20,000 women are diagnosed with ovarian cancer, which is a smaller number compared to cancer types such as breast cancer,” said Gil Mor, the scientific director of the C.S. Mott Center for Human Growth and Development at Wayne State University and a co-author of the paper. “However, unfortunately only around 4,000 of those women can survive the disease.”

The main reason behind the lethality of ovarian cancer is the lack of treatments preventing the recurrence of the disease. In 80 percent of cases, patients who respond positively to chemotherapy still experience a return of the disease, according to Mor. He explained that once the cancer comes back and begins to spread, there is little that doctors can do.

The inspiration for the study was born out of a collaboration between Van den Pol and Mor many years ago, when they worked in adjacent labs at the Yale School of Medicine. Van den Pol, a research scientist in the Neurosurgery Department, had concentrated his research on the long-term treatment of brain tumors. Mor, on the other hand, had been working on treatments for ovarian cancer. The two scientists decided to collaborate to find an alternative treatment for ovarian cancer through oncolytic viruses, which selectively infect and kill cancer cells.

In the experiment’s in vitro phase, in which the research takes place in laboratory tubes or petri dishes without a living component, researchers made a virus called Lassa-VSV in the laboratory. Lassa-VSV consists of three parts: the Lassa virus, the vesicular stomatitis virus, or VSV, and a fluorescent label to facilitate tracing, according to Nazli Albayrak, a scientist who was involved in the in vitro phase. During this phase, the team infected different ovarian cancer cell lines, eventually choosing the ones that were infected most frequently to proceed with the research. 

Then, after deciding on the cell line, the team injected tumor cells into the bodies of the mice, the paper explains. As the tumor cells began to replicate, the team then injected the Lassa-VSV virus into the tumor clusters. They observed that the virus infected the tumor cells very effectively yet did not harm the healthy cells

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medicine 

Worldwide Cancer Molecular Diagnostics Industry to 2025 – Personalized Medicine and Pharmacogenomics are Driving Growth

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DUBLIN, Dec. 1, 2020 /PRNewswire/ — The “Molecular Diagnostics for Cancer – Markets, Strategies and Trends. Forecasts by Cancer Type, Including Companion Dx and by Country with Executive and Consultant Guides and COVID-19 Pandemic Recession Forecast Revisions. 2021 to 2025” report has been added to ResearchAndMarkets.com’s offering.

A market with fundamental growth factors is impacted by the COVID-19 Pandemic. Molecular Diagnostics for Cancer is positioned to directly benefit from the explosion in genomics knowledge but shifting resources to deal with the COVID emergency may interrupt growth. Learn all about it in this new report. the publisher includes a special segment, Cancer Companion Diagnostics, a new segment of the market that is reshaping the industry. And now over 130 companies are profiled. A range of dynamic trends are pushing market growth and company valuations.

Trends like:

  • personalized medicine
  • pharmacogenomics
  • liquid biopsy
  • emergence of new economies with large markets
  • greater understanding of the role of genetic material in Disease and Health

Working against this dynamic market are the forces of the COVID Driven Recession. The publisher’s latest numbers factor in the different COVID forces, their timing, and their effect on growth.

Exciting technical developments especially in the area of pharmacogenics hold the promise of a dynamic, growing and evolving world market that is moving out of the national and regional orientation and onto a global stage.

This report provides data that analysts and planners can use. Hundreds of pages of information including a complete list of Current 2020 United States Medicare Fee Payment Schedules to help understand test pricing in detail. Make facilities planning decisions. Forecast demand for new testing regimes or technologies. Make research investment decisions.

Assistance in providing specific growth and market size estimates for new technology tests is normally provided without additional charges. Existing laboratories and hospitals can use the information directly to forecast and plan for clinical facilities growth. Again, assistance in using the information is normally provided without additional charges, please enquire further for more information.

The report includes detailed breakouts for 18 Countries and 4 Regions. A detailed breakout for any country in the world is available to purchasers of the report.

Key Topics Covered:

1. Introduction and Market Definition

2. Market Overview
2.1 Market Participants
2.1.1 Academic Research Lab
2.1.2 Diagnostic Test Developer
2.1.3 Genomic Instrumentation Supplier
2.1.4 Pharmaceutical/Reagent Supplier
2.1.5 Independent Testing Lab
2.1.6 Public National/regional lab
2.1.7 Hospital lab
2.1.8 Physician Lab
2.1.9 Audit Body
2.1.10 Certification Body
2.2 Market Segments
2.2.1 Traditional Market Segmentation
2.2.2 Laboratory Focus and Segmentation
2.3 Industry Structure
2.3.1 Hospital Testing Share
2.3.2 Economies of Scale
2.3.3 Physician Office Lab’s
2.3.4 Physician’s and POCT

3. Market Trends
3.1 Factors Driving Growth
3.1.1 New Diagnostics Create New Markets
3.1.2 New Roles for Diagnostics
3.1.3 Longevity and Outcomes
3.1.3 Expanding the Pharmaceutical Toolbox
3.1.4 Regulatory Retreat
3.2 Factors Limiting Growth
3.2.1 Falling Prices
3.2.2 Lower Costs
3.2.3 COVID Pandemic
3.2.4 Wellness has a Downside
3.3 Instrumentation and Automation
3.3.1 Instruments Key to Market Share
3.3.2 Bioinformatics Plays a Role

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medicine 

Worldwide Cancer Molecular Diagnostics Industry to 2025

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DUBLIN, Dec. 1, 2020 /PRNewswire/ — The “Molecular Diagnostics for Cancer – Markets, Strategies and Trends. Forecasts by Cancer Type, Including Companion Dx and by Country with Executive and Consultant Guides and COVID-19 Pandemic Recession Forecast Revisions. 2021 to 2025” report has been added to ResearchAndMarkets.com’s offering.

A market with fundamental growth factors is impacted by the COVID-19 Pandemic. Molecular Diagnostics for Cancer is positioned to directly benefit from the explosion in genomics knowledge but shifting resources to deal with the COVID emergency may interrupt growth. Learn all about it in this new report. the publisher includes a special segment, Cancer Companion Diagnostics, a new segment of the market that is reshaping the industry. And now over 130 companies are profiled. A range of dynamic trends are pushing market growth and company valuations.

Trends like:

  • personalized medicine
  • pharmacogenomics
  • liquid biopsy
  • emergence of new economies with large markets
  • greater understanding of the role of genetic material in Disease and Health

Working against this dynamic market are the forces of the COVID Driven Recession. The publisher’s latest numbers factor in the different COVID forces, their timing, and their effect on growth.

Exciting technical developments especially in the area of pharmacogenics hold the promise of a dynamic, growing and evolving world market that is moving out of the national and regional orientation and onto a global stage.

This report provides data that analysts and planners can use. Hundreds of pages of information including a complete list of Current 2020 United States Medicare Fee Payment Schedules to help understand test pricing in detail. Make facilities planning decisions. Forecast demand for new testing regimes or technologies. Make research investment decisions.

Assistance in providing specific growth and market size estimates for new technology tests is normally provided without additional charges. Existing laboratories and hospitals can use the information directly to forecast and plan for clinical facilities growth. Again, assistance in using the information is normally provided without additional charges, please enquire further for more information.

The report includes detailed breakouts for 18 Countries and 4 Regions. A detailed breakout for any country in the world is available to purchasers of the report.

Key Topics Covered:

1. Introduction and Market Definition

2. Market Overview
2.1 Market Participants
2.1.1 Academic Research Lab
2.1.2 Diagnostic Test Developer
2.1.3 Genomic Instrumentation Supplier
2.1.4 Pharmaceutical/Reagent Supplier
2.1.5 Independent Testing Lab
2.1.6 Public National/regional lab
2.1.7 Hospital lab
2.1.8 Physician Lab
2.1.9 Audit Body
2.1.10 Certification Body
2.2 Market Segments
2.2.1 Traditional Market Segmentation
2.2.2 Laboratory Focus and Segmentation
2.3 Industry Structure
2.3.1 Hospital Testing Share
2.3.2 Economies of Scale
2.3.3 Physician Office Lab’s
2.3.4 Physician’s and POCT

3. Market Trends
3.1 Factors Driving Growth
3.1.1 New Diagnostics Create New Markets
3.1.2 New Roles for Diagnostics
3.1.3 Longevity and Outcomes
3.1.3 Expanding the Pharmaceutical Toolbox
3.1.4 Regulatory Retreat
3.2 Factors Limiting Growth
3.2.1 Falling Prices
3.2.2 Lower Costs
3.2.3 COVID Pandemic
3.2.4 Wellness has a Downside
3.3 Instrumentation and Automation
3.3.1 Instruments Key to Market Share
3.3.2 Bioinformatics Plays a Role

… Read more
medicine 

How has medicine changed in the past 20 years? A look at dementia, cancer care and chronic disease

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The 21st century began with the first draft of the human genome, and with it, the promise of immense new powers to treat, prevent and cure disease.

In high-income countries like Australia, rates of heart disease were falling, and life expectancy was rising.

Over the past two decades, lots has changed about the factors that affect our health, wellbeing and how long (and well) we live.

So what do we know now that we didn’t then, and how far have we come?

As part of Radio National’s Big 20 series, Dr Norman Swan speaks to three leaders in their field to find out what’s happened in dementia research, cancer care and chronic disease over the last 20 years.

Chronic disease has been getting worse

Dr Norman Swan talks to Professor Chris Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.

Dr Swan: Take us back to the year 2000. What was the pattern of disease?

Professor Chris Murray: In the year 2000, right before the big push globally on reducing health problems in low income settings, we were pretty much nearing the peak of the HIV epidemic and, particularly in sub-Saharan Africa, we still had a very large number of deaths under age five — 12 million or so a year.

We hadn’t yet had the big efforts to control malaria. And many middle-income countries were right in that transition from a profile of disease burden dominated by infectious diseases and starting that shift towards cancer, heart disease, chronic kidney disease.

Listen to the podcast

Hear the full interviews with Dr Norman Swan on the Health Report podcast.

Read more

In the high-income world — Australia, Europe, North America — the [disease burden] looked pretty similar. It was already heavily dominated by heart disease and cancer, chronic kidney disease, but there was less obesity back then, there was less diabetes, and we were still back in the heyday of heart disease coming down pretty rapidly.

Dr Swan: What has happened in the two decades since?

Professor Murray: We’ve seen really dramatic progress bringing down child death rates.

In a place like Niger in West Africa, the improvements are just spectacular. You’ve probably halved child death rates in that period … bringing [it] down below the 5 million mark because of antiretrovirals for HIV.

There has been real progress on controlling malaria because of bed-net programs. So just lots of progress racked up, until COVID, on a number of fronts in the low-income world.

Then at the other end of the spectrum in the high-income world, we’ve seen heart disease progress slow, and in some places reverse.

We’ve seen this steady rise of obesity and bringing with it diabetes, high blood sugar, bringing up blood pressure levels in some countries, despite all the therapies that exist for them.

In the middle-income world we’ve seen progress but we’ve seen the rise of ambient air pollution in the last two decades. It’s becoming a bigger and

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medicine 

Philip Sharp: Senior with cancer chooses between medicine and food – Entertainment – Austin American-Statesman

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Philip Sharp is battling a case of the sniffles, but, beyond that, he says he’s feeling good.

He’s got his cat of 13 years, Sweetheart. He’s talked to his daughter, Jessica, recently, and the PBS signal is still coming in strong.

You’d never know that days earlier the soft-spoken Sharp had finished his most recent round of chemotherapy treatment.

Sharp is not prone to self-pity or asking for much help. On the day in question, as he stands in his modest apartment talking to me via a Zoom connection facilitated by his case manager with Family Eldercare, Sharp expresses gratitude for the assistance he’s received and the minimal side effects of the treatments for a cancerous lesion recently removed from his bladder. He also is slated to undergo gallbladder removal surgery in the spring.

While his polite demeanor and tender nature serve as no sign for concern, the truth is that recently the 65-year-old, who lives alone with Sweetheart, was dangerously close to having to make this choice: paying for medicine or paying for food.

On lean days like those, Sharp turned to a simple diet of canned beans. You’d be hard-pressed to get him to complain about it. He will talk about food, however. The things he loves. Like a pizza loaded with meat. Tacos. And the Hungry Man meals that Jessica delivered to him recently.

Sharp has lived in Austin since 1998, and while he’s had a long tenure in town, his social circle remains limited. He turns to online chat rooms to make friends with folks his age and talk about their lifestyles, and finds joy in watching PBS shows about American history and science.

“I’m not a real socialite,” Sharp says.

Sharp, who successfully manages schizoaffective disorder through a medication regimen, studied chemistry in college. The jazz flutist also studied music, forestry and computer science but eventually cut short a college education that included stints at Stephen F. Austin University and what is now Texas State University.

“It was all so boring; I couldn’t take it anymore,” Sharp says dryly.

After a period of homelessness following a divorce and car accident, Sharp received assistance from Family Eldercare, the organization that nominated him for Season for Caring, which helped stabilize his living situation.

The nonprofit has assisted Sharp, who lives off of disability benefits, with the stress of managing his finances and staying on top of his medical appointments and mounting bills. For that, Sharp is very grateful.

“It makes me feel very comforted to know somebody is going to be there,” Sharp says.

More Season for Caring.

Source Article …

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medicine 

AI-based earlier medicine development leveraging TWCC HPC to aid cancer prediction research

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AI-based earlier medicine development leveraging TWCC HPC to aid cancer prediction research

Artificial Intelligence (AI) is shaping the future of global medical industries. The practice of medicine is changing with the development of AI methods of machine learning. As the increasing accuracy of predictive medicine, AI technology, based on analyzing patient’s medical records, is entailing predicting the probability of disease in order to either further diagnosis of disease allowing for the estimation of disease risks or significantly decrease the cost to deal with its impact upon the patient. The AI based prediction medicine is a new type of earlier medicine

Hsuan-Chia Yang, assistant professor of the Graduate Institute of Biomedical Informatics, Taipei Medical University, explains Prediction of Principle Health Threat (PROPHET) project. Led by Dr. Li Yu-Chuan, a pioneer of AI in Medicine and Medical Informatics Research, earlier medicine for fatal diseases is leveraging AI technology and data mining systems to provide a personal, real-time, accurate and manageable healthcare program. The PROPHET project provides the prediction of cancer risks and boosts the new business opportunity of start-ups. Taiwan Ministry of Science and Technology provides the funding support for this kind of projects.

Taking breast cancer detection as an example, there are 5 persons confirmed as positive out of every 1000 people screening. Applying the AI earlier medicine perdition method, the effective rate will be reduced to 5 confirmed out of 233 people check. There are 77% saving of breast cancer earlier diagnosis. The saved cost is obvious.

The basic of PROPHET project is making AI Bio-maker model using AI technology to screen cancer and provide the prediction. Transforming the patient medical records to time matrix data diagrams, the skill is setting to predict 10 kinds of cancer risks after one year time frame based on sequential medical records to develop a prediction model. Each prediction of various cancers could reach 85% AUROC (Area under the receiver operating characteristic) curves. Taiwan Healthcare insurance program preserves every citizen’s healthcare digital records of treatments and medicine usage. PROPHET takes this strength to analyze three-year personal data records to predict the cancer risks of next 12-month. These lower cost AI-based cancer predictions allow healthcare professions to participate in the decision about whether or not it is appropriate testing or detection priority for patients.

From the technical point of view, the dynamic prediction value of personal diseases is a time-dependent scenario. The time matrix combined with personal medicine usage records and various diseases could make a two dimensional health diagram. The vertical axis is thousands of variables including medicine usage, set of medical signs and symptoms. The horizontal axis is time listings based on week or month. There are about 250 thousand health diagrams to use in the AI training process to get effective prediction AI models. After requiring repeat fine-tuning in training new AI models of each cancer, it can be derived effective prediction models based on above AI Bio-marker.

However, the huge compute power to perform these AI training tasks requires huge support

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health 

‘Hidden’ Prostate Cancer on Biopsy Usually Means Good Outcome: Study | Health News

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By Robert Preidt, HealthDay Reporter

(HealthDay)

MONDAY, Nov. 23, 2020 (HealthDay News) — Negative biopsies among early-stage prostate cancer patients who’ve chosen active surveillance are associated with a low risk of disease progression, but they aren’t a sign that their cancer has completely vanished, a new study indicates.

Active surveillance refers to close monitoring for signs of cancer progression — what’s often called “watchful waiting.” Patients sometimes get regular prostate-specific antigen (PSA) testing, prostate exams, imaging and repeat biopsies.

The objective of active surveillance is to avoid or delay treatment and its side effects without putting patients at risk of cancer progression and death.

Sometimes, active surveillance patients have negative biopsies that show no evidence of prostate cancer. While some of these patients may believe that their cancer has “vanished,” they most likely have low-volume or limited, hidden areas of prostate cancer that weren’t detected in the biopsy sample, according to the authors of the study published recently in The Journal of Urology.

“While a negative biopsy is good news, the long-term implications associated with such ‘hidden’ cancers remain unclear,” said study author Dr. Carissa Chu, from the University of California, San Francisco.

For the study, Chu and colleagues analyzed data from 514 men undergoing active surveillance for early-stage prostate cancer between 2000 and 2019. All of them had at least three surveillance biopsies after their initial prostate cancer diagnosis. Median follow-up time was nearly 10 years.

Of those patients, 37% had at least one negative biopsy, including 15% with consecutive negative biopsies, according to the report.

Men with negative biopsies had more favorable disease characteristics, including low PSA density and fewer samples with cancer at the initial prostate biopsy. Negative biopsies were also associated with good long-term outcomes, the researchers said.

After 10 years, rates of survival with no need for prostate cancer treatment (such as surgery or radiation) were 84% for men with consecutive negative biopsies, 74% for those with one negative biopsy and 66% for those with no negative biopsies.

After adjusting for other factors, the researchers concluded that men with one or more negative biopsies were much less likely to have cancer detected on a later biopsy.

“For men undergoing active surveillance, negative biopsies indicate low-volume disease and lower rates of disease progression,” Chu said in a journal news release. “These ‘hidden’ cancers have excellent long-term outcomes and remain ideal for continued active surveillance.”

SOURCE: The Journal of Urology, news release, Nov. 17, 2020

Copyright © 2020 HealthDay. All rights reserved.

Source Article …

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health 

Citing cancer experience, Ron Rivera advocates for Affordable Care Act

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“We need to have the Affordable Care Act, whether in its current structure or it’s been changed or corrected or fixed or being added onto,” Rivera said. “We need to have something for the folks of the United States of America. For us not to have affordable, quality healthcare, and be the richest nation in the world, that’s kind of disappointing.”

On Monday, Rivera spoke at length about the importance of voting in Tuesday’s election, as well as democracy writ large. He said it’s been “really cool” to hear players discuss current affairs, and he noted that the spectrum of political ideologies in the locker room was “huge.” The enthusiasm for engagement was echoed in a Monday blog post by team president Jason Wright, who wrote the team believed in “big, meaningful and comprehensive community activities versus a collection of small one-off ventures.”

“For example, we will continue to have a robust set of activities around social justice because the players on our team and our employees care about those issues,” he added. “Voting is one component, but there is much more we can and will do.”

Rivera reiterated Monday the importance of participation in democracy, saying that the thing that bothers him most is when people don’t vote. In past years, Rivera has gotten up early to be one of the first people at the polls. He loves the “I voted” stickers. This year, he and his wife Stephanie and daughter Courtney filled out their ballots and put them in the mailbox. On Tuesday, he said he plans to turn the television on around 5 p.m. and click between local and national stations to monitor elections.

“People always ask me: ‘Who did you vote for?’” the coach said. “I always tell them, ‘I voted American.’ I believe I voted for who I believe is going to be the best person for us.”

After his cancer diagnosis in July, Rivera has become an advocate for improved healthcare. The coach has grown more outspoken over the last three months, and he’s sometimes gone as far to call for “universal” healthcare. The message on Monday was more tempered, framed around the ACA, but the root of his activism remains personal. Rivera, 58, is now one year older than his brother Mickey was when he died of pancreatic cancer in 2015.

This season, the coach has been limited at times by chemotherapy and other treatments. He’s thought about others in the same fight during his time in the hospital, those who might not have a five-year contract worth millions.

“After seeing what I went through, and knowing what the cost has to be, you worry about the folks that can’t afford what I had,” he said. “I almost don’t want to say it’s unfair, but it is. These folks deserve every opportunity [to receive quality healthcare]. It just kind of struck a chord with me.”

On Monday, the coach mentioned an upcoming fundraiser for Inova Health System, the Northern Virginia hospital company where

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health 

IMRT New Standard of Care for High-Risk Cervical Cancer

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For women who receive radiotherapy after undergoing hysterectomy for high-risk cervical cancer, image-guided intensity-modulated radiotherapy (IG-IMRT) is superior to three-dimensional conformal radiotherapy (3D-CRT) at reducing late gastrointestinal (GI) toxicity and is similarly efficacious, according to new findings.

“IG-IMRT should represent the new standard of care for postoperative pelvic radiation therapy in women with gynecological cancers,” said study lead author Supriya Chopra, MD, of the Tata Memorial Center in Mumbai, India.

She noted that the study, known as PARCER, is the first in gynecologic cancer to show the impact of advanced technology in reducing long-term morbidity and thus improving the experience of survivors.

At 4 years, rates of late GI toxicity of grade 2 or higher in the IG-IMRT and 3D-CRT arms were 19.2% and 36.2%, respectively (P = .005). Rates of toxicity of grade 3 or higher were 2.0% and 8.7%, respectively (P < .01).

Chopra presented the results at the American Society for Radiation Oncology (ASTRO) 2020 Annual Meeting, which was held online.

Postoperative radiotherapy is indicated for women with cervical and endometrial cancers who have high-risk features, but long-term follow-up has shown an increase in GI symptom burden and toxicity in long-term survivors after adjuvant radiotherapy.

“The uptake of IMRT has been relatively slow in gynecological cancers,” said Chopra. She explained that previous data suggested a benefit with the use of IMRT, but long-term postoperative effects were unclear.

The new data amount to a “practice-change use” of IMRT for this indication, said Sue Yom, MD, PhD, of the University of California, San Francisco, who was not involved with the study. “I see this as having potentially important future impacts on clinical practice.”

I see this as having potentially important future impacts on clinical practice.
Dr Sue Yom

Yom explained that although there have been studies in the United States on the use of postoperative IMRT for pelvic cancer, “this is the first phase 3 study that has shown definite long-term advantages with the use of IMRT, and I would consider it confirmatory.”

In 2015, the preliminary results of PARCER were presented at the plenary session at ASTRO. The results showed that patients treated with IG-IMRT had fewer late GI toxicities at a median follow-up of 20 months. However, the difference between groups was not statistically significant in this earlier analysis.

Now at 49 Months’ Follow-Up

The study was conducted in three clinical sites of Tata Memorial Center and included a total of 300 patients with cervical cancer. The patients had undergone type III hysterectomy and had intermediate- or high-risk features, or they had undergone type I/II hysterectomy necessitating adjuvant chemoradiotherapy. They were randomly assigned to IG-IMRT (n = 151) or 3D-CRT (n = 149). Most patients (117 in the IG-IMRT arm and 114 in the 3D-CRT arm) received concurrent chemotherapy.

The primary endpoint was late GI toxicity of grade 2 or higher. Follow-up included clinical and quality-of-life evaluations, which were conducted every 3 months for 2 years and then every 6 months for years 2 to

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health 

Surgery May Not Be Needed With Locally Advanced Rectal Cancer

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A short course of radiation therapy followed by neoadjuvant chemotherapy resulted in a clinical complete response (CR) in almost half of 90 patients with locally advanced rectal cancer, allowing the majority of responders to skip surgical resection, a retrospective study indicates.

Specifically, at a median follow-up of 16.6 months for living patients, the initial clinical CR was 48% overall.

“While we do not have enough follow-up yet to know the late side-effect profile of this regimen, our preliminary results are promising,” Re-I. Chin, MD, Washington University School of Medicine, St. Louis, Missouri, told Medscape Medical News in an email.

The study was presented at the virtual 2020 meeting of the American Society of Radiation Oncology (ASTRO).

“Certainly longer follow-up will be needed in this study but none of the observed patients to date has experienced an unsalvageable failure,” said meeting discussant Amol Narang, MD, of Johns Hopkins University, Baltimore, Maryland.

He reminded conference attendees that despite good evidence supporting equivalency in oncologic outcomes between short-course radiation and long-course chemoradiation, the former is “highly underutilized in the US” with a mere 1% usage rate between 2004 and 2014.

The current study’s short-course treatment approach was compared in this setting to long-course chemoradiation and adjuvant chemotherapy in the  RAPIDO trial reported at the 2020 annual meeting of the American Society of Clinical Oncology (ASCO), Narang pointed out.

Short-course patients had a higher rate of pathological complete response (pCR) and a lower rate of treatment failure compared with patients who received long course chemoradiation and adjuvant chemotherapy; both patient groups underwent total mesorectal excision — which is different from the current analysis. The RAPIDO investigators concluded that the approach featuring the short-course “can be considered as a new standard of care.”

Narang said the data collectively “begs the question as to whether the superiority of long course chemoradiation should really have to be demonstrated to justify its use.”

But Chin highlighted toxicity issues. “Historically, there have been concerns regarding toxicity with short-course radiation therapy since it requires larger doses of radiation given over a shorter period of time,” Chin explained. “But [the short course] is particularly convenient for patients since it saves them more than a month of daily trips to the radiation oncology department.”

Seven Local Failures

The single-center study involved patients with newly diagnosed, nonmetastatic rectal adenocarcinoma treated with short course radiation therapy followed by chemotherapy in 2018 and 2019. Nearly all (96%) had locally advanced disease, with either a T3/T4 tumor or node-positive disease.  Median tumor size was 4.6 cm.

“Many of the patients in the study had low lying tumors,” Chin reported, with a median distance from the anal verge of 7 cm.

Radiation therapy was delivered in 25 Gy given in five fractions over 5 consecutive days, with the option to boost the dose to 30 Gy or 35 Gy in five fractions if extra-mesorectal lymph nodes were involved. Conventional 3D or intensity-modulated radiation was used and all patients completed treatment.

The median interval between diagnosis of rectal

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