Speaker
Descrizione
Radiation oncology has benefited from the digital era by improving its performance in terms of irradiation precision and selectivity. This has enabled dose escalation to regions of interest (ROIs) and dose reduction to organs at risk (OARs), supported by the availability of Volumetric Modulated Arc Therapy (VMAT). The introduction of proton beams, carbon ions (hadrons), and boron neutron capture therapy (BNCT) has further expanded the therapeutic armamentarium, although these technologies remain challenging to disseminate widely.
A major contributor to improved clinical outcomes has been the concomitant use of cytotoxic antineoplastic agents (cisplatin, 5-fluorouracil, mitomycin, gemcitabine), which enhance DNA damage. More recently, monoclonal antibody therapies and immunotherapeutic agents have raised new questions regarding their integration with radiotherapy. High doses per fraction, exceeding 8 Gy, have been shown to elicit immunological effects and to induce cytotoxic activity at sites distant from the irradiated volume (the abscopal effect).
Accordingly, treatment strategies initially evolved through modification of target volumes and the achievement of very high doses; subsequently, attention shifted to the type of radiation employed, leveraging higher linear energy transfer (LET) and biological effective dose (BED).
More recently, research has focused on the biological effects of dose-rate modulation, driven by growing evidence that very high dose-rate irradiation can selectively damage tumor cells (the FLASH effect). The development of very high-energy electron (VHEE) beams enables replication of the FLASH effect at depths comparable to those achieved with megavoltage (MV) photon dose deposition.
Finally, radiation oncology will need to engage with emerging pharmacological evidence and the field of network medicine, marked by the decline of the “one disease–one target–one drug” paradigm. This model is being replaced by the recognition that each disease is characterized by “disease modules” composed of multiple targets shared across different diseases, which may respond to the effects of multiple drugs.
