At the 2017 ASTRO Annual Meeting in San Diego, in between learning about the latest breakthroughs in radiation oncology, attendees were asked by ASTRO’s Science Council to answer the question, “What is the most important research question that needs to be answered in the next three to five years?” The goal of this exercise was not only to provoke discussion among attendees, but also to take the pulse of our membership--to survey what was on everyone’s mind as we look toward the future. Almost 100 respondents submitted answers online to the question, and five major themes emerged among the responses.
The first, and by far the most frequently mentioned single theme was “How do we best integrate immunotherapy with radiotherapy?” As immunotherapy has been THE hot topic in cancer treatment in recent years, how to incorporate radiotherapy with novel immunotherapy agents is on many people’s minds. Many of the respondents hinted that they believed that immunotherapy and radiotherapy may be synergistic (the words “enhance” and “complementary” were often used). Many clinical trials attempting to integrate radiation and immunotherapy are ongoing, and I am optimistic about the future of radiation therapy in this space.
The second most mentioned theme was generally the cost of radiation treatment and the need to prove cost effectiveness. As health care spending in the United States approaches 20 percent of our gross domestic product (GDP), proving that radiation can be a cost-effective adjunct or alternative to novel systemic agents would be of value, not only to our field, but to the fiscal health of our country.
Third, respondents thought that proving radiation effectiveness for oligometastatic disease was a key area of research. Recognizing that with metastatic disease patients are living longer, and that microscopic metastatic disease is being managed more effectively, the radiosurgical treatment of gross oligometastatic disease will become a key determinant in not only a patient’s quality of life, but perhaps overall survival, as well.
Fourth, the role of proton therapy remained on respondents’ minds. “Can we deliver robust proton therapy without degrading OAR sparing?” “Protons versus photons in prostate?” “Is proton therapy better than photon therapy?” Reflecting the rapid rise in proton therapy centers across the country, respondents thought that answering questions about the comparative effectiveness of proton beam treatment was critical for the future of our field.
Finally, more common than any single theme was either what I call “big picture” questions that were too broad to otherwise categorize or about niche subjects that were of interest to one or two respondents. The “big picture” questions centered around the personalization of radiation treatment, overcoming radioresistance, optimization of dose and fractionation and whether we could achieve treatment that minimized side effects and maximized cure—questions that we as a field have been pursuing for decades. Niche subject questions encompassed areas as diverse as artificial intelligence, to cancer survivorship, to improving international access to cancer treatment.
Based on the responses, we can rest assured that the field of radiation oncology is broad and interested in all areas of cancer research. As we approach 2020 and beyond, ASTRO looks forward to attempting to answer these questions—and perhaps more exciting, we wonder about what future questions will be asked that we can’t even imagine today.
It’s not too late to weigh in. What do you think is the most important research question that needs to be answered in the next three to five years? Let us know in the comments.