Highlights From the American Society for Radiation Oncology 2014 Annual Meeticonfereng

The annual meeting of the American Society for Radiation Oncology (ASTRO) took place in San Francisco, California, on September 14-17, 2014. The meeting draws more than 11,000 attendees, bringing together clinicians, scientists, and researchers from all oncology disciplines. ASTRO highlights how technology and biology advance the field of radiation oncology and improve outcomes and quality of life for patients. As ASTRO’s needs statement for the annual meeting points out, nearly two-thirds of the estimated 1.6 million people who will be diagnosed with cancer this year will receive radiation therapy - this makes it imperative that all members of the multidisciplinary team be aware of best practices. Below are summaries of some highlights from the meeting.

ASTRO’s Choosing Wisely List
Continuing its participation in the American Board of Internal Medicine’s Choosing Wisely campaign, ASTRO released its second list of 5 radiation treatments that should be questioned and not used routinely in clinical practice.

The 2014 list follows:

• Don’t recommend radiation following hysterectomy for endometrial cancer patients with low-risk disease.
• Don’t routinely offer radiation therapy for patients who have resected non–small cell lung cancer (NSCLC), negative margins, N0-1 disease.
• Don’t initiate noncurative radiation therapy without defining the goals of treatment with the patient and considering palliative care.
• Don’t routinely recommend follow-up mammograms more often than annually for women who have had radiotherapy following breast conserving surgery.
• Don’t routinely add adjuvant whole brain radiation to stereotactic radiosurgery for limited brain metastases.

Along with ASTRO’s 2013 list, this totals 10 radiation treatments that should not be used routinely without thorough discussion between patients and physicians.

ASTRO’s 2013 Choosing Wisely list included these recommendations:

• Don’t initiate whole breast radiotherapy as a part of breast conservation therapy in women age ≥50 with early stage invasive breast cancer without considering shorter treatment schedules.
• Don’t initiate management of low-risk prostate cancer without discussing active surveillance.
• Don’t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases.
• Don’t routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry.
• Don’t routinely use intensity-modulated radiotherapy (IMRT) to deliver whole breast radiotherapy as part of breast conservation therapy.

2014 ASTRO President Bruce Haffty, MD, was quick to note that there are specific circumstances where these treatments are warranted but said that they should not be prescribed routinely. He also noted that there is some evidence that clinical practice has shifted as a result of the campaign.

Choosing Wisely is aimed at reducing unnecessary healthcare expenditures while at the same time providing appropriate high-quality care. To see all the recommendations from medical societies in the United States, go to www.choosingwisely.org.