Seminars in Radiation Oncology RSS feed: Current Issue. Each issue of Seminars in Radiation Oncology is compiled by a guest editor to address a specific topic in the specialty, presenting definitive information on areas of rapid change and development. A significant number of articles report new scientific information. Topics covered include tumor biology, diagnosis, medical and surgical management of the patient, and new technologies. Seminars in Radiation Oncology has an Impact Factor of 4.312 and is ranked 10th of 90 journals in Radiology, Nuclear Medicine & Medical Imaging category and 38th of 141 in Oncology category on the 2009 Journal Citation Reports®, published by Thomson Reuters. 2009 Topics , Volume 19, Issues 1-4 January Head and Neck Cancer David Brizel, MD April Stem Cells in Radiation Oncology Dick Hill, PhD July High-Grade Glioma Kevin Camphausen, MD October Locally Advanced Breast Cancer Tom Buchholz, MDhttp://www.semradonc.com/?rss=yesElsevier Inc.en © 2010 Elsevier Inc. All rights reserved. Seminars in Radiation Oncology1053-4296201January 2010 © 2010 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semradonc.com/article/PIIS1053429609000605/abstract?rss=yes“Youth is a gift of nature, Age is a work of art.”Helen M. Carrall For those of us who care for patients with cancer, and struggle to understand its nature, the myriad of issues complicating that quest requires dissection. The biological imperative of aging is one such issue. In this edition of Seminars in Radiation Oncology, more than 20 scientists and clinicians discuss the vagaries of cancer across the age spectrum. Although we provide evidence where it exists, we also speculate on that which is incompletely understood. Some of the questions we address include:Introduction: The Ageless Quest to Understand Aging, but with a Malignant TwistLouis S. Constine10.1016/j.semradonc.2009.08.002Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-612http://www.semradonc.com/article/PIIS1053429609000617/abstract?rss=yesCancer genesis across the age spectrum is a complex, multifactorial process, and parallels changes in site-specific tissue development, maintenance, and senescence. Cancer is not a single disease, and different tumor and stem cells may demonstrate various manifestations of abnormal function. Mutations in DNA, some random and some explained by exogenous insults, accompanied by changes in the tissue microenvironment, generally precede the onset of aberrant replication and apoptosis. Moreover, increasing evidence suggests that genetic programs normally active only during development of human beings may be reactivated during tumorigenesis. The complicated underlying biology of human growth, development, and carcinogenesis is reflected in the highly disparate patterns in site-specific cancer incidence rates across age groups. In childhood, the peak years of an organ system's increase in size correlate with peak years of cancer incidence. Conversely, in most adult-onset cancers, it is exposure to exogenous toxins, the failure of maintenance and repair, and finally, dysfunction(s) in the normal cellular aging process that likely play a role in the development of these malignancies. Additional basic science investigations and epidemiologic studies will assist in our understanding of the mechanisms that underlie the notable difference in site-specific cancer incidence according to age.Cancer Genesis Across the Age Spectrum: Associations With Tissue Development, Maintenance, and SenescencePhilip Rubin, Jacqueline P. Williams, Susan S. Devesa, Lois B. Travis, Louis S. Constine10.1016/j.semradonc.2009.08.001Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-6311http://www.semradonc.com/article/PIIS1053429609000629/abstract?rss=yesLate effects in normal tissues following radiotherapy vary across the age spectrum. It seems that sensitivity to radiation injury is a function of the developmental dynamics and status of the organ, its regenerative potential, and ultimately the extent to which it has begun to senesce. For instance, organ maturational processes in children can be impaired or even disabled by radiation therapy, leading to a spectrum of effects that differ from those in adults, in which the capacity and means for tissues to repair damage are the predominant predictor for chronic injury. Thus, radiation-induced impairment of growth and maturation is unique to children, whereas organ damage, with tissue-specific dysfunction in repair processes, is common to both children and adults. Finally, the susceptibility to late effects in the elderly seems to involve not only a decline in their ability to repair damage, but also cell attrition, all intertwined with effects of comorbid illness that are frequent in this age group. The challenge for clinicians is to understand these differences in the sensitivity to radiation damage with respect to age to formulate a basis for modulating therapy that can rationally minimize late effects and maximize a survivor's quality of life.Normal Tissue Development, Homeostasis, Senescence, and the Sensitivity to Radiation Injury Across the Age SpectrumArnold C. Paulino, Louis S. Constine, Philip Rubin, Jacqueline P. Williams10.1016/j.semradonc.2009.08.003Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-61220http://www.semradonc.com/article/PIIS1053429609000630/abstract?rss=yesRadiation related effects in children and adults limit the delivery of effective radiation doses and result in long-term morbidity affecting function and quality of life. Improvements in our understanding of the etiology and biology of these effects, including the influence of clinical variables, dosimetric factors, and the underlying biological processes have made treatment safer and more efficacious. However, the approach to studying and understanding these effects differs between children and adults. Using the pulmonary and skeletal organ systems as examples, comparisons are made across the age spectrum for radiation related effects, including pneumonitis, pulmonary fibrosis, osteonecrosis, and fracture. Methods for dosimetric analysis, incorporation of imaging and biology as well a length of follow-up are compared, contrasted, and discussed for both organ systems in children and adults. Better understanding of each age specific approach and how it differs may improve our ability to study late effects of radiation across the ages.Radiation-Related Treatment Effects Across the Age Spectrum: Differences and Similarities or What the Old and Young Can Learn from Each OtherMatthew J. Krasin, Louis S. Constine, Debra L. Friedman, Lawrence B. Marks10.1016/j.semradonc.2009.09.001Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-62129http://www.semradonc.com/article/PIIS105342960900068X/abstract?rss=yesThe treatment of Hodgkin lymphoma is one of the success stories of modern medicine. There is a unified pathologic classification schema, a noninvasive staging evaluation and an increasingly sophisticated approach to therapy with risk and response adapted therapies in pediatric and adult patient populations. Survival rates have continued to improve while treatment modifications to decrease late effects are studied across all populations. However, a strong age gradient exists with respect to patient outcomes with younger patients faring somewhat better than their adult counterparts and older adults faring significantly worse. There has been a growing appreciation for the differences in epidemiology across age groups and the potential differences in disease biology. Novel approaches to prognostic stratification and therapy on the basis of these differences may be necessary to maximize cure and minimize late effects across the ages.Hodgkin Lymphoma Across the Age Spectrum: Epidemiology, Therapy, and Late EffectsAngela Punnett, Richard W. Tsang, David C. Hodgson10.1016/j.semradonc.2009.09.006Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-63044http://www.semradonc.com/article/PIIS1053429609000642/abstract?rss=yesIn most cancers, the age of the affected patient has a significant influence on how that cancer is approached. This is less often the case in sarcomas in that both children and adults are treated similarly. However, different types of sarcomas are most typical in these populations, and our understanding of these cancers in one group has provided direction for understanding them in the other group. For example, advances at the molecular level in Ewing sarcoma, a disease that affects predominantly children, helped spearhead the uncovering of several signature translocations in adult sarcomas, such as synovial sarcoma and myxoid liposarcomas. The success of chemotherapy in pediatric sarcomas continues to be a benchmark for adult sarcomas to emulate. Conversely, the demonstration of the viability of limb-sparing surgery combined with adjuvant radiation in adult extremity sarcomas helped advance that treatment approach in pediatric sarcomas. To illustrate some of these concepts and to enhance our understanding of sarcomas across the age spectrum, 4 types of sarcoma are discussed. The first 2 are Ewing sarcoma and rhabdomyosarcoma seen mainly, but not exclusively, in children. The other 2 are synovial sarcoma, which can be looked at as a bridge between pediatric and adult sarcomas as it affects mainly young adults, and liposarcoma that is almost exclusively an adult sarcoma.Sarcomas Across the Age SpectrumSuzanne L. Wolden, Kaled M. Alektiar10.1016/j.semradonc.2009.09.003Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-64551http://www.semradonc.com/article/PIIS1053429609000654/abstract?rss=yesCarcinomas of the head and neck occur in both children and adults, but notable differences exist in their relative frequency, pathologic subtypes, etiologies, presenting symptoms, and late effects. In contrast, treatment strategies are similar depending on the disease type and distribution at the time of diagnosis. Thus, in adult patients, squamous cell carcinomas or one of its variants are the most common malignancies in the head and neck. However, in children, cancers of the head/neck are most commonly rhabdomyosarcomas, lymphomas, including Hodgkin's lymphoma, lymphoblastic lymphomas, and Burkitt's lymphoma or neuroblastoma. Epithelial cancers are unusual in the pediatric population, with the exception of nasopharyngeal carcinoma. Although nasopharyngeal carcinoma is a rare disease in children, representing less than 1% of childhood cancers, it does constitute 20%-50% of pediatric malignancies of the nasopharynx. This is one of the few malignant tumors in children that arise from the epithelium. Despite the differences between the diseases in children from that in adults, the management strategy has been based largely on the experience in adults. This review will describe the epidemiology, etiology, management, and late effects in children and adults, and offer explanations for both the similarities and differences.Head and Neck Carcinomas Across the Age Spectrum: Epidemiology, Therapy, and Late EffectsKaren J. Marcus, Roy B. Tishler10.1016/j.semradonc.2009.09.004Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-65257http://www.semradonc.com/article/PIIS1053429609000666/abstract?rss=yesThe clinical difference between brain tumors in adults and children is striking. Compared with adults, pediatric tumor types (mostly glial and neuronal) are more sensitive to adjuvant irradiation and chemotherapy. Pediatric tumors more often require craniospinal irradiation based on their propensity to disseminate within the neuraxis. The spectrum of side effects is broader in the child based on age and extent of treatment: radiation therapy brings increased risk of severe long-term sequelae affecting neurologic, endocrine, and cognitive function. In this review of glioma, ependymoma, and medulloblastoma, we highlight the differences between adults and children, including the higher incidence of spinal cord ependymoma and supratentorial high-grade glioma in the adult and a higher incidence of medulloblastoma in the child. With the exception of completely resected low-grade glioma, radiation therapy remains a standard of care for most patients. In some settings, the radiation oncologist should suggest further surgery or additional adjuvant therapy in an effort to optimize local tumor control. An effort is underway to better characterize adult and pediatric brain tumors biologically with an emphasis on improving our understanding of tumor genesis, malignant transformation, and some of the similarities and differences between tumor types and their response to conventional therapy.Brain Tumors Across the Age Spectrum: Biology, Therapy, and Late EffectsThomas E. Merchant, Ian F. Pollack, Jay S. Loeffler10.1016/j.semradonc.2009.09.005Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-65866http://www.semradonc.com/article/PIIS1053429609000678/abstract?rss=yesDevelopment of a second malignancy is one of the most serious late effects in survivors of both childhood and adult-onset cancers. Patterns of second malignancy risk across the age spectrum can differ in terms of the types of second malignancies observed, magnitude of the risks, the latency period, associated risk factors, and modifying influences. Potential explanations for the varying risk patterns by age include differences in susceptibility of individual tissue/organ to carcinogenesis based on stage of development and level of tissue maturity, microenvironment, attained age, and lifestyle factors. A thorough understanding of these differences is essential when considering treatment modifications in newly diagnosed cancer patients who are aimed at reducing the risk of second malignancy and other late effects without compromising cure. Moreover, an understanding of the variations in second cancer risk according to age at treatment is important in customizing patient follow-up.Secondary Malignancies Across the Age SpectrumAndrea K. Ng, Lisa B. Kenney, Ethel S. Gilbert, Lois B. Travis10.1016/j.semradonc.2009.09.002Seminars in Radiation Oncology 20, 1 (2010)2010-01-01Seminars in Radiation Oncology2010-01-01201S1053-4296(09)X0005-66778