At Inspira Health, radiation oncologist Dr. David Gasalberti sees far more reason for optimism than a decade ago, with advances such as expanded lung‑cancer screening, high‑precision radiation, and new drug therapies reshaping cancer care.
Gasalberti pointed to lung, prostate and skin cancers as examples of how treatment has evolved. Lung cancer is being caught earlier and treated with targeted radiation for patients who can’t or don’t want surgery. Prostate cancer care has moved toward active surveillance and short‑course, high‑dose radiation when treatment is needed. For skin cancers, radiation offers an alternative to repeated surgeries.
Lung cancer, the leading cause of cancer deaths in the U.S., often goes undetected until it is in an advanced stage. In 2021, the U.S. Preventive Services Task Force updated its lung cancer screening recommendations, making millions more Americans eligible.
“As these screening programs have caught on, we’re catching more and more patients with early-stage lung cancers,” Gasalberti said.
One promising tool is the use of Stereotactic Body Radiation Therapy (SBRT) for early-stage lung cancer as well as prostate cancer, he said. While traditional radiation often requires daily treatments for as long as six weeks, SBRT uses very high-dose, targeted radiation, delivered in three to five sessions, making it ideal for patients who cannot have or do not want surgery.
Gasalberti said a select group of patients with “limited metastatic” lung cancer, which has spread to fewer than five sites, may also benefit from targeted radiation to all areas.
Technology has made radiation even more precise. Inspira uses four-dimensional computed tomography (4DCT) to track the movement of lung tumors caused by breathing. Surface-guided radiation therapy (SGRT), meanwhile, tracks the position of the patient on the treatment table with special lights and cameras to enhance safety and accuracy.
With prostate cancer, active surveillance is now standard for many men unless there are signs of progression, Gasalberti said. Many men choose active surveillance to avoid urinary or sexual side effects or because they have other medical issues. In advanced cases, Gasalberti has seen promising results with Pluvicto, an intravenous therapy that delivers radiation directly to cancer cells.
In July, the U.S. Food and Drug Administration approved Pluvicto to be used in combination with hormone therapy after clinical trials showed it reduced the risk of cancer progression. Initially used only after other treatments failed, it is now being offered earlier.
“We’ve had good success with it,” Gasalberti said. “It’s been moving up slowly within the treatment course.”
For skin cancer, radiation is increasingly used as an alternative to surgery. Gasalberti uses what’s called superficial radiation therapy, which treats cancer on or close to the skin surface. Patients choose radiation for cosmetic preservation, if they’ve had multiple prior excisions or if they have other medical issues that raise their risk. The treatment is less invasive, though it requires multiple sessions.
Beyond specific cancers, Gasalberti said advances in immunotherapy, targeted therapies and new drugs are reshaping treatment overall. “There’s a lot for patients to be optimistic about,” he said.
For information about Inspira Health, go to inspirahealthnetwork.org.
