Interview with Prof Piet Ost,

recipient of the Donal Hollywood Award at ESTRO 2024

Piet Ost Ghent University and Iridium Network Ghent/Antwerp, Belgium

 

 

The Hollywood Award is given in the memory of ESTRO President-Elect Donal Hollywood, who passed away from cancer before taking on the duties of President. This annual award is given to the best abstract selected for presentation at an ESTRO congress.

The recipient of this award delivers a lecture at the ESTRO Congress.

Firstly, our heartfelt congratulations on being honoured with the Hollywood Award! Can you share your initial reactions and emotions upon learning that your abstract was selected for this prestigious recognition?

Upon learning that our abstract was selected for the Hollywood Award, I was honestly overwhelmed with a mix of emotions—gratitude, excitement, and a sense of validation for the work we have dedicated ourselves to. It's an incredible feeling to have our efforts recognised through such a prestigious platform as ESTRO, and I'm truly honoured to receive this recognition. It motivates me even more to continue pushing boundaries and making meaningful contributions to my field.

The Hollywood Award is given in memory of ESTRO president-elect Donal Hollywood. How does it feel to receive an award associated with his legacy, and what does this honour mean to you personally and professionally?

Receiving an award associated with the legacy of Donal Hollywood is incredibly meaningful to me and the entire trial group. Professor Hollywood's contributions to the radiotherapy field are impressive, and to be recognised in connection with his legacy is truly an honour. Personally, it validates the hard work and dedication we have put into this trial, knowing that it's being acknowledged in the context of such a prestigious lineage. Professionally, it serves as motivation to continue striving for excellence and pushing boundaries in my field. It is a reminder of the impact one can have on others and the importance of leaving a lasting legacy of innovation and inspiration.

Your abstract was selected by the scientific programme committee from a pool of submissions. What inspired your research, and how did you approach the criteria of clarity, supporting data, scientific rigour, potential significance, and innovation in your work?

The idea for the trial into salvage treatment of oligo-recurrent nodal prostate cancer metastases (STORM) followed the introduction of imaging methods, such as choline positron-emission tomography-computed tomography (PET-CT), that showed improved sensitivity compared with what was in use at the time to detect prostate cancer recurrences. One of our PhD students, Aurélie De Bruycker, mapped locations of recurrences in patients who were undergoing choline PET-CTs in our centre. This revealed that the most dominant pattern of relapse was in the pelvis. This was later confirmed by other colleagues in the field and this finding remains the same with the use of more sensitive imaging such as prostate-specific membrane antigen (PSMA) PET-CT.

As we were confronted with an increasing number of patients with pelvic recurrences, it was clear that its management was far from obvious, and we saw the use of both focal approaches such as stereotactic body radiotherapy (SBRT) and limited salvage lymph node dissections, and broader approaches such as elective nodal radiotherapy (ENRT). In a first retrospective analysis by Elise De Bleser, we compared the outcomes of SBRT and ENRT. It seemed that ENRT prevented new pelvic recurrences to a higher extent than did SBRT, and its use even prolonged the time to detection of distant metastases. This finding fuelled the design of the STORM trial, in which we randomised patients between focal approaches, such as SBRT, with ENRT. Time to metastasis was the primary endpoint. As this phase 2 trial would require up to 200 patients to enable randomisation, we opened this academic trial in six different countries.

Could you provide some insights into the key findings or aspects of your abstract that you believe contributed to it being chosen for the Hollywood Award?

This is the first trial that has compared two different approaches to nodal prostate cancer recurrences and will shed light on what the optimal approach is from an oncological and toxicity perspective. As this is still one of the most common clinical scenarios in the recurrent setting, the results are timely and have the potential to impact treatment patterns and fuel new research.

The award highlights translational work and interdisciplinarity. How do you see these elements enhancing the impact of your research and its potential application in the field of radiation oncology?

The STORM trial has a big translational research part attached to it, with its collection of both liquids and tissue for future research. One of the first endeavours will be to explore the prognostic and predictive roles of circulating tumour DNA, plasma extracellular vesicles and tissue biomarkers such as multimodal artificial intelligence pathology and mRNA. The trial has been conceived as interdisciplinary with the involvement of radiation oncologists, radiation therapists and physicists as well as other specialities such as urologists and medical oncologists.

We hope that our translational work will enable us to detect which patients are ideally suited for SBRT and in which patients an ENRT approach is the better option. As such we could tailor the treatment field and limit potential side effects.

As part of the award tradition, you will be delivering a lecture at the ESTRO Congress. Can you give us a glimpse into the main themes or messages you plan to convey during your lecture, and how it connects with the significance of the Hollywood Award?

Without disclosing the results, we believe our results will impact the design of new trials and might immediately start to impact the standard-of-care approach for nodal recurrences. The insights gained from the side-effect profiles of both treatment options and the observed quality of life will help patients and physicians decide on the most optimal approach.

Reflecting on the selection process and the criteria, how do you view the role of awards like the Hollywood Award in recognising and promoting excellence in abstract presentations at ESTRO congresses?

Any award, but especially the Hollywood Award, is an additional welcome exposure that will improve the dissemination of results to the field. This will allow faster implementation of the results in the daily clinic.

In the context of your research, what implications do you believe it holds for the broader field of radiation oncology, and how might it influence future studies and practices?

As this is the first randomised phase 2 trial in the field that has compared SBRT with ENRT for nodal recurrences, the results are a benchmark for future trials. A first example is the oligopelvis trial, which will compare the use of systemic therapy alone with that of ENRT plus systemic therapy, and is currently recruiting. Together with the STORM trial, these results will impact the treatment approaches for these patients.

These trial results might be expandable to other tumour types in which nodal recurrences are a dominant pattern of failure, and they might inspire further optimisation of the results based on the presented data.

Considering the emphasis on innovation and usefulness in the selection criteria, what advice would you offer to fellow researchers who aim to create impactful abstracts for ESTRO Congress submissions?

I believe it is important to discuss your trial ideas with your peers prior to embarking on a trial to see whether the idea will gain sufficient traction and interest from the field. Look for typical clinical scenarios for which no standards of care exist but are relatively frequent. These niches are worth studying and have the potential to change the standard of care. Don’t be afraid to dream big and to find collaborators who support you and believe in the idea. I would advise you to do the same for the colleagues who helped you; help them to work out and improve their ideas. Everything you do will require a group of people thinking in the same way.

Finally, in memory of Donal Hollywood, whose legacy is honoured by this award, how do you see your work contributing to the ongoing advancement of radiation oncology and fulfilling the spirit of the Hollywood Award?

Honouring the legacy of Professor Hollywood through this award is both a privilege and a responsibility. I see our work contributing to the ongoing advancement of radiation oncology by striving for innovation, excellence, and patient-centred care. By pushing the boundaries of research, technology, and clinical practice, we aim to improve treatment outcomes, enhance the quality of life for patients, and contribute to the overall progress of the field. I believe this trial emphasises the impact that a local therapy can have on disease control, without negatively impacting quality of life. The technological improvements of the past decade allow the safe delivery of radiotherapy doses with a relatively low probability of long-term serious side effects. In doing this, I hope to fulfil the spirit of the Hollywood Award by embodying the dedication, passion, and commitment to excellence that defines Professor Hollywood's legacy.