Emerging Applications In Clinical Radiation Oncology

Emerging Applications In Clinical Radiation Oncology
by
Ross A. Abrams, M.D.


Topics

* Integration of Emerging Results From Molecular Biology Into Patient Selection and Treatment Strategies
* Integration of Enhanced Technology Into Clinical Practice
* Moving Beyond Photons (X-Rays) to Charged Particles (Protons, Heavy Ions)

Integration of Emerging Results From Molecular Biology

* Combining Radiotherapy With Targeted Therapy
* Using Genomics, Proteomics, Metabolomics to Help Define Prognosis
* Using Genomics, Proteomics, Metabolomics to Help Define Treatment

Cetuximab
Clinical Activity

* Colorectal Cancer
* Head and Neck

Side Effects – Minimal

* Infusion Reactions
* Rash
* Asthenia
* N/V/D


Radiation Synergies

* EGFR Blockade Results in Radiation Sensitization
* EGFR Expression Upregulated by Irradiation

Combining Radiotherapy With

Cetuximab + Radiotherapy
Minimal Increase in Toxicity
Other Target Agents Showing Promise w/ XRT

Integration of Emerging Results From Molecular Biology

* Combining Radiotherapy With Targeted Therapy
* Using Genomics, Proteomics, Metabolomics to Help Define Prognosis
* Using Genomics, Proteomics, Metabolomics to Help Define Treatment

Chung/Torres-Roca, et al.: Genomics for prognosis and treatment response prediction
Formalin Fixed Tissue Data Set:

Integration of Enhanced Technology

* Metabolic Imaging To Define/Refine Targeting – Prostate/Lung Cancer
* Body Stereotactic Therapy – Lung Cancer
* Image Guided Radiotherapy (IGRT)
* Physiologic Gating – Lung/GI Cancers
* Integrating Metabolic Imaging, IGRT, Gating with IMRT

Metabolic Imaging to Refine Rx & XRT Targeting

MRI Imaging To Refine XRT Boost:
Prostate cancer

Enhancing IMRT With Image Guidance
IMRT 3D
Image-Guidance

* Rigid Immobilization
o Stereotactic systems
* Ultrasound Guidance
o Pelvic ultrasound
* CT Guidance
o CT scanner in the treatment room
o Helical tomotherapy

3 cGy Verification CT

Soft Tissue Window

Tools for Patient Registration

Moving Beyond Photons

* Protons
* Intensity Modulated Proton Therapy
* Heavy Particle Therapy (Carbon)
Carbon Ion Radiotherapy:
Protons on Steroids!
LET and RBE of Carbon Ion Therapy

Dose vs. Biologic Effect:LET

Conclusions

Radiotherapy is evolving technologically through enhanced dose delivery and precision and biologically through enhanced understanding of factors that define or reveal tumor location, behavior, and/or vulnerabilities

Emerging Applications In Clinical Radiation Oncology