MO-D-217BCD-01: Personalizing Medicine: Adapting to the Individual

Personalizing medicine through patient-specific adaptation is quickly moving from retrospective research to clinical implementation. The commercial availability of clinical tools, including auto-segmentation, deformable registration, and dose accumulation, is enabling these techniques to be utilized more efficiently. Understanding the importance, rationale, and consequences of anatomical and physiological based adaptation is paramount for the safe implementation of these techniques. This includes accounting for radiobiological differences in delivered dose and the impact that this may have on tumor control and normal tissue response. This interactive session will highlight the evidence and rationale for anatomy-based adaptation, including retrospective studies from several anatomical sites indicating the uncertainties between the planned and delivered dose and the benefits achievable through adaptation. Translation of these techniques into the clinic will be discussed. The growing use of functional imaging enables more sophisticated adaptation and personalization of the treatment plan based on an understanding of the individual response of the tumor and normal tissue to radiation. Methods to understand and incorporate this information into the patient treatment plan will be discussed. The radiobiological impact of dose accumulation methods and adaptive strategies is often overlooked. Biological factors and their influence on these adaptive strategies will be addressed. The clinician's perspective will also be highlighted, including the benefits of dose accumulation, personalization, and adaptation for the patient and the impact that this technology may have on clinical trials and outcomes assessment.

LEARNING OBJECTIVES

1. Understand the need for anatomy-based adaptation and methods to safely implement this in the clinic 2. Recognize the need for physiological-based adaptation and methods to safely implement this into the clinic 3. Appreciate the radiobiological limitations and concerns associated with dose summation, and adaptation 4. Describe the clinical implications of dose summation and adaptation on individual patient treatments, clinical trials, and outcomes assessment.

American Society of Radiation Oncology recommendations for documenting intensity-modulated radiation therapy treatments

Despite the widespread use of intensity-modulated radiation therapy (IMRT) for approximately a decade, a lack of adequate guidelines for documenting these treatments persists. Proper IMRT treatment documentation is necessary for accurate reconstruction of prior treatments when a patient presents with a marginal recurrence. This is especially crucial when the follow-up care is managed at a second treatment facility not involved in the initial IMRT treatment. To address this issue, an American Society for Radiation Oncology (ASTRO) workgroup within the American ASTRO Radiation Physics Committee was formed at the request of the ASTRO Research Council to develop a set of recommendations for documenting IMRT treatments. This document provides a set of comprehensive recommendations for documenting IMRT treatments, as well as image-guidance procedures, with example forms provided.

Targeted gold nanoparticles enable molecular CT imaging of cancer

X-ray based computed tomography (CT) is among the most convenient imaging/diagnostic tools in hospitals today in terms of availability, efficiency, and cost. However, in contrast to magnetic resonance imaging (MRI) and various nuclear medicine imaging modalities, CT is not considered a molecular imaging modality since targeted and molecularly specific contrast agents have not yet been developed. Here we describe a targeted molecular imaging platform that enables, for the first time, cancer detection at the cellular and molecular level with standard clinical CT. The method is based on gold nanoprobes that selectively and sensitively target tumor selective antigens while inducing distinct contrast in CT imaging (increased X-ray attenuation). We present an in vitro proof of principle demonstration for head and neck cancer, showing that the attenuation coefficient for the molecularly targeted cells is over 5 times higher than for identical but untargeted cancer cells or for normal cells. We expect this novel imaging tool to lead to significant improvements in cancer therapy due to earlier detection, accurate staging, and microtumor identification.