Advances In Radiation Oncology Research Articles

Medical physics graduate education in Mexico and its relation to the advances in radiation oncology.

To evaluate the state of graduate education in medical physics and progress in radiation oncology (RO) equipment in Mexico since 2000, when conferring degrees from two master's-degree programs in Medical Physics began. Medical physics is a Health Profession and there are international recommendations for education, training, and certification. Both programs follow these education guidelines. The most common clinical occupation of graduates is in RO services. Techniques in Mexican RO include traditional and high-precision procedures. Academic and occupational information about the programs and their graduates were obtained from official websites. Graduates were invited to respond to a survey that requested information about their present job. We obtained data on RO equipment and human resources from public databases and estimated staffing requirements of medical physicists (MPs). Medical physics programs have graduated a total of 225 MPs. Half of them work in a clinical environment and, of these, about 90 work in RO services. MPs with M.Sc. degrees constitute 36% of the current MP workforce in RO, estimated to be 250 individuals. Survey responses pointed out the main merits and limitations of the programs. The number of MPs in RO has increased fivefold and the number of linacs sixfold in 15 years. The present number of MPs is insufficient, according to published guidelines. All MPs in RO services with advanced modalities must be trained following international recommendations for graduate education and post-graduation clinical training. Education and health institutions must find incentives to create more graduate programs and clinical residencies.

How Technology Is Improving the Multidisciplinary Care of Sarcoma.

Sarcomas are rare tumors but comprise a wide histologic spectrum. Advances in technology have emerged to address the biologic complexity and challenging diagnosis and treatment of this disease. The diagnostic approach to sarcomas has historically been based on morphologic features, but technologic advances in immunohistochemistry and cytogenetic/molecular testing have transformed the interdisciplinary work-up of mesenchymal neoplasms in recent years. On the therapeutic side, technologic advances in the delivery of radiation have made it a linchpin in the treatment of localized and oligometastatic sarcoma. In this review, we discuss recent advances in the pathologic diagnosis of sarcomas and discuss select sarcoma types that illustrate how newly discovered diagnostic, prognostic, and predictive biomarkers have refined existing classification schemes and substantially shaped our diagnostic approach. Such examples include conventional and epithelioid malignant peripheral nerve sheath tumors (MPNSTs), emerging entities in the group of round cell sarcomas, and other mesenchymal neoplasms with distinct cytogenetic aberrations. Recent advances in radiation oncology, including intensity-modulated, stereotactic, MRI-guided, and proton radiotherapy (RT), will be reviewed in the context of neoadjuvant or adjuvant localized soft-tissue sarcoma and oligometastatic or oligoprogressive disease. Innovations in translational research are expected to be introduced into clinical practice over the next few years and will likely continue to affect the rapidly evolving field of sarcoma diagnostics and therapy.

Brain metastases from germ cell tumor: time to reconsider radiotherapy?

The presence of brain metastases (BMs) from germ cell tumor (GCT) remains a rare situation. BMs predominantly occur among patients with testis primary tumor site, and are almost exclusively associated with non-seminomatous (NS) histologies. Two situations must be distinguished, which differ in terms of clinical presentation, overall prognostic and management. At diagnosis, BMs are almost systematically associated with extra-cerebral metastases and the cornerstone of treatment is chemotherapy, while the role of local treatment remains controversial. In the metachronous setting, BMs more frequently constitute an isolated site of relapse, the outcome is poorer, and the role of local treatment is more consensual. However, all these data widely come from old reports, with outdated radiation techniques. The recent advances in radiation oncology, especially the rising use of stereotactic radiotherapy, could lead to the reconsideration of ancient dogmas regarding the "radiosensitivity" of (NS)GCT and the role of radiotherapy among patients with BMs.

Current multidisciplinary management of brain metastases.

Brain metastasis (BM), the most common adult brain tumor, develops in 20% to 40% of patients with late-stage cancer and traditionally are associated with a poor prognosis. The management of patients with BM has become increasingly complex because of new and emerging systemic therapies and advancements in radiation oncology and neurosurgery. Current therapies include stereotactic radiosurgery, whole-brain radiation therapy, surgical resection, laser-interstitial thermal therapy, systemic cytotoxic chemotherapy, targeted agents, and immune-checkpoint inhibitors. Determining the optimal treatment for a specific patient has become increasingly individualized, emphasizing the need for multidisciplinary discussions of patients with BM. Recognizing and addressing the sequelae of BMs and their treatment while maintaining quality of life and neurocognition is especially important because survival for patients with BMs has improved. The authors present current and emerging treatment options for patients with BM and suggest approaches for managing sequelae and disease recurrence.

Radiation-Associated Pericardial Disease.

This review highlights the literature related to pericardial injury following radiation for oncologic diseases. Radiation-associated pericardial disease can have devastating consequences. Unfortunately, there is considerably less evidence regarding pericardial syndromes following thoracic radiation as compared to other cardiovascular outcomes. Pericardial complications of radiation may arise acutely or have an insidious onset several decades after treatment. Transthoracic echocardiography is the screening imaging modality of choice, while cardiac magnetic resonance imaging further characterizes the pericardium and guides treatment decision-making. Cardiac CT can be useful for assessing pericardial calcification. Ongoing efforts to lessen inadvertent cardiac injury are directed towards the revision of radiation techniques and protocols. As survival of mediastinal and thoracic malignancies continues to improve, radiation-associated pericardial disease is increasingly relevant. Though advances in radiation oncology demonstrate promise in curtailing cardiotoxicity, the long-term effects pertaining to pericardial complications remain to be seen.

Three discipline collaborative radiation therapy (3DCRT) special debate: Equipment development is stifling innovation in radiation oncology.

The field of radiation oncology has recently experienced a period of remarkable transformation of our technical capabilities. These technical and computational advancements have resulted in a tremendous improvement in our ability to precisely and accurately deliver radiation dose. However, this increased emphasis on technical capabilities may be inadvertently diverting attention and funding from scientific developments in other areas, even at a time when exciting new advances are occurring in cancer biology. Much of our recent technical development has been promoted and subsidized by the manufacturers of radiation oncology equipment. The question now becomes “who will encourage and subsidize the research needed to bring our recent biological advances to clinical fruition?” In a recent commentary which inspired this debate, Brown and Adler suggest that we “…are in a golden age of radiation and cancer biology” and that “…the industry's current focus on equipment development alone is undermining significant potential clinical advances in radiation oncology.”3 This is the subject of this month's 3DCRT debate. Arguing for the proposition will be Drs. Leonard Kim, Stephanie Markovina, and Samantha Van Nest. Dr. Leonard Kim has worked on defining microscopic disease target volumes for breast cancer radiotherapy at William Beaumont Hospital and Rutgers Cancer Institute of New Jersey. He is currently Chief Medical Physicist at the MD Anderson Cancer Center at Cooper. Dr. Stephanie Markovina is interested in improving therapeutic response to radiation in cervical cancer and other solid tumors by better understanding molecular mechanisms of radiation induced tumor cell death and survival. She is an Assistant Professor of Radiation Oncology and Cancer Biology at Washington University in St Louis where she specializes primarily in the treatment of patients with gynecologic cancers. Dr. Samantha Van Nest has worked to establish spectroscopic techniques for the personalization of radiation therapy. She is currently a Postdoctoral Associate at Weill Cornell Medicine in New York, where her research investigates the effects of radiation on tumor immunity, with a particular focus on improving our understanding of the abscopal effect. Arguing against the proposition will be Drs. Subarna Eisaman, Lakshmi Santanam, and Julie Sullivan. Dr. Subarna Hamid Eisaman is the clinical director and assistant professor at the University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center Department of Radiation Oncology at the J. Murtha Pavilion in Johnstown, Pennsylvania. She serves as co‐chair of the Radiation Oncology Lung and Lymphoma Via Oncology Pathways Physician Advisory Committee. Her clinical practice includes treatment of breast, GYN, lung, CNS, head and neck, skin and musculoskeletal malignancies. Dr. Lakshmi Santanam is an attending medical physicist at Memorial Sloan Kettering Cancer Center. Her primary interests include motion management and patient safety. She currently serves as vice chair for the AAPM Working Group on RO‐ILS and the Task Group on the Management of Respiratory Motion in Radiation Oncology. Dr. Julie Sullivan is a biologist at the U.S. Food and Drug Administration's (FDA) Center for Devices and Radiological Health. Her scientific interests include the use of radiation‐emitting medical devices in clinical trials and the medical planning for and response to radiological and nuclear incidents.

Cancer du rein et radiothérapie : radiorésistance et au-delà

RADIORESISTANCE AND BEYOND: Metastatic renal cancer has a poor prognosis because of the limited impact of usual treatment modalities, and notably radiotherapy. Renal cell carcinoma is traditionally considered to be radioresistant, and conventional radiotherapy fraction sizes of 1.8 to 2 Gy are thought to have little role in its management. Technological advances in radiation oncology have led to stereotactic approaches that overcome radio resistance mechanisms of renal cancer cells and could be successful. The technical ability of applying high dose per fraction, leads to a distinct biological response which is different from the one observed with conventional irradiation through high responses rates. The increased radiobiological effect is attributed to endothelial apoptosis triggered by high fractional dose. The combination of such radiotherapy regimens with targeted drugs paves the way for new therapeutic opportunities.

Advances in radiation therapy for thoracic malignancies

This special issue of Journal of Thoracic Disease ( JTD ) is a focused review of advances in radiation oncology for thoracic malignancies. The issue covers advances in technology relevant to the practice of radiation oncology in the modern era, as well as the most current treatment approaches for early-stage, advanced, recurrent and oligometastatic non-small cell lung cancer (NSCLC), while recognizing the importance of tumor biology, radiation fractionation, immunotherapy, and functional imaging in the modern treatment of NSCLC. The issue ends with reviews of current data and treatment approaches for small cell lung cancer (SCLC), thymic malignancies, and malignant pleural mesothelioma.

Ben Slotman: bringing advances in radiation oncology to the clinic is fulfilling

Prof. Ben Slotman ( Figure 1 ) received his MD [1985] and PhD [1990] both cum laude at the VU University in Amsterdam, The Netherlands. He was registered as radiation oncologist in 1994. In 1998 he was appointed full professor of Radiation Oncology and Chair of the department at VU University.

Recent advances in radiation oncology: multimodal targeting of high risk and recurrent prostate cancer.

The overview summarizes recent developments in radiation oncology for high risk and recurrent prostate cancer. A number of well known phase III prostate hypofractionated radiation therapy (HFxRT) trials were finally published with long-term follow-ups. These trials demonstrate patterns of equivalent tumor control with several showing worse toxicity rates. The ASCENDE-RT randomized trial demonstrated the superiority of brachytherapy boost in intermediate and high-risk prostate cancer. Important randomized trials show a clear benefit to androgen deprivation therapy (ADT) in both intermediate-risk prostate cancer and postprostatectomy patients with rising PSA. Finally, the first randomized trial of metastasis-directed therapy showed a delay in time to ADT and biochemical failures in oligometastatic prostate cancer. The use of brachytherapy boost in high-risk disease and ADT in locally recurrent cancer after prostatectomy are practice changing given the magnitude of benefit seen in the randomized trials. The benefit of metastasis-directed therapy in oligometastatic prostate cancer must be validated in a larger randomized trial. However, hypofractionated radiation therapy requires further long-term follow-up so that late toxicity risk can be accurately assessed before it becomes a standard of care in prostate cancer.

Improving Research in Radiation Oncology through Interdisciplinary Collaboration.

The contribution of radiation oncology to the future of cancer treatment depends significantly on our continued clinical progress and future research advancements. Such progress relies on multidisciplinary collaboration among radiation oncologists, medical physicists and radiobiologists. Cultivating collaborative educational and research opportunities among these three disciplines and further investing in the infrastructure used to train both clinicians and researchers will therefore help us improve the future of cancer care. This article evaluates the success of a short-term educational environment to foster multidisciplinary collaboration. The NIH-funded educational course developed at Wayne State University, called "Integration of Biology and Physics into Radiation Oncology" (IBPRO), was designed to facilitate the engagement of radiation oncologists, medical physicists and radiobiologists in activities that enhance collaborative investigation. Having now been delivered to nearly 200 participants over the past four years, the relative success of IBPRO in fostering productive interdisciplinary collaboration and producing tangible research outcomes can be evaluated. The 140 IBPRO participants from the first three years were surveyed to quantify the effectiveness of the course. In total, 62 respondents reported developing 23 institutional protocols, submitting more than 25 research grants (nine of which have been funded thus far), and publishing more than 30 research manuscripts attributable to participation in IBPRO. Nearly one-half (45%) of respondents reported generating at least one of these research metrics attributable to participation in IBPRO and these participants reported an average of over four such quantitative research metrics per respondent. This represents a very substantial contribution to radiation oncology research by a relatively small number of researchers within a relatively short time. Nearly one-half of respondents reported ongoing collaborative working relationships generated by IBPRO. In addition, approximately one-half of respondents stated that specific information presented at IBPRO changed the way they practice, and over 80% of respondents practicing in a clinical setting stated that, since participation in IBPRO, they have approached clinical dilemmas more collaboratively. We believe that educational opportunities such as IBPRO can have a significant impact on interdisciplinary collaborative research. In addition, such interventions have the ability to effect significant clinical change. Both of these should have a positive impact on future advancements in radiation oncology and affect the future contribution of radiation oncology to the treatment of cancer.

Khan's Treatment Planning in Radiation Oncology, 4th Edition. Editor: Faiz M.Khan, John P.Gibbons, Paul W.Sperduto. Lippincott Williams & Wilkins (Wolters Kluwer), Philadelphia, PA, 2016. 648 pp. Price: $215.99. ISBN: 9781469889979. (Hardcover) (*)

The classic with a modern touch! Since the publication of the first edition of this clinical treatise in 1998, the field of radiation oncology has seen changes in all modalities, most notably, in the treatment planning and delivery subprocesses. Beginning with the advent of intensity modulated radiation therapy (IMRT) which revolutionized the field, there have been important developments in image-guided radiotherapy (IGRT), volumetric modulated arc therapy (VMAT), stereotactic body radiotherapy (SBRT), and proton therapy. The book captures the essence of these technologies from a practitioner's viewpoint. The latest edition comes only five short years after the last one, but is timely, considering the rapid advances in radiation oncology. The book's main focus is treatment planning and it presents this area brilliantly from perspectives of physics, biology, and clinical practice. Important treatment planning-related topics in these areas have been highlighted for the reader. However, like the previous editions, the book's main focus remains unchanged: improved patient care through effective and efficient use of new technologies. The book's intended audience is the radiation oncology team: radiation oncologists, medical physicists, and dosimetrists. The inclusion of Key Points (chapter summary) and Study Questions at the end of each chapter should appeal to residents preparing for their board examination. The fourth edition of the book has been completely updated and is accompanied by an e-book with enhanced navigation tools including fully searchable text. All chapters have been revised and most re-written by new authors chosen for their expertise in the field. The new edition also includes an expanded coverage of proton therapy and SBRT. Owing to its increasing and somewhat controversial use, there is also a chapter devoted to comparing the role of protons versus photons in radiation oncology. The book is divided into two sections. Section 1 consists of 23 chapters addressing the physics and biology of treatment planning. This section provides a systematic and logical refresher on pertinent topics, starting with patient imaging, treatment simulation, and a discussion of treatment planning algorithms used for photons, protons, electrons, and brachytherapy. This is followed by a chapter on quality assurance and commissioning of treatment planning systems. The second half of this section is devoted to technical and radiobiological considerations related to various treatment modalities. Section 1 concludes with an important chapter on treatment plan evaluation. Section 2 has 11 chapters devoted to treatment planning for site specific cancers presented from a clinical perspective. The book is clearly written and easy to read—a hallmark of all books penned by Dr. Khan. It provides a ready resource for finding answers to treatment planning related questions in radiation oncology. Perhaps, owing to size limitations, some topics are not covered in detail; however, ample references are provided for the interested reader. It is my hope that the book's future edition will include an expanded list of Study Questions. It is also hoped that the next edition will cover topics related to the evolving, yet important, field of MR-based treatment planning and delivery. In summary, the book is a joy to read and should appeal to all readers interested in radiation oncology. Anil Sethi is an Associate Professor in Radiation Oncology at Loyola University Health System, Chicago, IL. He is board certified by the American Board of Medical Physics (ABMP) and the American Board of Radiology (ABR). He is teaching medical physics to residents and clinical physicists and his research interests are in IMRT, IGRT, and all special procedures in RT especially SRS and SBRT.

Abstract ES1-3: Advanced technologies to optimize outcomes and minimize toxicities

Abstract Advances in radiation technology offer substantial promise for improving the therapeutic ratio in breast cancer management, both by improving tumor control and by reducing toxicity. Multiple historical randomized trials and their meta-analysis have demonstrated that the benefits of radiation therapy have been accompanied by toxicity to incidentally irradiated structures, including the heart. However, the past two decades have witnessed a dramatic revolution in technological capabilities to allow greater sparing of normal tissues while simultaneously improving the ability to identify and target areas at greatest risk. Intended for the general audience, this presentation will provide an overview of transformative technological advances in radiation oncology in recent years, including three-dimensional conformal treatment planning, intensity modulation, prone positioning, and devices that allow reproducible deep inspiration to facilitate cardiac sparing. It will review the evidence from historical trials that have established the importance of minimizing dose to normal tissues and the heart in particular, as well as more recent data demonstrating excellent dose distributions and promising outcomes with new technologies, motivating their increased utilization. The presentation will include consideration of advances such as the development of contouring atlases to facilitate greater consistency and quality of care. It will also reflect on cost considerations and concerns about rapid uptake of certain technologies prior to studies establishing evidence of benefit, along with a description of ongoing endeavors to assess value. After summarizing new professional society guidelines on whole breast irradiation, it will identify the current consensus recommendations regarding the most appropriate uses of technology to optimize outcomes of whole breast and boost radiotherapy in the modern era. Finally, it will close with a mention of ongoing and future trials evaluating the potential role of even more advanced technologies, such as proton therapy, true inverse-planned intensity modulated radiotherapy, and stereotactic body radiotherapy, in the management of breast cancer. Citation Format: Jagsi R. Advanced technologies to optimize outcomes and minimize toxicities [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr ES1-3.

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current Trends and Controversies.

Hepatocellular carcinoma is the fourth leading cause of cancer-related death worldwide. Depending on the extent of disease and competing comorbidities for mortality, multiple liver-directed therapy options exist for the treatment of hepatocellular carcinoma. Advancements in radiation oncology have led to the emergence of stereotactic body radiation therapy as a promising liver-directed therapy, which delivers high doses of radiation with a steep dose gradient to maximize local tumor control and minimize radiation-induced treatment toxicity. In this study, we review the current clinical data as well as the unresolved issues and controversies regarding stereotactic body radiation therapy for hepatocellular carcinoma: (1) Is there a radiation dose–response relationship with hepatocellular carcinoma? (2) What are the optimal dosimetric predictors of radiation-induced liver disease, and do they differ for patients with varying liver function? (3) How do we assess treatment response on imaging? (4) How does stereotactic body radiation therapy compare to other liver-directed therapy modalities, including proton beam therapy? Based on the current literature discussed, this review highlights future possible research and clinical directions.

Recent advances in radiation oncology.

Radiotherapy (RT) is very much a technology-driven treatment modality in the management of cancer. RT techniques have changed significantly over the past few decades, thanks to improvements in engineering and computing. We aim to highlight the recent developments in radiation oncology, focusing on the technological and biological advances. We will present state-of-the-art treatment techniques, employing photon beams, such as intensity-modulated RT, volumetric-modulated arc therapy, stereotactic body RT and adaptive RT, which make possible a highly tailored dose distribution with maximum normal tissue sparing. We will analyse all the steps involved in the treatment: imaging, delineation of the tumour and organs at risk, treatment planning and finally image-guidance for accurate tumour localisation before and during treatment delivery. Particular attention will be given to the crucial role that imaging plays throughout the entire process. In the case of adaptive RT, the precise identification of target volumes as well as the monitoring of tumour response/modification during the course of treatment is mainly based on multimodality imaging that integrates morphological, functional and metabolic information. Moreover, real-time imaging of the tumour is essential in breathing adaptive techniques to compensate for tumour motion due to respiration.Brief reference will be made to the recent spread of particle beam therapy, in particular to the use of protons, but also to the yet limited experience of using heavy particles such as carbon ions.Finally, we will analyse the latest biological advances in tumour targeting. Indeed, the effectiveness of RT has been improved not only by technological developments but also through the integration of radiobiological knowledge to produce more efficient and personalised treatment strategies.

ASTRO's Advances in Radiation Oncology: Success to date and future plans

ASTRO's Advances in Radiation Oncology was launched as a new, peer-reviewed scientific journal in December 2015. More than 200 manuscripts have been submitted and 97 accepted for publication as of May 2017. As Advances enters its second year of publication, we have chosen to highlight subjects that will transform the way we practice radiation oncology in special issues or ongoing series: immunotherapy, biomedical analytics, and social media. A teaching case report contest for North American radiation oncology residents will be launched at American Society of Radiation Oncology 2017 to encourage participation in scientific publication by trainees early in their careers. Recognizing our social mission, Advances will also begin a series of articles devoted to highlighting the growing disparities in access to radiation oncology services in vulnerable populations in North America. We wish to encourage the American Society of Radiation Oncology membership to continue its support of the journal through high-quality manuscript submission, participation in the peer review process, and highlighting important manuscripts through sharing on social media.

9th International Conference on 3D Radiation Dosimetry

IC3DDose 2016 - 9th International Conference on 3D Radiation DosimetryPrefaceIt was a great pleasure to welcome participants to IC3DDose 2016, the 9th International Conference on 3D Radiation Dosimetry, held from 7–10 November 2016 in Galveston, Texas.The series of conferences has evolved considerably during its history. At the first conference, DOSGEL’99, the discussion centered around gel dosimetry. Held in Lexington, Kentucky in 1999, it was timed to coincide with the American Association of Physicists in Medicine (AAPM) Annual Meeting in Nashville, Tennessee. It was my honour to organize that first conference, and it was once again my honour to organize the 9th conference in the series now known as IC3DDose which was held in Galveston, Texas.As was the case with recent IC3DDose conferences, the topic has broadened considerably beyond gel dosimetry. Not only have newer 3D volumetric dosimeters appeared on the scene, but novel electronic dosimetry systems and software that generate quasi-3D dose information have also. These changes have tracked advances in radiation oncology as techniques such as IMRT, VMAT, and IGRT have become almost ubiquitous. At the same time, dynamic treatments including gating and tracking now enjoy widespread use. Novel treatment technologies have appeared with perhaps the most disruptive being combined MR imaging-treatment units such as the ViewRay MR-cobalt unit and the Elekta/Philips MR-Linac.The potential benefits offered by 3D dosimetry were explored, compared and evaluated during IC3DDose 2016. Novel and improved readout techniques, some of which take advantage of the contemporary treatment environment and new QA systems and procedures, as well as other aspects of clinical dosimetry were well represented in the program.Over the past several years, the importance of safety in radiation therapy has been highlighted. The benefits of 3D dosimetry in contributing to safe and accurate treatments cannot be overstated. The implementation of new dosimetry procedures also requires careful attention to safety, accuracy and thorough validation. Therefore, the aims of IC3DDose 2016 were similar to those from previous conferences:• to enhance the quality and accuracy of radiation therapy treatment through improved clinical dosimetry;• to investigate and understand the dosimetric challenges of modern radiation treatment techniques;• to provide a forum to discuss the latest research and developments in 3D and advanced radiation dosimetry; and,• to energize and diversify dosimetry research and clinical practice by encouraging interaction and synergy among advanced, 3D and semi-3D dosimetry techniques.IC3DDose 2016 was a stimulating and exciting conference and the program included substantial contributions to scientific progress in the field.Thanks are offered to those who helped make the conference possible. The Scientific Committee, led by Sam Beddar, conducted thorough peer reviews of submitted papers in a timely manner and made valuable and thoughtful suggestions for improvements. The Committee also contributed to the planning of the meeting and to the organization of the program. The distinguished invited speakers who agreed to present are thanked for the extra work they performed to design and prepare educational and timely talks. My colleagues at MD Anderson Cancer Center are also thanked for their contributions to the planning of the meeting, managing the logistics, and generally helping to make sure that the conference was a success.Geoff IbbottMD Anderson Cancer CenterINTERNATIONAL SCIENTIFIC COMMITTEESam Beddar (Chair) (USA)Claus Andersen (Sweden)Sven Back (Sweden)Clive Baldock (Conference Proceedings Editor) (Australia)Crister Ceberg (Sweden)Yves de Deene (Australia)Simon Doran (United Kingdom)Anna Karlsson Hauer (Sweden)Andrew Jirasek (Canada)Kevin Jordan (Canada)Martin Lepage (Canada)Daniel Low (USA)Mark Oldham (USA)John Schreiner (Canada)Cheng-Shie Wuu (USA)LOCAL ORGANIZING COMMITTEEGeoffrey Ibbott (Chair)Dana GarrisonKayla WhiteHannah LeeYvonne RoedMitchell CarrollSam Beddar

Management of unresectable intrahepatic cholangiocarcinoma: how do we decide among the various liver-directed treatments?

Intrahepatic cholangiocarcinoma often causes death due to obstruction of the biliary system or interruption of the vascular supply of the liver. This fact emphasizes the critical need for local tumor control in this disease. Successful local tumor control has traditionally been achievable through surgical resection for the small proportion of patients with operable tumors. Technological advances in radiation oncology and in interventional radiology have enabled the delivery of ablative radiation doses or other cytotoxic therapies for tumors in the liver. In some cases, this has translated into substantial prolongation of life for patients with this disease, but the indications for these different treatment options are still the subject of ongoing debate. Here, we review the technological advances and clinical studies that are changing the way intrahepatic cholangiocarcinoma is managed, and discuss ways to achieve individualized treatment of patients.

Stereotactic radiosurgery alone for multiple brain metastases? A review of clinical and technical issues.

Over the past three decades several randomized trials have enabled evidence-based practice for patients presenting with limited brain metastases. These trials have focused on the role of surgery or stereotactic radiosurgery (SRS) with or without whole brain radiation therapy (WBRT). As a result, it is clear that local control should be optimized with surgery or SRS in patients with optimal prognostic factors presenting with up to 4 brain metastases. The routine use of adjuvant WBRT remains debatable, as although greater distant brain control rates are observed, there is no impact on survival, and modern outcomes suggest adverse effects from WBRT on patient cognition and quality of life. With dramatic technologic advances in radiation oncology facilitating the adoption of SRS into mainstream practice, the optimal management of patients with multiple brain metastases is now being put forward. Practice is evolving to SRS alone in these patients despite a lack of level 1 evidence to support a clinical departure from WBRT. The purpose of this review is to summarize the current state of the evidence for patients presenting with limited and multiple metastases, and to present an in-depth analysis of the technology and dosimetric issues specific to the treatment of multiple metastases.

Big Data and machine learning in radiation oncology: State of the art and future prospects

Precision medicine relies on an increasing amount of heterogeneous data. Advances in radiation oncology, through the use of CT Scan, dosimetry and imaging performed before each fraction, have generated a considerable flow of data that needs to be integrated. In the same time, Electronic Health Records now provide phenotypic profiles of large cohorts of patients that could be correlated to this information. In this review, we describe methods that could be used to create integrative predictive models in radiation oncology. Potential uses of machine learning methods such as support vector machine, artificial neural networks, and deep learning are also discussed.