Global Summit on Radiation Therapy & Targeted Tumors April 22-23, 2019 Vancouver, Canada

Radio immunotherapy (RIT) is a combination of radiation therapy and immunotherapy used to treat non-Hodgkin B-cell lymphoma and other types of cancer. RIT uses engineered monoclonal antibodies paired with radioactive materials called radiotracers. When injected into the patient’s bloodstream, they bind to cancer cells and deliver a high dose of radiation directly to the tumor. In RIT, a monoclonal antibody is paired with a radioactive material, or radiotracer. When injected into the patient’s bloodstream, the radiation-linked monoclonal antibody, or agent, travels to and binds to cancer cells, allowing a high dose of radiation to be delivered directly to the tumor.

Nuclear medicine imaging procedures are non-invasive and, with the exception of intravenous injections, are usually painless medical tests that help physicians diagnose and evaluate medical conditions. Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose and determine the severity of or treat a variety of diseases, including many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body.

Nuclear medicine therapies include:

• Radioactive iodine (I-131) therapy used to treat some causes of hyperthyroidism and thyroid cancer
• Radioactive antibodies used to treat certain forms of lymphoma
• Radioactive phosphorus (P-32) used to treat certain blood disorders
• Radioactive materials used to treat painful tumor metastases to the bones
• I-131 MIBG used to treat adrenal gland tumors in adults and adrenal gland/nerve tissue tumors in children

The main goal of cancer screening is to reduce the number of people who die from the disease, or eliminate deaths from cancer altogether. Some cancer screening tests are Colonoscopy, sigmoidoscopy, and high-sensitivity fecal occult blood tests (FOBTs), Low-dose helical computed tomography, Mammography, Pap test and human papillomavirus (HPV) testing. Others Screening tests are Alpha-fetoprotein blood test, Breast MRI, CA-125 test, PSA test, Virtual colonoscopy.

Cancer Prevention and risk-reduction strategies can greatly lower the physical, emotional, and financial burden of cancer and improve the overall health of cancer survivors, including lowering the risk of the cancer coming back or the formation of a second cancer. It is estimated that more than 72% worldwide populations are having cancer, nowadays 30-50% cancers can be prevented. The most common diagnostic tests and procedures that are commonly used in cancer care 

• Barium Enema
• Biopsy
• Bone Marrow Aspiration and Biopsy
• Bone Scan
• Breast MRI
• Colonoscopy
• Computed Tomography (CT) Scan
• Positron Emission Tomography and Computed Tomography (PET-CT) Scans
• Magnetic Resonance Imaging (MRI)

A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition. Cancer biomarkers can be DNA, mRNA, proteins, metabolites, or processes such as apoptosis, angiogenesis or proliferation. The markers are produced either by the tumor itself or by other tissues, in response to the presence of cancer or other associated conditions, such as inflammation. Such biomarkers can be found in a variety of fluids, tissues and cell lines. A number of different types and forms of cancer biomarkers (tumor markers) exist

• Cancer Biomarker
• Prognostic biomarker
• Diagnostic (screening) biomarker
• Stratification (predictive) biomarker

A PET scan may be combined with a CT scan at many cancer treatment centres. However, you may hear your doctor refer to this procedure just as a PET scan. A PET-CT scan is one way to find cancer and learn its stage. Stage is a way to describe where the cancer is, if it has spread, and if it is changing how your organs work. Knowing this helps you and your doctor choose the best treatment. It also helps doctors predict your chance of recovery.

• Hybrid PET Imaging Systems
• PET vs. SPECT
• Short Half-lives of Radiotracers

Cancer drug resistance is a complex phenomenon that is influenced by drug inactivation, drug target alteration, drug efflux, DNA damage repair, cell death inhibition, EMT, inherent cell heterogeneity, epigenetic effects, or any combination of these mechanisms.  Cancer progenitor cells are often drug resistant as well. These progenitor cells can persist in patients seemingly in remission, and they are able to remain stationary or migrate to other sites during metastasis. Thus, cancer progenitor cells can cause cancer relapse at the original tumor site or in distant organs. The next step in anticancer therapy development should target the elimination of such cancer progenitor cells. 

Vaccines or vaccinations are medicines that help the immune system to recognize and destroy the cancer cells. Most of the cancer vaccine work in a same way to treat the cancer. Cancer treatment vaccines are different from vaccines that work against the viruses. The following types of cancer vaccines are most commonly under investigation throughout the world:

• Antigen vaccines
• Whole cell vaccines
• Dendritic cell vaccines
• DNA vaccines
• Anti idiotype vaccines

During a biopsy, a doctor removes a sample of tissue or fluid from the body. A pathologist inspects the cells under a microscope to see if they are cancerous. If the cells are found to be cancerous, a biopsy may help determine whether the cancer began at the site of the biopsy or if it started somewhere else in the body and spread to the biopsy site. Some biopsies are performed endoscopically, others under image guidance, such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) in the radiology suite. In some cases, biopsies are performed in the operating suite. This allows your doctor to collect tissue from deep inside the body.

Neuro interventional radiology, or neuro IR,  is a relatively new field of medicine, in which renowned physicians develop and perfect new techniques to treat stroke, brain tumors, cerebral aneurysm and other life threatening conditions of the central nervous system through endovascular approaches. The neuro interventional radiology physicians perform advanced techniques to diagnose and/or treat the following:

• Acute Stroke - Ischemic Stroke
• Acute Stroke - Hemorrhagic Stroke
• Arteriovenous Malformations (AVMs)
• Brain Tumors – Pre-Operative Embolization
• Carotid Artery Disease and Stenosis
• Dissection of Carotid and Vertebral Arteries
• Intracranial Atherosclerosis
• Pulsatile Tinnitus
• Retinoblastomas

The adaptive radiotherapy technique aims to customize each patient’s treatment plan to patient-specific variation by evaluating and characterizing the systematic and random variations through image feedback and including them in adaptive planning. Adaptive radiotherapy will become a new treatment standard.

Image-guided radiation therapy (IGRT) is the use of imaging during radiation therapy to improve the precision and accuracy of treatment delivery. IGRT is used to treat tumors in areas of the body that move, such as the lungs. Radiation therapy machines are equipped with imaging technology to allow your doctor to image the tumor before and during treatment. By comparing these images to the reference images taken during simulation, the patient's position and/or the radiation beams may be adjusted to more precisely target the radiation dose to the tumor. To help align and target the radiation equipment, some IGRT procedures may use fiducial markers, ultrasound, MRI, x-ray images of bone structure, CT scan, 3-D body surface mapping, electromagnetic transponders or colored ink tattoos on the skin.

Precision medicine is an approach to patient care that allows doctors to select treatments that are most likely to help patients based on a genetic understanding of their disease. This may also be called personalized medicine. According to the Precision Medicine Initiative, precision medicine is "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person." This approach will allow doctors and researchers to predict more accurately which treatment and prevention strategies for a particular disease will work in which groups of people. 

Stem cell transplantation is a procedure that replaces unhealthy blood-forming cells with healthy cells. Stem cell transplantation, sometimes referred to as bone marrow transplant, allows doctors to give large doses of chemotherapy or radiation therapy to increase the chance of eliminating blood cancer in the marrow and then restoring normal blood cell production. The basis for stem cell transplantation is that blood cells (red cells, white cells and platelets) and immune cells (lymphocytes) arise from the stem cells, which are present in marrow, peripheral blood and cord blood. Intense chemotherapy or radiation therapy kills the patient's stem cells. This stops the stem cells from making enough blood and immune cells.

Hormone therapy is a cancer treatment that slows or stops the growth of cancer that uses hormones to grow. Hormone therapy is also called hormonal therapy, hormone treatment, or endocrine therapy.

Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs," "molecularly targeted therapies," "precision medicines," or similar names. Targeted therapies are currently the focus of much anticancer drug development. They are a cornerstone of precision medicine, a form of medicine that uses information about a person’s genes and proteins to prevent, diagnose, and treat disease. Many targeted cancer therapies have been approved by the Food and Drug Administration (FDA) to treat specific types of cancer.

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system. Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.

Radiation therapy  is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumours. Doctors who specialize in treating cancer with radiation (radiation oncologists) use radiation therapy to treat a wide variety of cancers. Radiation therapy uses carefully targeted and regulated doses of high-energy radiation to kill cancer cells. Radiation kills cancer cells by damaging the chromosomes and DNA so that the cells can no longer divide and the tumor can't grow. The discussion extends to all available Cancer Therapies like Surgical Therapy, Chemotherapy, Adjuvant Therapy, Neoadjuvant Therapy, Immunotherapy, Hormonal Therapy, Proton Beam Therapy, Phototherapy, Stem Cell Therapy and Alternative Medicine. Radiation therapy uses highly advanced technology to deliver targeted beams of radiation to kill cancer cells.

Proton therapy delivers radiation to tumor tissue in a much more confined way than conventional photon therapy thus allowing the radiation oncologist to use a greater dose while still minimizing side effects. Protons are atoms that carry a positive charge. Just as x-rays (also known as photons) are used to treat both benign and malignant tumors, protons beams can be used to irradiate tumors in a similar way. However, protons deliver a dose of radiation in a much more confined way to the tumor tissue than photons. After they enter the body, protons release most of their energy within the tumor region and, unlike photons, deliver only a minimal dose beyond the tumor boundaries.

Medical imaging refers to several different technologies that are used to view the human body in order to diagnose, monitor, or treat medical conditions. Each type of technology gives different information about the area of the body being studied or treated, related to possible disease, injury, or the effectiveness of medical treatment.

• Ultrasound Imaging
• MRI (Magnetic Resonance Imaging)
• Pediatric X-ray Imaging
• Medical X-ray Imaging

The recent advances in medical imaging have revolutionized the diagnostic accuracy of the medical images. These advances included multi-modal imaging, dynamic imaging, and diagnostic imaging with non-ionizing radiation. Most of these advances included a development of robust, rapid, and reliable instruments, with an emphasis on seamless operation in the clinic.

As techniques like image guided radiation therapy (IGRT) and imaging guided  surgery (IGS) are becoming more prevalent in the clinic, the demand for quantitative information extraction is becoming much higher. As modern radiology is moving towards non-invasive procedures, these advances in medical imaging have improved the quality of life and reduced the associated risk with these procedures. At the same time, these advances in medical imaging posed new challenges and this talk will highlight these challenges along with the advances.

Angiogenesis inhibitors are drugs that block angiogenesis. These drugs are also called anti-angiogenics. Blocking nutrients and oxygen from a tumor can “starve” it. Angiogenesis inhibitors are unique cancer-fighting agents because they block the growth of blood vessels that support tumor growth rather than blocking the growth of tumor cells themselves. The U.S. Food and Drug Administration (FDA) has approved a number of angiogenesis inhibitors to treat cancer. Approved angiogenesis inhibitors include:

• Axitinib
• Bevacizumab
• Cabozantinib
• Everolimus
• Lenalidomide
• Lenvatinib mesylate
• Pazopanib
• Ramucirumab

The tumor microenvironment is created by the tumor and dominated by tumor-induced interactions. Although various immune effector cells are recruited to the tumor site, their anti-tumor functions are down regulated, largely in response to tumor-derived signals. A tissue microenvironment of developing tumor is comprised of proliferating tumor cells, the tumor stroma, blood vessels, infiltrating inflammatory cells and a variety of associated tissue cells. It is a unique environment that emerges in the course of tumor progression as a result of its interactions with the host.

Cancer genomics is the study of the totality of DNA sequence and gene expression differences between tumour cells and normal host cells. It aims to understand the genetic basis of tumour cell proliferation and the evolution of the cancer genome under mutation and selection by the body environment, the immune system and therapeutic interventions. Cancer genomics research also contributes to precision medicine by defining cancer types and subtypes based on their genetics. This molecular taxonomy of cancer can provide patients with a more precise diagnosis, and therefore a more personalized treatment strategy.

Radiopharmaceuticals or medical radio compounds are groups of pharmaceutical drugs that can be used either for diagnostic or therapeutic purposes. It is composed of a radioisotope bond to an organic molecule. The organic molecule conveys the radioisotope to specific organs, tissues or cells. The radioisotope is selected for its properties. Radioisotopes emitting penetrating gamma rays are used for diagnostic (imaging) where the radiation has to escape the body before being detected by a specific device (SPECT/PET cameras). Typically, the radiation emitted by isotope used for imaging vanishes completely after 1 day through radioactive decay and normal body excretion. The most common isotopes for imaging are: 99mTc, I-123, I-131, Tl201, In111 and F18.