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President's Symposium: Medical Physics in the Era of Genomic Medicine

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H Hricak

D Jaffray

J Hazle

H Hricak1*, D Jaffray2*, J Hazle3*, (1) Memorial Sloan-Kettering Cancer Center, (2) Princess Margaret Hospital, Toronto, ON, (3) UT MD Anderson Cancer Center, Houston, TX

MO-C-500-1 Monday 10:30AM - 12:30PM Room: 500 Ballroom

Unprecedented advances in molecular biology, biomedical imaging and information technology have opened up new avenues towards precision medicine, in which treatments are and will be tailored to specific diagnoses and their unique manifestations in individual patients. In oncology, the application of precision medicine offers tremendous hopes for improving outcomes but it also poses great challenges. Cancer is fundamentally a disease of genetic missteps or misregulation. Cancers are genetically heterogeneous, undergoing constant evolution (or Darwinian Dynamics) as they progress. Not only do biological features differ within primary tumors, but in up to 50% of cancers, metastases de-differentiate and demonstrate different biological features in different matrices (e.g., bone vs. liver vs. lung). Tissue and serum assays alone cannot sufficiently capture the spatial and temporal diversity of tumor biology. Precise, spatially localized molecularly-based evaluation of disease that incorporates genomics is essential.

Conventional anatomic imaging will continue to be indispensible for localizing cancer and determining where it has spread for both diagnostic and radiation therapy purposes. However, as precision medicine takes hold, the role of imaging in evaluating tumor biology will become even more important. Molecular imaging and the new field of radiogenomics holds great promise for advancing our ability to image tumor biology.

Further, the relatively recent enhanced understanding of the human genome is driving transformational changes in cancer research. As we will see from the first two talks of this session, genomics will be the driving factor in cancer research for the foreseeable future. As medical physicists we must consider how that impacts our science --- which is the application of physics principles to biology and medicine. While we have traditionally focused on rather narrow aspects of physics related to radiation oncology and biomedical imaging, we must ask ourselves how we should evolve in these areas to address the cancer research challenges of the future and “Is it time for us to embrace other aspects of medical physics?” Further, in order for the next generation of medical physicists to participate in cancer research, much less have a significant impact, we must at a minimum consider new dimensions to our educational programs. For example, how can we expect to participate in contemporary cancer research if we have such a limited understanding of molecular genetics and cancer biology that we can’t communicate effectively with our scientific peers?

In this session we will give an overview of precision and genomic medicine with the impact on diagnostic imaging (Hricak), how this will impact the practice of radiation oncology (Jaffray) a general perspective on how we should be addressing issues of research and education in this new era (Hazle).

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