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In Memoriam of Michael Sharpe: The Future of Precision in RT

D Jaffray

T McNutt

D Moseley

K Brock

D Jaffray1*, T McNutt2*, D Moseley3*, K Brock4*, (1) University Health Network, Toronto, ON, (2) Johns Hopkins University, Severna Park, MD, (3) Princess Margaret Hospital, Toronto, ON, (4) UT MD Anderson Cancer Center, Houston, TX


1:45 PM : Opening remarks and memorial, What is the future of precision in RT and what does it mean for cancer therapy - D Jaffray, Presenting Author
2:15 PM : IMRT optimization: from the origins and delivery to robustness, automation and big data - T McNutt, Presenting Author
2:45 PM : What and how would we treat if we never missed? - D Moseley, Presenting Author
3:15 PM : The current trajectory of personalized adaptive RT - K Brock, Presenting Author

MO-DE-205-0 (Monday, July 31, 2017) 1:45 PM - 3:45 PM Room: 205

Intensity modulated radiation therapy (IMRT), image guided radiation therapy (IGRT), and adaptive radiotherapy (RT) has seen significant advancement in the past 2 decades, Dr. Sharpe played an important role in all 3 of them. In this session, we will take a brief look back at where we have come and then discuss the pioneering efforts ongoing today in the field of robust optimization, novel in room image guidance, and functional-imaging and personalized medicine for adaptive RT.

The evolution of inverse planning and optimization of intensity modulated treatment planning will be discussed. The history will highlight need for the current improvements for robust optimization and adaptive re-planning with multiple delivery modalities including VMAT and protons. Improved methods to search the complete delivery space using Pareto fronts offer improved means for exploring the search space. Lastly, Big Data approaches promise to ensure high quality and achievable dose predictions for plan automation as well as the opportunity to revisit biological outcomes using predictive modeling that can help steer the delivery to limit adverse outcomes to patients.

In October 2003, the first linac-based cone-beam CT patient images were captured at Princess Margaret Cancer Centre. This was a milestone in the technological journey but it was only the beginning of process development for the clinical IGRT workflow and clinical decision making. It has been quite the journey, from the first cobbled together TPS hotscripts to a clinical program that performs over a thousand IGRT deliveries per week. This talk will detail Dr. Sharpe's enormous contribution to this field and ponder about the future of IGRT – how precise can we get? Where does the return on investment of precision plateau?

Adaptive radiotherapy was first pioneered in the 90s, with a focus on understanding the variable uncertainty that existing in individual patients and adapting to this variation. As image guidance advanced to 3D, visualization of soft tissue changes were noted and research into anatomical adaptation began. These studies demonstrated that ‘what you plan, is not what you deliver’ highlighting the opportunity to improve conformity of the delivered dose to the target, potentially improving tumor control and reducing normal tissue toxicity. More recently, adaptive radiotherapy has focused on functional adaptation, noting that metabolic information of the tumor can be targeted and functioning normal tissue can be avoided more precisely when monitored over the course of treatment.

Learning Objectives:
1. Describe the evolution of IMRT and the impact of this technology on big data approaches for plan automation and predictive modeling for improved tumor control with reduced toxicity.
2. Understand the trajectory of improved precision in IGRT, what has been accomplished and what can be achieved in the future.
3. Define the tools developed and clinical advances made in anatomical and functional adaptive radiotherapy


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