Evolution of Hypofractionated Radiotherapy in Breast Cancerkoustavmajumder1986
Hypofractionated radiotherapy in breast cancer is one of the major evolution. It started few decades back. We have to know its history and radiobiological perspective. In this presentation I have tried to cover as much as possible. It would be helpful for all Radiation Oncologist specially the trainees.
Current controversies in cervical cancer management (2014)Jyotirup Goswami
Overview of the current controversies in the management of cervical cancer, including screening, prevention, staging, chemoradiation,teletherapy techniques, brachytherapy techniques
Evolution of Hypofractionated Radiotherapy in Breast Cancerkoustavmajumder1986
Hypofractionated radiotherapy in breast cancer is one of the major evolution. It started few decades back. We have to know its history and radiobiological perspective. In this presentation I have tried to cover as much as possible. It would be helpful for all Radiation Oncologist specially the trainees.
Current controversies in cervical cancer management (2014)Jyotirup Goswami
Overview of the current controversies in the management of cervical cancer, including screening, prevention, staging, chemoradiation,teletherapy techniques, brachytherapy techniques
Tony seruga yolanda seruga business expert. Tony Seruga Yolanda Seruga hates scam and fraud and any kinds of ripoff. Tony Seruga a business i con knows pros and cons and has got very good reviews as he got the best review of internet marketer.In the early years, Tony Seruga started a professional lawn service, employing college kids to do the actual work when he was only 14 years old building revenues to over $12,000 per year by the time he was 17. Tony built his first computer from a kit in 1976 and started his first “online” business in the early 1980s, using AOL and Compuserve.
Tony is a serial entrepreneur, having personally started over 240 businesses and over 600 with business partners. Tony has mentored thousands upon thousands of business owners.
Tony has been an early stage investor and entrepreneur since 1987. Tony has over two decades of experience in the venture capital, technology and entertainment industries in a multitude of investing, operational and engineering roles acting as a key adviser. In addition to his investing efforts, Tony has been active with several non-profit organizations. Tony holds a Juris Doctorate, although he never chose to practice law, opting for buying and selling businesses and investing in those projects he felt had the best chance of success.
Tony was co-owner of half a dozen early search engines including three pay-per-click search engines and was an early angel investor and adviser to four different businesses that went on to become multi-billion dollar companies. As a business adviser, Tony’s past client roster included a number of household names and celebrities.
And while Tony enjoyed speaking at business and marketing events all over the world, his real passion is to empower entrepreneurs and business owners to create massive success. Tony loves to help people to understand specifically what it takes to build a successful business. He has a very successful background in venture capital, investing and marketing. He has spent two decades working with start-ups to major global brands increasing sales, productivity and overall success and is an innovator with a remarkable ability to determine and dictate success strategies that enable companies to seize global market opportunities.
For everyone that either wishes to start their own business, currently owns a business or would like to capitalize the entrepreneurial dream, Tony’s message will enlighten them with knowledge and actionable principles to turn that passion into success. Tony has an extensive background in starting businesses, commercial real estate development and building companies around the world. Over the past two decades, he has specialized in helping companies launch, grow and create exponential valuation in the marketplace.
For more info about Tony Seruga visit http://tonyserugatonyserugatonyseruga.blogspot.com/
Curative lung radiotherapy has historically been hampered by inadequate imaging techniques. Conventional CT provides poor information regarding tumour shape, size and motion throughout the patient’s breathing cycle. Consequently lung radiotherapy techniques have been characterised by excessively large targets to ensure the actual tumour receives the intended treatment.
Imaging biobanks, report from the european society of radiology Emanuele Neri
In March 2014 the European Society of Radiology (ESR) established a dedicated working group (ESR WG on Imaging Biobanks) aimed at monitoring the existing imaging biobanks in Europe, promoting the federation of imaging biobanks and
communication of their findings in a white paper. The WG provided the following statements:
Imaging biobanks can be defined as “organised databases of medical images and associated imaging biomarkers (radiology and beyond) shared among multiple researchers, and linked to other biorepositories”.
The immediate purpose of imaging biobanks should be to allow the generation of imaging biomarkers for use in research studies and to support biological validation of existing and novel imaging biomarkers.
A long-term scope of imaging biobanks should be the creation of a network/federation of such repositories integrated with the already existing biobanking network.
Developing a national strategy to bring pathogen genomics into practiceExternalEvents
http://www.fao.org/about/meetings/wgs-on-food-safety-management/en/
Developing a national strategy to bring pathogen genomics into practice. Presentation from the Technical Meeting on the impact of Whole Genome Sequencing (WGS) on food safety management and GMI-9, 23-25 May 2016, Rome, Italy.
Normalization of Tumor Microenvironment in Hepatocellular Carcinoma
Oral presentation made at the 2016 World Gastrointestinal Cancer Symposium in Barcelona by Eric Raymond MD, PhD at Saint-Joseph Hospital. This presentation comprehensively updates drugs targeting the microenvironment such as antiangiogenic agents such as VEGF/VEGFR inhibitors, stromal signaling inhibitors such as HGF/c-MET, FGF19/FGFR4, TGF-beta targeting agents and immunotherapy such as PD1/PDL1 and CTLA4 inhibitors in hepatocellular carcinoma. This presentation is aimed at targeting physicians, scientists, students, and experts in pharmas who are interested in drug development in this area of oncology.
Radiomics Data Management, Computation, and Analysis for QIN F2F 2016Ashish Sharma
Large Scale Data Management Computation and Analysis for Quantitative Imaging Research
Talk at the 2016 QIN Annual Meeting — covers resources developed for the Quantitative Imaging Network. Includes TCIA data curation, APIs, supported data types, as well as co-located computing and systematic phenotyping of imaging biomarkers
Genomics England and the power of DNA databis_foresight
Presentation by Sir Mark Walport at the Wired Health Conference on 29 April 2014.
Read a report of the presentation at: http://www.wired.co.uk/news/archive/2014-04/29/sir-mark-walport
#wiredhealth
Oncology Immunotherapy - Nivolumab and other PD-1/PD-L1 Targeted Agents (061213)Will Roettger
This is a short briefing on the oncology immunotherapy PD-1/PD-L1 targeted agents currently under development. In this briefing we look at the competitive landscape, PD-1/PD-L1 product profiles, positioning, strategy, as well as a development timeline and SWOT on the BMS PD-1 blocker nivolumab. Updates to this briefing will come as newer information is discovered.
High Risk disease is defined as “apparent localized cancer that has a high propensity of micro-metastatic disease” (cancer that is not visible on convention radiography, such as bone and CT scans). These cancers, once removed via radiation or surgery, are likely to "return," but in fact, they were never removed in the first place because the cancer cells were outside the treated region.
Therefore, successful eradication of high risk disease requires both aggressive local control and systemic treatment with androgen deprivation therapy and extended field radiation. This lecture will review the most up-to-date data on dose-intensity radiation therapy, pelvic radiation, surgery with adjuvant radiation, and adjuvant hormone therapy. Finally, data on experimental chemotherapy and abiraterone (Zytiga) will be presented.
CyberKnife is an option in inoperable or medically not suitable for surgery
& in patient with progression / not tolerating systemic therapy
- Initial results are impressive with low toxicity, good response rate
Pts with small tumour, no prior treatment with good performance
treated with high dose have significantly better survival
Dose >45 Gy; 15Gy/# and small vol tumour (<50cc) have better prognosis
There is minimal toxicity with CyberKnife in liver tumours
Addition of chemotherapy along with CyberKnife will be the future
11. Breath adapted radiotherapy D eep inspiration breath hold Free breathing Irradiated heart volume 8% Irradiated heart volume 1%
12. 4D radiotherapy ‘ .. is the explicit inclusion of temporal changes in anatomy during imaging, planning and delivery of radiotherapy [Keall ’03] 4D imaging 4D planning 4D delivery 4D CT scans Tumour mobility Normal organ avoidance Respiratory gating
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14. T owards optimization of r adiotherapy Treatment and patient tailoring Better imaging Better beam delivery
15. T owards optimization of r adiotherapy Treatment tailoring Better imaging Better beam delivery Integration with targeted therapy Optimal integration with medical therapy
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20. Van Nuys Prognostic Index Scores of 3-4 - 98% local control without RT Scores of 5-7 - 32% failed without RT, 16% with RT Scores of 8-9 - 100% failure without RT, 60% with RT
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22. Distant Failure Jatoi et el. JCO 2005. Trial Pt Time pt. Mast. BCT WHO 1972-79 179 22 yrs 24% 23% Milan I 1973-80 701 20 51% 54% NSABP06 1976-84 1406 20 33% 40% US NCI 1979-89 279 20 34% 39% EORTC 10801 1980-86 903 10 34% 30% Denmark 82TM 1983-89 859 6 32% 34%
23. Local Failure Jatoi et el. JCO 2005. Trial Pt Time pt. Mast. BCT WHO 1972-79 179 22 yrs 14 % 9 % Milan I 1973-80 701 20 2 % 9 % NSABP06 1976-84 1406 20 10 % 14 % US NCI 1979-89 279 20 6 % 22 % EORTC 10801 1980-86 903 10 12 % 2 0% Denmark 82TM 1983-89 859 6 4 % 3%
24. Overall Survival Trial Pt Time pt. Mast. BCT WHO 1972-79 179 22 yrs 41% 42% Milan I 1973-80 701 20 47% 46% NSABP06 1976-84 1406 20 58% 53% US NCI 1979-89 279 20 66% 65% EORTC 10801 1980-86 903 10 79% 82% Denmark 82TM 1983-89 859 6 67% 67%
30. Randomized Clinical Trials No significant differences are seen in toxicity or LRR Canadian Start A Start B RMH/GOC Necker Pts 1234 2236 2215 1410 230 Med FU 12 yrs 5.1 yrs 6.0 yrs 9.7 yrs 4 yr Min Arms (Gy x Fx) 2 x 25 2.67 x 16 2 x 25 3 x 13 3.2 x 13 2 x 25 2.67 x 15 2 x 25 3 Gy x 13 3.3 x 13 1.8 x 25 5.75 x 4
31. RANDOMI ZED adjuvant radiotherapy – 16 x 2.67 Gy – no boost adjuvant radi therapy – 25 x 2 Gy – no boost 1234 patients T1 and T2, N0 patients, BCS and ALND Primary endpoint: Local recurrence (LR) Other endpoints: Toxicity, cosmetic results, overall survival (OS) Long-Term Results of Hypofractionated Radiation Therapy for Breast Cancer Whelan et al.NEJM 2010.
34. 10- Yr Toxicity Whelan TJ et al. N Engl J Med 2010;362:513-520 P = NS Standard HypoFx Skin 0 71% 67% 1 22% 24% 2-3 7% 9% Subcut Tissue 0 45% 48% 1 44% 40% 2-3 11% 12%
35. 10-Yr Cosmetic Results Whelan TJ et al. N Engl J Med 2010;362:513-520 P = NS Standard HypoFx Excellent 28% 31% Good 44% 39% Fair 26% 25% Poor 3% 5%
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38. Patients in the RCT’s Patients older, favorable cancers, chemo/boost not routine Canadian Start A Start B RMH/GOC Necker ER- 27% 21% 12% - - Gr 3 19% 28% 23% - 10% Age < 50 25% 23% 21% 30% - Boost 0% 61% 43% 75% 0% Nodal RT 0% 14% 7% 21% - Chemo 11% 36% 22% 14% 21%
39. ASTRO Guidelines (2010) Smith B et al . IJROBP In Press Age/Stage > 50 yrs, T1,2 N- Surgery BCS Chemotherapy None Fractionation 266 cGy x 16 Heart in Field 0 Boost No Agreement Dose Homogeneity < +/- 7%
40. Clinical Trials in Progress FAST IMPORT High IMPORT Low SHARE RTOG # Pts 915 840 2100 2796 2150 Sites UK UK UK France US Arms (Gy x # Fx) 2 x 25 5.7 x 5 6 x 5 All in 5 weeks 2.4 x 15 integrated boost 2.67 x 15 -> boost 2.67 x 15 2.4 x 15 integrated boost APBI 2.67 x 15 2 x 25 + 2 x 8 2.67 x 15 APBI 4 x 10 2.0 x 25 -> boost 2.67 x 15 integrated boost
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45. 10 trials of post BCS RT Effect on LR and breast cancer mortality in N- pts BC S BCS + RT BCS BCS + RT
46. 10 trials of post BCS RT Effect on LR and breast cancer mortality in N+ pts BCS BCS + RT BCS + RT BCS
47. The 18-y probability of any DM was significantly higher in No RT vs RT group No RT median time RT median time
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49. Incidence of 2nd cancers and mortality from causes other than breast cancer
50. Breast cancer and overall mortality after BCS/RT BCS + RT BCS BCS + RT BCS
51. Main findings II RT can increase mortality for heart disease and lung cancer and incidence of contr a lateral breast cance r which reduce its net beneficial effect on 15-y breast cancer mortality. Nevertheless, RT produced reductions not only in 15-y breast cancer mortality but also in 15-y overall mortality.
Figure 1. Outcomes in Patients with Breast Cancer Who Received a Hypofractionated Regimen of Radiation Therapy as Compared with Patients Who Received the Standard Regimen. Panel A shows Kaplan-Meier estimates for local recurrence (P<0.001 for noninferiority), and Panel B shows Kaplan-Meier estimates for overall survival (P=0.79).
Figure 2. Hazard Ratios for Ipsilateral Recurrence of Breast Cancer in Subgroups of Patients.
Table 1. Late Toxic Effects of Radiation, Assessed According to the RTOG-EORTC Late Radiation Morbidity Scoring Scheme.
Table 2. Global Cosmetic Outcome, Assessed According to the EORTC Scale.