- Email: [email protected]
488 speaker THE BEST OF TWO WORLDS
W EDNESDAY, M AY 11, 2011
P RESIDENTIAL SYMPOSIUM
S 199
Conference lecture
Presidential symposium
Honorary Members Award Lectures
ESTRO-ESMO-ESSO-ECCO Presidential symposium: Clinical Oncology: The future of Radiotherapy, Medical Oncology and Surgical Oncology
488 speaker THE BEST OF TWO WORLDS A. Chiti1 1 IRCCS H UMANITAS, Nuclear Medicine, Rozzano - Milano, Italy
Purpose: The increasing use of molecular imaging in radiation treatment planning is reshaping the way of thinking of both radiation oncologists and nuclear medicine physicians. This contribution is aimed at looking what has been done, what is on the way and what can be forecasted in the future. Methods: Great efforts are on their way to have a better integration of two worlds: radiation oncology and nuclear medicine. These efforts are not only on the technical and methodological side but, most of all, on the professional collaboration and integration. Results: The fruitful cooperation between ESTRO and EANM is leading the integration of the best molecular approaches to cancer detection and characterization within the best treatment procedures in radiation oncology. Conclusions: The future is going to be one of a deeper integration between molecular imaging and radiation oncology. 489 speaker HEAD NECK CANCER: PROMISES, PITFALLS, CHALLENGES & OPPORTUNITIES J. P. Agarwal1 1
TATA M EMORIAL H OSPITAL, Radiation Oncology, Mumbai, India
Head-neck cancer is the commonest cancer in developing countries including India where it constitutes over a quarter of the overall cancer burden. Early stage disease is treated equally well with either surgery or radiotherapy. Advanced stage disease mandates the use of combined modality treatment. Traditionally, surgery followed by post-operative radiotherapy has been used for improving outcomes. Recent evidence supports the use of adjuvant chemo-radiotherapy in high-risk resected squamous cell carcinoma. The current emphasis on organ and function preservation has made definitive radiotherapy with concurrent systemic chemotherapy the contemporary standard of care in the non-surgical management of loco-regionally advanced headneck cancer. There has been renewed interest in Induction chemotherapy followed by loco-regional therapy both as part of an organ-preservation protocol as well as improving resectability in borderline tumors. With deeper insights and mature understanding of molecular biology of head-neck cancer, EGFR-directed therapy is being widely integrated into the therapeutic armamentarium. Progress in head-neck cancer can be largely attributed to meaningful biological, translational, and clinical research conducted worldwide over the last two decades resulting in shifting paradigms and changing clinical practice. In keeping with the times, we at the Tata Memorial Centre have evolved from simple two-dimensional techniques to high-precision conformal radiotherapy (3D-CRT, IMRT, IGRT). There has been a concerted effort to generate quality evidence from within our own population by hypothesizing and answering clinical questions through simple relevant trials, both at the institutional, national, and international level. The presentation will discuss progress in head-neck cancer and describe our evolution over the years.
490 speaker CLINICAL ONCOLOGY: THE FUTURE OF RADIOTHERAPY AND MEDICAL ONCOLOGY, LANCET APRIL 18, 1981. STATUS THEN AND NOW (30-YEARS LATER) – DID THE WISHES COME TRUE? M. Peckham Abstract not received.
491 speaker CLINICAL ONCOLOGY IN EUROPE 2011 AND BEYOND D. Kerr Abstract not received.
492 speaker CLINICAL ONCOLOGY IN EUROPE 2011 AND BEYOND - THE ROLE OF SURGERY P. Naredi1 1 U MEÅ U NIVERSITY, Umeå, Sweden
Cancer care develops rapidly and the individual physician is replaced by the multidisciplinary team in the decision making. The evolution of new cancer drugs based on increased knowledge in cancer biology catches most headlines but will for many years to come not replace potentially curative treatments. Radiotherapy and/or cancer surgery can and will be used with a curative intent. There will be improvements in surgical treatment to minimize the trauma and enable an aging population to receive surgery. Surgery will be less invasive. Laparoscopic procedures will not be the big leap forward but the principles of video- and robotic-assisted surgery will enable development of high precision procedures in narrow areas. Nano techniques and tracers targeted against cancer specific receptors will facilitate image guided surgery. The hunt for detectable cancer nodules can be motivated in several cancers, e.g. ovarian and colorectal cancer, when combined with adjuvant systemic treatments. A fifty percent five years survival after liver resection for colorectal liver metastases shows that systemic spread of cancer cells still can lead to localised disease worth resecting. The difficulty lies in identification of cancer patients who will benefit from extensive cancer surgery. Clinical trials will define the role of surgery. This has been the case for rectal cancer where a substantial decrease in local recurrences is observed after the introduction of total mesorectal excision (TME). Trials have also shown the added value of preoperative radiotherapy. In breast cancer diagnostic axillary dissection is replaced by sentinel node biopsy and most likely clinical trials will define the patient population where there is limited advantage of additional axillary surgery. Nothing indicates that insufficient (not radical) surgery can be substituted by local radiotherapy or systemic treatments. These treatments should be considered as part of the multimodality treatment and not as salvage therapies. Clinical trials will also define the role of surgery versus local ablative treatments for smaller localised cancers. Radiofrequency ablation or stereotactic radiotherapy become more common and need to be evaluated in wellconducted randomized trials. The indications for treatment with curative as well as palliative intent must be decided. The cancer surgeon from 2011 and beyond must be prepared to submit to a broad practical as well as theoretical training. Technical skills are necessary but the cancer surgeon must be perceptive, have knowledge in basic science and understand the principles behind pharmaceutical and radiation therapies. Surgery will be less costly than many other cancer therapies but an increasing incidence of cancer and improved possibilities to treat cancer patients will force surgeons as will as other cancer specialists to economize with resources. The question will not be "can we resect the tumour" but "is it indicated to resect the tumour". Rarely will the surgeon take that decision herself/himself but instead as an important member of a team of cancer specialists.
P RESIDENTIAL SYMPOSIUM
S 199
Conference lecture
Presidential symposium
Honorary Members Award Lectures
ESTRO-ESMO-ESSO-ECCO Presidential symposium: Clinical Oncology: The future of Radiotherapy, Medical Oncology and Surgical Oncology
488 speaker THE BEST OF TWO WORLDS A. Chiti1 1 IRCCS H UMANITAS, Nuclear Medicine, Rozzano - Milano, Italy
Purpose: The increasing use of molecular imaging in radiation treatment planning is reshaping the way of thinking of both radiation oncologists and nuclear medicine physicians. This contribution is aimed at looking what has been done, what is on the way and what can be forecasted in the future. Methods: Great efforts are on their way to have a better integration of two worlds: radiation oncology and nuclear medicine. These efforts are not only on the technical and methodological side but, most of all, on the professional collaboration and integration. Results: The fruitful cooperation between ESTRO and EANM is leading the integration of the best molecular approaches to cancer detection and characterization within the best treatment procedures in radiation oncology. Conclusions: The future is going to be one of a deeper integration between molecular imaging and radiation oncology. 489 speaker HEAD NECK CANCER: PROMISES, PITFALLS, CHALLENGES & OPPORTUNITIES J. P. Agarwal1 1
TATA M EMORIAL H OSPITAL, Radiation Oncology, Mumbai, India
Head-neck cancer is the commonest cancer in developing countries including India where it constitutes over a quarter of the overall cancer burden. Early stage disease is treated equally well with either surgery or radiotherapy. Advanced stage disease mandates the use of combined modality treatment. Traditionally, surgery followed by post-operative radiotherapy has been used for improving outcomes. Recent evidence supports the use of adjuvant chemo-radiotherapy in high-risk resected squamous cell carcinoma. The current emphasis on organ and function preservation has made definitive radiotherapy with concurrent systemic chemotherapy the contemporary standard of care in the non-surgical management of loco-regionally advanced headneck cancer. There has been renewed interest in Induction chemotherapy followed by loco-regional therapy both as part of an organ-preservation protocol as well as improving resectability in borderline tumors. With deeper insights and mature understanding of molecular biology of head-neck cancer, EGFR-directed therapy is being widely integrated into the therapeutic armamentarium. Progress in head-neck cancer can be largely attributed to meaningful biological, translational, and clinical research conducted worldwide over the last two decades resulting in shifting paradigms and changing clinical practice. In keeping with the times, we at the Tata Memorial Centre have evolved from simple two-dimensional techniques to high-precision conformal radiotherapy (3D-CRT, IMRT, IGRT). There has been a concerted effort to generate quality evidence from within our own population by hypothesizing and answering clinical questions through simple relevant trials, both at the institutional, national, and international level. The presentation will discuss progress in head-neck cancer and describe our evolution over the years.
490 speaker CLINICAL ONCOLOGY: THE FUTURE OF RADIOTHERAPY AND MEDICAL ONCOLOGY, LANCET APRIL 18, 1981. STATUS THEN AND NOW (30-YEARS LATER) – DID THE WISHES COME TRUE? M. Peckham Abstract not received.
491 speaker CLINICAL ONCOLOGY IN EUROPE 2011 AND BEYOND D. Kerr Abstract not received.
492 speaker CLINICAL ONCOLOGY IN EUROPE 2011 AND BEYOND - THE ROLE OF SURGERY P. Naredi1 1 U MEÅ U NIVERSITY, Umeå, Sweden
Cancer care develops rapidly and the individual physician is replaced by the multidisciplinary team in the decision making. The evolution of new cancer drugs based on increased knowledge in cancer biology catches most headlines but will for many years to come not replace potentially curative treatments. Radiotherapy and/or cancer surgery can and will be used with a curative intent. There will be improvements in surgical treatment to minimize the trauma and enable an aging population to receive surgery. Surgery will be less invasive. Laparoscopic procedures will not be the big leap forward but the principles of video- and robotic-assisted surgery will enable development of high precision procedures in narrow areas. Nano techniques and tracers targeted against cancer specific receptors will facilitate image guided surgery. The hunt for detectable cancer nodules can be motivated in several cancers, e.g. ovarian and colorectal cancer, when combined with adjuvant systemic treatments. A fifty percent five years survival after liver resection for colorectal liver metastases shows that systemic spread of cancer cells still can lead to localised disease worth resecting. The difficulty lies in identification of cancer patients who will benefit from extensive cancer surgery. Clinical trials will define the role of surgery. This has been the case for rectal cancer where a substantial decrease in local recurrences is observed after the introduction of total mesorectal excision (TME). Trials have also shown the added value of preoperative radiotherapy. In breast cancer diagnostic axillary dissection is replaced by sentinel node biopsy and most likely clinical trials will define the patient population where there is limited advantage of additional axillary surgery. Nothing indicates that insufficient (not radical) surgery can be substituted by local radiotherapy or systemic treatments. These treatments should be considered as part of the multimodality treatment and not as salvage therapies. Clinical trials will also define the role of surgery versus local ablative treatments for smaller localised cancers. Radiofrequency ablation or stereotactic radiotherapy become more common and need to be evaluated in wellconducted randomized trials. The indications for treatment with curative as well as palliative intent must be decided. The cancer surgeon from 2011 and beyond must be prepared to submit to a broad practical as well as theoretical training. Technical skills are necessary but the cancer surgeon must be perceptive, have knowledge in basic science and understand the principles behind pharmaceutical and radiation therapies. Surgery will be less costly than many other cancer therapies but an increasing incidence of cancer and improved possibilities to treat cancer patients will force surgeons as will as other cancer specialists to economize with resources. The question will not be "can we resect the tumour" but "is it indicated to resect the tumour". Rarely will the surgeon take that decision herself/himself but instead as an important member of a team of cancer specialists.