Integration of Technology and Biology for Precision and Personalized Radiation Oncology
Abstract
Purpose
There are many recent advances in linear energy transfer (LET) optimized proton therapy planning, radiation biology, immune therapy, and molecular imaging with the potential to improve the efficacy of radiation oncology. The aim of this talk is to present feasible integration of technology and biology that can further enhance the therapeutic gain in radiation oncology.
Methods
High LET proton beam dose-painting of the tumor coupled with immunotherapy can potentially increase tumor cell killing of the irradiated tumor and can stimulate regression of distant unirradiated (abscopal) tumors. The hypo-fractionated ablative proton therapy has the potential to increase tumor control while keeping the doses to OAR under their tolerances and may enhance the immune response to inhibit metastatic tumor progression. Lattice based spatially fractionated proton therapy (LSFPT) has the potential to deposit high LET and high ablative doses to selected sub-volumes of target determined from molecular and functional imaging for higher tumor control probability (TCP) with reduced or same level of normal tissue damage compared conventional radiation therapy regimen. The promises of combining high LET proton therapy dose using LSFPT and quasi-proton arc therapy to selective radioresistant sub volumes of the target to enhance antitumor immune response with added immune enhancing drugs for personalized ablative therapy will be discussed. Potential use of combined radiation therapy and immune therapy with suitable biomarker monitoring before, during and after the ablative radiation therapy and novel dose fractionation schemes for improving the efficacy of radiation therapy to control both primary and metastatic diseases will be presented.
Results
The use of the promising techniques described above is expected to enhance the efficacy of the radiation oncology.
Conclusion
Higher level of therapeutic gain in radiation oncology is possible with the integration of recent developments in technology and biological features of the tumor and body's immune response.