RadOnc 2020 -- the future of personalized radiation therapy is here: how to bring genomics to the radiation oncology clinics to inform dose with existing technology.

 

Radiation oncology advances in the last two decades have been driven by improvements in dose delivery through conceptual advances in radiation physics planning. Our ability to give conformal, precise doses of radiation therapy is now unparalleled, and is no longer limiting when it comes to our ability to cure cancers. Giving a precise dose, however, does not mean that we are giving the RIGHT dose – and in this way, our understanding of personalized radiation biology (from patient to patient) is holding back our ability to improve in the clinic.  In this talk I will present a published method of understanding the appropriate dose to give ANY individual patient (the genomic adjusted radiation dose (GARD)), and show what we hypothesize are fundamental distributions of radiation sensitivity. From these distributions, I will explain the failure of a series of recent all-comers dose-escalation trials, then quantify the inefficiencies in current radiation prescription practice, and show how to ameliorate this going forward in trials, and day to day practice.