|Pietro Gabriele, M.D.
“Personalized” Radiation-therapy based on genetic, biological, statistical and “theragnostic” parameters.
The improved IMRT techniques (Intensity Modulated Radiation Therapy) allow the use of high doses, perfectly “sculpted” on the areas that are going to be treated. A further improvement of radiation treatment is provided by “daily image control” based on the IGRT technique (Image Guided Radiotherapy). Genomic information and “theragnostic” data allow the defining models to optimize the use of radiotherapy, in order to personalize treatment.
(i) We have proved - in collaboration with the cancer stem cell laboratory - that ionizing radiation (IR) leads to the expression of an oncogene (Met) involved in invasion and metastasis control; this data contributes to the ‘vexata questio’ debate about the possible radiotherapy side effects on metastasis sprouting. (ii) We performed a feasibility study on large fields, using Tomotherapy. (iii) A controlled clinical trial on IMRT-IGRT treatment protocols for head and neck tumors and recurrences, and three studies on prostate cancers are in progress. (iv) We are contributing to an international multicenter randomized phase III clinical trial on locally advanced rectal cancer. (v) We are leading the european project “Computational Horizons in Cancer” to create a predictive nomogram of prognosis.
Conclusions and perspectives:
We plan (i) to evaluate the possible impact of genetics and molecular biology data on radiotherapy of Glioblastoma Multiforme (GBM). The preclinical research will be implemented by “xenopatients” (immunocompromised mice transplanted with GBM of single patients, see above); (ii) to develop personalized radiotherapy treatment of pancreas cancer, of clivus cordoma, of pleural mesothelioma and of gynecological tumors; (iii) to implement treatment protocols by microwaves and radiofrequencies and by radiochemo-hyperthermia. This information will be the basis for personalized treatment by Tomotherapy , performing ‘Adaptive Radiotherapy’ treatment.