20^th Euro-Global Summit on Cancer Therapy& Radiation Oncology August 28-29, 2017 Brussels, Belgium

The branch of Oncology dealing with Radiation therapy is termed as Radiation Oncology. The main Radiotherapeutic methods can be classified in: Teleradiotherapy, Brachy-radiotherapy, and Metabolic radiotherapy. Tele-radiotherapy is also termed as External transcutaneous / Distant radiotherapy , in which case the radiation source is situated at a certain distance from the tissue to be treated. Brachytherapy is also termed Short direct radiotherapy /Curitherapy. The radiation source can be placed in contact with the tumor or it can be implanted in the tumor. Curative radiotherapy is indicated to be used in: Sticker’s sarcoma, Mastocytomas with particular locations, such as ears, nose, extremities, eyelids, etc.; Acanthomatous epulis; Ameloblastoma; Nasal cavity adenocarcinoma and Anal gland adenocarcinoma. Stereotactic radiosurgery is a single-day procedure for treating small intracranial lesions. Metabolic radiotherapy represents the administration of isotopes or isotope carrying molecules that selectively concentrate in a certain tissue into which they enter as metabolites. For Example; iodine 131 - in Thyroid cancer; phosphorus 32 - in Myeloproliferative disorders. 

There are more than 200 types of cancer, including Breast cancer, skin cancer, lung cancer, colon cancer, Prostate cancer, and lymphoma. Symptoms and Treatment varies depending on the type of Cancer. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. The Anticancer therapies include Surgical therapy, Chemotherapy, Adjuvant therapy, Neoadjuvant therapy, Palliative therapy, Immunotherapy, Hormonal therapy, Radiotherapy, Nutritional therapy, Phototherapy. Phototherapy / proton beam therapy is the most advanced among all the therapies. All Anticancer agents act by disturbing cell multiplication or normal functioning, DNA synthesis or chromosomal migration, and by blocking or changing RNA and protein metabolism.

Medical imaging is the technique and process of creating visual representations of the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues. Imaging technologies include X-ray imaging, Computed tomography, Planar scintigraphy, Imaging modalities, Emission tomography, Magnetic Resonance Imaging, Multimodal systems. It helps in diagnosis of Cancer, Cardiovascular disease, Neurological disorders (e.g., Alzheimer’s disease) and in drug development via small animal imaging with micro PET or micro SPECT, micro CT, micro MRI, bioluminescence and fluorescence imaging systems. 

Diagnostics plays an important role throughout your Cancer treatment. Before treatment, to accurately locate tumors, stage the disease, and determine an appropriate combination of cancer treatments for you. During your treatment, to track the size of the tumor, progression of the disease, and your response to treatment, and modify your treatment accordingly.  After you complete treatment, to monitor for any signs of metastasis or recurrence. To confirm the diagnosis of most cancers, a Biopsy needs to be performed in which a tissue sample is removed from the suspected tumor and studied under a microscope to check for cancer cells. In Endoscopy, a flexible plastic tube with a tiny camera on the end is inserted into body cavities and organs, allowing the physician to view the suspicious area. Screening tests serve to detect the possibility that a cancer is present before symptoms occur. In women, two of the most widely used screening tests are the Pap smear test to detect Cervical Cancer and Mammography to detect Breast Cancer. In Men, Prostate Specific Antigen (PSA) levels in the blood may be used to screen for Prostate Cancer. A common screening test for Colon Cancer involves checking the stool for Blood that cannot be seen by the naked eye (occult blood).

Clinical Oncology includes full spectrum of Nonsurgical Cancers including the Radiotherapy, Chemotherapy, Biological targeted therapy and Palliative care. Clinical oncologists treat Solid tumors with Conventional radiotherapy, Brachytherapy, Chemotherapy, biological therapy, molecularly targeted agents, and increasingly with a combination of these. Clinical oncologists determine which treatment to use by considering a range of factors including Tumor type, the site of the tumor, the stage of the disease and the patient’s general health. They then assess the relative merits of different treatments before presenting these to the patient so that an informed decision can be made. The branch also includes the study of Cancer staging, Cancer Clinical trials, Cancer epidemiology, Cancer biostatistics etc.

Cancer is a Genetic disease caused mainly due to the Alterations in different kinds of Genes. A change in a gene is called a ‘fault’ or ‘mutation’. All cancers develop because something has gone wrong with one or more of the genes in a cell. Cancer Genetics is the branch of Genetics dealing with gene alterations in Cancer patients. Mutations in Oncogenes and Tumor suppressor genes contribute to the development of cancer. The most commonly mutated gene in people who have cancer is p53. Genetic changes that increase cancer risk can be inherited from our parents if the changes are present in germ cells, which are the reproductive cells of the body (eggs and sperm). Such changes, called Germ line changes, are found in every cell of the offspring. Germ line mutations in BRCA1 or BRCA2 genes increase a women’s risk of developing Hereditary Breast Cancer or Ovarian Cancers. Mutations in tumor suppressor gene of PTEN protein causes Cowden Syndrome, an inherited disorder that increases the risk of Breast, Thyroid, Endometrial and other types of cancer.

Among all Anti-cancer therapies, treatment of Cancer by surgery remains a basic method for oncology. Surgical oncology is the branch of Oncology that deals with the surgical aspects of cancer including biopsy, cancer staging, and surgical resection of tumors; although there are numerous limits and contraindications such as Adenopathies, Metastases, etc. This method is the key to success in many cases of tumors like colorectal, small and large bowel cancer, some lung, ovarian, thyroid, testicular, stomach and uterine cancers, because it is effective, easy to perform and economical. 

Cancer chemotherapy involves the selection of drugs and dose levels, which will eradicate disseminated cancer cells, without causing severe host toxicity. Depending on the primary location and the extension of the disease, chemotherapy can be curative or palliative. In the majority of cases, Chemotherapy leads to the prolongation of survival, and in other cases it results in the eradication of the disease. Chemotherapy can be in most cases a major adjuvant to surgical therapy and/or radiotherapy. It is most successful against Leukemias. Mechanism-based approaches have also been explored for several decades. About 30 chemotherapeutic drugs are in regular use in the treatment of cancer till date. In fact, the only available Anti-neoplastic drugs which can be administered orally are limited to: cyclophosphamide, methotrexate, trofosfamide, capecitabine, S-1, UFT, navelbine, etoposid, temozolomide, dexamethasone, estramustin, chlorambucil, busulfan, 6-mercaptopurine, procarbacin, treosulfan, idarubicin, topotecan and hydroxycarbamid. All Antitumor drugs may be placed into one of three classes based on the relationship of the effect to the mitotic cycle of the cell: 1. Cell cycle active, phase specific 2. Cell cycle active, phase non-specific 3. Non-cell cycle active. 

The term Palliation indicates non curative intent for more advanced diseases. Palliative care is a multidisciplinary approach to specialized medical care for people with serious illnesses like Cancer, Congestive heart failure(CHF), Chronic Obstructive Pulmonary Disease(COPD), Kidney Disease, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS) and many more. Palliative care is also called as Comfort care, Supportive care and Symptom Management. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Palliative care is given throughout a patient’s experience with cancer. It should begin at diagnosis and continue through treatment, follow-up care, and the end of life. When a patient reaches a point at which treatment to destroy the cancer is no longer warranted, palliative care becomes the total focus of care. Palliative care is provided by a specially-trained team of doctors, nurses, social workers and other specialists who work together with a patient’s doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

Hormones are substances made by glands in the body that function as Chemical signals. They affect the actions of cells and tissues at various locations in the body, often reaching their targets by travelling through blood stream. Treating disease condition with Hormones is called as Hormonal therapy. Hormonal therapy may also be called Anti-hormone treatment.  Think of it as the opposite of hormone replacement therapy (HRT).Hormone therapy is a form of systemic therapy, meaning it reaches cancer cells anywhere in the body and not just in the breast. It is recommended for women with hormone receptor-positive (ER-positive and/or PR-positive) Breast cancers, but it does not help women whose tumors are hormone receptor-negative (both ER- and PR-negative). Most types of hormone therapy for breast cancer either lower estrogen levels or stop estrogen from acting on breast cancer cells. For treating Breast cancer, majorly two types of drugs are generally used. First, Drugs that block estrogen like Tamoxifen, Fulvestrant (Faslodex^®) or Drugs that lower estrogen Aromatase inhibitors (AIs). Hormonal therapy is also used in treating few cases of Prostate cancer.

The three currently used weapons, Surgery, Radiotherapy and Chemotherapy, are symbolically compared to iron, fire and poison. The opposite of these therapies, which attempts to compensate and replace these “brutal” treatments by a less aggressive treatment, remains the mobilization of the inner defense or repair systems of affected cells. In time, the understanding of the complex phenomena occurring as a result of the reaction of the neoplastic organism and of tumor cell behavior has led to the progress, diversification and increased efficacy of Immunotherapeutic means. This has allowed the development and use of therapies based on Cytokines, Monoclonal antibodies, Chemical immunostimulators, Interferon, Tumor necrosis factor, Anti-tumor growth factor antibodies, Antiangiogenesis factors, and many others. The techniques of creating Hybridomas able to produce Monoclonal antibodies that might recognize a single antigen also give hope for both the early diagnosis and therapy of Cancer metastases.

Stem cells are defined as the cells that have the ability to perpetuate themselves through self renewal and generate mature cells of a particular tissue through differentiation. Hematologic diseases like leukemia, multiple myeloma, non-Hodgkin lymphoma and Hodgkin lymphoma arise from mutations that accumulate in HSC. Hence Hematopoietic progenitor cell transplantation, commonly referred to as a Stem cell transplantation  can treat such cancers. The source of stem cells is most commonly either from the Bone marrow or the peripheral blood. Cancer Stem cells can be defined as cells in the Tumor growth with a Tumor initiating potential. Compared to normal stem cells, the cancer stem cells are believed to have no control on the cell numbers. the concept of the cancer stem cells may allow new treatment options in the possible cure of the cancer. However, further research is required to identify and separate the cancer stem cells in various cancers from normal stem cells and other cancer cells. 

Dynamic phototherapy refers to the use of Hematoporphyrin or photofrin II preparations, at specific light wavelengths, in the detection and treatment of malignant solid tumors. Both the detection and treatment of tumors by the dynamic phototherapy technique depend on the character of the neoplasm, on the location of the preparation in the tumor, Hematoporphyrin concentration, molecular oxygen availability and visible light. Proton therapy is useful for treating tumors that have not spread and for tumors near important parts of the body, such as near the eye, the brain, and the spinal cord. It is also used for treating children because it lessens the chance of harming healthy, developing tissue. Children may receive proton therapy for cancers of the brain and spinal cord and the eye, such as Retinoblastoma and orbital Rhabdomyosarcoma. Proton therapy also may be used to treat these cancers: Central nervous system cancers - including Chordoma, Chondrosarcoma, and Malignant meningioma; Eye cancer, including melanoma or choroidal melanoma, Head and neck cancers, including nasal cavity and Para nasal sinus cancer and some Nasopharyngeal cancers, Lung cancer, Liver cancer, Prostate cancer, Spinal and Pelvic sarcomas, which are cancers that occur in the soft-tissue and bone, Noncancerous Brain tumors.

Use of Radiation to kill diseased cells has become a standard treatment option for a wide range of malignancies. It utilizes either  X-rays, gamma rays, electron beams or protons to treat cancer. Radiotherapy can be used in three modalities:– Curative radiotherapy; Adjuvant radiotherapy and Palliative radiotherapy. Among all the available Anti-cancer therapies, Radiation therapy is the most conventional method of treating Cancers. Success depends on early diagnosis, the volume and histological nature of the tumor. Techniques in Radiation therapy include  Triggered imaging radiosurgery, Gamma Knife surgery, Medical dosimetry, Three-Dimensional Conformal Radiation Therapy, Brachytherapy, External Beam Radiation Therapy, Image-Guided Radiotherapy, Intensity Modulated Radiation Therapy, radioisotope therapy, Stereotactic body radiation therapy, Total Body Irradiation, and Total Skin Irradiation.

The field of Radiotherapy has undergone an amazing series of developments since its inception over a century ago. The use of Ionizing radiation for the treatment of cancer dates back to the late 19th century, remarkably soon after Roentgen described X-rays in 1895 and the use of brachytherapy after Marie and Pierre Curie discovered radium in 1898.  These initial efforts stimulated a revolution of conceptual and technological innovations throughout the 20th century, forming the basis of the safe and effective therapies used today. This is largely the result of dedicated and inventive pioneers, whose conceptual and technological advances created an entire specialty of one early observation of “a new type of ray.” Perhaps the most important of these developments has been the paradigm of fractionated dose delivery, technologic advances in X-ray production and delivery, improvements in Medical Imaging and computer-based treatment planning, and evolving models that predict how cancers behave and how they should be approached therapeutically.  Advances in our ability to shape Radiation beams have also led to major treatment planning advances. Image-Guided Radiotherapy, Intensity Modulated Radiation Therapy, Stereotactic body radiation therapy for treating brain tumors are the recent advances in Radiation therapy.

Proton therapy is an advanced type of radiation treatment that uses a beam of protons to deliver radiation directly to the tumor, destroying cancer cells while sparing healthy tissues. Protons enter the body with a low radiation dose, stop at the tumor, match its shape and volume or depth, and deposit the bulk of their cancer-fighting energy right at the tumor. Proton therapy benefits patients, whose tumors are solid with defined borders, meaning that the cancer has not spread to other parts of the body. Proton radiation, once delivered to the targeted tumor site, has a very short life. After you complete treatment, one can leave the treatment room without any risk or radiation exposure to others. Depending on the case and type of cancer, proton therapy may be used in combination with traditional radiation therapy, chemotherapy and surgery. Currently, Proton Therapy is used to treat cancers of the prostate, lung, head and neck, liver, esophagus and brain, as well as for the treatment of lymphoma, pediatric cancers.

Cancer Biomarkers are endogenous proteins or metabolites whose amounts or modifications are indicative of tumor state, progression characteristics, and response to therapies. The markers are produced either by the tumor itself or by other tissues, in response to the presence of cancer or other associated conditions, such as inflammation. Cancer biomarkers can include Proteins, Gene mutations (changes), Gene rearrangements, Extra copies of genes, Missing genes etc., generally present in tumor tissues or Body fluids and cell lines. They play a major role in Screening Cancers like Ovarian Cancer, Prostate Cancer. Advances in Genomics, Proteomics and Molecular pathology have generated many biomarkers with potential clinical value. Their use for cancer staging and personalization of therapy at the time of diagnosis could improve patient care.

Vaccines given for treating Cancer are termed as Cancer Vaccines. Viruses causing cancers are grouped together as Oncoviruses, which are known to cause majorly cervical cancer and Liver cancer. Traditionally, vaccines against those viruses, such as HPV Vaccine, Hepatitis B Vaccine are given to prevent those types of cancers. Based on action, Vaccines can be Prophylactic or Therapeutic. Gardasil, which primarily vaccinates against Human papillomavirus and secondarily prevents several forms of Cervical cancer, Provenge is designed to directly vaccinate against Prostate cancer. Hence, Gardasil is used for prophylaxis while Provenge will be used therapeutically. Recently, a number of promising approaches have been developed using synthetic chemistry, materials science, and bioengineering-based strategies to address challenges in the design of more effective Cancer vaccines.

CAM Cancer therapies include Complementary and Alternative Medicine, which are generally non mainstream practices. Recently, CAM therapies are gaining importance in managing adverse symptoms of Cancer. If a non-mainstream treatment is used together with conventional medicine, it’s considered as “Complementary treatment.” If a non-mainstream treatment is used in place of conventional medicine, it’s considered as “Alternative treatment.” CAM consists of treatments that are based on prescientific concepts of human physiology and pathology. Most people who use non-mainstream approaches use them along with conventional treatments. CAM therapies include a wide variety of botanicals and nutritional products, such as dietary supplements, herbal supplements, and vitamins.