Virtual Winter School 2021
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Debates- Current Workflows in SBRT Recording This will be an opportunity for participants to break out into smaller discussion groups and share experiences in their various clinics. The intent is to provide context for the remainder of the school and to share best practices. Panel Discussion Recording To learn first-hand from radiation therapy patients how diagnosis and treatment has impacted their lives before, during, and after treatment. Jeff and Kristen Eaton, Cambridge, ON Where We Are, Where We Have Been, and Where We Are Going Recording Medical Physics Perspective Alanah Bergman, PhD, FCCPM, Medical Physicist, BC Cancer Agency |
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Current State of SBRT Trials Recording In this section, participants will have the opportunity to hear from Dr. Zsolt Gabos, Dr. David Palma and Dr. Nick van As about the current state of SBRT trials and data as well as possible future orientations of SBRT treatments. Participants will also have the opportunity to discuss with our panelists afterwards. Zsolt Gabos, MD, FRCPC, Radiation Oncologist, Alberta Health Services An Overview of the Radiobiology of Hypofractionation and Stereotactic Radiotherapy Recording As the field of Radiation Oncology continues to shift towards hypofractionation, made possible through advances in imaging and treatment delivery technology, there remains a need to better understand the underlying biological mechanisms in an effort to improve clinical outcomes. While vital data from clinical trials of high-dose stereotactic radiation therapy continues to emerge, further optimization of treatment planning, fractionation, and delivery have the potential to improve patient care. An overview of biological mechanisms, alternate biophysical models, and recent clinical data for stereotactic radiotherapy will be presented. Our conceptual understanding and mathematical models of biological dose response are often based on in vitro or animal data leading to the question: do the classical 5 R’s of radiobiology still apply in the clinical paradigm of SRS and SBRT? The possibility of unique radiobiological mechanisms and secondary targets in addition to tumor cell DNA will be discussed, including tumor vasculature, immune system activation, and the impact of tumor hypoxia. Molecular imaging of inter-patient variation in radiosensitivy and treatment response may also provide opportunities for treatment individualization. Mathematical models can be used to evaluate the biological effectiveness of altered dose fractionations and to facilitate the design and comparison of treatments. The applicability of the linear-quadratic (LQ) model at high doses per fraction has been critically examined by many investigators. A brief overview will be given of several extensions to the LQ model that have been proposed in an attempt to overcome this potential high-dose limitation. However, while the LQ model is known to be an approximation to more sophisticated kinetic reaction rate models, some clinical outcome data suggest the LQ is still a reasonable approximation at stereotactic doses. David Carlson, PhD, DABR, FAAPM, Medical Physicist, University of Pennsylvania Keynote Address - Timothy Caulfield - Battling Misinformation Recording Team Communication in SBRT Recording An expert panel will discuss the importance of team communication in the initial implementation of SBRT, in translating the SBRT experience from one site to another, in multi-site SBRT and in an adaptive radiation therapy environment. Each presenter will share their institutional experience in SBRT team communication and the role team members play in communication with the patient and other team members to ensure quality and safety. There will be an opportunity for panel discussion Maria Corsten, MSc, MCCPM, CHE, Medical Physicist, Eastern Health - Cancer Care Program |
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Adaptive Approach to SBRT Recording Over the years, advances in radiation planning and delivery have markedly improved the ability to focus radiation on target tissues, sparing nearby healthy organs. Adaptive radiotherapy represents various ways of making changes in the treatment to correct for gradual or sudden changes in target volumes and organs at risk due to tissue deformation. In this session, three renowned experts will speak to their own experience with online adaptive therapy by comparing and contrasting three commercially available modern adaptive treatment solutions. The panelists will discuss how to efficiently and accurately implement these technologies in existing practice. Attendees can expect to learn about clinical evidence regarding adaptive radiotherapy, practical workflow considerations and the role of emerging artificial intelligence (AI), machine learning (ML) and automation in adaptive therapy. Finally, the panelists will provide insight in what it will take to make adaptive therapy accessible to all patients and how online adaptation opens the door to more opportunities in cancer treatment. Lesley Baldwin, PhD, MCCPM, Medical Physicist, Cross Cancer Institute Differentiating Between Best Practice and Billing Driven Practice Recording This presentation will look into how financial and reimbursement systems can dictate radiation oncology practices. Specifically comparing and contrasting the US insurance based model to the publicly funded Canadian system, one-time fee per oncology referral with a preview into the soon to be introduced Ontario new reimbursement system, QBP – Quality Based Protocols. The distribution of work between the various professional groups as well as the tasks that are required for a patient’s journey through radiation treatments will be discussed. Annie Hsu, PhD, Medical Physicist, Odette Cancer Centre Overcoming Obstacles to A Wider Adoption of SBRT Recording There are many obstacles that must be overcome to gain a wider adoption of SBRT in our clinics. Most of these obstacles are due to the lack of departmental resources that is usually fixed to budgets and prioritization. This session is to try and decipher how to evaluate and utilize existing resources wisely and work towards a wider SBRT program. Resources can be categorized into financial, personnel, education, training, equipment (machines, dosimetry, set-up, disposables goods, etc.) and more. It can be daunting for many departments to try and adopt SBRT practices when resourcing it “properly” is not possible. However, if one can objectively look at what is available, what resources can be gained, decide on an SBRT site to begin the program, a safe, wider adoption may be possible. In this session, we will try and explore through a short didactic, and through wider group discussions, try to understand what resources can be tapped into, what is the “minimum requirement” in a department to start an SBRT program. We will aim to tie together previous didactics and panel discussions as well as explore the resourcing through clinical trials and power of networking to adopt a safe, sustainable SBRT program. Young Lee, PhD, FIPEM, MBA, Medical Physicist, Elekta Patient Reported Outcomes from the Patient's Point of View Recording Patient Reported Outcomes (PROs) are an increasingly recognized valid outcome by researchers and clinicians comparing different treatment modalities. In addition, their routine use in certain clinical scenarios, when coupled with a well-formulated clinical support model, can improve patient survival and reduce hospitalization rates. While researchers, and now clinicians, have a strong appreciation for the benefit of utilizing PROs in research and clinical practice, it is less clear how well the routine use of PROs is accepted by patients. This short session will discuss the different formats of PROs, and the potential burden they put on patients, especially when administered by multiple groups in an uncoordinated fashion. A primary purpose will be a call to the national radiation oncology community to advocate for PROs that are patient-friendly, specific to radiation oncology, and nationally coordinated, while also integrated with partner groups in your local organization such as medical oncology. Louise Bird, Patient Advisor, Saskatchewan |
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Emerging Smarter- How Covid-19 is Reshaping the Future of Radiation Medicine Recording The COVID-19 pandemic has disrupted numerous lives and dramatically impacted the health care systems. On the flip side, it has served as a catalyst for the transformation of radiation medicine, research and education. In this section, physicist Dr. Wayne Beckham and physician Dr. Arjun Saghal provide their views of how the fields radiation oncology and medical physics are changing in response to the pandemic. The panelist will comment on the clinical evidence for and safety of rapid uptake of hypofractionation and SBRT protocols in clinics across Canada in 2020. The participants can expect to learn about factors that play a role in the permanent and wide-spread integration of hypofractionation in the clinic. Research activities both at the bench and clinical levels are undergoing transformations as well, and the panelists will present commentaries addressing scientific concerns. In this session, we will spotlight creative initiatives of the session participants that are paving the way for improved and re-invigorated cancer care. Wayne Beckham, PhD, MACPSEM, FCCPM, FCOMP, Medical Physicist New Horizons in SBRT Recording In this session, we are joined by two experts who are exploring new frontiers in SBRT through non-standard clinical applications of ablative radiotherapy. Through his recent work, physician Dr. Fabio Cury challenges the dogma that kidney cancer is a radioresistant tumour while physicist Dr. Geoffrey Hugo uses radioablation to treat cardiac arrhythmias. Both speakers will explore the rationale for treatment, address site-specific technical issues, and present early clinical results.
Lesley Baldwin, PhD, MCCPM, Medical Physicist, Cross Cancer Institute Setting up SBRT Program Recording As part of the panel discussion on ‘Setting up an SBRT program’, I will share my experience in setting up a prostate SBRT program at the Allan Blair Cancer Centre in Regina, Saskatchewan. Topics of discussion may include, but are not limited to: · Knowledge resources available Louise Bird, Patient Advisor, Saskatchewan |