This 2-day conference will bring together world-reknowned experts in the field to share ideas, present innovative research and clinical findings, and work towards furthering collaborations between researchers, clinicians and industry. Specific topics will include:

1. Current clinical success stories and methodology (IMRT, beam filtering, dose fractionation, respiratory gating and patient immobilization)
2. Current limitations and identification of key clinical needs
3. Vendors Visions of the future of SBRT
4. Cutting edge research in target motion modeling and registration
5. Advances in real-time lesion tracking and on-board position verification
6. Monitoring and moderating normal tissue damage
7. Error reduction and quality control in SBRT
8. Future ontologies in clinical care

The conference coincides with the opening of the new URMC Cancer Center and also overlaps with the Rochester International Jazz Festival, as a means to showcase Rochester as a viable research environment to live and work.

Stereotactic RadiationTherapy (SRT) is a method for delivering focused radiation fields targeting almost exclusively the tumor while excluding tissues not grossly involved with tumor. While SRT has gained clinical acceptance and become the method of choice for treatment of certain brain lesions, only recently has clinical data been achieved that indicate efficacy of SRT to regions outside the brain -- collectively known as Stereotactic Body Radiation Therapy (SBRT).

Initial application of SBRT has focused on metastatic disease. For most cancers, the primary cancer itself can be controlled locally [1]. The usual approach to treatment of the primary tumor features combined modality therapy, emphasizing a local therapy, typically surgery or radiation. Deaths most commonly result from tumor that has spread. Therapy for metastastic tumors, unlike that for primary tumors, typically features only systemic chemotherapy or palliative radiation. The latter is given at ??palliative?? doses that are not expected to be sterilizing, but which reduce symptoms and delay tumor growth. Metastatic disease to the lung and/or liver is one of the most common life threatening complications of cancer. Metastases to either or both the lung and liver are very common and can be seen with most cancer types. The impact of these metastases is substantial. For example, most patients diagnosed with a metastasis(-es) to the lung survive only about a year and rare survivors at three years [2]. Progression-free survivors after chemotherapy are not generally expected; however effective chemotherapy, which produces a complete or near complete response, might successfully down-stage micrometastatic disease, leaving patients oligometastastic. Oligometastasis refers to a situation wherein metastases might not be disseminated, but rather present only in a few sites. In this case, it is possible that chemotherapy down-staging can leave a patient curable by local therapy alone. Surgery might be considered for easily resectable lesions.

Recent clinical studies [3,4] conducted at our institution have supported the hypothesis that aggressive management of metastases, particularly those to the lung and/or liver, reduce complications of cancer and prolong survival. These studies investigated the feasibility and potential utility of SBRT (using Novalis?Shaped Beam SurgeryTM) combined with respiratory gating in patients with lung and/or liver metastases. For SBRT of the liver the actuarial overall infield local control rate of the irradiated lesions in sixty evaluable patients was 76% and 57% at 10 and 20 months, respectively. The median overall survival time was 14.5 months. The progression-free survival rate was 46% and 24% at 6 and 12 months, respectively [3]. For SBRT of the lung, of the 125 total lesions treated (size range 0.3-7.7 mm), only eight progressed after treatment (94% crude local control) and all eight failures were lesions > 15 mm diameter at the time of treatment. The median overall survival time from time of treatment completion of the curatively treated patients was 23.4 months (mean follow-up was 18.7 months). The progression-free survival of the same group of patients was 25% and 16% at 12 and 24 months, respectively[4]. In both studies, none of the patients developed Grade 3 or higher toxicity and median survival time and progression-free survival both appear better than that achieved with standard care alone. Long-term progression-free survival can be seen in a subset of patients when all tumors are targeted.

Additional data was collected for the subset of patients with breast as the primary cancer. For this group historical data indicates that nearly all breast cancer patients deaths are due to metastatic spread to bone, lung, liver and brain; rather than from the primary tumor. 80% of women who die of breast cancer have spread to the lungs. With standard of care chemotherapy and lose-dose radiation the disease-free rate after detection of metastases to the lung is <2% at 2.5 years and the 2-year survival < 35%. However, in our lung SBRT study women with breast cancer treated with curative intent (<= 5 lesions of size <=30 mm) enjoyed a 36% 40-month progression-free survival (NED), representing both a dramatic improvement in both overall survival and disease-free survival.

The initial clinical success of SBRT has motivated venders of radiotherapy hardware and treatment planning systems to develop new commercial products to address the special needs and requirements of this new and challenging treatment arena. In parallel, many academic and government groups have infused new ideas and methodologies to this exciting clinical problem. In most instances input from other areas of expertise have been brought together to leapfrog SBRT as rapidly as it has into the clinical trial phase. For some research fields, such as deformable image registration, SBRT was a problem for which the research field had already been working for decades toward a solution. These efforts from the wide array of sources are beginning to come together to bring SBRT to national attention.

4. Research Plan and Methods:

This conference will be unique in its focus on high-dose radiation therapy of targets outside the brain, yet the presentations and discussions will have a broad scope and wide impact for research, clinical and commercial enterprises. Day 1 will begin with introduction of the recent clinical successes and movement toward national trials with the goal to impart to the participants the meaningfulness of this area of study, and of this scientific conference. The next session of talks will present limitations to the clinical application of high-dose SBRT, both in terms of the patient point of view (including harmful biologic side-effects, discomfort during treatment, and perceptions of radiation exposure); technical difficulties in SBRT hardware design, treatment verification and treatment planning; and hindrances to national trials via assurance of quality care and establishment of clinical norms. The third round of presentations will be given by our commercial sponsors/collaborators, highlighting their plans for overcoming the current limitations and visions for future clinical applications of SBRT technology. Abstracts of the 2nd round of talks will be provided to the venders well before the conference date so that they are able to give directed presentations of their products. The end of the first day of the conference will consist of open discussions in key topic areas for expansion of clinical trials, including SBRT of new organs, visions for interactive RT. Here we will ask participants to outline to the venders their dreams for SBRT.

The second day of the conference will emphasize the cutting edge research in the field in the key areas of tumor motion modeling & deformable image registration; real-time target position verification; and novel strategies for beam delivery, including target following and beam gating.

Below is a the working outline of sessions and speaker presentations, with suggested presenters given where appropriate. This list will be modified depending upon speaker availability and topics of interest to the session moderators. Items and persons with a question mark indicate that the topics and/or speakers are tentative.

The conference committee acknowledges that additional planning will be needed to determine precisely the expected tangible outcomes of this conference, whether we will require each presenter to submit a publishable document as part of their participation and have as outcome a special journal issue dedicated to the presentations at this conference; or should a summary of our collective discussions and consensus be compiled by the PI and submitted for publication as a communication; or whether it will be sufficient to have completed a detailed outline of collaborative research opportunities with the expectation that the top 2 or 3 will lead to a fundable grant application to the NIH or related funding entity.

The vision is to hold this scientific conference in the main conference room within the new James P. Wilmot Cancer Center. The plan is to house the participants from outside the area in a downtown hotel such as the Strathallen, through whom the University and the PI's department have had arrangements in the past. Shuttle buses will be provided to transport the participants to/from the Cancer Center and the downtown hotel.

A continental breakfast and sandwich lunch will be provided to the attendees on both days of the conference. A gala dinner will be provided on the evening of the first day of the conference, with refreshments/hors d'oeuvres provided at the commencement of the 2nd conference day. Efforts will be made to emphasize local cuisine and specialties, notably upstate NY wineries, local breweries, and chicken wings in various styles.

1. Suit H, Skates S, Taghian A, Okunieff P, Efird JT.
Clinical implications of heterogeneity of tumor response to radiation therapy.
Radiother. Oncol 1992; 25:251-60

2. DeVitaVT, Hellman S, Rosenberg SA.
Cancer: Principles and Practice of Oncology, 5thed.
Philadelphia: Lippincott; 1997. p2532-606

3. Katz AW, Carey-Sampson M, Muhs AG, Milano MT, Schell MC, Okunieff P.
Hypofractionated stereotactic body radiation therapy (SBRT) for limited hepatic metastases.
Int J Radiat Oncol Biol Phys. 2007 Mar 1;67(3):793-8.

4. Okunieff P, Petersen A, Philip A, Milano M, Katz A, Boros L, Schell M.
Stereotactic Body Radiation Therapy (SBRT) for Lung Metastases.
Acta Oncologica, 2006; 45: 808-817.