A Global strategy for better healthcare

A broad community of experts involved in diagnosis, treatment, and cure gathered to share and discuss their latest results in the ICTR-PHE 2012 Conference, which took place in Geneva from February 27 to March 2.

This large event resulted from the merging of two – formerly independent – successful gatherings: the International Conference in Translational Research in Radio-Oncology, which had been held every two years since 2000, and CERN’s Physics for Heath, whose first edition took place in 2010.

ICTR-PHE 2012 was co-chaired by Manjit Dosanjh, CERN’s Life Sciences Advisor, and Jacques Bernier, Head of the Radiotherapy Department at the Genolier Clinic (Switzerland).

With more than 600 participants, submission of 400 abstracts, and presentation of 150 posters, the conference was an important opportunity for researchers coming from different backgrounds, however all working towards better healthcare, to meet, to debate scientific and medical issues, and to establish or reinforce collaborations.

“This turns out to be an important meeting in order to get medical doctors, physicists, and engineers to collaborate together”, pointed out Steve Myers, CERN’s Accelerators and Technology Department Director. “In such occasions we – physicists and engineers – can find out what clinicians and biologists need and they can discover what we can give them in terms of technologies”.

The need to establish a solid network between different scientific communities is strongly felt by most of the researchers and practitioners involved in life sciences. It is also becoming more and more evident that new synergies must be initiated in order to apply new findings from science and technology directly to clinical practice. A continuous and constant interaction is necessary to develop a common strategy, which would integrate the various perspectives.

An even farther step should and can be taken in this direction: “Collaboration is not enough, we need union between the physics and clinical worlds”, claimed Jean Pierre Gérard, professor of Oncology and Radiotherapy, member of the Centre Antoine Lacassagne (Nice, France).

This concept was strongly reiterated by Soren Bentzen, oncologist with a background in medical physics, who gave a public lecture on “Treatment of cancer in the XXI century: biology, physics, and genomics”. He highlighted that when it comes to oncology and development of new treatments for cancer, researchers expert in different fields necessarily end up working in the same playing field.

Bentzen explained that, in the past, medical physics used to lie at the interface between physics and engineering on one side, and medicine on the other. Medical physicists had a background that gave them the ability to understand the languages of the two communities and they used to play the role of intermediaries between the two worlds, with the goal to implement a device or a treatment to be used in clinical practice. However, the situation has evolved, and nowadays the boundaries between different disciplines are fading away, so that physics, engineering, information technology, biology, medicine, and genomics are merging into a unique new science: clinical biophysics.

Even though the ICTR-PHE 2012 Conference aimed at discussing a range of health issues, most of the talks over the five days of workshop focused on strategies and technologies for fighting cancer. Ranging from new technologies in radiation therapy, detectors, and medical imaging, to radiobiology, radioisotopes for diagnostic, to molecular biology, and use of drugs and markers, the presentations gave an extensive overview of the state of the art and demonstrated that common efforts in this field can lead to important results.

Even though surgery and chemotherapy are commonly used for treating cancer, radiotherapy has become a major weapon in the fight against this disease. Usually, it is performed by applying high-energy photons (X-rays) to target and destroy tumour cells: often referred to as conventional radiotherapy. Recently the exploitation of charged particles, such us proton, and carbon ions, has been explored, and the results are very encouraging. The main advantage of this technique, which is called hadron-therapy (charged particle therapy), is that the specific dose delivery profiles of such particles allow to better target the lesion and spare the surrounding healthy tissues to a greater degree.

As Jean Pierre Gérard explained, radiotherapy counts on three important characteristics (the 3 C’s) that make it an appealing treatment. First of all, it is curative in several cases: 45-50% of tumours are defeated, half of which by using radiotherapy (the other half by surgery). Second, it is conservative, because it does not lead to the removal of organs and mutilation of the body. Last, it is cost-effective: “only 5-10% of the actual medical expenses for cancer treatment are due to radiotherapy, the rest is connected to surgery, chemotherapy, and other medical procedures”. Therapies with charged particles are more expensive, but still cheaper or costly comparable to other combined modalities.

An interesting concept that emerged from the discussions during the conference is that the competition between the different treatments is actually a non-issue: research and clinical practice are showing how, in most cases, a combination of various treatment options is preferable and even mandatory. Modern cancer treatment is taking one step further from the “one size fits all” philosophy: Bentzen explained that cancer patients used to be classified in boxes, according to their age, the organ in question, and other basic characteristics. People in each box used to go through exactly the same series of treatments. The new frontier is a highly personalized approach, where the treatment is tailored to the patient, in order to increase the success rate and when possible to be more cost-effective. This is much more feasible nowadays because of new results of research in engineering and biology. For example, novel sophisticated imaging techniques offer the opportunity to monitor the effect of the therapy almost in real time, and a deeper understanding of the physiology of the cancerous tissues gives new insights for a better treatment.

Indeed the conference programme devoted a large amount of time to imaging. This research field is progressing quickly thanks to the development of new detectors for better resolution, the exploitation of powerful computers and fast electronics, as well as the combination of different imaging modalities. Medical imaging is useful not only for diagnostics, but also for guiding surgeons when operating on patients. In addition, it can be employed to monitor the position of the tumour during radiotherapy and to see how it responds to treatment.

Meetings such as the ICTR-PHE 2012 conference are important occasions for researchers to share their experiences and establish collaborations, but they also offer the opportunity to be involved in the discussion with decision-makers, who are called to establish research guidelines for the future and decide funding policies and directions.

Political issues were discussed by José Mariano Gago, professor of Particle Physics and former Minister of Science and Technology in Portugal: “Health research must be a driving force for the renewal of science policy”, Gago stated in his talk, “a European Council for Health Research is urgently needed and its establishment is being already discussed”.

The large participation and the request for a follow up to the ICTR-PHE 2012 conference showed that the interest around the defined research themes is high, as well as the will to foster collaborations between different scientific communities.

New bridges were being built during the workshop and some multidisciplinary projects will probably take their first steps from there. The participants went home with deeper knowledge on health issues and related technologies, and hopefully with new ideas. “I come here to dream”, stated Alejandro Mazal, Head of Physics Institut Curie, Centre de Protonthérapie d’Orsay (France), and Chair of PTCOG, “tomorrow I will be back treating patients, but I will carry with me lots of dreams and ideas”.