Personalized and precise medicine is the future of health care, and Sunnybrook is leading the way. With the support of our donors, we aim to deliver customized therapies based on each patient's particular physiology, biology and genetics, maximizing our impact via minimally invasive techniques. This personal approach is exemplified by the Gamma Knife Icon.

One third of Sunnybrook's game-changing Cancer Ablation Therapy Program (along with the MR-Linac and our MRI-Brachytherapy Suite), the Gamma Knife Icon delivers radiation with pinpoint accuracy to many targets in the brain, thus sparing patients the negative side effects of whole-brain radiation like memory loss and cognitive decline.

Sunnybrook was the first hospital in Canada to install this donor-funded technology. Our current focus is on treating patients with multiple brain metastases, cancer that originated in another part of the body and spread to the brain. We also use the Gamma Knife Icon to treat benign tumours such as meningiomas (tumours that arise from the membranes surrounding the brain and spinal cord) and hearing nerve tumours, and, in collaboration with Sunnybrook's focused ultrasound experts, to treat psychiatric disorders like obsessive compulsive disorder.

To further enhance the Gamma Knife Icon's impact, Sunnybrook researchers are trying to identify how tumours will respond to radiation therapy in advance so they can treat each individual patient more effectively.

"We are using quantitative imaging techniques to extract various features of a tumour, and then applying data mining and machine learning to identify those biomarkers that best correlate with outcomes of treatment," says Dr. Ali Sadeghi-Naini, scientist at the Sunnybrook Research Institute, who is leading a team of experts in medical physics, oncology and radiology. This is part of a new field of study called radiomics: recognizing biomarkers from medical images to learn features of disease that can't be seen with the naked eye.

Dr. Sadeghi-Naini is developing an image-analysis framework to distinguish people who will benefit from radiotherapy from those who will not, so that non-responders can try another treatment, like surgery, more quickly.

"If we can use imaging to see who's going to respond, we can say, 'We're going to treat you with either a high dose or low dose, depending on that signal,'" says Dr. Arjun Sahgal, director of the Cancer Ablation Therapy Program. "If we don't expect you to respond to radiation — because about 20 per cent of metastases will not respond — let's cut that tumour out."

By capitalizing on the promise of radiomics, Sunnybrook is making great advances toward customized metastatic brain cancer treatment. The future of cancer care is personal and precise, and that future is approaching more quickly every day.