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Summer 1998, Volume 1, No. 2
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| Radiation oncologists are
faced daily with a difficult task of attempting to eradicate malignant tumors, which are
most often surrounded by non-malignant, healthy tissues. The radiation doses necessary to
eradicate tumors or stop their progression are often close to the doses tolerated by the
normal tissues. Thus, for optimal treatment, radiation delivery must be planned with a
high degree of accuracy. In recent years, such accuracy has been afforded by the
development of three-dimensional (3D) computer planning systems. At such centers as the
Bodine Center, cross-sectional imaging is available for most patients and new computer
technologies allow a conversion of these images into 3D displays. Multiple radiation beams
are used to focus the dose on the tumor while maximally excluding normal tissues from the
volume receiving high radiation doses. Several academic radiation oncology centers in
the US have conducted clinical trials in the area of 3D radiation therapy. University of
Michigan focused attention of their team on dose escalation trials in prostate, brain and
liver tumors, Washington University investigated 3D treatment of lung cancer, and Memorial
Sloan-Kettering Cancer Center, 3D treatment of prostate cancer. Over the past several
years, Jefferson’s physicians and physicists have implemented a number of innovations
in 3-D radiation therapy, particularly for patients with tumors of the lung, head and
neck, brain, and prostate.
It has been estimated that radiation doses as high
as 80-100 Gy (or 8000-10000 rad) may be necessary to control lung tumors measuring |
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more than 3 cm in largest
dimension. Until now, the tolerance of normal intrathoracic tissues, such as lung
parenchyma, heart or spinal cord, did not allow the delivery of such high doses due to the
fear of causing permanent harmful damage to those tissues. The Radiation Therapy Oncology
Group (RTOG), a national cancer research group, is studying 3D conformal (=conforming
tightly to the tumor) radiation therapy and dose escalation for lung cancer patients. This
study is now open for patient accrual at the Department of Radiation Oncology of Thomas
Jefferson University Hospital, which possesses a dedicated spiral CT simulator, a
state-of-the-art 3D treatment planning system, ideally suited for such treatment. To
qualify for patient accrual, the participating radiation oncology departments must go
through a rigorous quality-assurance process to demonstrate their ability to implement the
state-of-the-art 3D radiotherapy for lung cancer. Jefferson is the first facility in the
Delaware Valley to receive this approval. Another novel area of radiotherapy delivery is
the so-called "intensity-modulated radiation therapy", or IMRT. In simple terms,
it allows us to vary the intensity of the photon beam depending on the shape and location
of the tumor. That in turn results in superior dose distributions of radiation, with high
dose regions surrounding tumors tightly, at the same time sparing normal tissues .
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Above is a display of
radiation beams as applied to the lung tumor shown in figure 1. |
significantly. A commercially available IMRT system,
named "Peacock" (which has been recently FDA-approved) has been installed in our
Department and is currently undergoing a commissioning process. It will be used in the
early fall to treat patients with several types of tumors, among them lung cancer.
Since lung tumors are subject to significant motion
within the chest, due to respiration, pulsation of the heart, or movement of the
diaphragm, another challenge is to be able to immobilize them at least partially and
therefore limit the volume of normal lung receiving high dose irradiation. One of the
promising approaches lies in the use of a sternal compression device, which minimizes the
respiratory excursion of the chest. Such a device will be soon tested here at Jefferson in
cooperation with the Elekta Corporation.
In summary, there have been several promising new
approaches to the 3D radiation therapy in lung cancer which are now available at
Jefferson. We hope they will contribute to an improved outcome of patients with lung
cancer.
Pictured at left is a
3-dimensional image of a lung tumor displayed in relationship to the spinal cord, airway
and chest outline. |
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Walter J. Curran, Jr., MD
Chairman
Department of Radiation Oncology
Bodine Center for Cancer Treatment
Kimmel Cancer Center
Thomas Jefferson University
Phone: (215) 955-6700
Fax: (215) 955-0412
E-mail: walter.curran@mail.tju.edu |
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Neelofur R. Ahmad, MD
Editor, Bodine Bulletin
Jefferson-Lower Bucks
Radiation Oncology Center
Phone: (215) 785-9910
Fax: (215) 785-9911
E-mail: neelofur.ahmad@mail.tju.edu |
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Joy Soleiman, MPA
Assistant Administrator
Department of Radiation Oncology
Bodine Center for Cancer Treatment
Thomas Jefferson University
Phone: (215) 955-5948
Fax: (215) 923-5269
E-mail: joy.soleiman@mail.tju.edu
Website: http://www.kcc.tju.edu |
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u At the annual meeting of the American Urological Association
(AUA), in May, 1998, in San Diego, Dr. Richard K. Valicenti gave a presentation
regarding early postoperative radiation therapy for prostate cancer. Additionally, Dr.
Benjamin W. Corn presented data from the Radiation Therapy Oncology Group (RTOG) on
the effect of combined hormonal therapy and radiation therapy after radical prostatectomy.
u Dr. Corn has been
appointed Chairman of the Kimmel Cancer Center of Jefferson’s Clinical Cancer
Research Review Committee. This committee reviews the scientific merit and feasibility of
all clinical oncology trials proposed at the Kimmel Cancer Center and the Jefferson Cancer
Network prior to their activation.
u Dr. Adam P. Dicker
gave a presentation entitled "Peripheral-based loading with verification by dose
volume histograms of transperineal prostate implants allows dose escalation for
brachytherapy," at the 3rd Biennial Forum on Prostate Cancer, Prostate Cancer
Charitable Trust in Amsterdam, Holland in May, 1998.
u Maria Werner-Wasik, M.D., is a recipient of a 1998
ASTRO/ESTRO Travel Grant. The grants are awarded by the American Society for Therapeutic
Radiology and Oncology (ASTRO) to junior faculty members to enable them to visit a
European cancer treatment center and attend the meeting of the European Society for
Therapeutic Radiology and Oncology (ESTRO). Additionally, Dr. Werner-Wasik presented the
results of a recursive partitioning analysis of 1999 RTOG patients with non-small cell
lung cancer at the annual meeting of the American Society for Clinical Oncology in Los
Angeles in May, 1998.
u In January 1998, resident physician Dr. Steven DiBiase
was elected to a 3-year term on the Associate Member Council of the American Association
for Cancer Research (AACR). Subsequently, at the annual meeting of the AACR in New
Orleans, LA, in March, 1998, Dr. DiBiase presented a paper titled "Differential
hotspot mutations in p53 do not affect cellular radiosensitivity or DNA repair in an
isogenic group of osteosarcoma cells." Also presenting at the AACR meeting was
resident physician Eric Gressen, M.D., who reported "Variability in hexokinase
activity in human melanoma explants." Additionally, Dr. DiBiase gave a presentation
titled "Different p53 mutations do not affect radiosensitivity" at the 9th
Annual p53 International Workshop, in Crete, Greece, in May, 1998.
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u Frank Waterman, Ph.D., of the Division of Medical
Physics, reported the results of "The response of human tumor blood flow to a
fractionated course of thermoradiotherapy" at the combined annual meeting of the
North American Hyperthermia Society and the Radiation Research Society, in Louisville, KY,
in April 1998. Additionally, Ronald A. Coss, Ph.D., of the Division of Radiation
Biology, gave a presentation titled "Acute acidification inhibits 42-degree induction
of HSP72 in human melanoma cells adapted to growth at low pH." George Iliakis,
Ph.D., of the Division of Radiation Biology, gave several invited lectures at the
meeting, including such topics as hyperthermia and DNA damage, and in vitro DNA repair
assays. Finally, Dennis B. Leeper, Ph.D., Chief of the Division of Radiation
Biology, reported the results of "Sensitization of human melanoma xenografts to
hyperthermia by hyperglycemia and MIBG."
u Dr. Leeper presented a paper on the "Effect of
hyperglycemia on the response of recurrent adenocarcinoma of the breast to
thermoradiotherapy" at the 5th International Congress on Hyperthermia in Clinical
Oncology, in Venice, Italy, in May 1998.
u Dr. Leeper and
co-investigators have been awarded interim grant support by the National Cancer Institute
(NCI) for the Program Project titled "Modification of Hyperthermia Response."
Additionally, Drs.Leeper and Iliakis were awarded a 5-year NCI grant for cancer
research training in the science of damage response. Dr. Iliakis also has been awarded a
grant by the National Aeronautics and Space Administration to study factors modulating
radiation-induced G2 delays.
u Dr. Walter J. Curran,
Jr. announced Jefferson Health System approval of the Jefferson Oncology Group (JOG)
effective July 1998. JOG will function as the means by which clinical cancer research will
be conducted within the Jefferson Cancer Network. For further information on JOG, call
215-503-1061. At the American Society on Clinical Oncology in May, Dr. Curran presented on
a phase I study of the oral administration of the bioreductive agent tirapazamine from a
trial recently completed at Jefferson and three other sites.
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On June 25, 1998,
Jefferson's Kimmel Cancer Center and its Jefferson Cancer Network sponsored an educational
program entitled "Progress in the Management of Locally Advanced Non-Small Cell Lung
Cancer (NSCLC)." More than 100 registrants participated in this program directed by
Dr. Curran and led by both Jefferson faculty members and a national roster of invited
faculty. Invited speakers included Dr. David Sugarbaker, the director of thoracic surgery
at Harvard's Brigham and Women's Hospital, Dr. Roger Byhardt of the Medical College of
Wisconsin and the chairman of the RTOG Lung Cancer Committee, Dr. Greg Loewen of the
Roswell Park Cancer Institute, Dr. David Ettinger of the Johns Hopkins Cancer Center, and
Dr. Chandra Belani of the University of Pittsburgh. Jefferson speakers included Dr. Carlo
Croce, the Kimmel Cancer Center director, and Drs. Rita Axelrod, Maria Werner-Wasik,
Charles Scott, and Herbert Cohn. Of particular interest were the observations
reported by Dr. Croce regarding the relationship between the presence of FHIT gene
deletions and other prognostic factors among a large cohort of NSCLC patients. These
results will be reported in an upcoming issue of the New England Journal of Medicine. This
conference was made possible through an unrestricted grant from the Bristol Myers Squibb
Corporation: Oncology/Immunology Division. Another "first" for the Jefferson
Department of Radiation Oncology! On April 8, 1998, Dr. Nagalingam Suntharalingam’s
contributions to the the field of medical physics, Jefferson Medical College, and the
Department of Radiation Oncology were recognized as part of a special event organized in
his honor. The First Annual Nagalingam Suntharalingam Lecture featured a talk by Dr. James
Purdy, Professor and Associate Director of the Radiation Oncology Center of the
Mallinckrodt Institute of Radiology in St. Louis. Dr. Purdy’s lecture, titled
"Technical Improve-ments in Radiation Oncology: Treatment Planning and Treatment
Delivery," focused on new state-of-the-art techniques in radiation therapy. Members
of the Delaware Valley radiation oncology community filled theSolis- Cohen Auditorium at
Jefferson Alumni Hall. Dr. Purdy expressed his satisfaction in being able to take part in
an event honoring the accomplishments of his friend of many years. It was a pleasure to
see "Dr. Suntha" in attendance with his wife Siva, and children Sivanthini,
Mohan, and Nan. His friend and mentor Dr. Simon Kramer was also in attendance. The
Suntharalingam Lectureship will be an annual event with prominent speakers like James
Purdy addressing the Jefferson and greater Philadelphia radiation oncology community on
various topics.
Dr. Suntharalingam
(shown above) was honored at the First Annual Nagalingam Suntharalingam Lecture. |
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Following are other treatment
locations:
Department of Radiation Oncology
Bodine Center for Cancer Treatment
Thomas Jefferson University
111 South 11th Street
Philadelphia, PA 19107-5097
Phone: (215) 955-6702
Fax: (215) 955-5331
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Jefferson-Chestnut Hill
Radiation Oncology Center
Chestnut Hill Hospital
8835 Germantown Avenue
Philadelphia, PA 19118
Phone: (215) 248-8712
Fax: (215) 248-8717
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Jefferson-Lower Bucks
Radiation Oncology Center
Lower Bucks Hospital
501 Bath Road
Bristol, PA 19007
Phone: (215) 785-9910
Fax: (215) 785-991
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Revised: October 05, 1999. URL:
http://www.kcc.tju.edu/RadOnc/Bod_Bulletin/sum_1998.htm
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