Tool to Ensure Accuracy of Radiation Treatment Plan Will Improve Quality and Save Time for Cancer Patients

It is critical that a cancer treatment plan that uses radiation be checked, and checked again, before patients are exposed to the therapy. Radiation mistakes can reduce survival, increased toxicity, and result in poor tumor control. Evaluating the radiation treatment plan, however, can be time-consuming and labor-intensive, especially in large-scale multi-institutional clinical trials, say radiation physicists at Thomas Jefferson University and at China’s Fudan University.

Now, these physicists have collaboratively developed a computer-based plan-quality evaluation program they say improves quality and efficiency for cancer patients participating in clinical trials.

In the May 14 issue of Physics in Medicine and Biology, investigators demonstrates that use of a semi-automated process improves review efficiency by reducing human error and minimizing wait times for patients.

Physicist Jiazhou Wang, M.S., from the Department of Radiation Oncology at Fudan University Shanghai Cancer Center and physicist Ying Xiao, Ph.D., of Thomas Jefferson University lead respective international collaborative team efforts to develop the quality improvement methodology, which can also be used in a clinical setting.

“The tools developed from the study will benefit Chinese radiation oncology departments where a large number of patients are being cared for,” says Zhen Zhang, M.D., Ph.D., Chairman of Radiation Oncology at Fudan University Shanghai Cancer Center.

In multi-institutional clinical oncology trials, verifying medical physics plan quality takes time, and is both laborious and costly. This study evaluated reducing the waiting period for treatment by automating critical data parameters for multiple benefits.  It measured the effectiveness of an XML (Extensible Markup Language)-based data collection system in plan-quality evaluation.

The study found that there was a slight improvement in data accuracy, but a marked improvement in evaluation time.  XML was developed to create a plan evaluation report, which improves the clarity of specific dose-volume and other indices thereby improving communication and simplifying future analysis, says Dr. Xiao.

“As comprehensive radiation treatment technologies become more precise, our ability to effectively evaluate plan quality through improved communication tools among multi-disciplinary physicians and researchers improves patient care,” states Adam Dicker, M.D., Ph.D., Professor and Chairman of radiation oncology, Thomas Jefferson University Hospital.

Fudan University Shanghai Cancer Center (FUS), one of the largest cancer centers located in Shanghai, will become the first affiliate member of the Radiation Therapy Oncology Group, sponsored by the Department of Radiation Oncology, Thomas Jefferson University, Kimmel Cancer Center. “This historical accomplishment was achieved by a decade of close collaboration between physicians and scientists from Fudan University Shanghai Cancer Center and Thomas Jefferson University,” Dr. Dicker says.

This work was funded in part by the NCI P30 grant to the Kimmel Cancer Center, Thomas Jefferson University.

For more information, contact: Jackie Kozloski, 215-955-5296, jackie.kozloski@jefferson.edu.



Bench to Bedside: How to Fast Track Targeted Cancer Drugs with Radiation into the Clinic

Researchers from the translational research program of the National Cancer Institute and the Radiation Therapy Oncology Therapy Group have developed new guidelines to help fast track the clinical development of targeted cancer drugs in combination with radiation therapy.

The suggested strategic guidelines, published in the Journal of the National Cancer Institute in a recent commentary with lead author Yaacov Richard Lawrence, MRCP, an adjunct Assistant Professor in the Department of Radiation Oncology at Thomas Jefferson University and Director of the Center for Translational Research in Radiation Oncology at Sheba Medical Center in Israel, offers specific steps in the preclinical and early phase clinical trial process to get well-studied and novel targeted agents into the clinic more quickly.

Over the last decade, molecular agents that target cellular survival and growth, like Erlotinib and Sunitinib, have been developed but alone have had modest effect on improved survival. Combining such targeted agents with radiation therapy, however, has the potential to improve cure rates and long-term overall survival.

“There’s a missed opportunity in today’s cancer care treatment,” says Dr. Lawrence. “There is very promising laboratory data out there, but the clinical development of these new drugs with radiation has been limited. Here, we have put together a road map to help overcome obstacles and speed the development of new pipeline drugs with radiation.”

Adding radiation therapy to existing chemotherapy agents to radiation therapy has improved survival, and the authors of the commentary, which includes Adam P. Dicker, Chair of the Department of Radiation Oncology at Jefferson, believe new targeted therapies can follow in the same path.

“We know we want to repeat that success with new biological drugs,” says Dr. Lawrence. “In order to do that, we need direction, which is sorely lacking. These guidelines explicitly explain how much evidence is needed to go forward from the lab into the clinic, and furthermore how to design the clinical trials in humans.”

The guidelines discuss key questions when investigating specific targeted agents and tumor types, designing new clinical trials, such as the ‘time-to-event continual reassessment method design’ for phase I trials, and randomized phase II “screening” trials, and the use of surrogate endpoints, such as pathological response.

It also discusses the role and purpose of preclinical studies in radiation oncology drug development and how to identify new, radiation response agents.

There are challenges to drug development with radiation, the authors explain. A major problem is the limited interest from the pharmaceutical industry in developing drugs with radiation, which is of special importance since the pharmaceutical industry fund a large amount of clinical cancer research. Furthermore, significant individual skills and institutional commitments are also required to ensure a successful program. The situation has been extenuated by the decrease in radiation biologists in recent years.

It is hoped that by providing a clear pathway, the guidelines will help the field overcome these barriers and create a focus and interest in drug development.
Some new approaches, the researchers say, include combining radiosensitizers with hypofractionated (high daily dose) radiation schedules and integrating immunomodulators with radiation therapy.

“We feel passionate that a a good way to push clinical care forward for cancer patients is by combining these two types of treatment: advanced radiation treatment together with the new generation of anticancer drugs,” says Dr. Lawrence. “We know where the future lies, and guidelines provide the path to bring us there.”

The full guidelines in the JNCI can be found here: http://jnci.oxfordjournals.org/content/early/2012/12/07/jnci.djs472.full



More Designated Time Equals More Published Research for Radiation Oncology Residents

What helps radiation oncologist residents publish more academic research?

Giving them more time to do it, physicians in the Department of Radiation Oncology at Thomas Jefferson University Hospital conclude in a study published recently in the Journal of American College of Radiology.

Based on results from a web-based survey completed by 97 radiation oncologists and current senior residents from academic medical centers across the country, the biggest factor contributing to more first-author publications for residents is the amount of designated research time given during residency.

Anecdotally, there seems to be much variability in the productivity of radiation oncology residents. Some publish numerous articles, whereas others produce less. However, what leads to this variability remains undefined.

It appears that previous individual accomplishments or values among residents—often thought of as critical factors—seem to play less of a role than time and structure of a program.

To determine the predictors, researchers from Jefferson and Drexel University College of Medicine, invited 232 radiation oncologists and senior residents to partake in the web-based survey.

The survey addressed demographic factors, previous academic accomplishments, and residency program structure. The end point—research productivity—was defined as the number of first-author papers produced or research grants awarded on the basis of work initiated during residency.

There was a 42 percent response rate, most of whom were women. The median number of publications produced on the basis of work during residency was three. The average amount of dedicated research time was six months. 16 percent had less than three months. The more time a resident had, the more papers they published.

The results imply that academic success is not simply the result of innate ability but rather the structural aspects of residency programs.

“Medical research by residents is an important part of training, contributes to the academic growth of the radiation oncology field, and ideally makes them better physicians,” said Robert B. Den, M.D., Assistant Professor of Radiation Oncology at Jefferson and author of the paper.  “The structure of a program highly influences resident research capability,” he added.

Other authors on the paper includes Jordan M. Gutovich of Drexel University, Maria Werner-Wasik, M.D., Associate Professor of Radiation Oncology at Jefferson, Adam P. Dicker, M.D., Ph.D., Chair of Radiation Oncology at Jefferson, and Yaacov Richard Lawrence, MRCP, an adjunct Assistant Professor in the Department of Radiation Oncology at Jefferson University and director of the Center for Translational Research in Radiation Oncology at Sheba Medical Center in Israel.

The full study can be found here: http://www.jacr.org/article/S1546-1440%2812%2900386-9/abstract



Voichita Bar-Ad, M.D., Named Residency Program Director in Jefferson’s Radiation Oncology Department

Voichita Bar-Ad, M.D., an associate professor in the Department of Radiation Oncology at Thomas Jefferson University Hospital

Voichita Bar-Ad, M.D., an associate professor in the Department of Radiation Oncology at Thomas Jefferson University Hospital and Jefferson’s Kimmel Cancer Center, has been named Residency Program Director.

Dr. Bar-Ad is a board-certified radiation oncologist who treats primarily head and neck and gastrointestinal cancer cases. Her research focuses on treatment-related side effects and toxicities, patient quality of life and symptom management. She has paid specific attention to radiation-induced oral mucositis for head and neck cancer patients treated with radiotherapy or concurrent chemoradiotherapy, using the intensity- modulated radiation therapy technique.

“I am devoted to my patients and immersed in my research projects, but teaching is my joy, my passion,” Dr. Bar-Ad said last fall when she was named an “Educator of the Year” by the Association of Residents in Radiation Oncology (ARRO).

“This new role as Program Director enables me to continue what I love to do, guiding and teaching residents,” said Dr. Bar-Ad. “I’m greatly honored, and feel fortunate to lead a program that trains the radiation oncologists of tomorrow to have excellent clinical and research skills.”

Radiation oncology residency at Jefferson is a four-year training program, with resident having already completed one year of post-graduate training in medicine, surgery, or a transitional program.

The residency in radiation oncology trains residents broadly in cancer management and emphasizes interdisciplinary care.  Faculty members provide instruction in all modes of radiation oncology:  megavoltage photon- and electron-beam therapy, interstitial and intracavitary radioactive-source implantations, stereotactic radiosurgery and radiotherapy, intensity modulated radiation therapy and the diagnostic and therapeutic uses of radioactive isotopes.

In addition to the residents unanimously selecting Dr. Bar Ad for the ARRO 2011 Teacher of the Year Award, they also selected her to receive the 2012 Department of Radiation Oncology’s “Teacher of the Year Award,” an honor bestowed every June by the residents to the one faculty member who has helped them the most in their educational experience.

Jefferson’s Residency Program became accredited in 1973, but has been in existence since 1960.  The first resident, Dr. Carl Mansfield, went on to become a Chair of the Department, a position he maintained until May 1995, when he went to the National Cancer Institute to serve as a director of the Radiation Research Program

“Thomas Jefferson University Hospital has created one of the nation’s most outstanding residency programs in radiation oncology, and it is with great honor to have such a distinguished physician, researcher and teacher help continue that tradition,” said Adam P. Dicker, M.D., Ph.D., Chair of the Department of Radiation Oncology. “A strong residency program is essential for the successes of an academic medical center, and I look forward to having Dr. Bar-Ad’s leadership bring significant benefits to our residents and patients.”



Nicole Simone, M.D., Receives ASTRO Research Award

Nicole L. Simone, M.D., Department of Radiation Oncology

The American Society for Radiation Oncology (ASTRO) has awarded five physicians with research grants to promote the continued advancement of radiation therapy.

One of this year’s recipient for the Junior Faculty Career Research Training Award is Nicole L. Simone, M.D., of the Department of Radiation Oncology at Thomas Jefferson University Hospital.

The Junior Faculty Award provides $100,000 annually for two years to help develop the careers of promising junior faculty by allowing them dedicated time to work on research relevant to radiation oncology and cancer treatment.

It is presented each year to board-eligible physicians or physicists in radiation oncology or radiobiologists who are within the first three years of their junior faculty appointment.

The Residents/Fellows in Radiation Oncology Research Seed Grant Award was established to support residents or fellows who are planning a career focused on basic science or clinical research to support a pilot project related to radiation therapy. The grants are awarded each year for a one-year project and are in the amount of $25,000 each.

Recipients were selected by ASTRO’s Research Evaluation Committee.

‘Providing these leaders of tomorrow with the necessary funding for their valuable research is essential for the radiation oncology field,” said Leonard L. Gunderson, MD, MS, FASTRO, chairman of the ASTRO Board of Directors, said in a release. “It is very rewarding to know that these grants are going to physicians whose research will make a lasting impact on our field.”

For more on the ASTRO awards, visit https://www.astro.org/News-and-Media/News-Releases/2012/ASTRO-awards-five-research-grants.aspx



Jefferson appoints Administrator, Radiation Oncology

Thomas Jefferson University Hospital has selected Alex Khariton to become its Administrator for the Department of Radiation Oncology.

Previously, Mr. Khariton had been the Administrative Director for the Department of Radiation Oncology at Cooper University Hospital in Camden, N.J., for the past eight years.

“I”m looking forward to working for an  NCI-designated cancer center that provides excellent clinical car, partakes in innovative research, and has a well-respected medical school,” says Alex.

Alex is also Co-Chair of the Reimbursement and Economic committee for the SROA (Society of Radiation Oncology Administrators) and a member of  the American Society for Therapeutic Radiology and Oncology (ASTRO).

The new hire announcement was featured online in the Philadelphia Business Journal’s “People on the Move” section:

http://www.bizjournals.com/philadelphia/potmsearch/detail/submission/511141



Brachytherapy reduced death rates in high-risk prostate cancer patients, study finds

Xinglei Shen, M.D., a resident in Jefferson’s Department of Radiation Oncology and a part-time master’s degree student in the Jefferson School of Population Health

Brachytherapy for high-risk prostate cancers patients has historically been considered a less effective modality, but a new study from radiation oncologists at the Kimmel Cancer Center at Jefferson suggests otherwise. A population-based analysis looking at almost 13,000 cases revealed that men who received brachytherapy alone or in combination with external beam radiation therapy (EBRT) had significantly reduced mortality rates.

Their findings are reported online January 23 in the International Journal of Radiation Oncology,Biology,Physics.

Brachytherapy involves the precise placement of radiation sources directly at the site of a tumor and is typically used to treat low and intermediate risk prostate cancers. However, brachytherapy treatment for high-risk patients is less common and controversial, given in part to early retrospective studies that found it to be associated with lower cure rates compared to EBRT.

Many experts believe that these early series were limited by poor brachytherapy technique, and that high-quality contemporary brachytherapy may be an effective tool against high-risk prostate cancer.

“The study contradicts traditional policies of using brachytherapy in just low and intermediate risk patients by suggesting there may instead be an improvement in prostate cancer survival for high-risk patients,” said co-author Timothy Showalter, M.D., assistant professor in the Department of Radiation Oncology at Thomas Jefferson University Hospital, and associate research member of Jefferson’s Kimmel Cancer Center. “Although studies like this cannot prove an advantage for brachytherapy, our report does suggest that brachytherapy is no less effective than EBRT and should be considered for some men with high-risk prostate cancer.”

Researchers identified 12,745 Surveillance, Epidemiology and End Results database patients diagnosed from 1988 to 2002 with high-grade prostate cancer of poorly differentiated grade and treated with brachytherapy (7.1 percent), EBRT alone (73.5 percent) or brachytherapy plus EBRT (19.1 percent). The team used multivariate models to examine patient and tumor characteristics associated with the likelihood of treatment with each radiation modality and the effect of radiation modality on prostate cancer-specific mortality.

Treatment with brachytherapy alone or brachytherapy in combination with EBRT, the researchers found, was associated with significant reduction in prostate cancer-specific mortality rates compared to EBRT alone.

Significant predictors of use of brachytherapy or brachytherapy plus EBRT were younger age, later year of diagnosis, urban residence and earlier T-stage.

According to the researchers, including lead author Xinglei Shen, M.D., a resident in Jefferson’s Department of Radiation Oncology and a part-time master’s degree student in the Jefferson School of Population Health, the study’s findings provide ample evidence to further study brachytherapy as part of an effective treatment strategy for men with high-grade prostate cancer.

“Today, for the most part, brachytherapy is not being used for these high-risk patients or even recommended,” Dr. Shen said. “But if you look at the biology and theory behind it, it makes sense: you can really give a lot more dose with brachytherapy than with EBRT alone to the prostate. And this presents an opportunity for high-risk patients.”



Dr. Bo Lu to Lead the Radiation Therapy Oncology Group’s Lung Cancer Translational Research Program

The Radiation Therapy Oncology Group (RTOG) announced that Bo Lu, M.D., Ph.D., of Thomas Jefferson University and the Kimmel Cancer Center at Jefferson, has been appointed chair of the group’s Translational Research Program (TRP) Committee’s Lung Cancer Subcommittee. The RTOG TRP Committee supports the integration of new scientific discoveries into the design of multi-center clinical trials.

Bo Lu, M.D., Ph.D., of Thomas Jefferson University Hospital and the Kimmel Cancer Center at Jefferson

Dr. Lu is professor in the Department of Radiation Oncology at Jefferson, where he also serves as director of the department’s Division of Molecular Radiation Biology.  Prior to joining Jefferson in early 2011, Dr. Lu was associate professor in the Departments of Radiation Oncology and Cancer Biology at Vanderbilt University School of Medicine and director of the Department of Radiation Oncology’s translational research program.  He is also a visiting professor of radiation oncology at Tianjin Medical University Cancer Hospital, in Tianjing, China.

“As a member of RTOG’s Translation Research Program Committee since 2009, it has been exciting to be part of research efforts incorporating novel cancer treatment strategies into the design of early phase, multicenter clinical trials,” says Dr. Lu. Among Dr. Lu’s basic science research interests are the development of drugs that cause tumor cells to be more sensitive to radiation therapy and that target lung cancer stem cells.

“Dr. Lu is internationally renowned for his work in translational radiation oncology, and I am enthusiastic about his leadership role with regard to guiding the RTOG’s translational research agenda in lung cancer,” says Adam Dicker, M.D., Ph.D, Professor and Chairman of Radiation O­ncology at Thomas Jefferson University and RTOG’s Translational Research Program Chair. “He has demonstrated talent for applying findings from the laboratory into clinical research,” remarks Dr. Dicker.

“Dr. Lu’s extensive basic science background and insight about promising new agents will be a tremendous asset to RTOG’s Lung Cancer Committee,” says committee chair and radiation oncologist Jeffrey Bradley, M.D., Associate Professor of Radiation Oncology at Washington School of Medicine. Dr. Bradley adds, “I anticipate an exciting and productive collaboration.”

“The opportunity to work with RTOG colleagues to advance new treatment options and improve clinical care for lung cancer patients is very rewarding,” says Dr. Lu, “and I am pleased to assume an expanded role within a research organization that promotes the robust evaluation of new therapeutic approaches in radiation oncology.”

Dr. Lu received his Ph.D. in cell and molecular biology from Baylor School of Medicine and his doctorate in medicine from Shanghai Medical University in China. He completed his residency in radiation oncology at the University of Southern California. Dr. succeeds Quynh Le, M.D., Ph.D. from Stanford University who recently was named chair of RTOG’s Head and Neck Cancer Committee.

“An important goal at the Kimmel Cancer Center is to foster translational medicine—taking basic science research and moving it closer to clinical practice,” said Richard Pestell, M.D., Ph.D., FACP, Director of the Kimmel Cancer Center at Jefferson. “With his lab investigations focusing on just that, and now this appointment to RTOG’s lung cancer subcommittee, Dr. Lu will no doubt help us discover safer and more effective treatments for patients suffering from this disease.”

For more information about RTOG and the group’s Translational Research Program: www.rtog.org

# # #

The Radiation Therapy Oncology Group (RTOG) is administered by the American College of Radiology (ACR), and located in the ACR Center for Clinical Research in Philadelphia, PA. RTOG is a multi-institutional international clinical cooperative group funded primarily by National Cancer Institute grants CA21661, CA32115 and CA37422. RTOG has 40 years of experience in conducting clinical trials and is comprised of over 300 major research institutions in the United States, Canada, and internationally. The group currently is currently accruing to 40 studies that involve radiation therapy alone or in conjunction with surgery and/or chemotherapeutic drugs or which investigate quality of life issues and their effects on the cancer patient.

The American College of Radiology (ACR) is a national professional organization serving more than 32,000 radiologists, radiation oncologists, interventional radiologists and medical physicists with programs focusing on the practice of radiology and the delivery of comprehensive health care services.



Ulrich Rodeck receives Ben Franklin-PCF Creativity Award

Ulrich Rodeck, M.D., Ph.D.

Ulrich Rodeck, M.D., Ph.D., a professor in the Department of Dermatology and Cutaneous Biology, at Jefferson Medical College, Thomas Jefferson University, received the Ben Franklin-Prostate Cancer Foundation Creativity award for his work in improving the therapeutic window of radiation therapy for prostate cancer.

Radiation therapy of locally advanced prostate cancer is associated with severe toxicity limits. Dr. Rodeck will test the hypothesis that modulators of inflammation will preferentially protect normal tissues, but not tumor tissues against radiation-associated toxicity. A series of novel radioprotective compounds have been selected to test this hypothesis in models of prostate cancer and in patients.

This radiobiology proposal will allow higher doses of external beam radiation to be administered, resulting in improved cancer control with reduced side effects to normal adjacent tissue.

Dr. Rodeck received the award on October 4 during the Prostate Cancer Foundation award ceremony and auction at the Union League.

Philadelphia Magazine also featured photos from the Prostate Cancer Foundation event on October 11.



Robert B. Den, M.D., Joins the Department of Radiation Oncology at Jefferson

Robert M. Den, M.D., Department of Radiation Oncology

Radiation oncologist Robert B. Den, M.D., recently joined Thomas Jefferson University Hospital as an attending physician, and was also named an assistant professor at Jefferson Medical College of Thomas Jefferson University in the Department of Radiation Oncology.

Dr. Den is a clinical scientist who specializes in the treatment of prostate cancer, combining his laboratory research that investigates novel anticancer agents in combination with radiation and hormonal therapy for locally advanced and high risk prostate cancer.

A graduate of Yale University with a B.S. in chemistry, Dr. Den received his medical degree from Harvard University in 2006. Dr. Den’s postgraduate training began at Massachusetts General Hospital in Boston as an intern of medicine before becoming a resident in radiation oncology at Thomas Jefferson University Hospital from 2007 to 2010, and ultimately serving as chief resident (2010-2011).

Dr. Den will serve as a radiation oncologist in the Bodine Center for Radiation Therapy at the Kimmel Cancer Center at Jefferson.

“I’m looking forward to continuing my prostate cancer research with my colleagues here at Jefferson, including the department’s chair, Dr. Adam Dicker, and Dr. Karen Knudsen,” said Dr. Den. “What’s equally important is taking that research to bedside so patients may benefit.”

“Our goal is to personalize the care for each man with prostate cancer, to effectively eradicate the disease,” he added.

Dr. Den is the 2010 recipient of the prestigious Prostate Cancer Foundation Ben Franklin Young Investigator Award. That work is examining the importance of the retinoblastoma tumor suppressor gene, RB, in the response of prostate cancer cells to radiation and hormonal therapy. The research begins to address the ability to personalize therapy based on RB status.

Expanding on that research, Dr. Den is also the principal investigator for a Department of Defense Physician Research Training Award to study whether RB can be used to determine which therapeutic modalities should be administered to patients with locally advanced prostate cancer.  He is also working towards opening a clinical trial to study preoperative radiation for high risk prostate cancer patients.

Dr. Den is member of several professional societies including the American Society for Therapeutic Radiology and Oncology and the American Society of Clinical Oncology, and has co-authored over 25 scientific papers, abstracts and book chapters.



Radiation after prostate removal is cost-effective, but less likely to be recommended by urologists

Timothy Showalter, MD, Department of Radiation Oncology

Receiving radiation therapy immediately after a radical prostatectomy is a cost-effective treatment for prostate cancer patients when compared with waiting and acting on elevated prostate-specific antigen (PSA) levels, according to a new study by researchers at Thomas Jefferson University and Hospital.

What’s more, a separate, but related study, found that urologists were less likely than radiation oncologists to recommend adjuvant radiation therapy or to believe it improves overall survival.

There has been question over whether administering adjuvant radiation therapy after removing the prostate is an appropriate course of action because of associated toxicities, risk of overtreatment and costs, even with data supporting its benefits to overall survival, but a new decision analysis published online in the Annals of Oncology on June 9 found that the procedure is a practical option for patients.

“This work demonstrates that adjuvant radiation therapy is a cost-effective strategy for selected patients after prostatectomy,” said Laura Pizzi, PharmD, associate professor at the Jefferson School of Pharmacy, and senior author of the study. “It is typical for cancer treatments to provide clinical be

nefit at a cost; however, the cost per success that we reported for adjuvant radiation therapy is on the low end when one broadly considers the cost per success reported for other cancer treatments.”

The objective of the study was to construct a decision analytic model to estimate the real world cost of adjuvant radiation therapy versus observation from the payers’ perspective, using peer-reviewed, published data from a Southwest Oncology Group prospective, randomized trial. Side effects, overtreatment and the price tag were taken into account.

Nearly one-third of newly diagnosed men with prostate cancer—almost 220,000 men were diagnosed in 2010—undergo radical prostatectomy. Previous studies have shown that adjuvant radiation therapy improves biochemical progression-free survival and overall survival for these patients; however, most do not receive the treatment.

“Despite being shown to be effective, less than 20 percent of qualifying patients receive it,” said Timothy Showalter, M.D., assistant professor of Radiation Oncology at Thomas Jefferson University, associate research member of the Kimmel Cancer Center at Jefferson, and lead author of the study. “Although not all patients will benefit from adjuvant radiation therapy, the level of utilization is low

er than expected based on the positive, published results of randomized clinical trials.”

“Studies like this one are an important step toward establishing the value of this treatment and suggest that adjuvant radiation therapy should have a role in the treatment of selected patients. Our group has embarked on a large-scale research program to evaluate and improve treatments after prostatectomy for patients with high-risk prostate cancer, and these studies are critical foundational accomplishments,” he added.

Side effects, risk of overtreatment (the subset of patients who may not have failed PSA tests after radiation therapy despite adverse pathologic factors) and the high price have cast some doubts for patients and physicians alike. In many cases, physicians choose to observe patients closely with serial PSA tests and offer radiation therapy only as a salvage treatment after a rise in the PSA levels.

But this new analysis, Dr. Showalter says, “substantiates the benefit of adjuvant radiation therapy,” taking these factors into consideration, including toxicity and overtreatment.

Another study by Dr. Showalter and colleagues, published online in the International Journal of Radiation Oncology, Biology and Physics on May 25, attempted to gauge physician beliefs and practices for adjuvant radiation therapy after a radical prostatectomy.

Leonard Gomella, MD, Department of Urology

Significant discordance was identified. An online survey found that urologists were less likely to recommend radiation therapy immediately after a radical prostatectomy than radiation oncologists. Instead, those clinicians most likely opt to perform frequent PSA tests to monitor cancer, recommending salvage therapy if levels become elevated.

The investigators designed a Web-based survey of post-radiation prostatectomy radiation therapy beliefs and policies. A total of 218 radiation oncologists and 92 urologists completed the survey instrument. Adjuvant radiation therapy after a radical prostatectomy was recommended for qualifying patients by 78 percent of radiation oncologists and only 44 percent of urologists.

Urologists were also less likely to believe that adjuvant radiation therapy improves overall survival (71 percent of radiation oncologists vs. 63 percent of urologists), and perceived higher rates of radiation-related toxicities than radiation oncologists. Physicians’ estimates of radiation-induced urinary problems affected their likelihood of recommending radiation therapy.

The fact that adjuvant radiation therapy use has not increased since the publication of randomized trials supporting the therapy suggests that clinicians have not embraced it, according to the researchers.

“These two studies provide important insights into decision-making regarding radiation therapy after prostatectomy,” said Leonard Gomella, M.D., the Bernard W. Godwin, Jr. Professor of Prostate Cancer and Chairman of the Department of Urology at Thomas Jefferson University. “The disagreement between urologists and radiation oncologists highlights the need for additional research to determine the role of adjuvant therapy in selected patients, and is another example of the importance of multidisciplinary prostate cancer care for our patients to make informed medical decisions.”



Bernadette E. Garofola Named ASRT Fellow

Bernadette E. Garofola, chief radiation therapist at Thomas Jefferson University Hospital

Bernadette E. Garofola, M.Ed., R.T.(R)(T)(CT), chief radiation therapist at Thomas Jefferson University Hospital, has been named a Fellow of the American Society of Radiologic Technologists.

Ms. Garofola was honored at a ceremony on June 18 at the ASRT Annual Governance and House of Delegates Meeting in Albuquerque, N.M.

The honorary Fellow category was established by ASRT in 1956 to recognize members who have made outstanding contributions to the profession and to ASRT. Fellows have volunteered in leadership positions at the national and local levels, written articles for publication, presented at professional meetings and helped advance the radiologic science profession.

Backed by a radiologic science career that spans nearly 30 years, Ms. Garofola has participated in ASRT volunteer activities since she joined the association in 1986. In addition to serving terms as a delegate for the Radiation Therapy and Management Chapters, she has been a member of a number of ASRT communities including the Committee on R.T. Advocacy, Committee on Bylaws and Committee on Nominations. She also is a member of the Philadelphia Society of Radiologic Technologists and served as its president in 2001.

For more information about ASRT and the radiologic science profession, visit www.asrt.org.



Reception to Celebrate Dr. Dicker’s Appointment as Chairman

A reception to celebrate Dr. Adam Dicker’s appointment as Chairman of Radiation Oncology was held in the Hamilton Building on Wednesday May 26, 2010. For more about Dr. Dicker’s appointment please go here

Dicker_Party

Reception Attendees



Adam P. Dicker Appointed Chairman of Radiation Oncology at Thomas Jefferson University

Adam P. Dicker, M.D., Ph.D.

Adam P. Dicker, M.D., Ph.D.

Adam P. Dicker, M.D., Ph.D., has been appointed chairman of the department of Radiation Oncology at Jefferson Medical College of Thomas Jefferson University. Dr. Dicker is an international authority in radiation oncology, drug development, and the treatment of prostate cancer and brain tumors.

Dr. Dicker co-leads the Radiation Research and Translational Biology Program at the Kimmel Cancer Center at Jefferson. In addition, he serves as director of the Christine Baxter Research Laboratory for Experimental Cancer Therapies at Jefferson Medical College. He has been a principal investigator of a significant number of “first in human” developmental therapeutic trials involving novel signal transduction agents and radiation therapy.

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