Departmental Programs, Department of Radiation Oncology

Radiation Oncology
Departmental Programs

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The Department of Radiation Oncology is divided into five major divisions:

Clinical Radiation Oncology,

Clinical Investigative Radiation Oncology,

Radiation Biology,

Radiation Physics, and

Education.

(Addendum: Research Publications and Funding)

Treatment: Clinical Radiation Oncology

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The delivery of clinical radiation therapy is the major concern of this division. In the year 2001, the Department of Radiation Oncology performed over 40,000 radiation treatment procedures. At Strong Health Facilities, approximately 1800 new patients are consulted each year, of whom 85% are accepted for treatment. This allows for approximately 1500 new patients annually in addition to ongoing treatments and patient recurrences, all of which translates into a work-load of approximately 160 patients daily. In order to treat the many varied cancers and non-malignant diseases, innovative approaches to treatment have been carefully introduced, such as total body irradiation, prophylactic hip irradiation to prevent heterotropic bone formation, high dose rate brachytherapy, and stereotactic radiation therapy.

Clinical radiation oncology encompasses faculty practicing at radiation oncology facilities in two major hospitals in the city, Sands Cancer Center, and a freestanding center on the Park Ridge Hospital campus. The respective physicians hold appointments at the University of Rochester and many have been members of our faculty in their formative years. This engenders a cohesiveness that enables us to conduct clinical studies, both retrospective and prospective, within the JWCC and in national cooperative groups.

Faculty

The Chairman of the Department of Radiation Oncology is Paul Okunieff, M.D., who is the Philip Rubin Professor of Radiation Oncology and has been a member of the faculty for 4 years. He directs all radiation oncology treatment services and research, and is responsible for formalizing the policy and procedures of the DRO. There are six major services. Each service includes direct patient management and consultation to other disciplines and referring physicians along with the integration of in-patient and out-patient treatment care. The clinicians are:

Paul Okunieff, M.D., Department Chair

Dr. Okunieff, with the assistance of the radiation oncology Fellows, is responsible for introducing and developing new innovative techniques, and supervising the Orange Service, which includes high dose brachytherapy, 3D treatment planning, and stereotactic radiosurgery.

Ralph Brasacchio, M.D., Assistant Professor (Green Service)

Dr. Brasacchio is responsible for genitourinary radiation oncology patients, and is also a Director of the Radiation Oncology Residency Program.

Yuhchyau Chen, M.D., Ph.D., Associate Professor (White service)

Dr. Chen is responsible for radiation treatment of non-small cell lung cancer, small cell lung cancer, Head & Neck tumors (tongue, larynx, tonsil, tongue base, sinus tumors, nasopharyngeal tumors), upper esophageal cancer, and cervical cancer. Dr. Chen is also on the lung committee of national cooperative groups RTOG and SWOG.

Louis Constine, M.D., Vice Chairman, Professor (Blue Service)

Dr. Constine is responsible for pediatric, hematologic (Hodgkin's disease, non-Hodgkin's lymphoma, leukemia), musculoskeletal radiation oncology patients, as well as for those undergoing bone marrow transplantation (and requiring total body irradiation).

Alan Katz, M.D., Instructor of Clinical Radiation Oncology (Yellow Service)

Dr. Katz treats genitourinary radiation oncology patients, as well as vascular cases. He also performs brachytherapy treatments.

Marilyn Ling, M.D., Assistant Professor (Red Service)

Dr. Ling is responsible for gynecological and breast cancer patients, and she is a member of the multidisciplinary Breast Cancer Clinic.

Interdepartmental Faculty Affiliations
The DRO utilizes the James P. Wilmot Cancer Center general ambulatory facility for consultations and follow-ups. Joint clinics and conferences have been organized with divisions of the Departments of Medicine (including Hematology for bone marrow transplantation), Pediatrics, Surgery, and Surgical subspecialties (such as Urology, Neurosurgery, Otolaryngology, Orthopedic, Thoracic, and Gynecology). In addition there are weekly conferences with departments of Radiology, Pathology and Nuclear Medicine (bone metastases and thyroid malignancies). Both triage and new patient decision-making occurs on an interdisciplinary basis, as does follow-up and selected treatment. Programs unique to the DRO includes linear accelerator based radiosurgery for brain tumors and arterio-venous malformations, high dose-rate brachytherapy for gynecologic and thoracic tumors, total body irradiation in the setting of bone marrow transplantations and pediatric radiation therapy.

Faculty Affiliations with Other Rochester Hospitals
Radiation oncologists and qualified physicists in other Rochester hospitals are members of the faculty of the DRO. This enables JWCC extramural radiation oncologists to utilize our radiation (electron beam, high dose rate brachytherapy) and treatment planning facilities as well as to participate in cooperative group studies (e.g. RTOG and ECOG) and cooperative training/educational programs.

Ongoing Procedures:

Linear Accelerator Based Radiation Therapy

The radiation treatment facility is located in the B-3000 area of the JWCC. It has approximately 9,000 square feet and contains three radiation treatment vaults. There is a Varian Clinac 2100EX (pictured left, dual energy photons and high energy electrons), and a Varian 2300C linear accelerator.

The Department of Radiation Oncology performed over 16,000 standard therapeutic radiation procedures this year, as well as nearly 1,000 advanced radiation treatment procedures.

(click for a larger view)

·Total Body Irradiation

This technique entails the delivery of potentially lethal doses of radiation in conjunction with chemotherapy to eradicate disseminated cancers and suppress the immune system; hematopoetic stem cell rescue, usually in the form of bone marrow, must follow. This is particularly effective in treating leukemia and lymphomas, and is an investigational tool in solid tumors in adults such as breast cancer, and pediatric cancers such as neuroblastoma and Ewing's sarcoma. Radiation dose, fractionation, and shielding techniques are all variables that influence efficacy and toxicity. Other investigations relating to bone marrow transplantation include assessment of the efficacy of "boost" irradiation to sites of previous or persistent cancer, and analysis of the morbidity that follows various preparative regimens.

· Prophylactic Hip Irradiation

This treatment for non-malignant disease is generally used in conjunction with hip replacement surgery. Patients undergo low-dose radiation therapy 48 hours prior/post surgery to prevent the growth of heterotropic bone fragments, which would otherwise inhibit joint movement.

· High Dose Rate Brachytherapy

This methodology allows for the precise delivery of radiation therapy from internally placed sources (brachytherapy). High doses are accurately shaped and delivered to tumor volumes in extremely short periods of time, allowing this to be an outpatient procedure. This is particularly effective in lung cancer, gynecologic tumors, sarcomas, and in head and neck cancers. Placement of catheters into the operative bed at the time of surgery makes this techniques particularly valuable when the neoplasm is incompletely resected as in the thorax and for soft tissue sarcomas.

· Stereotactic Radiosurgery

Stereotactic radiosurgery is a modality that precisely isolates an intracranial lesion and enables the delivery of a concentrated dose to the tumor or target while maintaining a low dose to the surrounding normal tissues. Computerized tomography and magnetic resonance imaging, as well as stereotactic angiography, are used to characterize the shape and extent of the lesion. The dose is delivered with an modified linear accelerator which produces a tightly collimated beam of x-rays. The overall uncertainty of this procedure and position is 2.5-3.7 mm as opposed to 7-10 mm for normal radiation oncology techniques. An extension of this is the delivery of multiple stereotactic doses to a single patient, termed stereotactic radiotherapy.

· Prostate Seed Implants

In this procedure, tiny pellets containing radioactive isotopes, such as Iodine-125 seeds, are implanted in the prostate, and they release low-dose radiation for approximately one year. The procedure does not require a surgical incision, but rather, using a TRUS imaging guided needle, the seeds are positioned so that radiation is distributed throughout the prostate gland. This treatment has a higher 5 year disease-free survival rate than prostatectomies and external beam radiation therapy to the prostate.

New Treatments/Developments:

A multi-pronged effort to improve the quality and precision of simulation, treatment planning, and treatment delivery systems is a constant process. The DRO continues to acquire state-of-the-art equipment and integrates it into comprehensive and cutting-edge radiation treatment delivery systems through computerized linkages.

· Flavin Shaped-Beam Radiosurgery Center

This procedure combines the extreme precision of computer interactive stereotactic guidance, the lightning speed of image processing computers for surgical treatment planning, and the harnessed energy of tightly focused photons through linear acceleration. A single dose of high-energy rays are aimed at a tumor from many angles and can be directed to that precisely defined spot, decreasing the exposure of normal cells to radiation.

Stereotactic radiosurgery using shaped beam surgery offers an extremely safe and effective treatment for many intracranial lesions. It is also available as a potentially curative therapy for patients with cancers that have spread to various vital organs.

The patient is immobilized on a table with sub-millimeter precision. His or her position is continuously monitored by digital cameras in the room. The shaped-beam radiosurgery is delivered from a variety of angles and from each direction to conform to the tumor. The treatment is focused on the tumor and not on the normal tissue.
The James P. Wilmot Cancer Center at the University of Rochester has an interdependent team of trained and experienced subspecialists performing stereotactic radiosurgery using shaped beam surgery. The interdisciplinary surgical team includes a stereotactic neurosurgeon, radiation oncologists, radiation therapists, radiation physicists, a biomedical engineer, and a radiation oncology nurse. Every member of this team participates in all phases of the procedure in order to ensure a successful treatment.

· Novoste Intravascular Radiation Therapy

After significant success in the clinical trial phase, this innovative radiation therapy procedure received Federal Drug Administration (FDA) approval this year.

The University of Rochester Department of Radiation Oncology was one of 50 clinical sites worldwide to take part in the Novoste clinical trial; this procedure, used in cardiac patients, utilizes a catheter beta-radiation source to treat restenosis and neointimal hyperplasia caused by vascular manipulation. The DRO is now leading the way in offering this often life-saving procedure that prevents aberrant tissue growth and vessel occlusion after balloon angioplasty or other vascular procedures.

· DRO CT Scanner

Exact and comprehensive imaging technology is fundamentally essential to the success and clinical effectiveness of more precise radiation therapy technologies. Because of this, the Department of Radiation Oncology recently acquired its own Dynamic CT Scanner, which provides for an integrated therapy process.

The Strong Health Radiation Oncology System

The past year has seen the incorporation of several area radiation oncology treatment centers into the Strong Health Radiation Oncology System. The University of Rochester Department of Radiation Oncology now offers treatment through the SANDS Cancer Center, Highland Hospital, and on the campus of Park Ridge Hospital. All three of these new treatment locations have fully functioning radiation therapy facilities, and with these integrations, the James P. Wilmot Cancer Center can treat more patients in a timely fashion through four convenient geographically dispersed locations.These treatment facilities perform a combined 160 radiation treatments daily, and over 40,000 radiation therapy procedures annually.

Faculty

Meri Atanas, M.D., Clinical Associate Faculty

Director at the Park Ridge Center, Dr. Atanas specializes in the treatment of breast and head and neck cancer patients.

Farhataziz, M.D., Clinical Associate Faculty

Dr. Farhataziz is responsible for the treatment of genitourinary radiation oncology patients at Highland Hospital.

Muammer Tasbas, M.D., Clinical Senior Instructor

Dr. Tasbas Specializes in the treatment of colorectal tumors at the SANDS Cancer Center.

Joy Anderson, M.D., Instructor of Clinical Radiation Oncology (Highland/Sands)

Dr. Anderson treats breast and gynecological patients.

Ahmad Matloubieh, M.S.,

Mr. Matloubieh is the Chief Physicist and the Radiation Safety Officer for all Satellite treatment centers.

Satellite Centers Staff:

SANDS Cancer Center

Chris Gibson, RT		Radiation Therapy�Manager
Marianne Albrecht, RT		Radiation Therapist
Mary Bacon, RT		Radiation Therapist
Ann Bremer, RN		Radiation Oncology Nurse
Lynda Swartele		Secretary

Highland Hospital

Carol Billone, RN		Radiation Oncology Nurse
Nancy Butler, RT		Radiation Therapist
Karen Contestable		Secretary
Michelle Donowsky		Radiation Therapist
Mary Durkin		Secretary
Rosa Flowers, RT		Patient Care Technician
Laura Fuller, RT		Radiation Therapist
Noreen Henning, RT		Radiation Therapist
Kathy Kimball, RT		Radiation Therapist
Terri Kwiatkowski		Dosimetrist
Diane Martin		Secretary
Cathi Masucci, RT		Radiation Therapist
Elly Mayer		Social Work
Rose Mullen		Dosimetrist
Allisa Nary		Secretary
Joyce Nonkes, RN		Radiation Oncology Nurse
Debbie Poodry		Administrative Assistant
Jean Rotoli, RN		Radiation Oncology Nurse�Supervisor

Park Ridge Hospital

Patty Herrington, RT		Radiation Therapy�Manager
Diane Caruso, RN		Radiation Oncology Nurse
Andrea Cartwright, RT		Radiation Therapist
Lee Chapin		Secretary
Darlene Harmor, RN, NP		Radiation Oncology Nurse Practitioner
Lynn Hermenet, RT		Radiation Therapist
Donna Lipson		Social Work

Satellite Centers Equipment:
The satellite radiation oncology treatment centers offer patient treatment with the following therapeutic equipment:

Varian Clinac 2100C with 6 & 10 mv x-rays and 5 electron energies

Varian Clinac 1800 with 6 & 18 mv x-rays and 5 electron energies

Varian 6/100 with multileaf collimation.

Radiation Oncology Veterinary Treatment Center:

Housed in the department�s non-clinical laboratory area, the veterinary treatment center offers radiation therapy for canines and felines with various types of cancer. These animals come from the pet population of the Northeast states. The treatment protocols have been developed from protocols in place at the University of Wisconsin, and adapted through our in-house experience.

Since beginning veterinary treatments in 1992, the Department of Radiation Oncology has treated over 200 companion animals from New York and neighboring states. The most common tumors treated are mast cell tumors, and fibrosarcomas. Patients are housed off-site , and are transported to the University of Rochester for treatment throughout their 2 to 3 weeks of treatment.

Sample Treatment Schedules:
Standard Schedule Used For Sarcomas:

The schedule used for many of the treatments is a 15 day schedule in which the patient receives 1 treatment daily for 15 days, skipping weekends.

Hyperfractionation Schedule Used For Mast Cell Tumors:

During days 1 & 2, the patient receives 2 treatments per day, 6 hours apart. The patient returns on days 14 & 15 for 2 treatments each day, again 6 hours apart.

Nasal And Oral Cavity Tumors:

The traditional 15 day schedule that was used for these tumors has recently been revised. We now treat these tumors every other day using a Monday, Wednesday, Friday schedule, allowing time for the tissue to heal and therefore minimizing side effects. We have seen good results so far with this revised schedule of treatments.

Clinical Investigative Radiation Oncology
Radiation Oncology Research, Clinical Research, Therapeutic Control

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Radiation Oncology Research

The basic working relationship between scientists and clinicians that has evolved in the Department of Radiation Oncology (DRO) has become the translational research model of the James P. Wilmot Cancer Center (JWCC) at the University of Rochester. The interactions between these investigators has led to the clinical investigation of laboratory derived ideas. Such concepts are tested in small, high quality controlled pilot studies to determine if they should be mounted in larger clinical trials of the national cooperative groups. It can be said that the development and conduct of pilot studies at the institutional level is the backbone of national cooperative group trials. Throughout the past several years, we have developed the resources, facilities, and support personnel to conduct Phase I and II feasibility studies while searching for efficient and effective treatment schedules and combinations. The important feature of our work has been the establishment of a mechanism for developing studies which we believe represent the leading edge in radiation oncology research.

The research programs constitute the major investigative activities of the Department of Radiation Oncology and rely heavily on the laboratory to model and simulate clinical and physiopathological effects of radiation on human malignant disease and normal tissues. All research programs are discussed at weekly conferences allowing for a continuing exchange of ideas for protocol development. The major strength of the research programs is the ability of the basic and clinical scientific faculty to interact in a synergistic fashion.

The intellectual integration of faculty into a coherent, yet individualized, scientific research program is realized by our carefully selected set of scientific themes: cellular and molecular mechanisms and diagnostics, chemoprevention and intervention, the monitoring of late effects and their prevention, biologic response modifiers, and psychosocial interventions. There has also been some specialization in systems or organs where we have a degree of expertise (lung, brain, bone and bone marrow), although these are not exclusive.

Our laboratory space design permits the juxtaposition of research laboratories for radiation oncology, radiation biology and radiation physics, with the involvement of investigators, post-doctoral and pre-doctoral students, fellows and residents. The T wing section of the Medical School was the original space of the DRO and housed the first linear accelerator in Rochester, NY. The division of Radiation Oncology moved to the Cancer Center in 1980, which allowed the T wing to be renovated into 11 research laboratories consisting of 6,350 sq. ft. A deliberate and successful attempt to form investigative teams, consisting of a basic scientist and a clinical investigator, has been the essential building block leading to larger research teams involving faculty of other departments. In addition to a wide variety of support services and patient care facilities, an NIH designated Clinical Research Center is available at Strong Memorial Hospital to assist with conducting high risk pilot studies in an atmosphere conducive to performing sophisticated biologic studies as well as to provide optimum patient care.

The interface between the basic science studies and clinical investigative studies is well demonstrated by a few examples of studies:

JWCC 1597: A Phase I/II Clinical Trial Of Pulsed Paclitaxel And Concurrent Thoracic Radiotherapy For Inoperable (Stage I/II) Or Unresectable (Stage III) Non-Small Cell Lung Cancer

Yuhchyau Chen, M.D., Ph.D.

The purpose of the study is to determine the maximal tolerable dose (MTD) of pulsed paclitaxel with concurrent daily fractionated thoracic irradiation and to seek preliminary evidence of the efficacy using pulsed paclitaxel treatment for radiosensitization. A secondary purpose is to determine relationships of treatment related toxicity with cell cycle analysis of oral mucosa epithelial cells and plasma levels (pharmacokinetics) of paclitaxel.

JWCC 4595R Circulating Cytokines as Correlates of Radiation Induced Pulmonary Toxicity in Primary Lung Cancer

Yuhchyau Chen, M.D., Ph.D.

The purpose of this protocol is to determine and study the development of cytokine cascades and their persistence and correlation with pulmonary toxicity syndromes, i.e., pneumonitis / fibrosis following intensive thoracic irradiation. Based on U of R laboratory research findings, this study will seek to determine if the blood concentrations of a selected panel of cytokines (IL-1, IL-6, TNFa, TGF�, PDGF) collected serially, correlate with the patient clinical course or radiation pulmonary toxicity using, PFT�s, chest film (X-rays, and Chest CT) and LENT-SOMA scales as measurement tools and to determine the predictive and monitoring value of these cytokines.

Clinical Investigative Radiation Oncology

This clinical division of the DRO encompasses investigative programs related to humans in which radiation therapy is used, including clinical trials in national cooperative groups (RTOG, ECOG, POG) and unique JWCC Phase I/II clinical trials. The DRO has played a leading role in the protocol design activities of the RTOG and ECOG and in the development of clinical trials in a variety of tumor sites including lung cancer in localized stages, GI malignancies, head and neck cancers, Hodgkin's Disease, non-Hodgkin's lymphoma, pediatric neoplasms and gynecologic cancers.

An integral component of many of our clinical protocols are DRO-based laboratory techniques, including cell elutriation and cell sorting techniques, identification of hypoxic fractions, and various tumor assays designed to predict radiation effectiveness and responsiveness. The current thrust of a new group of DRO clinical trials is to study the role of cytokines as correlates or indicators of late toxicity in patients undergoing radiation treatment to the lung or the brain. Protocols focusing on therapy-induced normal tissue damage have also emerged as an area of interest, particularly with regard to neuroendocrine, pulmonary, bone marrow and CNS systems. LENT�Late Effects Normal Tissue National Conference sponsored by NCI to redesign late effects scoring and scales was co-chaired by Philip Rubin, M.D. and Louis S. Constine, M.D. and the results were published in late 1995. Second malignant tumors are a major new focus along with chemoprevention and clinical trials using intermediate oncologic markers as endpoints.

Trials are conducted in cooperation with such national groups as the Radiation Therapy Oncology Group (RTOG), Eastern Cooperative Oncology Group (ECOG), and Pediatric Oncology Group (POG). The Department of Radiation Oncology has played a leading role in the protocol design of the RTOG, POG, and ECOG. Unique Cancer Center trials are also conducted by this division.

In addition to the Department of Radiation Oncology Project Officer there are five Clinical Research Associates responsible for the development of studies, registration/randomization of patients, management of the patient data, dissemination of information regarding studies and maintenance of the patient database for the DRO. They also assist the faculty by providing data analysis, research, and editing for scientific papers and presentations.

Clinical Research Staff:

Ann G. Muhs, CCRC�Senior Health Project Coordinator

Joanne Egamino, Ph.D.
Amy Huser, M.A. (ABT)
Leslie Gillis. CRC
Susan Connor Proe, M.S., CCRC
Therese Smudzin, CCRC
Deepinder Singh, M.D.
Cindy Gu, M.D.

Currently there are 45 clinical trials involving radiation oncology researchers.

2394 (RTOG 94-02): PH II Randomized Comparison of Radiation Alone vs Pre-Radiation Chemotherapy for Pure and Mixed Anaplastic Oligodendrogliomas.
DFCI ALL Consortium Protocol 2000-1: Treatment of Acute Lymphoblastic Leukemia in Children.
I1399: A Phase II Study Of Recombinant Human Keratinocyte Growth Factor (rHuKGF) In Head And Neck Cancer Patients Receiving Concurrent Chemotherapy With Standard Or Hyperfractionated Radiation Therapy.
I2399: A Long-Term Follow-Up Study Of Head And Neck Cancer Study Subjects Previously Enrolled In Amgen-Sponsored Clinical Trials With Recombinant Human Keratinocyte Growth Factor (rHuKGF).
POG 9404: T-Cell #4: Treatment for T-Cell Acute Lymphoblastic Leukemia and Advanced Stage Lymphoblastic Non-Hodgkin Lymphoma: A Pediatric Oncology Group Phase III Study.
POG 9425: Advanced Stage Hodgkins Disease - A POG Phase III Study for Pediatric Patients with Advanced Stage Hodgkins Disease.
POG 9803: Randomized Study of Vincristine, Actinomycin-D, and Cyclophosphamide (VAC) versus VAC alternating with Vincristine, Topotecan and Cyclophosphamide for Patients with Intermediate-Risk Rhabdomyosarcoma.
R1100 (RTOG99-15/SWOG9927): Randomized Trial of Post-Mastectomy Radiotherapy in Stage II Breast Cancer in Women with One to Three Positive Axillary Nodes. PH III.
R11001 (RTOG BR-0023): A PH II Trial of Accelerated Radiotherapy Using Weekly Stereotactic Conformal Boosts for Supratentorial Glioblastoma Multiforme.
R11096 (RTOG 95-08): A PH III Randomized Trial Comparing Whole Brain Irradiation with vs without Stereotactic Radiotherapy Boost for Patients with One to Three Unresected Brain Metastases.
R1201 (RTOG R-0012): A Randomized PH II Trial of Preoperative Chemotherapy and Radiation for Rectal Cancer.
R1301 (RTOG 99-01): A PH III Study to Test the Efficacy and Safety of GM_CSF to Reduce the Severity and Duration of Mucosal Injury and Pain (Mucositis) Associated with Curative Radiation Therapy in Head and Neck Cancer Patients.
R1501 (RTOG 99-09): A PH II Study of Postoperative Adjuvant Immunotherapy and Radiation in Patients with Completely Resected Stage II and Stage IIIA Non-Small Cell Lung Cancer.
R1594 (RTOG 93-09): PH III Comparison Between Concurrent Chemotherapy Plus Radiotherapy and Concurrent Chemotherapy Plus Radiotherapy Followed by Surgical Resection for Stage IIIA Non-Small Lung Cell Cancer.
R1800 (RTOG 99-10): A Phase II Trial to Evaluate the Duration of neoadjuvant Total Androgen Suppression (TAS) and Radiation Therapy (RT) in Intermediate Risk Prostate Cancer.
R1801 (RTOG P-0019): A PH II Study of External Beam Radiation Therapy Combined with Permanent Source Brachytherapy for Intermediate Risk Clinically Localized Adenocarcinoma of the Prostate.
R1898 (RTOG 9601): A PH III Trial of Radiation Therapy with or without Casodex in Patients with PSA Elevation Following Radical Prostatectomy for pT3N0 Carcinoma of the Prostate.
R21094 (RTOG 93-05): PH III Study Comparing Stereotactic External Beam Irradiation Followed by Conventional RT with BCNU to Conventional RT with BCNU for Supratentorial Glioblastoma Multiforme.
R2201 (RTOG G-0114): A Randomized PH II Comparison of Two Cisplatin-Paclitaxel Comtaining Chemoradiation Regimens in Resected Gastric Cancers.
R2298 (RTOG 9704/ECOG R9704): PH III Study of Pre and Post Chemoradiation 5-FU vs Pre and Post Chemoradiation Gemcitabine for Postoperative Adjuvant Treatment of Resected Pancreatic Adenocarcinoma.
R2300 (RTOG 99-03): A Randomized PH II Trial to Assess the Effects of Erythropoietin on Local-Regional Control in Anemic Patients Treated with Radiotherapy for Carcinoma of the Head and Neck.
R2301 (RTOG 99-13): A PH III Comparison of Biafine to Declared Institutional Preference for Radiation Induced Skin Toxicity in Patients Undergoing Radiation Therapy for Advance Squamous Cell Carcinomas of the Head and Neck.
R2501 (RTOG L-0017): A PH I Study of Gemcitabine, Carboplatin, or Gemcitabine, Paclitaxel and Radiation Therapy Followed by Adjuvant Chemotherapy for Patients with Favorable Prognosis Inoperable Stage IIIA/B Non-Small Cell Lung Cancer.
R2799 (RTOG 98-09): PH II Study of Pentosanpolysulfate (PPS) in Treatment of GI Tract Sequelae of Radiotherapy.
R2801 (RTOG P-0011): A Randomized PH III Study of Adjuvant Therapy for High Risk pT3N0 Prostate Cancer.
R2894 (RTOG 94-08): PH III Trial of the Study of Endocrine Therapy Used as a Cytoreductive and Cytostatic Agent Prior to Radiation Therapy in Good Prognosis Locally Confined Adenocarcinoma of the Prostate.
R31098 (RTOG 9802): PH II Study of Observation in Favorable Low-Grade Glioma and a PH III Study of Radiation with or without PCV Chemotherapy in Unfavorable Low-Grade Glioma.
R3201 (RTOG PA-0020): A Randomized PH II Trial of Weekly Gemcitabine, Paclitaxel, and External Irradiation (50.4Gy) Followed by the Farnesyl Transferase Inhibitor R115777 (NSC #702818) for Locally Advanced Pancreatic Cancer.
R3298 (RTOG 98-11): A PH III Randomized Study of 5-Florouracil, Mitomycin-C and Radiotherapy Versus 5-Florouracil, Cisplatin and Radiotherapy in Carcinoma of the Anal Canal.
R3799 (RTOG 97-14): Randomized Trial of Palliative Radiation Therapy For Osseous Metastases: A Study of Palliation of Symptoms and Quality of Life.
R9813: PH I/II Randomized study of RT + Temozolomide vs RT + BCNU vs RT + Temozolomide + BCNU for Anaplastic Astrocytoma
U1597: A Phase I/II Clinical Trial Of Pulsed Paclitaxel and Concurrent Thoracic Radiotherapy for Inoperable (Stage I/II) or Unresectable (Stage III) Lung Cancer.
U1899: Intraoperative Treatment Plan For Prostate Brachytherapy; A Randomized Phase II Study Of PIPER Guided Prostate Brachytherapy.
U2298: A Phase I/II Trial of the Feasibility of Treatment of Cancer Involving the Liver with High Dose Radiation Delivered by 3D Conformal Radiation Therapy and Radiosurgery.
U2500: Feasibility Study for the Detection Of Lung Cancer Tumor Cells in the Circulation.
U2701:Patient Positioning Technique Comparison with Electronic Portal Imaging (Novalis Body System) and the BrainLAB ExacTrac System.
U4595: Cytokine Cascades and Cytokine Storms as Related to Chemo-Radiation Induction Of Pulmonary Toxicity (Pneumonitis vs Fibrosis).
U4901: Assessing Information Needs of Cancer Patients Undergoing chemotherapy and radiation Therapy.
U8700: A Phase II Study for Using Radiosurgery on Limited Metastases of Breast Cancer.
U9700: A Pilot Study For Using Radiosurgery on Limited Metastases.
URCC I1301 A Phase III, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Safety of Cevimeline in the Treatment of Xerostomia Secondary to Radiation Therapy for Cancer in the Head and Neck Region.
URCC 1500� A Phase II Trial of One-Cycle Induction Chemotherapy Followed by Pulsed Docetaxel and Concurrent Radiation for Non-Small Cell Lung Cancer.
URCC 3496: The Genetic Regulation of Telomerase Activity in Hodgkin's Disease.
URCC U1702: Measuring Alterations in DNA in Human Blood.
URMC 1198: A Prospective Trial to Determine if Low dose External Beam Radiation Can Prevent or Reduce Anastamotic Intimal Hyperplasia of Vascular Access for Hemodialysis.

Cooperative Group Involvement

The Department of Radiation Oncology works closely with other departments within the Medical Center to further cancer treatment and research. The following Inter-Departmental projects have been ongoing during 2000:

Peripheral Restenosis (Vascular Surgery)

Cardiovascular Restenosis (Cardiology)

Hemodialysis (Nephrology)

Stereotactic Neurosurgery (Neurosurgery)

Multidisciplinary Clinics (Medical Oncology & Surgery)

Listed below are the major cooperative groups in which we participate and the faculty members active in each:

RTOG - Dr. Okunieff is Principal Investigator to the RTOG for the University of Rochester. He is active as the National Chairman of the Tumor Biology Committee. The RTOG is the primary cooperative group conducting clinical trials in Radiation Oncology in the US. Dr. Yuhchyua Chen is on the Lung Committee of the RTOG. A strong affiliate program exists with several of our former residents and faculty members. These include Sandra McDonald, M.D. The Genesee Hospital, Henry Keys, M.D. and Vernon King, M.D., Albany (NY) Medical Center, Thomas Noell, M.D., Romagosa Radiation Oncology Center, Lafayette, LA, and Paul Anthony, M.D., St. Joseph's Cancer Center, Albuquerque, NM. In addition to these centers, four other institutions affiliate with us to participate in RTOG trials. This group is responsible for 70 patients being entered on RTOG studies annually.

SWOG - Yuhchyau Chen, M.D., Ph.D. is an active member in this group. Dr. Chen is a member of the GYN Committee and Lung Committee and regularly attends the semi-annual meetings.

POG - Louis Constine, M.D. is the active participant in Pediatric Oncology Group (POG) and prior to this, in the Children's Cancer Study Group. He is currently Vice-Chair of the Radiation Oncology Committee and on the Core committees for Hodgkin's Disease, bone marrow transplantation, and Late Effects. He co-developed protocols in these various areas, including a recent protocol for children with advanced-stage Hodgkin's disease.

Cancer Therapeutic Control Division

The side effects of cancer treatment can, at times, be so severe as to interfere with and, in fact, derail treatment programs. Thus, this division works to develop treatments that counter the negative side effects of radiation therapy and chemotherapy. Through research, the Cancer Therapeutic Control (CTC) Division combats patient fatigue, nausea, emesis, as well as depression and other psychosocial effects. The development of remedies for these effects of cancer treatment is central to not only the full and successful treatment of cancer, but also the patient�s quality of life, an issue highlighted in the Department of Radiation Oncology�s mission statement.

Gary R. Morrow, Ph.D., Professor

Dr. Morrow is a trained Clinical Psychologist and medical statistician, and he oversees all cancer therapeutic control trials.

Joseph A. Roscoe, Ph.D., Assistant Research Professor

Dr. Roscoe is responsible for the design and analysis of research studies concerned with the therapeutic side effects of cancer treatment and patient quality of life.

Cancer Therapeutic Control Division Staff:

Alexandra Dimatteo		Analyst
Kelly Kita		Health Project Coordinator
Sara Matteson		Analyst
Shonda Ranson		Analyst
Ann Wiater		Secretary

Currently, this division is the national Community Clinical Oncology Program (CCOP) Research Base Center, and as such, it facilitates the development, enrollment, conduct, quality assurance, monitoring, and evaluation of clinical trials designed to combat the side effects of cancer treatment. Research and treatment centers from as far away as Hawaii and as near as Vermont report their study findings to the James P. Wilmot Cancer Center�s CTC Division.

from the CCOP web site:

The James P. Wilmot Cancer Center serves as a Research Base for URCC Community Clinical Oncology Program (CCOP) applicant institutions. An original Research Base serving the CCOP program since 1983, the URCC CCOP Research Base has evolved into one of the leading resources for cancer control research activities. Through its development and growth, it has attracted a research-oriented community of investigators pursuing CCOP alliance.

The purpose of the CCOP Research Base is to facilitate the development, conduct, quality assurance, monitoring and evaluation of clinical trials in the area of cancer control to community-based institutions participating in the Community Clinical Oncology Program. The emphasis of this Research Base is to enhance investigator-initiated research.

Another significant project underway through the Cancer Therapeutic Control Division is research into the use of methylphenidate for radiation therapy induced fatigue.

Radiation Biology Division
Faculty, Mission, Resources, Research

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This division is devoted to study of the basic principles of the interaction of radiation and biology systems. Applications to clinical radiation therapy are developed by selection of animal models and correlative in vitro and in vivo systems for predicting the value of combining radiotherapeutic and chemotherapeutic modalities, radiosensitizers and radioprotectors to overcome therapeutic resistance. The major radiation research interface investigations in progress are supported by our NCI program project grant (CERRIS) currently in its twenty-eigth year. In addition, the division has a number of other grants listed in the grant section of this report.

Faculty

Peter Keng, Ph.D., Director

Dr. Keng is a radiation biologist with expertise in cell cycle checkpoints and radiation sensitivity who oversees all research projects through the Radiation Biology Division. In addition, Dr. Keng directs the Medical Center's Cell Sorting and Flow Cytometry Core Facility.

Bruce Fenton, Ph.D. , Associate Professor

Dr. Fenton is trained in chemical engineering and bioengineering and specializes in micro vascular physiology, oxygen transport and theoretical models of hemodynamic function. Current research focuses on characterizing tumor micro-regional physiology and the manipulation of blood flow and oxygen delivery to optimize chemotherapy and radiation therapy.

Jacqueline P. Williams, Ph.D., Research Assistant Professor

Dr. Williams has a broad based background in radiation oncology and pharmacology specializing in skin and tumor vasculature. As a faculty member in Radiation Oncology she acts in a coordinating and supervisory role to facilitate laboratory studies and modeling for clinical faculty, fellows and residents.

Ivan Ding, M.D., Assistant Professor

Dr. Ding has extensive experience working on translational clinical studies, transgenic and knockout mice, gene therapy and new transfection techniques, as well as a full range of pathohistological skills.

Chin-Rang Yang, Ph.D., Instructor

Dr. Yang�s expertise is in human cancer biology, radiation biology, and molecular biology, and his research is focused on DNA repair.

Radiation Biology Staff:

Brian Beauchamp
Eric Hernady, M.S.
Dongping Hu, M.D.
Melissa Levitt
Weimin Liu, M.D., Ph.D.
Joan Morrow
Scott Paoni, M.S.
Wang Wei, M.D.
Jianhua Xu, M.D., Ph.D.

Mission

The major aim of this division is the development of biological in vivo/in vitro models to simulate clinical problems and to provide a scientific basis for clinical protocol design. The interaction between the basic scientist and the clinician is an essential component. It is this process, begun among the radiation oncology and radiation biology faculty, that lead to the development of interface studies and is best expressed in the goals of our CERRIS grant. The human tumor model, more than the murine or rodent cancer, is the focus for exploring new combinations of radiation therapy and chemotherapy and biologic response modifiers such as interferon. The identification of mechanisms of therapeutic resistance, particularly in exploring hypoxia but also in analyzing subsets of cells in existing populations and their microenvironment, is being performed. Predictive assays of tumor cell proliferation and normal tissue injury is an ongoing effort. The study of late pathophysiologic effects in a variety of tissues/organs includes the lung, bone marrow, central nervous system, and hypothalmic-pituitary axis. Many of these concepts have been translated into radiation oncology protocols, as previously described. Our weekly research meetings concentrate on a variety of different topics. Encouragement from and the participation of younger faculty, fellows, residents and selected faculty from other departments has given a multidisciplinary character to our research efforts.

Space and Major Equipment

Renovated space in the Jennings Research Laboratory (the former Radiation Oncology Department) as well as laboratory space on the third floor of the Cancer Center constitutes the laboratory space used for the Radiation Biology Division projects. All radiation disciplines are represented--clinical radiation oncology, radiation biology, and radiation physics. The radiation services available there include a cobalt-60 and cesium-137 unit, which are shared resources of the JWCC as well as the DRO.

Animal research is conducted in facilities maintained by the University of Rochester Vivarium. The Vivarium occupies 37,000 square feet of space devoted to housing, treatment rooms, and special care facilities for animals including surgery, radiology, and research diet preparation.

Current Research

Clinical/Experimental Radiation Research Interface Studies (CERRIS)
This P01 grant has been the major research project combining the interests and expertise of the Radiation Oncology research team for the past twenty-six years. Many ideas have been pursued during that time both in the laboratory and in the clinic. Because of its emphasis on moving the ideas from the laboratory into the clinic or using clinical problems as the basis for laboratory exploration it has served to bring investigators together in a unique fashion leading to some very significant scientific accomplishments.

Biomarkers
As an extension of the studies being performed under CERRIS, a number of departmental research projects are looking at potential markers of either treatment outcome or late effects. These investigations are part of national cooperative group studies or in-house investigations and involve such diverse tissues as lung (Chen & Williams), esophagus (Williams), prostate (Ding), breast (Ding), and brain (Okunieff & Brasacchio).

External Beam Irradiation for the Inhibition of Restenosis
In conjunction with the ongoing development of intravascular radiation sources in the field of cardiovascular restenosis (see Novoste), for nearly a decade a team led by Drs. Rubin and Williams has also been involved in exploring the use of external beam irradiation for treating restenosis in the peripheral circulation. This work has involved collaborations with both the Departments of Cardiology and Vascular Surgery. The team has successfully developed a number of large and small animal models in order to study the efficacy of irradiation in these models, and also to gain an understanding into the biological and molecular mechanisms underlying the process.

Back to the Radiation Oncology Home Page

This page was last updated July 2, 2002.
URL: http://radonc.urmc.rochester.edu/mission.html