Radiation Therapy: A Rising Cancer-Fighting Superpower

In the battle against cancer, radiation therapy is emerging as a frontline hero in attacking some of the most aggressive enemies in the cancer world: brain tumors like glioblastoma; cancers that have invaded vital organs such as the lungs, liver, kidney and pancreas; and cancers that have metastasized or spread to the brain.

For some patients, the technology is used as a curative treatment, while others are given additional precious time with loved ones and an improved quality of life.

Leading the revolution are physician-investigators at Baptist Health Miami Cancer Institute whose groundbreaking research is transforming cancer treatment. Recently, within just a few weeks, five major studies by Rupesh Kotecha, M.D., and the Institute team, were published in prestigious medical journals including the Journal of Neuro-Oncology and the International Journal of Radiation Oncology, Biology, Physics. Dr. Kotecha is chief of radiosurgery and director of the Central Nervous System Metastasis Program at the Institute.

“We are very excited about the research we are leading here and the impact it is having on patients,” Dr. Kotecha says. “I don’t know of another institution that has had multiple manuscripts published in such significant, peer-reviewed journals on different subjects at the same time.”

Rupesh Kotecha, M.D., chief of radiosurgery and director of the Central Nervous System Metastasis program at Miami Cancer Institute.

 

Radiation therapy works by directing high-energy rays or particles at cancer cells, damaging their DNA and stopping them from dividing and growing. It can be used alone, or in combination with surgery and chemotherapy. Recent advances have made radiation therapy safer and more effective, particularly with technologies like MRI-guided machines, adaptive therapy and proton therapy.

The studies most recently published include:

• Temporospatial Tumor Dynamic Changes in Glioblastoma During Radiotherapy (Journal of Neuro-Oncology). The study showed that using MR-guided radiation therapy allows doctors to “follow” the shifts and shape changes in tumors during chemoradiation, which is helping develop adaptive therapy, in which treatment plans adjust in response to tumor changes.
  
  
• Integrating a Novel Tablet-Based Digital Neurocognitive Assessment Tool in Brain Metastases Patients (Journal of Neuro-Oncology). The investigator-initiated trial showed that a simple, multi-language test used by the Institute and administered digitally by patients with brain metastasis is able to provide neurocognitive assessment, important in determining how treatment affects memory, thinking skills and quality of life. The test is available in English and Spanish. Of those who participated, 94% said the test was easy to understand, 96% found it easy to use and 74% found it relevant to their care. “In the past, this was a pen-and-paper test that took hours to administer and a special team that included psychological professionals,” Dr. Kotecha says. “It was only available in English and French, which was a problem for many of our patients whose first language is Spanish. This is an investigator-initiated trial, and we partnered with BrainLab to test the software.”
  
  
• Stereotactic Magnetic Resonance Guided Adaptive Radiation Therapy in One Fraction: A Multicenter, Single-Arm, Phase 2 Trial (International Journal of Radiation Oncology, Biology, Physics) revealed that it is feasible, safe and effective to deliver one session, called a fraction, of stereotactic body radiation therapy to a tumor with MR-guided radiation therapy instead of the usual CT-based approach. The study looked at patients with primary or metastatic lesions of the lung, liver, pancreas, adrenal gland, kidney and abdominal/pelvic lymph nodes.
  
  
• Stereotactic Magnetic Resonance Guided Adaptive Radiation Therapy for Infradiaphragmatic Oligometastatic Disease: Disrupting the One-Size-Fits-All Paradigm (International Journal of Radiation Oncology, Biology, Physics) showed that MR-guided radiation therapy can be customized for patients with a small number of metastatic tumors in such organs as the liver, kidney and pancreas. The personalized approach leads to long-term tumor control with minimal side effects.
  
  
• Contrast-Enhancing Lesions Induced by Central Nervous System-Directed Intensity Modulated Proton Therapy: Distribution Patterns, Kinetics, Risk Factors, and Outcomes (International Journal of Radiation Oncology, Biology, Physics) studied the side effects of intensity modulated proton therapy, a different form of energy than traditional radiation. Risk increased with age, tumor volume and location, and new information is helping doctors better spare nearby tissues with advanced proton therapy planning techniques.

Other Institute physicians involved in the clinical trials and listed as authors on the manuscripts include Minesh Mehta, M.D., deputy director, chief of radiation oncology and the John and Mary Lou Dasburg Endowed Chair in Radiation Oncology; and Michael Chuong, M.D., medical director of radiation oncology.

“We are very fortunate to offer every radiation therapy modality in one setting,” Dr. Kotecha says. “It makes us unique. And coupled with our research, it means that we are able to offer our patients the best option for them.”