Download Appendix: Email Interview Transcript - English 3010-010

Ivan C. Bell
ENG 3010 Section 10
Fall 2012
Reflection Essay
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Table of Contents:
Table of Contents……………………………………..……….…….…………2
Reflection Essay…………………………………………………...…….……..3
Appendix……………………………………………………………………….8-42
Email Interview Transcript……………………………………………..8-14
Bell Annotated Bibliography…………………………………….…….15-22
Bell Research Proposal.........................................................................23-38
Bell Research Proposal Rough Draft……………………………….….39-42
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Reflection Essay
The English 3010 course at Wayne State University has been more than just a lecture to
me; instead it has become a fast forward button into the realm of writing as well as my own
major. Unlike other classes I have taken and even other English classes, this class taught directly
to our own discourse community in our future careers by teaching four major learning objectives
in writing. This class started out by first going through the basics of discourse communities by
using scholars’ works, such as those by John Swales. After a few class periods we took a
different approach and started working on our own future discourse communities in our field of
study. We then used our four major papers to conduct an interview, create an annotated
bibliography and historical overview, come together on a presentation, and finally write a
research proposal on a relevant topic in each of our own fields of study. Each of these papers
helped complete the four learning outcomes set out in the rubric of this course. These course
objectives were clearly stated throughout the entirety of the course and are as follows:
1. Produce writing that demonstrates your ability to identify, describe, and
analyze various occasions for writing, genres, conventions, and audiences in
your discipline or profession from a rhetorical perspective.
2. Produce an extended writing project that uses research methods and research
genres to explore a topic applicable to the course and that draws substantively
on concepts from primary AND/OR secondary sources.
3. Produce writing that shows use of a flexible writing process (generating ideas,
drafting, substantive revision, and editing) and shows your ability to adapt this
process for different writing situations and tasks.
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4. Produce writing that shows how you used reflection to make choices and
changes in your writing and that explains how you would use reflection and
the other skills taught in this course to approach a completely new writing
task. (Heiniger, English 3010 Syllabus)
These objectives were successfully completed in the first four papers of the course as well as in
this reflective essay.
Learning outcome number one may be the broadest objective in this English course. My
ability to identify and analyze different occasions for writing was something that I had to learn
by attending this course. The four major genres we covered as a class were an interview,
annotated bibliography, speech, and research proposal. All four of these genres are majorly
different and a complete writing style change was needed when switching from one paper to the
next. Being able to transition like this requires a lot of flexibility in writing styles. This flexibility
came from being able to identify and analyze what style is needed.
One of the best learning experiences I received in this course dealing with writing in
different occasions would have to be my email interview.(Bell, Email interview transcript) Going
in to this interview, I thought that it would be like any other casual email but with a formal
format. I quickly learned that this genre of writing first of all needs a lot of time in some cases.
After getting my first response back from my interviewee I learned in a very hands on way that
more time is needed when emailing a professional. Another hurdle that I had to jump through
was not getting all of the information I needed from my email interview to successfully complete
my project one. One question I asked from my email interview was what kind of style of writing
radiation therapists use. This question went unanswered because the interviewee did not know
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the answer. As time was running out before my project was due, I had to improvise and find this
information from another source. This taught me how to effectively do research on my own,
which leads into learning outcome number two which states that I am able to utilize research
methods that draws from primary and secondary sources.
Researching a topic for a research paper was something I thought would be easy since I
have been in writing classes since high school. This however was not the case. In the past when
writing a research paper; I would simply make a basic outline and fill it in. My instructor in
English 3010 taught us the effectiveness of using an annotated bibliography instead. (Bell, Bell
Annotated Bibliography) This annotated bibliography was something I have never done before
or even heard of before. Completing my first annotated bibliography and receiving a good grade
on it had made me realize what a great research method it really is. This annotated bibliography
was not just another assignment that I did and then forgot about like others from my past, in this
case I have used this annotated bibliography for my speech presentation as well as using it
extensively in my research proposal paper. (Bell, Bell Research Proposal) These secondary
sources I found and used were similar to my research I have done in the past, but using primary
sources like from my interview was a new way to research for me. All of this new learning truly
requires flexibility as explained before, which leads to the third learning objective.
Editing and revision are standard process for writing any form of paper. It has always
been a good thought to revise a rough draft but it was always hard for me to put it into practice.
One of the best aspects of this class curriculum was that there were mandatory conferences with
the instructor. These conferences gave an opportunity to significantly revise a rough draft. One
of my most visible changes in rough draft to final draft of a paper came in my project four. (Bell,
Bell Research Proposal Rough Draft) In this paper I completely changed my research proposal
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thanks in part to the instructor who had enough insight to see what would work much better. This
insight is something I would have never seen on my own without another party viewing my
paper. This also showed me that the person proofreading my papers does not have to have
extensive knowledge in the topic of the paper (radiation therapy in this case). Looking back on
this course and how my papers were worked through I can see how things changed and how I
had to make choices to finish things successfully.
Reflecting back on mistakes I have made such as procrastinating on my project one
interview has definitely changed my outlook on starting research sooner. All reflections that I
have encountered have been beneficial in one way or another. Mentioned above was the fact that
we had one-on-one conferences to revise our papers, this also gave the necessary time to reflect
on mistakes made and how to better them. These reflections along with the reflections we did
orally in class were the majority of reflections we did in this class, whether big or small
reflections. In my annotated bibliography I had discovered and wrote about an article that
discussed the continuing education requirements in the field of radiation therapy. (Bell, Bell
Annotated Bibliography) This continuing education may require me to write in the future to keep
my job. I truly believe that this course has connected the dots between general writing and
writing for specific discourse communities, which may help save my career in the future.
In conclusion I believe that this English course has successfully taught me a large skill set
that will be used for a lifetime. Also, I believe that our instructor’s method of teaching by diving
directly into each of our own future discourse communities rather than the conventional teaching
of this course was effective. What this technique did for me was going beyond the minimum and
attaching a real reason for many of us to take this course seriously. This method however did not
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in any way take away from the teaching of the four learning outcomes that I now feel very
strongly that I have accomplished in a thorough manner.
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Appendix:
Email Interview Transcript
First EmailDear Jennifer Mann
My name is Ivan Bell and I am a student at Wayne State University. I am currently enrolled in
English 3010 (intermediate composition) where I must contact someone important from my field
of study to conduct an interview. I was hoping that you would be available to sit down for a few
interview questions that should not take more than 30 minutes. If you would like to participate in
helping me understand the Radiation Therapy program please email me back at
[email protected] and I can send you a list of questions for the interview. Thank you for taking
the time to read and consider my request.
Best Regards, Ivan Bell
[email protected]
Follow-up EmailJennifer,
Thank you for helping me with this interview process. In this email I will send you a list of
questions that I have, these questions will not only help me complete a project for class, but also
help me better understand the field. I would appreciate a response email at your earliest
convenience and I would also like to come in and speak to you at a later time to better
understand things in greater detail.
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1.What is it like working as a radiation therapist?
2.Is radiation therapy all that you expected?
3.What got you interested in radiation therapy?
4.What supprised you the most once you were involved in the field of radiation therapy?
5.What kind of writings/journals do you use in radiation therapy?
6.What kind of research do you do?
7.What kind of citation and styles do u use for research/writing?
8.What topics are hot right now in the field of radiation therapy?
9.Do you do a lot of research while practicing radiation therapy in the field?
10.Has working in the field changed your views on anything related to the job?
11.Are there any areas of research in radiation therapy that have not been touched on very much,
such as gaps in research?
12.What other communities do you often converse with in the field of radiation therapy?
Thank you again, Ivan Bell
Return Email-
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Ivan, attached is the answers to your questions. I am available all weekend if you wish to talk in
person. I love what I do and I am very passionate about my job. Let me know if I can be of any
assistance,.
Sincerely,
Jennifer
1)
What is it like working as a radiation therapist?
Working as a radiation therapist is a wonderful career. It is very rewarding helping people
during a very difficult time.
2)
Is radiation therapy all that you expected?
Radiation therapy is more than I expected. I love going to work every day. I never have a day
where it is exactly the same as the day before. Each day holds a new challenge and there is
always something new happening the field of oncology.
3)
What got you interested in radiation therapy?
I found radiation therapy by accident. I called Wayne State to inquire if they offered a degree in
radiology. I was given the phone number for Adam Kempa to contact in the Radiation Therapy
Program. We discussed the differences between the two medical fields. He asked me to come
for a tour so that he could show me what radiation therapy was and where you could go with a
degree in this specially. I met Adam and saw the therapist and what they did and the technology
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and the machines and knew that it was the right choice for me. I loved that the fact that I could
help people and never have a day where I felt that I was just part of another worker for a
corporation.
4)
What surprised you the most once you were involved in the field of radiation therapy?
The thing that surprised me the most and surprises most people when they learn that I work with
cancer patients is that this is not a depressing job. Cancer patients are amazing! They are truly
inspiring and uplifting.
5)
What kind if writings/journals do you use in radiation therapy?
We don’t use journals and writings on a regular basis. There are several wonderful ones called
the Journal of Oncology and Advance and Radiation Therapy. The Journal of Oncology has
articles written by Radiation Oncologists, Medical Oncologist, Medical Physicists, and others
involved in the oncology world. The main purpose of this journal is to discuss what is being
researched and done all over the world. The other two I mentioned are geared strictly at
radiation therapy and radiation therapists. We do have to do 24 Continuing Education credits
every 2 years to maintain our professional license. So these journals help to maintain this
requirement.
6)
What kind of research do you do?
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Here at St. Joseph we are not involved in research per-say. We do take part in clinical trials with
other various hospitals in the area and across the country like U of M, Mayo Clinic and MD
Anderson. We also do some research for the National Cancer Institute and provide statistics and
other things of that nature, but the majority of the leg work on the research end is handled by a
specific department called ROTG/Research. Most of the research that is done in our field is
done at hospitals attached to Medical Universities.
7)
What kind of citation and styles do you use for research/writing?
I have not done any of this type of work since I was in the Radiation Therapy program at Wayne
State.
8)
What topics are hot right now in the field of radiation therapy?
There are several areas that are hot topics in radiation therapy. One is called IMRT – Intensified
Modulated Radiation Therapy. This means that we can deliver a higher curative dose to the
cancer cells while avoiding the critical structures and organs that maybe surrounding the tumor
bed. Another hot topic is Radio Stereotactic Surgery. This also for a pencil fine beam of
radiation to be delivered to a tumor from many angles, sometimes over 500 different angles and
beam configurations. A third hot topic is called rapid arc.
9)
Do you do a lot of research while practicing radiation therapy in the field?
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If you mean research in the traditional sense, then no. If you mean do we do research in the
sense of participating in clinical trials and protocols, then yes.
10)
Has working in the field changed your views on anything related to the job?
During the course of my career, I have learned that I believe in being a patient advocate. I am
not just there to deliver a treatment. There are many challenges that our patients face whether it
is having reliable transportation to treatment every day, or being able to pay for the different
prescriptions that they may be given during the course of their therapy. For many patients just
navigating the insurance issues is a full-time job and can get very confusing. My job is not just
delivering the radiation treatments. You are sometimes needed to be a social worker, a shoulder
to cry on, or just a friendly face for the patient. Being a good radiation therapist is more than just
knowing how to work the machines Radiation therapy was a second career for me. I used to be
in the business world and I switched careers in my late twenties. I have grown to love this field
more and more each year. Much of this because of the people that I have come to know and take
care of but it is also due to my fellow co-workers and the physicians that I work with closely.
11)
Are there any areas if research in radiation therapy that have not been touched upon, such
as gaps?
There is research being done every day some where regarding radiation therapy and how it can
be improved upon. I cannot at this time think of any areas that have not been touched upon.
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12)
What other communities do you often converse with in the field of radiation therapy?
I communicate with the radiation oncologists, nurses, dosimetrists, medical physicists, medical
oncologists, medical assistancts, secretaries, surgeons, social workers, nursing homes, rehab
facilities, volunteers, and other cancer support groups such as the American Cancer Society and
the Cancer Wellness Center.
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Bell Annotated Bibliography
1.Animashaun, A. (2011). Radiosurgery for Extracranial Lesions. Radiation Therapist, 20(1), 4762.
This article is a directed reading which is given out by the journal Radiation Therapist to
assist in continuing education (CE) which is required of all radiation therapists. This type of
writing is commonplace in the field of radiation therapy. Advantages and disadvantages of
certain radiologic procedures are clearly placed in this article. This article also shows the best
way to treat certain areas of the body as of 2011, which is still good for using now.
This article is the main type of literature to be found and read once in the field of
radiation therapy. This article is a very good for if someone needs a reference for a basic
procedure or technology about radiation therapy. This article outlines what is common
knowledge for a well-trained Radiation Therapist.
2.Barker, E. (1998). Evolutions revolutions: beyond conventional radiation... intensity modulated
radiation therapy (IMRT). Rn, 61(6), 34-37.
In this article, intensity modulated radiation therapy (IMRT) is under the scope. IMRT is
compared and contrasted to conventional radiation therapy in this article. In 1998 IMRT was on
the cutting edge and this article shows how lives can be saved using this technique. This is a very
big leap from conventional therapy which is not very precise.
Intensity modulated radiation therapy is the new technology in the late 90’s which was a
big advancement in technology at the time. IMRT however is still in use today as a technique in
radiation therapy. Some information in this article is outdated, such as the fact that only 20
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hospitals are equipped with IMRT systems. The number of these systems is now much higher
currently and IMRT systems are also now in place in clinics.
3.Battista, R. (2009). Gamma knife radiosurgery for vestibular schwannoma. Otolaryngologic
Clinics Of North America, 42(4), 635-654. doi:10.1016/j.otc.2009.04.009
This article outlines how ever since the invention of the gamma knife by Lars Leksell it
has been used more and more. Also in this article are others’ studies showing how radiosurgery
has improved year after year. This article also shows side effects and symptoms of radiation from
radiosurgery.
This is a good article showing summaries of other scholars’ articles all showing what
gamma knife radiosurgery can do. This article however does not have its own study. Like most
other scholarly articles, this shows how technology in radiation therapy evolves rather than
becoming out of date like most other medical professions.
4.Bhatnagar, A., Beriwal, S., Heron, D., Flickinger, J., Deutsch, M., Huq, M., & ... Shogan, J.
(2009). Initial outcomes analysis for large multicenter integrated cancer network implementation
of intensity modulated radiation therapy for breast cancer. Breast Journal, 15(5), 468-474.
doi:10.1111/j.1524-4741.2009.00761.x
This article is about using IMRT for the treatment of breast cancer. In this study,
hundreds of patients were studied and it was shown that IMRT is an effective treatment. This
study shows factors such as breast size influence how treatment may be performed.
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This article is a large scale study that shows that IMRT can be used for treatment of
breast cancer. This is a good article and the study has a solid scientific base. This article shows
that IMRT can be put in place in almost any large scale healthcare network.
5.Gordon, K. (2006). What is FACET? Stereotactic radiosurgery. European Journal Of Cancer
Care, 15(1), 96-104.
This article is not about a research topic, however it is an explanation of one of the ways
Radiation Therapists can to their continuing education to keep their licensing. This article shows
how slides can be incorporated in teaching the basics of radiation therapy. Gordon shows us that
there are many possibilities that the use of radiation gives us.
As an article, this writing gives a lot of information about what we know, how
technology is progressing and what is in the future. This paper however does not use a research
study to prove something that is under review.
6.Hammick, M., Tutt, A., & Tait, D. (1998). Knowledge and perception regarding radiotherapy
and radiation in patients receiving radiotherapy: a qualitative study. European Journal Of Cancer
Care, 7(2), 103-112.
This article is about the population’s knowledge of radiation therapy from back in 1998.
This study aims to gather what people who are undergoing their first round of therapy actually
know about what they are going through. This study asked patients a few questions about what
they know about radiation and radiation therapy. The findings of this study showed that most of
the knowledge came from the media and it was mostly negative.
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The relationship between the patient and the therapist is of utmost importance which is
why this is a relevant topic to research. This study may be out of date now because of the
public’s knowledge of the safety that goes into all medical procedures.
7.Lalonde, R. R., & DeFoe, S. G. (2012). Concurrent Chemotherapy and Intensity-modulated
Radiation Therapy for Anal Carcinoma — Clinical Outcomes in a Large National Cancer
Institute-designated Integrated Cancer Centre Network. Clinical Oncology, 24(6), 424-431.
doi:10.1016/j.clon.2011.09.014
This study is of seventy-eight patients who had IMRT as well as chemotherapy treatment
for anal carcinoma. This study shows that IMRT used in conjunction with chemotherapy is a
well tolerated and effective treatment for this type of cancer. It is discussed that the conventional
treatment for this cancer is surgery, which is a more invasive route.
This is a great article that shows how radiation therapy can be used with chemotherapy to
fight cancer. The authors show how this can be much safer than conventional surgery in small
size tumors.
8.
Lasak, J., & Gorecki, J. (2009). The history of stereotactic radiosurgery and radiotherapy.
Otolaryngologic Clinics Of North America, 42(4), 593-599. doi:10.1016/j.otc.2009.04.003
This is an overview of the history of radiotherapy. It begins by explaining how the
stereotactic apparatus came to life and how it took fifty years to incorporate radiotherapy to this
other technology. Also shows how technological advancements were added to radiation therapy
and improved upon, starting with stereotactic radiosurgery and concludes with the use of linear
accelerators, which are new technology today.
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This article is a very good source for the history of radiation therapy. But it does not go
into detail. It identifies the inventors of important radiation therapy technologies. All of this
information is good for finding other topics.
9.McGregor, J., & Sarkar, A. (2009). Stereotactic radiosurgery and stereotactic radiotherapy in
the treatment of skull base meningiomas. Otolaryngologic Clinics Of North America, 42(4), 677688. doi:10.1016/j.otc.2009.04.010
The authors say in this article how the use of radiosurgery after brain surgery to remove
tumors can be beneficial. They also say how as technology advances, radiosurgery may become
a more prominent treatment option for this type of cancer.
This article does a good job of stating facts that show that radiation therapy can be a
viable option for eliminating this type of brain cancer. This article also gives many different
examples of different types of radiation therapy that could be used. In the article, there is no
specific studies that are being performed however.
10.
Sale, C., Yeoh, E., Scutter, S., & Bezak, E. (2005). 2D versus 3D radiation therapy for
prostate carcinoma: a direct comparison of dose volume parameters. Acta Oncologica, 44(4),
348-354.
Radiation Therapy advancements are the topic of this article from 2005. This article
shows how 3D radiation therapy (RT) could have been used to treat patients more thoroughly
than with the use of 2D radiation therapy. This research was done not by getting new patients,
but by putting information from previous 2D RT treatments into new 3D RT systems and seeing
how much it could have been improved.
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This article is similar to those that talk about the benefits of intensity modulated radiation
therapy. One downfall of this article is that it did not use real life patients which could have
affected the real life outcome of such a study. This study also has many charts and graphs which
assist in understanding of the study.
11.
Scorsetti, M., Bignardi, M., Alongi, F., Fogliata, A., Mancosu, P., Navarria, P., & ...
Cozzi, L. (2011). Stereotactic body radiation therapy for abdominal targets using volumetric
intensity modulated arc therapy with RapidArc: Feasibility and clinical preliminary results. Acta
Oncologica, 50(4), 528-538. doi:10.3109/0284186X.2011.558522
This article shows how IMRT delivered by RapidArc had good results with low toxicity.
Ninety-five patients were involved in this study that showed that all patients had low toxicity to
the radiation. This study was put in place to prove that IMRT can be used instead of conventional
surgery because it reduces patient down time.
This is a good study that has very good visuals of the materials and methods. They do a
good job of reasoning that IMRT can be an alternative to surgery. This study is similar to many
others that show that radiation therapy can be an effective alternative to invasive surgery.
12.
Teh, B., Lu, H., Sobremonte, S., Bellezza, D., Chiu, J., Carpenter, L., & ... Butler, E.
(2001). The potential use of intensity modulated radiotherapy (imrt) in women with pectus
excavatum desiring breast-conserving therapy. Breast Journal, 7(4), 233-239.
In Teh’s article, the use of intensity modulated radiation therapy is shown to be a
valuable resource in treating cancer. IMRT is and can be used in conjunction with conventional
radiation therapy to maximize effectiveness of treatment. The use of body casts is shown in a
diagram which helps show how they are used.
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This article is a very good overall article even today. This article also has many graphs
and figures that help understand the research process. In one of these graphs, a stereotactic body
mold is also shown which is used for immobilizing the patient.
13.
Teh, B., Woo, S., & Butler, E. (1999). Intensity modulated radiation therapy (IMRT): a
new promising technology in radiation oncology. Oncologist, 4(6), 433-442.
This article shows what a hot topic was in 1999. IMRT is discussed in this article as well
as other technologies in 1999. This article also shows what types of cancer were treated by
IMRT in 1999.
This article is good for looking to see how the field of radiation technology has evolved,
including cost, treatable cancers, and which technologies it is used in conjunction with. This
article has its downfall because it is outdated in many aspects. This article does show how we
still use the same general technologies but much more evolved in present day.
14.
Vieillot, S., Azria, D., Lemanski, C., Moscardo, C., Gourgou, S., Dubois, J., & ... Fenoglietto, P.
(2010). Plan comparison of volumetric-modulated arc therapy (RapidArc) and conventional
intensity-modulated radiation therapy (IMRT) in anal canal cancer. Radiation Oncology, 592.
doi:10.1186/1748-717X-5-92
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In this article, RapidArc is compared to IMRT. They show that RapidArc technology can
be used instead of IMRT and it may even be a faster technique. This article uses a real study of
people to find its discoveries.
This is a good recent article that shows that different methods and techniques can be used
for different types of cancers. Both types of radiation therapy described in this article are tried
and true methods for radiation therapy.
15.
Yong, J. E., Beca, J. J., McGowan, T. T., Bremner, K. E., Warde, P. P., & Hoch, J. S.
(2012). Cost-effectiveness of Intensity-modulated Radiotherapy in Prostate Cancer. Clinical
Oncology, 24(7), 521-531. doi:10.1016/j.clon.2012.05.004
This article uses models and estimates rather than a real life study to show that IMRT can
be as cost effective as 3D conformal radiation therapy. IMRT is the topic of this article because it
reduces toxicity compared to 3D RT.
The study of this article could be more realistic if it used real people in a study instead of
using computer models, but it is still a quality study. This article shows how radiation technology
has evolved but still uses some of the same techniques.
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Bell Research Proposal
Radiation Therapy is one of the oldest known cancer treatment techniques. One of the
major starting points of radiation therapy was when Horsley and Clarke invented a system to
study the brain by keeping it completely immobile. Later in the 1950’s the stereotactic device
was used in conjunction with the addition of radiation to treat cancer. (see figure 1) Soon after
this, the whole brain was mapped with MRIs and CAT scans. Before radiologic neurosurgery,
the best way to treat cancer of the brain was to surgically remove the tumor. This proved to be
very dangerous and caused the patient a long stay in the hospital. Lars Leksell is known as the
father of stereotactic radiosurgery because he applied stereotactic procedures to radiation
delivery. (Lasak. J., & Gorecki, J., 2009) Radiation therapy has been a viable option to treat
cancers of all different forms since its inception. Recently, radiation therapy has become more
and more advanced with the advancement of technology. With technologies such as radiosurgery
and intensity modulated radiation therapy being in existence for decades (Lasak, J., & Gorecki,
J., 2009); it is time to look at other ways to vastly improve radiation therapy.
Figure 1. Stereotactic Apparatus (Elektra Limited Hong Kong, 2012)
Radiation therapy however does have some flaws. Whenever dealing with dangerous
medical equipment and techniques there is the possibility of harm. In recent years, research has
switched in the field of radiation oncology to deal with reducing toxicity from the radiation
therapy. One benefit of the research of reducing radiation toxicity is that by reducing toxicity,
more radiation can be given which will benefit the patient by eliminating more of the tumor as
well as shortening the course of treatment. (Lalonde, R. R., & DeFoe, S. G., 2012) The major
method of reducing toxicity that this proposal will outline is the method of hyperthermia, or
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thermoradiotherapy. This method is a recent advancement in reducing toxicity in a similar way
that chemotherapy does. (De Haas-Kock, D. et al, 2009) By heating the tumor, radiation does a
much better job of destroying cells, therefore as long as the heat is kept in a localized area. This
procedure will be a very beneficial technique for integrating into a radiation therapy regiment to
reduce radiation toxicity as well as provide a better overall patient experience.
Literature Review
In the past, researchers and scholars have been working to understand the mechanisms of
action that radiation therapy plays. In the early days of radiation therapy, it was used in the brain
with not always perfect results. Once radiation therapy was proposed and started being used
clinically, the research really started. The reason there was so much research at this time was
because of the kind of radiation therapy that was implemented upon its inception. This
conventional type radiation therapy is a very poor medical procedure by today’s standards. This
conventional radiation therapy is just a large beam of high energy radiation. This type of
sporadic radiation can obviously cause toxicity to a large area around the target tumor. (Barker,
E., 1998)
In the late 1990’s a study was performed to see what the public’s knowledge was the
perception of radiation and radiation therapy. This study performed by Hammick in 1998 is a
very good information source for understanding the basis of what people thought of radiation at
the time. This research which was done only fifteen years ago shows that even though radiation
therapy has been implemented for almost fifty years, the public view may still be skewed.
(Hammick, M., Tutt, A., & Tait, D. 1998) What this article does show however is that the public
is more than well aware that radiation is dangerous. To ease the public’s negative perception on
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radiation, this research proposal would also help ease the public’s worry about radiation toxicity
coming from medical procedures.
Research has consistently gone in the direction of finding techniques to save healthy
tissue and reduce damage to surrounding areas. In the late 1990’s once again, one of the most
ground breaking discoveries was made in the field of radiation oncology. Barker explains in his
article about intensity-modulated radiation therapy how IMRT makes huge advancements in
radiation therapy. (Baker, E., 1998) Going into almost any clinic or hospital that provides
radiation therapy, one would see most likely that an IMRT machine would be still in use. The
research in finding out how to perform IMRT was a very large accomplishment because of the
way that the radiation is produced. The use of a LINAC system to produce the ionizing radiation
used in radiation therapy is a major update to the radioactive isotope core of the old conventional
RT. (Baker, E., 1998) Linear accelerators are a much safer and more efficient way to produce
radiation, but the most important thing that was discovered upon the research of linear
accelerators was that the beam could be made so thin. Making these beams thinner and thinner
allowed for radiosurgery to become more prevalent for small tumors. (Battista, R. 2009) This
method of research that improves on existing treatment methods is what was and still is being
used in this field to further the art and science of improving a tried and true method of treating
cancer.
In even more recent years radiation therapy is being used on bigger cancers in all reaches of the
body. In 2011, Scorsetti and others from his team took on a research proposal that went to see
what the results of using radiation therapy on abdominal targets would be. (Scorsetti et al, 2011)
This study is just one of many that are slowly expanding the horizon on what radiation therapy
can treat. With new areas of the body come new problems. Treating a bigger area can mean that
26
more radiation can go outside of the target area which can cause even more late onset toxicity if
not performed correctly. Now in recent years, the professional community of oncologists has
devised methods of treating cancer with concurrent radiation therapy and chemotherapy.
(Lalonde, R., & DeFoe, S., 2012). Using radiation therapy alongside chemotherapy greatly
reduces radiation toxicity by making the cancer cells more susceptible to the radiation therapy.
This method however does not come without problems. Now we are at a time that needs an
improvement once again in the treatment of cancer without any damaging side effects. This gap
in research of not finding a way to reduce toxicity without causing other damaging side effects
needs to be met.
In the field of oncology and cancer treatment; new technologies are always being investigated.
Now, not all cancer treatments are radiation therapy, there are such things as surgery and
chemotherapy that make up a large portion of cancer treatments. Even outside of the medical
fields, research is being done in holistic medicine to treat and prevent cancer. With all of these
research topics, it may be easy to decide on what to research to use in conjunction with the very
positively accepted radiation therapy in the form of intensity modulated radiation therapy. In an
article just published in November of 2012, it outlines the use of hyperthermia to cause apoptosis
in lab mice. (Yoo, D., 2012) Research has been limited in radiation therapy by not having
enough trials combining the effects of hyperthermia and radiation therapy used together in one
procedure.
Research Question
The use of high energy radiation can be an effective treatment for cancer if performed
correctly. Radiation therapy has been used in conjunction with many other treatment options for
27
years, and something needs to be done to advance it. The best way to perform radiation therapy
is to use it in conjunction with other methods of treating cancer, and in some cases; to use as
many methods as possible together. One problem with radiation therapy is that high doses of
radiation can cause toxicity that can onset at a later time. This has always been a problem with
radiation therapy even with other treatments are used alongside radiation therapy. A new means
of reducing late onset toxicity must be put in place to greatly improve the quality of life of all
cancer patients. This late onset toxicity can become a problem because of the nature of a cancer
patient and his or her already weakened immune system.
The problem of late onset toxicity is well known and researched in the field of radiation
therapy, however new inventive ways are not being researched effectively enough to be
integrated into a large healthcare network. As stated in the literature review, there are
technologies in place that treat cancer by different methods, all of which help reduce late onset
toxicity from high levels of radiation being administered to the human body. These methods
have however not been implemented into being used concurrently with radiation therapy. The
outcome of using another method such as thermoradiotherapy to treat cancer has the potential to
reduce late onset radiation toxicity to a level not seen with any previous type of radiation
therapy.
Proposed Research Method
Definition of Key Terms
IMRT- A form of highly precise radiation therapy that conforms to many tumor sizes and shapes.
(mayoclinic.org, 2011)
28
Radiosurgery- A noninvasive form of radiation therapy that focuses a powerful beam of radiation
into a very small area. (mlm.nih.gov, 2012)
Stereotactic- a term for describing the stillness that the patient must remain in during the
procedure. (mlm.nih.gov, 2012)
Rf induced hyperthermia- high energy radio frequencies are projected to either gold or carbon
nanoparticle receivers located on or near a tumor to heat it. (thefreedictionary.com, 2009)
Thermoradiotherapy- when heat is used in conjunction with radiation therapy.
(thefreedictionary.com, 2009)
Late onset toxicity- when effects of radiation are seen 3 months after radiation therapy.
Examples of such toxicity are localized hair loss, fibrosis, localized dryness, and even cancer.
(Pederson et al, 2012)
Chemotherapy- The use of drugs or chemical agents delivered into the body to arrest cell
division of tumor cells. (mayoclinic.com, 2011)
MRI- Magnetic resonance imagery. An MRI is a picture representing the interior workings of the
human body. (webMD..com, 2011)
LINAC- Linear accelerator. A linear accelerator is used to produce radiation used in intensity
modulated radiation therapy. (Radiologyinfo.org, 2012)
Stereotactic Radiosurgery- non-surgical procedure to deliver high doses of radiation in a very
small area as compared to conventional radiation therapy. (Radiologyinfo.org,2012)
29
Materials/Tools (equipment, surveys...)
Needed in this research study would be access to twenty patients in need of radiation therapy in
either a hospital or clinic with the proper materials. These twenty patients must be people with
their first experience with cancer and radiation therapy with a cancer that affects an area of the
body that is outside of the brain. These criteria must be met to make study of this technique
much easier. This study must be done in a facility that houses an MRI machine as well as a
LINAC system to deliver radiation. A specialized team of radiation oncologists as well as
radiation therapists would be needed to accomplish this study. Other materials needed for this
study would be a machine to produce Rf signals to be used in the hyperthermia procedure as well
as the manufactured nanoparticle receivers. The use of this technology was used previously in a
study done by Yoo, D. and company. (Yoo, D., 2012) The survey used to gather information
would consist of areas for patients to check boxes to tell what their symptoms are.
Induced hypothermia to create cellular apoptosis in itself is its own proceedure. As detailed in
Yoo, D.’s research, this hypothermia can kill cancer cells in its own right. What this means is
that a specialized team dealing with this new technology must be assembled. These specialists
must know about the machines that are used to create the magnetic fields that interact with the
magnetic nanoparticles that generate heat. (Yoo, D., 2012) With a large team comes a large
budget, and this budget must include pay for these professionals. The materials used in this study
should be of minimal cost if this study is to be done in a hospital that already has the equipment
30
needed. What this means is that the majority of this budget would go towards paying the
professionals who take on this study more than the actual materials.
This study would require adequate time to accomplish legitimate results. For each of the twenty
patients who would receive thermoradiotherapy, they would fill out a survey every three months
for one year after their treatment. This time of one year would allow for time to decide if any
toxicity would show up. The fact that not many proposals like this have been performed in the
past; this is a good start to research. More on what this study will entail will be talked about in
depth in the next section.
Figure 2. Different forms of nanoparticles (Challa, K., and Faruq, M., 2011)
Method of Evaluation
This proposal is to research the use of Rf induced hypothermia to reduce the presence of
radiation toxicity. Such therapies to be used with radiation therapy would include the use of all
of the latest techniques with the further implementation of radio frequencies to induce
hyperthermia in specialized locations that are being prepared for radiation therapy. This has of
course has been used before and is referred to as thermoradiotherapy, however this technique is
majorly underutilized in a clinical setting. This proposal is here to say that a study of
thermoradiotherapy should be done by combining the use of IMRT, chemotherapy, and Rf
induced hyperthermia to maximize the effectiveness of all of these procedures.
The research of this proposal will be carried out by recording the patients’ physical health on a
survey to detect acute and late onset radiation toxicity. This survey will be a standard simple
31
form that will be easy to read and understand by patients of all ages. The proposed survey will be
made specifically for this study to be a simple way of receiving information from the patients.
During the course of this study, four surveys will be administered every three months for one
year starting three months after initial treatment. This survey will ask about current side effects
that the patient is experiencing, in the list of possible side effects listed on the survey will
include: local hair loss, fibrosis, local skin dryness, tumor, loss of organ function, or anything
else related to receiving large doses of radiation.
In this randomized trial of therapy only ten patients will be treated with radiation therapy
with concurrent chemotherapy as well as local hypothermia to the tumor, while the other ten will
only receive radiation therapy and chemotherapy. This will help determine the effects of
hyperthermia on reducing late onset toxicity in cancer patients. The use of chemotherapy will be
used in all patients as well as radiation therapy because this is the trend of most cancer treatment
programs. (Lalonde, R. R., & DeFoe, S. G., 2012) Another great aspect of trying hyperthermia
for radiation therapy is that other studies have shown that hyperthermia can also increase the
effectiveness of chemical agents and drugs used in chemotherapy. (Chella, K., & Faruq, M.,
2011) As in all medical oncology treatments, proper protocol will be implemented in the
delivery of the proper doses of radiation as well as the proper drugs used to treat cancer when
used in conjunction with radiation therapy.
Hypothesis/Expectations
This proposed research is being put in place to further explore cancer treatment options
for all patients of all ages in all stages of cancer. If all goes well in this study then it will be seen
that the new technique will vastly improve the recovery of cancer patients and their quality of
32
life by reducing radiation toxicity. The results should find that with the introduction of heat into
tumor will increase the effectiveness of the radiation and chemotherapy. This hypothesis is
supported by the previously stated findings of other researchers that have used hyperthermia in
conjunction with other cancer treatments such as chemotherapy. (Chella, K., & Faruq, M., 2011)
Hyperthermia was also studied as a treatment by itself in such research done by others (De HaasKock, D., et al, 2009) and (Yoo, D., et al, 2012) and it was found that it may be a viable option
for a study such as this one. Not only should this study find that thermoradiotherapy can be
implemented on a major scale to treat cancer, but also that it does in fact reduce late onset
radiation toxicity. These findings need to be tested and tried because of the major health benefits
that could arise from such a study.
This is a truly important study that needs to be done to further advance the field of
radiation therapy and cancer treatment. The current status of radiation therapy is still seen as a
dangerous treatment option to some people. More needs to be done with radiation therapy to help
the population realize that radiation therapy is not harmful. This perception of harm does have
some backing since radiation does have a negative effect on some people regardless of how well
the procedure was performed. This is another reason this study is so important; if this study is
proven to work as planned then less radiation will have to be delivered and thus less toxicity will
come from treatment. Not only does the medical field have to know and understand that radiation
therapy is a great way to treat cancer, but also the public must know of its benefits and safety so
that they may be more willing to undergo treatments without fear of late onset toxicity or even
death.
This proposal in not here just for one purpose, however it is to bring many ideas together.
Radiation therapy as well as chemotherapy, surgery, hyperthermia, and any other cancer
33
treatment option must be all thought of as great options. Instead of thinking of only using one
treatment method for treating cancer, this proposal is put in place to combine the best of all
therapies to reduce toxicity of any treatment and achieve the overall goal of cancer remission and
living cancer free.
Concluding Remarks
This study proposes to use IMRT as the source of radiation therapy for the reason that it
is easily accessible and can be used to treat a variety of cancers. (Bhatnagar, A. et al, 2009) I also
believe that chemotherapy should be used in conjunction with this study because it is common
practice to use chemotherapy and radiation therapy alongside each other in cancer treatment.
What this study brings to the table is the implementation of magnetic nanoparticles to generate
heat at almost any depth of human tissue to cause local hyperthermia. (Yoo, D. et al, 2012) This
local hyperthermia should greatly improve the action of the radiation therapy without raising the
dose of radiation, which in turn will generate less radiation toxicity. This is why this research is
needed in this area of study.
This study is of course limited in a few select ways. It is important to research other areas
that are important to helping further radiation therapy technology. A problem with using this new
technology of hyperthermia in radiation therapy is that the receivers must be made increasingly
small to be as precise as the pencil thin beams of IMRT. Another issue with this new technology
is that it has not and may not be implemented for use in the brain. The technology is not yet
available to safely and effectively treat the very important human brain with this technique. This
may be changed in the future, but as of now, treating the brain requires much more skill and is a
much riskier procedure.
34
Overall, this study should be a quick and easy way to discover a lot of information that
can be used in a very real way. Instead of investing millions and millions of dollars to reinvent
the wheel by doing a study that is completely new, this study provides innovation that is needed
in the field on oncology. This is accomplished by extensively reviewing previous proposals and
articles and making connections between them. This also follows the general idea of how
radiation therapy has evolved in the past since it was first implemented by great scientists such as
Lars Leksell. This research should point to the future of radiation therapy as the first option to
treat cancer and maybe one day become a procedure that makes cancer only a minor
inconvenience.
It is of utmost importance to not only test this hypothesis of combining treatment methods using
my research proposal, but also to use this as a template to research other alternatives to
conventional radiation therapy. This may seem daunting to bring so many health care
professionals together, but in the grand scheme of things, the patient is the most important part of
the equation. This may be a long process of innovation coming slowly over the years, but every
bit helps. This proposal that using all of these techniques together to reduce toxicity will not only
help in the actual effectiveness of cancer treatment but maybe even more importantly; reduce the
negative connotation that cancer is a death sentence, which it truly is not.
References:
1.
Barker, E. (1998). Evolutions revolutions: beyond conventional radiation... intensity
modulated radiation therapy (IMRT). Rn, 61(6), 34-37.
35
2.
Battista, R. (2009). Gamma knife radiosurgery for vestibular schwannoma.
Otolaryngologic Clinics Of North America, 42(4), 635-654. doi:10.1016/j.otc.2009.04.009
3.
Bhatnagar, A., Beriwal, S., Heron, D., Flickinger, J., Deutsch, M., Huq, M., & ... Shogan,
J. (2009). Initial outcomes analysis for large multicenter integrated cancer network
implementation of intensity modulated radiation therapy for breast cancer. Breast Journal, 15(5),
468-474. doi:10.1111/j.1524-4741.2009.00761.x
4.
Challa, K., and Faruq, M., (2011), Magnetic nanomaterials for hyperthermia-based
therapy and controlled drug delivery, Adv Drug Deliv. rev. 2011 August 14; 63(9): 789–
808.Published online 2011 April 5. doi: 10.1016/j.addr.2011.03.008
5.
De Haas-Kock, D., Buijsen, J., Pijls-Johannesma, M., Lutgens, L., Lammering, G.,
Mastrigt, G., & ... J. (2009). Concomitant hyperthermia and radiation therapy for treating locally
advanced rectal cancer. Cochrane Database Of Systematic Reviews, (3),
doi:10.1002/14651858.CD006269.pub2
6.
Elekta Limited Hong Kong (2012). Elekta neuroscience in hong kong. [ONLINE]
Available at: http://www.elekta.hk/neuroscience/ [Last Accessed December 3 2012].
7.
Hammick, M., Tutt, A., & Tait, D. (1998). Knowledge and perception regarding
radiotherapy and radiation in patients receiving radiotherapy: a qualitative study. European
Journal Of Cancer Care, 7(2), 103-112.
36
8.
Healthwise Staff (2011). What is magnetic resonance imaging. [ONLINE] Available at:
http://www.webmd.com/a-to-z-guides/magnetic-resonance-imaging-mri. [Last Accessed
December 3, 2012].
9.
Lalonde, R. R., & DeFoe, S. G. (2012). Concurrent chemotherapy and intensity-
modulated tadiation therapy for anal carcinoma — clinical outcomes in a large national cancer
institute-designated integrated cancer centre network. Clinical Oncology, 24(6), 424-431.
doi:10.1016/j.clon.2011.09.014
10.
Lasak, J., & Gorecki, J. (2009). The history of stereotactic radiosurgery and
radiotherapy. Otolaryngologic Clinics Of North America, 42(4), 593-599.
doi:10.1016/j.otc.2009.04.003
11.
Levin, Ken (2012). Stereotactic radiosurgery. [ONLINE] Available at:
http://www.nlm.nih.gov/medlineplus/ency/article/007274.htm. [Last Accessed December 3
2012].
12.
Mayo Clinic Staff (2011). Chemotherapy. [ONLINE] Available at:
http://www.mayoclinic.com/health/chemotherapy/MY00536. [Last Accessed December 3,
2012].
13.
Mayo Clinic Staff (2011). Intensity-modulated radiation therapy. [ONLINE] Available
at: http://www.mayoclinic.org/IMRT. [Last Accessed December 3, 2012].
14.
Mosby's Medical Dictionary (2009). Hyperthermia. [ONLINE] Available at:
http://medical-dictionary.thefreedictionary.com/hyperthermia. [Last Accessed December 3,
2012].
37
15.
Mosby's Medical Dictionary (2009). Thermoradiotherapy. [ONLINE] Available at:
http://medical-dictionary.thefreedictionary.com/thermoradiotherapy. [Last Accessed December
3, 2012].
16.
Pederson A.W., Fricano J., Correa D., Pelizzari C.A., Liauw S.L. (2012) Late toxicity
after intensity-modulated radiation therapy for localized prostate cancer: An exploration of dosevolume histogram parameters to limit genitourinary and gastrointestinal toxicity. International
Journal of Radiation Oncology Biology Physics, 82 (1) , pp. 235-241.
17.
Radiological Society of North America (2012). linear accelerator. [ONLINE] Available
at: http://www.radiologyinfo.org/en/info.cfm?pg=linac. [Last Accessed December 3, 2012].
18.
Radiological Society of North America (2012). Stereotactic radiosurgery. [ONLINE]
Available at: http://www.radiologyinfo.org/en/info.cfm?pg=stereotactic. [Last Accessed
December 3, 2012].
19.
Scorsetti, M., Bignardi, M., Alongi, F., Fogliata, A., Mancosu, P., Navarria, P., & ...
Cozzi, L. (2011). Stereotactic body radiation therapy for abdominal targets using volumetric
intensity modulated arc therapy with RapidArc: Feasibility and clinical preliminary results. Acta
Oncologica, 50(4), 528-538. doi:10.3109/0284186X.2011.558522
38
20.
Yoo, D., Jeong, H., Preihs, C., Choi, J.-s., Shin, T.-H., Sessler, J. L. and Cheon, J. (2012),
Double-Effector Nanoparticles: a synergistic approach to apoptotic hyperthermia. Angew. Chem.
Int. Ed.. doi: 10.1002/anie.201206400
39
Bell Research Proposal Rough Draft
Background on Topic
Radiation therapy has been a viable option to treat cancers of all different forms for years.
Recently, radiation therapy has become more and more advanced with the advancement of
technology. With technologies such as radiosurgery and intensity modulated radiation therapy
being in existence for decades (Lasak, J., & Gorecki, J., 594); it may be time to look at other
ways to vastly improve radiation therapy.
•Literature Review/Scholarship Review
In the past and even now researchers and scholars have been working to understand the
mechanisms of action that radiation therapy plays. In the early days of radiation therapy, it was
used in the brain with not always perfect results. In recent years radiation therapy is being used
on bigger cancers in all reaches of the body. In 2011, Scorsetti and others from his team took on
a research proposal that went to see what the results of using radiation therapy on abdominal
targets would be. (Scorsetti et al, 528-538) This study is just one of many that are slowly
expanding the horizon on what radiation therapy can treat.
•Research Question
With all of these studies being done to gradually improve the state of radiation therapy,
what more can be done? This is a simple question if you dig deep into what can be done to treat
cancer. Radiation therapy has been used in conjunction with many other treatment options for
years, and it is just about time for more advancement. There are a few major problems with
radiation therapy as it is used now. One of these problems is known to be toxicity of high
40
radiation doses that can onset at a later time. We must find a way to reduce this toxicity which
may lead to death, but how?
•Proposed Research Method
I am proposing that a research study be done to further advance the knowledge and valid
use of radiation therapy in conjunction with other therapies. Such therapies to be used with
radiation therapy would include the use of all of the latest techniques with the further
implementation of radio frequencies to induce hyperthermia in specialized locations that are
being prepared for radiation therapy. This has of course has been used before and is referred to as
thermoradiotherapy, however this technique is majorly underutilized in a clinical setting. I
propose that a study of thermoradiotherapy be done by combining the use of IMRT,
chemotherapy, and Rf induced hyperthermia to maximize the effectiveness of all of these
procedures.
In this study I propose to use IMRT as the source of radiation therapy for the reason that
it is easily accessible and can be used to treat a variety of cancers. (Bhatnagar, A. et al, 468-474)
I also believe that chemotherapy should be used in conjunction with this study because it is
common practice to use chemotherapy and radiation therapy alongside each other in cancer
treatment. What this study brings to the table is the implementation of magnetic nanoparticles to
generate heat at almost any depth of human tissue to cause local hyperthermia. (Yoo, D. et al,
2012)
◦Definition of Key Terms
IMRT- Intensity modulated radiation therapy. A form of highly precise radiation therapy that
conforms to many tumor sizes and shapes.
41
Rf induced hyperthermia- Radio frequency induced hyperthermia. Rf induced hyperthermia is
when high energy radio frequencies are used to heat a receiver made of either gold or carbon
nanoparticles located on or near a tumor to heat it.
Thermoradiotherapy- This is when heat is used in conjunction with radiation therapy.
Late onset toxicity- This is when an adverse reaction to ionizing radiation occurs. Examples of
such toxicity are localized hair loss, fibrosis, localized dryness, and even cancer.
Chemotherapy- The use of drugs or chemical agents delivered into the body to arrest cell
division of tumor cells.
MRI- Magnetic resonance imagery. An MRI is a picture representing the interior workings of the
human body.
LINAC- Linear accelerator. A linear accelerator is used to produce radiation used in intensity
modulated radiation therapy.
◦Materials/Tools (equipment, surveys...)
To successfully study this hypothesis many things are needed. This study would most
easily be done in a hospital setting; however some clinics may have the equipment and room
necessary to accomplish this study. This study must be done in a facility that houses an MRI
machine as well as a LINAC system to deliver radiation. It would be best to cooperate with a
hospital that already has this machinery as the price to purchase just these two machines could
easily run over five million dollars, not including construction costs. Along with these two large
machines, a specialized team of radiation oncologists as well as surgeons would be needed to
accomplish this study. Other materials needed for this study would be a machine to produce Rf
42
signals to be used in the hyperthermia procedure. Of course a hospital would provide many of
the small materials and tools needed to perform related procedures.
◦Method of Evaluation
•Hypothesis/Expectation
•Concluding Remarks
Is thermoradiotherapy a viable option for treating cancer? We will never know unless
measures are taken to test this hypothesis. It is of utmost importance to not only test this
hypothesis using my research proposal, but also to use this as a template to research other
alternatives to conventional radiation therapy. This may seem daunting to bring so many health
care professionals together, but in the grand scheme of things, the patient is the most important
part of the equation.
References:
1.Lasak, J., & Gorecki, J. (2009). The history of stereotactic radiosurgery and radiotherapy.
Otolaryngologic Clinics Of North America, 42(4), 593-599. doi:10.1016/j.otc.2009.04.003
2.Scorsetti, M., Bignardi, M., Alongi, F., Fogliata, A., Mancosu, P., Navarria, P., & ... Cozzi, L.
(2011).
3.Yoo, D., Jeong, H., Preihs, C., Choi, J.-s., Shin, T.-H., Sessler, J. L. and Cheon, J. (2012),
Double-Effector Nanoparticles: A Synergistic Approach to Apoptotic Hyperthermia . Angew.
Chem. Int. Ed.. doi: 10.1002/anie.201206400