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Radiation Oncology
December 2015
Volume 2, Issue 5
Total Body Irradiation Program
Launched
U
SC Radiation Oncology launched a total body irradiation (TBI)
program this year in support of our growing Bone Marrow Transplant
Program at USC Norris Cancer Hospital. This complicated procedure
involves delivering radiation to a patient’s entire body in order to
eliminate microscopic
diseases and decrease
immune system response, all
with the intent of improving
outcomes in bone marrow
transplants. Performed at
USC Norris on our state-ofthe-art TrueBeam STx linear
accelerator, the procedure is
done with patients lying on
their side in order to maximize
dose distribution and patient comfort, rather than in a standing position.
In partnership with USC Hematology, we have also used TBI as part of
transplantation for benign diseases, such as severe aplastic anemia.
With USC witnessing rapid acceptance of TBI for transplant patients,
growth in this program has exceeded initial projections. TBI has now
become an integral part of USC Norris’ transplant service.
Gynecologic Oncology HDR
Brachytherapy Program Update
A
lthough the program was launched one year ago, USC Norris
is already seeing solid patient numbers in our high-dose-rate
(HDR) brachytherapy program for gynecologic oncology patients.
This HDR procedure involves inserting a radioactive source directly
into the tumor via a computer-controlled afterloader and letting it
dwell temporarily in the tumor area before it is retracted back into
the afterloader. This technique involves precise radiation to the
tumor and takes only a few minutes to deliver.
As an important component in the treatment of gynecologic
malignancies, we are happy to be able to offer this service to
patients at Norris.
For referrals, call (323) 865-3050
For more information visit cancer.KeckMedicine.org/referradonc
Chair’s Corner
I am happy to share
with you some exciting
developments in the
Keck School of Medicine
of USC Department of
Radiation Oncology. We
continue to work toward
Eric L. Chang, MD, FASTRO
our goal of excellence
Professor and Chair
USC Department of
in patient care, research
Radiation Oncology
and education and are
appreciative of the opportunity to share some
of these highlights with you.
Over the past several months, we have
launched new clinical programs like total body
irradiation (TBI) and have plans to launch
other clinical programs soon. We continue
to roll out new technologies at our various
sites of care. We have grown our residency
program and remain committed to educating
the next generation of leaders in the field. On
the research front, we have opened important
investigator-initiated and industry-sponsored
studies. We are pleased to be hosting our
third Multi-Disciplinary Breast Cancer
Symposium in January 2016, furthering the
momentum created by our CME events the
past two years.
I am grateful for your support, and I thank
you for taking the time to read and learn more
about these and other developments in the
Keck School of Medicine of USC Department of
Radiation Oncology.
LAC+USC Medical Center:
Cone-Beam CT
U
SC Radiation Oncology has installed Cone-Beam CT technology at Los
Angeles County + USC Medical Center. Cone-Beam CT imaging capability
gives doctors an important third modality for pinpointing the exact location of
the tumor. It is especially useful when the tumor is far from any bony landmarks
and hard to distinguish from surrounding soft tissues. Having access to
volumetric cone-beam CT data has the potential to significantly improve tumor
targeting in these difficult cases. This technology also creates the platform
upon which we will eventually launch a stereotactic body radiation (SBRT/SABR)
program at LAC+USC.
Physician Faculty
Eric L. Chang, MD, FASTRO
CNS, Gamma Knife, CyberKnife
Leslie Ballas, MD
GU, Lymphoma, Melanoma
Eugene Chung, MD, PhD, JD
Thoracic, Breast
Richard L.S. Jennelle, MD
Residency Director, Head & Neck
and other specialties
Naomi Schechter, MD
Breast, Head & Neck and Skin Cancers
We are delighted to be able to offer access to advanced technology, such as
cone-beam CT, to patients at LAC+USC, one of the largest academic safety net
hospitals in the US. Through diligent and hard work over three years, we were
able to make this a reality.
Michael Senikowich, MD
Gyn, Brachytherapy and other
specialties, LAC+USC based
3rd Annual USC Multi-Disciplinary
Breast Cancer Symposium
Nicholas Trakul, MD, PhD
Head & Neck, Thoracic, SBRT, CNS
O
n January 30th, 2016, the USC Office of Continuing Medical Education
will be holding an all-day CME event focused on breast cancer at the
Intercontinental Hotel in Los Angeles. The symposium was originally started by
the Keck School of Medicine of USC Department of Radiation Oncology and is
currently funded in part by an endowed lectureship known as The Henry L. Jaffe,
MD, Annual Oration in Therapeutic Radiology.
The program will review the current state of the art in breast cancer
management, highlighting the key components of multi-disciplinary treatment
to include surgery, medical oncology, radiation oncology, radiology and genetics.
Among other topics, it will include an update on American Cancer Society
Screening Guidelines for Breast Cancer, a discussion on current controversies in
the multidisciplinary management
of ductal carcinoma in-situ,
locoregional management of
advanced breast cancer, an
analysis of the current role of
various radiotherapy treatment
strategies including partial breast
irradiation using brachytherapy,
and hypofractionation and an
examination of the impact of
molecular subtyping of triple
negative breast cancer and the
future of liquid biopsies.
Feedback from prior attendees
has been very positive and we are
looking forward to seeing new and
past attendees.
Suisui Song, MD
Gyn, GI, Sarcoma
Kenneth Wong, MD
Pediatrics
Physics Faculty
Almon Shiu, PhD
Vice Chair, Chief of Physics
Hyman Bernstein, PhD
Assistant Professor
Guoqiang Cui, PhD
Assistant Professor
Jing Cui, D.Sc.
Assistant Professor
Jonathan Kin Ha, PhD
Assistant Professor
Arthur Olch, PhD
Professor
Sue Zhou, MS
Assistant Professor
Audrey Zhuang, PhD
Assistant Professor
Radiobiology Faculty
Charles Gomer, PhD
Eric L. Chang, MD
Received Prestigious
FASTRO Designation
O
n October 20, 2015, Eric L. Chang, MD,
professor and chair of the Keck School
of Medicine of USC Department of Radiation
Oncology was awarded the prestigious
designation of Fellow by the American Society for
Radiation Oncology (ASTRO). This select honor is
awarded in recognition of commendable service
to the field of radiation oncology and to ASTRO
based on leadership/service, research, patient
care and education.
Residency Program News
T
his year we welcomed a new resident into our training program,
Stella Yoo, MD. Dr. Yoo joins USC Radiation Oncology after
completing medical school at Temple University School of Medicine
in Philadelphia, PA, and her internship at Abington Memorial
Hospital, part of Jefferson University Hospitals. Graduating from the
program this past summer was Omar Ragab, MD, who is currently
performing a brachytherapy fellowship at UCLA.
We are also pleased to announce that our residency program
has grown, with the Accreditation Council for Graduate Medical
Education (ACGME) adding a seventh position. This additional slot
will concentrate on training and education focused on our advanced
technologies and stereotactic body radiation therapy program at
Norris, which has seen significant growth over the past few years.
USC Radiation Oncology Abstract Selected for 2015
Best of ASTRO
U
SC Radiation Oncology resident, Lydia Ng, MD, working in conjunction with Kenneth Wong, MD, assistant professor of
clinical radiation oncology at USC, and Arthur Olch, PhD, professor of clinical radiation oncology, received the honor
of having her abstract, “Dose Sculpting Intensity Modulated Radiation Therapy for Vertebral Body Sparing in Treatment of
Neuroblastoma,” selected for the Best of ASTRO meeting in 2015. The Best of ASTRO meeting offers “only the most relevant
and highly influential abstracts” from the American Society for Radiation Oncology (ASTRO) meeting each year and the
selection of Dr. Ng’s study is a testament to the importance of her work.
For many years in neuroblastoma, some radiation oncologists like Dr. Wong have been using IMRT in an attempt to preserve
vertebral body growth rates. Drs. Ng, Wong & Olch looked at Children’s Hospital Los Angeles patients dating back to 2000
and found that their neuroblastoma survivors have reduced vertebral growth rates, however that vertebral body sparing did
indeed seem to have a protective effect, which seemed greater in lumbar vertebral bodies than in thoracic bodies.
Two Newly Open Studies
T
argeted Radiofrequency Ablation (t-RFA) and Radiofrequency Targeted Vertebral Augmentation (RF-TVA) prior to or
following radiation therapy is a multi-center trial that is the first prospective study to evaluate the treatment of painful
metastatic lesions covering vertebral compression fractures. The trial aims to evaluate the degree and durability of the
palliative effect of t-RFA and vertebral augmentation combined therapy. The primary outcome measure is reduction of
patients’ pain. Secondary outcomes being evaluated are changes in quality of life, reduction of pain medications and the time
to achieve adequate pain relief. Tumor control will also be evaluated.
Dr. Leslie Ballas recently opened a study to assess how well patients tolerate SBRT to the prostate fossa following
prostatectomy. The underlying hypothesis is that SBRT to the prostate fossa in the post-operative setting will be well tolerated
with toxicity comparable to normal fractionation schedules. It is believed that a higher dose-per-fraction of radiation kills
more prostate cancer cells than a lower dose-per-fraction of radiation because of the inherent radiobiologic properties of
prostate cancer cells. What has limited our field’s ability to treat the prostate with higher dose-per-fraction treatments in the
past was a fear of toxicity to normal surrounding tissues. We now know from multiple studies that stereotactic body radiation
therapy (SBRT) to the intact prostate (one that has not been taken out by surgery) has not increased treatment toxicity.
However, we have limited data of SBRT and hypofractionation in the post-operative setting.
For referrals, please call (323) 865-3050. For questions on topics covered here or for any other USC Radiation Oncology
inquiries, please feel free to contact Nikos Carli, senior clinical administrator, at [email protected].
Recent Publications
Drzymala, RE, Alvarez, PE, Bednarz,G, Bourland, JD, DeWerd, LA, Ma, L, Meltsner, SG, Neyman, G, Petti, PL, Rivard, MJ, Shiu, AS, and Goetsch, SJ: A Round
Robin Gamma Stereotactic Radiosurgery Dosimetry Intercomparison of Calibration Protocols. Med Phys (submitted) 2014.s)
Kim EY, Chapman TR, Ryu S, Chang EL, Galanopoulos N, Jones J, Kubicky CD, Lee CP, Teh BS, Traughber BJ, Van Poznak C, Vassil AD, Weber K, Lo SS. ACR
Appropriateness Criteria Non-Spine Bone Metastases. Journal of Palliative Medicine. 2015 Jan: 18(1)”11-7.
Lo SS, Kubicky CD, Chang EL, Sahgal A. Is there any role for stereotactic body radiotherapy in the management of metastatic epidural spinal cord compression?
CNS Oncology 2015 Jan;4(1), 1-4.
Sellin JN, Reichardt W, Bishop AJ, Suki D, Rhines LD, Settle SH, Brown PD, Li J, Rao G, Chang EL, Tatsui CE. Factors Affecting Survival in 37 Consecutive patients
undergoing de novo Stereotactic Radiosurgery for Contiguous Sites of Vertebral Body Metastasis From Renal Cell Carcinoma. J Neurosurg Spine. 2015 Jan; 22(1):52-9
Sahgal A, Aoyama H, Kocher M, Neupane B, Collette S, Tago M, Shah P, Beyene J, Chang EL. Phase 3 Trials of Stereotactic Radiosurgery with or Without Whole
Brain Radiation Therapy for 1 to 4 Brain Mestastases: Individual Patient Data Meta-Analysis. Int J Radiation Onc Biol Phys, 2015 Mar; 91(4):710-717.
Awan M, Liu S, Sahgal A, Das S, Chao ST, Chang EL, Knisely JP, Redmond K, Sohn JW, Machtay M, Sloan AE, Mansur DB, Rogers LR, Lo SS. Extra-CNS Metastasis
from glioblastoma: a rare clinical entity. Expert Rev Anticancer Ther. 2015 May; 15(5):545-52.
Lo SS, Ryu S, Chang EL, Galanopoulos N, Jones J, Kim EY, Kubicky CD, Lee CP, Rose PS, Sahgal A, Sloan AE, Teh BS, Traughber BJ, Van Poznak C, Vassil AD. Expert
Panel on Radiation Oncology-Bone Metastases. ACR Appropriateness Criteria® Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis. J
Palliat Med. 2015 Jul;18(7):573-84.
Kumar R, Nater A, Hashmi A, Myrehaug S, Lee Y, Ma L, Redmond K, Lo SS, Chang EL, Yee A, Fisher CG, Fehlings MG, Sahgal A. The era of stereotactic body
radiotherapy for spinal metastases and the multidisciplinary management of complex cases. Neuro-Oncology Practice Jul 2015; 0:1-11.
Bishop AJ, Tao R, Rebueno NC, Christensen EN, Allen PK, Wang XA, Amini B, Tannir NM, Tatsui C, Rhines LD, Li J, Chang EL, Brown PD, Ghia AJ. Outcomes for
Spine Stereotactic Body Radiation Therapy and an Anaylsis of Predictors of Local Recurrence. Int J Radiation Oncol Biol Phys. 2015 Aug; 92(5), 1016-1026.
Lo SS, Slotman BJ, Lock M, Nagata Y, Guckenberger M, Siva S, Foote M, Tan D, Teh BS, Mayr NA, Chang EL, Timmerman RD, Sahgal A. The development of
stereotactic body radiotherapy in the past decade: A global perspective. Future Oncology. 2015 Sep [Epub ahead of print].
Sahgal A, Thibault I, Lo SS, Chang EL, Sheehan J, Ahluwalia MS, Guckenberger M, Sohn MJ, Ryu S, Foote M, Muacevic A, Soltys SG, Chao S, Gerszten P, Lis E, Yu E,
Bilsky M, Fisher C, Schiff D, Fehlings MG, Ma L, Chang S, Parelukar WR, Vogelbaum MA. Challenges Determining Response after Stereotactic Body Radiotherapy
(SBRT) for Spinal Metastases and Review of Current Practices: Part 1 of a First Report from the Spine Response Assessment in Neuro-Oncology (SPANO) Group.
2015. The Lancet Oncology
Lo SS, Ryu S, Chang EL, Galanopoulos N, Jones J, Kim EY, Kubicky CD, Lee CP, Rose PS, Sahgal R, Sloan AE, Teh BS, Traughber BJ, Poznak CV, Vassil AD. ACR
Appropriateness Criteria Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis. J Palliative Medicine.
Redmond KJ, Sahgal A, Foote M, Knisely J, Gerszten PC, Chao ST, Suh JH, Sloan AE, Chang EL, Machtay M, Lo SS. Single versus multiple session stereotactic
body radiotherapy (SBRT) for spinal metastasis: The risk-benefit ratio. Future Oncology. 2015
Lo SS, Slotman BJ, Lock M, Nagata Y, Guckenberger M, Siva S, Foote M, Tan D, Teh BS, Mayr NA, Chang EL, Timmerman RD, Sahgal A. The development of
stereotactic body radiotherapy in the past decade: A global perspective. Future Oncology. Accepted for publication
Nguyen QN, Shiu AS, Chang EL. Spinal Metastases: Viewpoint – Fractionated Radiation Therapy. Chapter 46. In: Principles and Practice of Stereotactic
Radiosurgery. Ed(s) Chin LS and Regine WF. Springer Science. 2015
Ragab O, Ng L, Batth SS, Bian SX, Chang EL. Imaging, Target Delineation, and Dose Prescription. 2nd Edition. Chapter 10. In: Spine Radiosurgery. Ed(s)
Gerszten PC and Ryu S. Thieme. 2015
Ballas LK. Modern radiotherapeutic strategies in the management of lymphomas. Future Oncol. 2015 Mar;11(6):1011-20.
Satkunasivam R, KimAE, Nguyen MM, Quinn DI, Ballas L, Lewinger JP, Stern MC, Hamilton AS, Aron M, Desai M, Gill IS. Radical Prostatectomy or External Beam
Radiation Therapy versus No Local Therapy for Survival Benefit in Metastatic Prostate Cancer - A SEER-Medicare Analysis. J Urol. 2015 Feb 21. pii: S00225347(15)00394-8.
Browne AW, Dandapani SV, Jennelle R, et al. Outcomes of medium choroidal melanomas treated with ruthenium brachytherapy guided by three-dimensional
pretreatment modeling. Brachytherapy. 2015;14(5):718-725. doi:10.1016/j.brachy.2015.04.010.
Dandapani SV, Zhang Y, Jennelle R, Lin YG. Radiation-Associated Toxicities in Obese Women with Endometrial Cancer: More Than Just BMI? Scientific World
Journal. 2015;2015:483208.
Tung L, Liu CW, Singareeka A, Carey J, Sposto R, Schechter N, MacDonald H, Baker R, Sener S, Lang J. Factors leading to lower rates of immediate breast
reconstruction in a public safety-net hospital. Invited for Poster Presentation ASBS 5/1/2015.
Department of Radiation Oncology
Keck School of Medicine of USC
USC Norris Comprehensive Cancer Center
1441 Eastlake Avenue, Los Angeles, CA 90033-0804
For referrals, call (323) 865-3050
© 2015 Keck Medicine of USC