| Radiation Medicine Program - Research Bites
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Your source for the latest in RMP research
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Cancers of the Central Nervous System (CNS) include those of the brain and spinal cord. Due to the complex structures and functions of these organs, CNS cancers are challenging to treat. In RMP, our CNS Site Group is composed of a highly specialized and multidisciplinary team of radiation oncologists, radiation therapists, medical physicists, and allied health professionals. In this issue, we explore how some of our CNS experts are advancing research to improve survival and care for our patients.
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Derek Tsang
MD, MSc
Radiation Oncologist – CNS Site Group,
Princess Margaret
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Meningioma are tumours of the meninges, the membranes that surround the brain and spinal cord. Developing and refining treatments for meningioma is currently a key focus in CNS research. “We have a very large radiosurgery program with a wealth of data, and using this to improve patient outcomes is important so that we can improve existing treatments and develop new treatments for patients,” says Dr. Derek Tsang. While conducting a clinical trial that compared adjuvant radiation therapy (RT) versus observation after complete surgical resection for atypical meningioma, Dr. Tsang along with a multidisciplinary team of radiation oncologists, medical physicists, and neurosurgeons evaluated the usefulness of radiosurgery in treating meningioma.
Aware that not all patients with meningioma might benefit from treatment with radiosurgery, Dr. Tsang is collaborating with researchers in neurosurgery to investigate molecular characterizations of meningioma and the role of RT in treatment with the ultimate goal of delivering individualized, precision-based radiation medicine for patients. “I hope that we are able to offer RT to the patients who need it the most, while avoiding unnecessary RT in patients who might not benefit as much from it.” Read the full interview. |
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David Shultz
MD, PhD
Radiation Oncologist –
CNS Site Group & Co-Director –
Brain Metastases Clinic, Princess Margaret
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Patients with brain metastases often ask their healthcare providers how their brain tumours and treatment will affect their memory and thinking. At present, our understanding of how RT affects neurocognition is incomplete, especially regarding long-term outcomes. Dr. David Shultz is dedicated to helping patients with brain metastases lead longer, healthier lives. “I want to ensure that I am providing my patients with the very best treatment possible so that their quality of life is as good as it can possibly be. As patients live longer and longer following their cancer diagnosis, this has become an increasingly important goal,” he says.
Dr. Shultz’s research focuses on reducing toxicity and improving healthcare outcomes in patients with large brain metastases receiving RT. His study on patients’ cognitive abilities before and after treatment will help to better understand how patients are affected by their brain metastases and therapy. Dr. Shultz envisions a combined approach to treating brain metastases in the near future: “I foresee improved integration of radiation with other forms of therapy (for example immunotherapies and targeted therapies) in the treatment of brain metastases. This will lead to improved survival and improved quality of life among cancer survivors.” Read the full interview. |
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Chrison Lee
MRT(T)
Radiation Therapist – CNS Site Group Lead,
Princess Margaret
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Motivated by his passion to improve patient care throughout the treatment journey, CNS Radiation Therapy Site Lead Mr. Chrison Lee communicates with CT-simulation and radiation treatment staff about study requirements to implement the most up-to-date policies into clinical practice. Mr. Lee’s research projects aim to increase patient comfort during treatment, such as a pilot study looking at customized neck rests for patients with paraspinal tumours. “The objective is to improve patients’ comfort level and enhance positional reproducibility between CT, MR, and treatment units.”
Mr. Lee oversees clinical practice in palliative treatment, paraspinal disease, and the Gamma Knife ICON, in addition to helping set new initiatives to improve patient care – such as increasing collaboration between the ICON and planning teams to reduce waiting times for patients. “Of all the research studies I am either involved in or helping to implement, I hope and firmly believe that improvements in patients’ prognosis and quality of life will be the ultimate result. In the meantime, I am trying my best to minimize the burdens added to patients from their participation in research,” he says. Read the full interview.
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Catherine Coolens
PhD
Medical Physicist – CNS Site Group,
Princess Margaret
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Brain metastases are often treated with stereotactic radiosurgery on the Gamma Knife system. Recently, the combined use of advanced imaging technologies with molecular tracing has enabled better observation, diagnosis, and monitoring of disease. Dr. Catherine Coolens is investigating functional imaging in patients receiving combined stereotactic radiosurgery and immunotherapy treatment. “The ability to non-invasively monitor tracer/drug distribution and have that biophysical understanding validated through preclinical and phantom experiments would be a great step forward in understanding the tumour microenvironment. This would not only help CNS patients, but most patients with solid tumours,” she says.
Dr. Coolens hopes to see the development of automated treatment workflows that use radiomics and deep learning approaches to provide auto segmentation of brain metastases and ultimately improve quality and efficiency of treatment. An automated pipeline that can extract imaging information and radiomics signatures from a large patient brain metastases database will enable researchers to “prospectively evaluate radiomics signatures to predict a patient’s response to treatment… mak[ing] it easier for us to manage patient treatment and hopefully improve patient care.” Read the full interview.
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Rodin et al. discussed global cancer control within Canada’s health agenda and opportunities for creating a national cancer control network to promote health equity.
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Leung et al. developed an innovative sequencing method for detecting circulating HPV DNA that could enhance disease monitoring in patients with HPV malignancies.
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- Elamir AM, Stanescu T, Shessel A, Tadic T, Yeung I, Letourneau D, Kim J, Lukovic J, Dawson LA, Wong R, Barry A, Brierly J, Gallinger S, Knox J, O'Kane G, Dhani N, Hosni A, Taylor E. Simulated dose painting of hypoxic sub-volumes in pancreatic cancer stereotactic body radiotherapy. Phys Med Biol. 2021 Sep 9;66(18).
- Glicksman RM, Liu SK, Cheung P, Vesprini D, Chu W, Chung HT, Morton G, Deabreu A, Davidson M, Ravi A, Musunuru HB, Helou J, Ho L, Zhang L, Loblaw A. Elective nodal ultra hypofractionated radiation for prostate cancer: safety and efficacy from four prospective clinical trials. Radiother Oncol. 2021 Sep 4;163:159-164.
- Gottwald J, Han K, Milosevic M, Yeung I, Jaffray DA. Impact of PET scanner non-linearity on the estimation of hypoxic fraction in cervical cancer patients. Phys Med. 2021 Dec 8;93:1-7.
- Keilty D, Khandwala M, Liu ZA, Papaioannou V, Bouffet E, Hodgson D, Yee R, Cushing S, Laperriere N, Ahmed S, Mabbott D, Ramaswamy V, Tabori U, Huang A, Bartels U, Tsang DS. Hearing loss after radiation and chemotherapy for CNS and head-and-neck tumors in children. J Clin Oncol. 2021 Sep 27:JCO2100899.
- Hosni A, Ringash J, Han K, Liu ZA, Brierley J, Wong R, Dawson LA, Cummings BJ, Krzyzanowska MK, Chen EX, Hedley D, Knox J, Easson AM, Lindsay P, Craig T, Kim J. Impact of definitive chemoradiation on the quality of life changes for anal cancer patients: long-term results of a prospective study. Dis Colon Rectum. 2022 Jan 20.
- Huo M, Rose M, van Prooijen M, Cusimano MD, Laperriere N, Heaton R, Gentili F, Payne D, Shultz DB, Kongkham P, Kalia SK, Schwartz M, Bernstein M, Spears J, Zadeh G, Hodaie M, Tsang DS. Importance of cobalt-60 dose rate and biologically effective dose on local control for intracranial meningiomas treated with stereotactic radiosurgery. Neurosurgery. 2022 Jan 1;90(1):140-147.
- Mak DY, Laperriere N, Ramaswamy V, Bouffet E, Murray JC, McNall-Knapp RY, Bielamowicz K, Paulino AC, Zaky W, McGovern SL, Okcu MF, Tabori U, Atwi D, Dirks PB, Taylor MD, Tsang DS*, Bavle A*. Re-evaluating surgery and re-irradiation for locally recurrent pediatric ependymoma – a multi-institutional study. Neurooncol Adv. 2021 Nov 9. *Co-Senior Author.
- Papadakos J, Samoil D, Umakanthan B, Charow R, Jones JM, Matthew A, Nissim R, Sayal A, Giuliani ME. What are we doing to support informal caregivers? A scoping review of caregiver education programs in cancer care. Patient Educ Couns. 2021 Oct 23:S0738-3991(21)00671-6.
- Ramotar M, Chua MLK, Truong H, Hosni A, Pintilie M, Davicioni E, Fleshner NE, Dicker AP, Bristow RG, He HH, van der Kwast T, Den RB, Berlin A. Subpathologies and genomic classifier for treatment individualization of post-prostatectomy radiotherapy. Urol Oncol. 2021 Sep 16:S1078-1439(21)00376-8.
- Ray SK, Ghosh N, Vitkin A. Diattenuation and retardance signature of plasmonic gold nanorods in turbid media revealed by Mueller matrix polarimetry. Sci Rep. 2021 Oct 8;11(1):20017.
- Sherwood M, Giannopoulos E, Papadakos J, Martimianakis MA, Kulasegaram K, Giuliani M. Clinical objectives of the Canadian licensing examination: exploring the representation of oncology. J Cancer Educ. 2021 Oct 27.
- Sinho N, Taylor E, Milosevic M, Jaffray DA, Coolens C. Incorporating cross-voxel exchange into the analysis of dynamic contrast-enhanced imaging data: theory, simulations and experimental results. Phys Med Biol. 2021 Oct 14;66(20).
- Tsang DS, Tsui G, McIntosh C, Purdie T, Bauman G, Dama H, Laperriere N, Millar BA, Shultz DB, Ahmed S, Khandwala M, Hodgson DC. A pilot study of machine-learning based automated planning for primary brain tumours. Radiat Oncol. 2022 Jan 6;17(1):3.
* Select publications with RMP first and/or last author. See the full list.
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Awards and Distinctions
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Scott Bratman:
2021 Local Impact Award for Commercialization (Team), UHN.
2021 Co-Inventor of the Year Award, UHN. |
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Ali Hosni: Rising Star Research Award, UTDRO. |
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Alex Vitkin: 2022 G.G. Stokes Award in Optical Polarization, The International Society for Optics and Photonics (SPIE).
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According to the 2021 NRG Oncology Performance Report, the Princess Margaret’s network score over the past year was 91.89%, indicating exceptional performance. We also exceeded our membership accrual target for 2021 by 140%, achieving 21 of the targeted 15 accruals. Congratulations to our clinical study teams and multidisciplinary site groups on their excellent work throughout this past year!
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Grants
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- Building a radiation therapy capacity through a case based distant simulation learning program 9CB-DSLP) – a demonstration project. Global Oncology Fund, Princess Margaret Cancer Center. PI: Harnett N. Co-Is: Bradley R, Balakrishnan R, Wan V, Guo K, Bekalu W, Seife E, Wong R. $20,000.
- Circulating HPV DNA for early detection of recurrence in HPV-positive cancers. Agnico Eagle Intercept Cancer Grand Challenge, Princess Margaret Cancer Centre. PIs: Han K, Bratman S. Co-Is: Hosni A, Kim J, de Almeida J, Waldron J, Spreafico A, Lheureux S, Keshavarzi S, Xu W. $500,000.
- Differentiating radionecrosis from tumour progression using hybrid FLT-PET/MRI in patients with brain metastases treated with stereotactic radiosurgery. 2021 Catalyst Grant, UHN. PIs: Shultz D, Coolens C. Co-Is: Veit-Haibach P, Alcaide-Leon P, Zhiu A. $100,000.
- iCALD-PRO (iPAD or e-interpreters and patient-reported outcome questionnaires for patients with culturally and linguistically diverse backgrounds).Grand Challenge Grant: The Human Touch in Cancer Care, UHN. PIs: Lheureux S, Berlin A. Co-Is: Bouchard-Fortier G, Bowering V, Calamia MA, Croke J, Kasherman L, Liu Z, Oza A, Prince R, Papadakos J, Rodin D, Zimmerman C. $140,000.
- MERIT Study: Manganese Enabled Radiotherapy and Imaging of Tumors. Innovation Accelerator Fund, Princess Margaret Cancer Centre. PI: Milosevic M. $250,000.
- Methylated DNA as a novel early detection test for oral squamous cell carcinoma. 2021 Operating Grants Competition, Cancer Research Society. PI: Bratman S. $120,000.
- MIRA Clinical Learning Environment (MIRACLE) for lung cancer treatment. 2022 Catalyst Grant, University of Toronto Data Sciences Institute. PIs: Hope A, Tadic T, McIntosh C, Patel T, Liu G, Kandel S. $100,000.
- Molecular residual disease interception in locoregionally-advanced high risk HPV-positive and HPV-negative HNSCC (MERIDIAN). Clinical Translation Pathway CATA Grant, Ontario Institute for Cancer Research (OICR). PIs: Bratman S, Siu L. Co-Is: de Almeida J, Haibe-Kains B, Hansen A, Hope A, Perez-Ordonez B, Sanz Garcia E, Spreafico A, Waldron J, Xu W. $1,287,792.
- Prevalence of sexual dysfunction in women treated with rectal cancer. OneWalk Resident/Fellow start-up Grant, UHN. PI: Lukovic J. Co-Is: Brezden-Masley C, Wolfman W, Kennedy ED, Jacobson M, Liu A, Mejia-Gomez J. $5,000.
- Targeted therapeutics to enhance radiotherapy efficacy and safety in the era of image-guided conformal treatment. Canadian Foundation for Innovation John Evans Leadership Fund and Ontario Research Fund. Co-PIs: Bratman S, Koritzinsky M, Milosevic M. $1,578,550.
- US pediatric photon therapy comparison cohort study. National Cancer Institute. PI: Tsang D. $293,970 USD.
- Validation of ultrasensitive HPV ctDNA analysis platforms for detection of molecular residual disease in HPV-positive cancers. Clinical Translation Pathway Pre-CATA Grant, Ontario Institute for Cancer Research (OICR). PI: Bratman S. Co-Is: Han K, Kim J, de Almeida J, Lheureux S, Keshavarzi S, Hosni A, Spreafico A, Waldron J, Xu W. $749,358.
* Select grants with RMP PI/co-PI
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Grant Resources
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