| Radiation Medicine Program - Research Bites
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Your source for the latest in RMP research
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Lung Cancer is the most commonly diagnosed cancer in Canada and is the leading cause of cancer death in Canadians. Despite advances in Lung Cancer treatment, survival remains among the lowest of all cancer types. In RMP, our Lung Site Group is comprised of a highly specialized and multidisciplinary team of radiation oncologists, medical physicists, radiation therapists and allied health professionals. In this issue, learn how some of our experts are making headway in Lung Cancer research to improve survival and care for our patients.
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Benjamin Lok
MD
Radiation Oncologist – Lung Site Group, Princess Margaret
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Cancer recurrence is the leading cause of death in many patients with small cell lung cancer (SCLC). While most SCLC patients do respond to cancer treatments initially, 70-80% of patients inevitably suffer from cancer relapse and resistant disease. "The treatments that have worked before don’t seem to work as effectively," says Dr. Benjamin Lok. "Something clearly has changed about their cancer."
Guided by his passion to help SCLC patients live longer and better, Ben’s research is centred on understanding what causes cancers to be resistant to therapy, and exploring new therapeutic strategies. “Cancers often have genomic instability and deranged DNA repair pathways, which allow some cancers to better tolerate and repair the damage we induce from cancer treatments. We are learning how to target and inhibit these DNA repair pathways, which may enhance anti-cancer treatments, including radiation.”
“Our goal is to create a treatment strategy for patients that will delay or decrease the risk of cancer recurrence,” he says. “One way we could do that is to apply radiation strategically and combining radiation with novel radiosensitizers that will make it more impactful and powerful.” Ben is currently leading a clinical trial (NCT04170946) at the Princess Margaret (PM) for patients with SCLC that combines radiation therapy with Talazoparib, a drug that can stop the cancer from repairing its DNA and enhance the effectiveness of radiation therapy. “It is very exciting to be able to translate our laboratory findings into the clinic and turn it into a clinical trial here at the PM.” Read the full interview. |
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Jean-Pierre Bissonnette
PhD
Medical Physicist
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Lung Site Group,
Princess Margaret
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Patients with non-small cell lung cancer (NSCLC) can experience rapid disease progression from the time of diagnostic imaging to the start of their radiation therapy treatment. While co-leading a clinical trial with Dr. Alex Sun on the use of positron emission tomography (PET) scans to identify radiation resistant “hot spots” in NSCLC tumours, Dr. Jean-Pierre Bissonnette noticed that disease had worsened in 20-25% of patients. This observation led to a collaboration between five international cancer centres, where the group collected data prospectively from close to 200 patients and reported on rates of disease progression in the largest cohort of NSCLC patients studied to date.
“Our international, collaborative wait times analysis has shown that many lung cancer patients do not have the luxury to wait long for treatment,” says Jean-Pierre. “About one in six locally-advanced lung cancer patients will encounter disease upstage or progression after three weeks.” Jean-Pierre hopes that the findings of this study will help inform clinicians, cancer agencies and patients on the potential impact of extended treatment wait times and the importance of radiation treatment planning with PET/CT to ensure that disease progression is identified and that these patients receive the most appropriate therapy.
In addition, Jean-Pierre is collaborating fellow medical physicists, Drs. Teo Stanescu and Tony Tadic to build advanced imaging and AI tools to reconstruct radiotherapy doses delivered to patients with lung cancer to ensure that anatomical changes during treatment can be accounting for, and to identify any potential issues that can be improved on. Read the full interview. |
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Olive Wong
MRT(T)
Radiation Therapist – Lung Site Group,
Princess Margaret
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To ensure safety of patients and staff during the pandemic, radiation therapist Olive Wong wanted to create an efficient process to detect potential COVID-19 infections in cancer patients who are asymptomatic, or slightly symptomatic while on radiation treatment. As part of standard of care, patients undergo cone beam CT (CBCT) imaging prior to radiation therapy. “Radiation therapists can perform weekly offline review of a patient's own daily imaging, which may provide a useful screening tool to identify patients with early pulmonary changes related to COVID-19,” says Olive.
In collaboration with radiation therapists Winnie Li and Paul Kwan, as well as radiation oncologist Dr. Derek Tsang and research associate Jason Xie, the team determined the workflow, time requirements and effectiveness of performing weekly offline reviews of CBCT images and conducted a pilot assessment over eight weeks. If a reviewer observes changes in lung opacity in a patient’s CBCT scans, their most responsible physician (MRP) would be notified via email, and further assessment for COVID-19 would be triggered. The weekly review of CBCT images for changes in lung opacity has since been implemented across RMP’s radiation therapy department in the form of a weekly quality assurance check. “I'm hoping that this process has prepared our department for heightened vigilance in the setting of widespread community transmission of COVID-19.” Read the full interview.Back to top
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Harnett et al. described the impact of the PM Accelerated Education Program's immersive continuing medical education courses on participants and their local radiation medicine practice.
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Cho et al. reported on the final results of a phase 2 trial evaluating a novel approach for managing malignant pleural mesothelioma - surgery for malignant pleural mesothelioma after radiotherapy (SMART).
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Berlin A, Lovas M, Truong T, Melwani S, Liu J, Liu ZA, Badzynski A, Carpenter MB, Virtanen C, Morley L, Bhattacharyya O, Escaf M, Moody L, Goldfarb A, Brzozowski L, Cafazzo J, Chua MLK, Stewart AK Krzyzanowska MK. Implementation and outcomes of virtual care across a tertiary cancer center during COVID-19. JAMA Oncol. 2021 Jan 7:e206982.
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Bissonnette JP, Sun A, Grills IS, Almahariq MF, Geiger G, Vogel W, Sonke JJ, Everitt S, Manus MM. Non-small cell lung cancer stage migration as a function of wait times from diagnostic imaging: A pooled analysis from five international centres. Lung Cancer. 2021 Mar 30;155:136-143.
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Chan M, Palma D, Barry A, Hope A, Moore R, O’Neil M, Papadakos J, Schellenberg D, Tadic T, Tsai J, Giuliani M. Practical considerations for the implementation of a stereotactic body radiation therapy program for oligo-metastases. Adv Radiat Oncol. 2021 Jan;6(1) 100499.
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Dasgupta A, Co J, Winter J, Millar BA, Laperriere N, Tsang DS, van Prooijen M, Damyanovich A, Heaton R, Coolens C, Bernstein M, Kongkham P, Zadeh G, Berlin A, Conrad T, Moraes FY, Shultz DB. Clinicopathologic and treatment features of long-term surviving brain metastasis patients. Curr Oncol. 2021;28(1):549-559.
- de Almeida JR, Seungyeon Kim V, O'Sullivan B, Goldstein DP, Bratman SV, Huang SH, Su J, Xu W, Parulekar W, Waldron JN, Hosni A. Comparing unilateral vs bilateral neck management in lateralized oropharyngeal cancer between surgical and radiation oncologists: An international practice pattern survey. Oral Oncol. 2021 Mar;114:105165.
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Giuliani M, Samoil D, Agarwal A, Croke J, Golden DW, Hirsch AE, Jimenez R, Malik NH, Papadakos J, Wu CHD, Ingledew PA. Exploring the perceived educational impact of COVID-19 on postgraduate training in oncology: Impact of self-determination & resilience. Can Med Educ J. 2021 Feb 26;12(1):e180-e181.
- Glicksman RM, Metser U, Vines D, Valliant J, Liu Z, Chung PW, Bristow RG, Finelli A, Hamilton R, Fleshner NE, Perlis N, Zlotta AR, Green D, Bayley A, Helou J, Raman S, Kulkarni G, Catton C, Lam T, Chan R, Warde P, Gospodarowicz M, Jaffray DA, Berlin A. Curative-intent metastasis-directed therapies for molecularly-defined oligorecurrent prostate cancer: A prospective phase II trial testing the oligometastasis hypothesis. Eur Urol. 2021 Mar 5:S0302-2838(21)00151-2.
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Hindle D, Liu ZA, Rosewall T. Pre-radiotherapy pain intensity and health-related quality of life in patients with bone metastases at various vertebral levels. J Med Imaging Radiat Sci. 2020 Dec 18:S1939-8654(20)30382-9.
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Kwan JYY, Lin LT, Bell R, Bruce JP, Richardson C, Pugh TJ, Liu FF. Elevation in viral entry genes and innate immunity compromise underlying increased infectivity and severity of COVID-19 in cancer patients. Sci Rep. 2021 Feb 25;11(1):4533.
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Lee M, Simeonov A, Stanescu T, Dawson LA, Brock KK, Velec M. MRI evaluation of normal tissue deformation and breathing motion under an abdominal compression device. J Appl Clin Med Phys. 2021 Jan 15.
- Moraes FY, Mansouri A, Dasgupta A, Ramotar M, Kosyak N, Weiss J, Laperriere N, Millar BA, Berlin A, Conrad T, van Prooijen M, Heaton R, Coolens C, Winter J, Bernstein M, Zadeh G, Kongkham P, Doherty M, Shultz DB. Impact of EGFR mutation on outcomes following SRS for brain metastases in non-small cell lung cancer. Lung Cancer. 2021 Mar 2;155:34-39.
- Munoz-Schuffenegger P, Barry A, Atenafu EG, Kim J, Brierley J, Ringash J, Brade A, Dinniwell R, Wong RKS, Cho C, Kim TK, Sapisochin G, Dawson LA. Stereotactic body radiation therapy for hepatocellular carcinoma with macrovascular invasion. Radiother Oncol. 2020 Dec 5;156:120-126.
- Patel PS, Vyravanathan S, Milne E, Bezjak A, Wouters BG, Bennewith K, Seuntjens J, Liu ZA, Harding SM, Liu FF, Koritzinsky M, Koch CA. Strategic Training in Transdisciplinary Radiation Science for the 21st Century (STARS21): 15-year evaluation of an innovative research training program. Int J Radiat Oncol Biol Phys. 2021 Jan 10:S0360-3016(21)00023-7.
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Pilar A, Yu E, Su J, O'Sullivan B, Bartlett E, Waldron JN, Ringash J, Spreafico A, Hansen AR, de Almeida J, Bayley A, Bratman SV, Cho J, Giuliani M, Hope A, Hosni A, Kim J, Tong L, Xu W, Huang SH. Prognostic value of clinical and radiologic extranodal extension and their role in the 8th edition TNM cN classification for HPV-negative oropharyngeal carcinoma. Oral Oncol. 2021 Jan 25;114:105167.
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Tosoni S, Voruganti I, Lajkosz K, Habal F, Murphy P, Wong RKS, Willison D, Virtanen C, Heesters A, Liu FF. The use of personal health information outside the circle of care: consent preferences of patients from an academic health care institution. BMC Med Ethics. 2021 Mar 24;22(1):29.
* Select publications with RMP first and/or last author. See the full list.
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Grants
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Integrated use of wearable diagnostics in lung cancer. UTDRO Collaborative Seed Grant Competition. PI: Raman S. Co-PIs: Hope A, Croke J, Cheung P, Louie A, Brade A, Wu R, Liu G, Conrad T, Yoon F. $50,000.
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Optimization of radiation patient scheduling. ScaleAI. Co-PIs: Raman S, Wong P. Co-I: Liu FF. $1,500,000.
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Patient Reported Outcomes/Metrics Program Trial (PROMPT) – Palliative Radiation. PMCF. Co-PIs: Barry A, Wong P. Co-I: Raman S, Hope A, O’Connor B, Hannon B, Liu ZA, Berlin A, Haibe-Kains B. $250,000.
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Shedding light on SBRT: Functional optical coherence tomography and MR imaging for in vivo monitoring of high-dose few-fractions radiotherapy of pancreatic cancer. Project Grant, CIHR. PIs: Vitkin IA. Co-Is: Harding SM, McKee TD, Taylor EK. $3,203,435.
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SPECT-CT guided ELEctive Contralateral Neck Treatment (SELECT) for patients with lateralized oropharyngeal cancer: A Phase III randomized controlled trial. Project Grant, CIHR. PIs: Parulekar WR, de Almeida JR, Hosni A. Co-Is: Bahig H, Belzile M, Chen BE, Chepeha D, Christopoulos A, Eskander A, Hilton J, Krahn MD, Lai SY, Martino R, Patel MR, Prisman E, Ringash J, Waldron J, Zhang H. $3,203,435.
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Supporting the mental health of palliative cancer patients and their caregivers through a pandemic and beyond: feasibility of a virtual patient-reported outcome model of care. MSH UHN AMO Innovation Fund. PIs: Croke J, Hannon B. $72,360.25.
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Tailored adjuvant therapy in POLE-mutated and p53-wildtype early stage endometrial cancer (TAPER). Co-PIs: Han K, McAlpine J. Co-Is: Ferguson S, Fyles A, Gilks C, Huntsman D, Lheureux, Liu Z, Mackay H, Oza A, Stockley T, Talhouk A, Welch S. $1,082,474.
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The characterization and therapeutic targeting of metabolic and inflammatory signaling in chronic lymphedema. Project Grant - Priority Announcement: Infection and Immunity, CIHR. PI: Liu FF. Co-Is: Kwan JYY, Haibe-Kains B, Haykal S, Reed MA, Yip KW. $100,000.
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The effects of a residency curriculum change on near-peer mentorship of radiation oncology residents. AACE REEDS Grant, American Association for Cancer Education. PIs: Mal D, Giuliani M. Co-Is: Croke J, Ingledew PA, Loewen S, Alfieri J, Papadakos J. $5,000 USD.
* Grants with RMP PI/co-PI
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Grant Resources
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