Adaptive radiation therapy represents a paradigm shift in cancer care, and UT Southwestern is leading the charge in delivering these more precise and personalized treatments. Dr. Robert Timmerman, Chair of Radiation Oncology, and Dr. Nina Sanford, Chief of Gastrointestinal Radiation Oncology, explain how “smart” radiation benefits patients, and why it is at the heart of our newly expanded Radiation Oncology building in Dallas.
By the time 2021 concludes roughly 1.9 million Americans will have received a cancer diagnosis. About half of them will have undergone radiation therapy, a treatment that is becoming increasingly more personalized and more precise here to explain our two experts in the field, Dr robert Timmerman, who directs our clinical programs and radiation oncology and Dr Nina Sanford, chief of the gastrointestinal radiation oncology service. Thank you both for joining us. Dr Sandford, What is radiation oncology and how does it fit in the realm of cancer treatments. Radiation is basically using high energy beams that kill the D. N. A. Of tumor cells. It's generally given with a high energy X rays. The most common form of radiation is external beam radiation which uses an external radiation source. So it's non invasive. It can be given anywhere between just one treatment over one day to treatments over several weeks. We know that throughout a patient's cancer course, approximately 50% or even more. A little more patients require radiation therapy, Dr Timmerman, we hear the term steri attacked IQ radiation. What does that mean? And how has that evolved over the course of radiation therapy during your career for conventional radiotherapy, large regions of the body that include the and potential microscopic spread are targeted. Now this conventional radiotherapy gives multiple very small daily doses to the region including a fairly large amount of normal tissues such as treating the whole breast for a focal breast cancer. Now, in contrast, stereotype Actiq radiation which we helped develop here at UT Southwestern uses technology to strictly to market to um are from normal tissue. Then we use a large and more damaging dose of radiation to the um are separate from the normal tissues. We only give 1-5 treatments as opposed to 22 30 Treatments. Which is much more convenient, stereotype Actiq radiation is considerably more potent and even a bladed than conventional radiotherapy. So we now call it saber or stereotype Actiq a blade of radiotherapy. Dr Timmerman. We pride ourselves at UT Southwestern on being on the very cutting edge of radiation. Oncology, radiation therapy. I know you've worked to develop a new technique called pulsar technology. Tell us what that is pulsars. The next step to take this saber like treatment that I just described and purposely putting a pause between the treatments. The pause allows biological processes that are associated with the cancer or the environment around the cancer. To complete, we investigate then these biological processes. So as such, we can personalize the therapy, giving fewer and less potent potent pulses for those where it's going well or in turn intensifying it if it's not going so well. Dr stanford. I know a lot of your work and your research involves combining radiation treatments, radiation therapies with immunotherapy or chemotherapy for cancer. Tell us the methodology behind all that one of the trials that I'm leading here along with my team um is looking at pulsar in the treatment of rectal cancer. So rectal cancer. Traditionally treatment requires surgery, radiation is also part of treatment for rectal cancer, but traditionally it's given before surgery. What we're trying to do with our pulsar study is actually improve both the efficacy but decrease the toxicity of radiation so that more patients can have just radiation and chemotherapy and have a complete response to those treatments. Um and eventually not need surgery with the pulsar treatment, we're giving pulses of radiation four weeks apart and during that time they're actually receiving ongoing chemotherapy for a total of six months. So actually capitalizing on the radiation and chemotherapy working together. Um But with the pulse of the radiation a month apart being less toxic than if they were given every day. So many different ways to sequence it but really depends on the tumor biology um what the tumor looks like on the scans and also the intent of the treatment and also patient preference as well. Dr Timmerman radiation oncology is a field where artificial intelligence and machine learning is really being pioneered. Tell us how that works and what you're learning about these new technologies as you apply them to treatment of patients, artificial intelligence from our perspective is a form of automation and it tries to mimic human human intelligence and behaviors for problem solving. So we've been partnering with various investigators, including investigators in the light of Hill department of bioinformatics pathology. Even at Ut Dallas and other centers to uncover important biological information related to cancer that's not obvious to the human eye. And this would include things like patient data information where a fresh perspective might uncover a trend. And AI can also be used to automate routine or more cumbersome tasks that otherwise might be associated with human error, such as carefully reviewing imaging or pathology. And finally the way we use AI is to automate complex tasks like radiotherapy treatment planning that would allow it to be used at a high quality and standardization from center center Dr stanford. Throughout my career, a lot of progress has been made in the treatment of gastrointestinal cancers. As you look at what we're doing today and you think about what we might be doing for patients diagnosed with these cancers five or 10 years from now, what do you think the big changes will be one of the major advancements in radiation oncology over the past five years has been really personalization of therapy and and sort of just exactly like what Dr Truman said, our department has really been at the forefront um of designing clinical trials um that sort of try to personalize and optimize radiation therapy according to those factors. We recently acquired some some new technologies in our new building um One is for adaptive radiation which is basically again, knowing that not one size fits all actually adapting each radiation treatment to changes in tumor from either day to day or week to week if we're using pulsar pulses. Um and also using M. R. I. To better delineate the tumor. Either during radiation planning or treatment. one of the exciting things is really um our department to define how best to use these technologies. Again to really personalize and individualize radiation treatments. DR Timmerman is the most senior clinical leader at UT Southwestern in radiation Oncology. You've seen a lot of advances during your time here. If you were to pick one disease or one problem that you think will be treated differently in the next five or 10 years at UT Southwestern, what do you think that might be? That's actually a fairly easy one. This is going to be metastasis. So in the past, radiotherapy was used in the earlier stages of disease, at least in a curative situation and for patients with metastatic disease which is actually a large percentage of patients. Unfortunately, radiotherapy was only used for paley ation or improvement of quality of life typically at end of life. The problem has been residual gross tur that can't be eradicated either by surgical extra patient or by these drugs. And so these focused radiation techniques that Nina described could be used to eradicate that gross disease and either put the patient in a chronic state where their own immune system can fight any residual tumor or outright cure them. And this is very exciting and could lead to great expanding of the indications for radiotherapy. Thank you both for joining us today. There's a lot of new advances in radiation oncology as a field and certainly at UT Southwestern. And we really appreciate all the good advice and information that you've given us today. Thanks for having us. I appreciate the opportunity to talk to you about these exciting topics. Thank you for joining us until next episode. Stay safe and stay healthy.