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Lung Cancer Protocol
Our radiation oncologists are developing a combined modality treatment approach to locally advanced (inoperable) lung cancer. The goal is to provide the community with state-of-the-art treatment while producing data on a uniformly treated group of patients. This data would determine the efficacy and toxicity of the treatment.
Background: Lung cancer is the number one cause of cancer deaths in both men and women, accounting for approximately 29% of all cancer deaths. It is the second most common cancer diagnosed yearly after cancer of the prostate in men and cancer of the breast in women. Smoking remains the major cause of lung cancer. To date we have not identified a successful screening test to discover early disease in high-risk patients. By the time patients present with symptoms such as cough, shortness of breath or coughing up blood (approximately 75% of cases), the cancer is typically very advanced having spread to the lymph nodes or to distant sites such as bone and liver. New chemotherapy agents have begun to improve survival and, when used in combination with radiation therapy, they may improve local control as well. The best way of combining these two modalities remains to be determined. Large national research trials are ongoing involving primarily patients who are being treated at large academic centers. The major challenge of lung cancer treatment protocols is to improve control of the tumor in the lung and throughout the body. The Center For Radiation Oncology is interested in combining state of the art radiation therapy with the most active systemic agents available for the treatment of lung cancer.
Induction Chemotherapy followed by 3-D Conformal Radiation Therapy and concurrent chemotherapy may offer the best control of tumor in both the lung and in distant sites. The induction therapy is intended to control tumor cells wherever they may reside in the body. Frequently the tumor in the lung will also shrink in response to this treatment. To improve control of the primary tumor, the volume of the cancer in the lung can be targeted using our AcQsim system. This system allows 3-D spiral CT data to be directly downloaded into our treatment planning computer so that the tumor can be defined in relation to the surrounding normal tissues. The optimal radiation dose distribution is determined so that the tumor receives the prescribed dose while normal tissues are maximally spared.
Results of multiple randomized trials have shown the benefit of combining radiation and chemotherapy in the treatment of lung cancer that is not surgically resectable. We believe that our treatment protocol will improve patient outcomes in the community because of our advanced radiation therapy planning system, and our ability to collaborate with medical oncologists interested in using new effective agents. These new agents include Taxol in combination with carboplatin (a less toxic agent compared to cisplatin) rather than the prior standard therapy of etoposide/cisplatin. In consultation with pulmonary medicine specialists, we are also able to evaluate patients appropriate for high dose rate, endobronchial radiation therapy.
Breast Cancer Risk Study - Kathryn L. Kepes, M.D.
The medical community has had great success in terms of early detection of breast cancer due to the use of mammography as a screening test. We have reduced mortality by finding and treating early breast cancers. It would be even better to be able to identify women at high risk for developing breast cancer and offer a preventative approach. Until recently the only form of breast cancer "prevention" has been prophylactic mastectomy which merely reduces risk by removing the breast tissue. Even then, some women develop breast cancer after bilateral mastectomy because the surgery does not remove 100% of the breast tissue. Recently results of a national randomized study by the National Surgical Adjuvant Breast and Bowel Project (NSABP) showed that women aged 35 years and older identified as being at high risk for developing breast cancer (using the Gail Model for risk assessment) benefitted significantly from taking Tamoxifen versus a placebo. Tamoxifen is a selective estrogen receptor modulator (SERM), and it blocks the body's natural estrogen from binding to receptors on the surface of tumor cells and stimulating cell growth. It is not a perfect drug; it has side effects; it may delay tumor growth rather than truly preventing it. Nevertheless, Tamoxifen has the longest track record as an effective anti-cancer drug, having been used successfully to treat women diagnosed with breast cancer in both early and advanced stages. As radiation oncologists we see newly diagnosed cancer patients. In an effort to determine whether in retrospect these women would have been considered at high risk according to the Breast Cancer Prevention Trial, the Center For Radiation Oncology is assessing the risk factors of its breast cancer population prior to diagnosis using the Gail Model method. Dr. Kepes hopes to determine if the Gail Model has predictive value for determining which patients in the local population would be at significant risk such that Tamoxifen under the current guidelines and recommendations would be warranted.