Innovations

Discoveries

• Oligometastases

  Dr. Ralph Weichselbaum, in conjunction with Dr. Samuel Hellman, has pioneered the treatment of potentially curative treatment of oligometastases with radiotherapy. Based on the observation that not all breast cancer may be widely metastatic at initial presentation, Dr. Samuel Hellman advanced our understanding of the natural history of metastasis through proposal of a spectrum hypothesis, with some breast cancers remaining locoregionally confined, others being metastatic at presentation, and some progressing from locoregional confinement to metastatic. Soon thereafter, Hellman and Weichselbaum described the clinically relevant oligometastatic state, where metastases are limited in number and destination organ, and where long-term disease control may be achievable with metastasis-directed therapy.

  Dr. Steven Chmura is now leading a national team of radiation oncologists to test this treatment through a national clinical trial of oligometastatic breast cancer, in cooperation with the NCI and NRG Oncology. The Phase I trial will test the safety and efficacy of treating patients with 3-4 metastases with stereotactic body radiotherapy (SBRT). To complement this trial, a Phase II/III trial will randomize breast cancer patients with 1-2 metastases to standard of care chemotherapy or to SBRT followed by systemic therapy. These trials are the first in the world to ask these questions.

  

  

• Pediatric Oncology

  Dr. Connell is a physician-scientist specializing in rare pediatric malignancies. As part of his clinical research, Dr. Connell performs studies that quantify the outcomes of patients treated at University of Chicago. In particular, he focuses on clinical responsiveness of lung cancers and sarcomas to chemotherapy and radiation therapy. In one study, published in the American Journal of Clinical Oncology, he showed that neoadjuvant chemotherapy with high dose concurrent RT is well tolerated and results in favorable outcomes. Similarly, he has focused on patient outcomes following neoadjuvant approaches in the treatment of locally advanced soft-tissue sarcomas. Our institution has offered a uniquely modified regimen for these sarcomas, consisting of preoperative treatment with chemotherapy and concurrent hypo- fractionated radiotherapy. Our study concluded that this well-tolerated approach yields excellent rates of limb preservation and disease control. This work is published in the International Journal of Radiation Oncology Biology and Physics.

  

• Head and Neck Cancer

  Dr. Haraf is an internationally recognized radiation oncology expert in the treatment of head and neck cancer. Dr. Haraf is a Co-investigator and the Radiation Oncology Chair of several innovative clinical trials, including the DECIDE trial: (A Phase III Randomized Trial of Docetaxel Based Induction Chemotherapy in Patients with N2/N3 Locally Advanced Head and Neck Cancer); the EPIC trial: (A Randomized Phase II Trial of Concurrent Chemoradiation with Cetuximab (ERBITUX®), 5‑Fluorouracil, Hydroxyurea, and Twice-daily Radiation (CetuxFHX) versus Cextuximab (ERBITUX®), weekly Cisplatin, and Accelerated Radiation with Concomitant Boost (CetuxPX) after Cetuximab,  Paclitaxel, Carboplatin Induction Chemotherapy in Patients with Locally Advanced Head and Neck Cancer); the Abraxane trial for recurrent head and neck cancer: Nab-Paclitaxel-based re-induction chemotherapy followed by response-stratified chemoradiotherapy in patients with previously treated squamous cell carcinoma of the head and neck; and the Everlimus trial: Selection of Chemoradiotherapy Based on Response to Induction Chemotherapy – a randomized Phase 2 Study in Locally Advanced Squamous Cell Carcinoma of the Head and Neck.  This trial combines a novel agent Everlimus (an MTOR inhibitor) in or standard FHX regimen with BID radiation.  The protocol has a novel aspect for radiation as well.  Those patients who respond to induction get a much reduced field of XRT in an attempt to decrease toxicity. Finally, Dr. Haraf is developing a new protocol for HPV positive head and neck cancer.

• Breast and Gynecologic Malignancies

  Dr. Chmura and Dr. Hasan treat breast cancer patients at the University of Chicago in Hyde Park, Dr. Halpern treats patients at our UIC clinic, and Dr. McCall treats patients at our Silver Cross clinic.

  We were the first hospital in Chicagoland to offer prone positioning (i.e., laying on belly) to treat breast cancer. Prone positioning allows the radiation beam to target the cancer without delivering unnecessary dose to the heart and lungs.

  In addition to optimizing treatment positioning, we are the first hospital in Chicagoland to use 3D surface imaging to position the breast accurately for deep-inspiration breathhold (DIBH) treatments. DIBH moves the heart and lungs as far out of the radiation field as possible for supine treatments. This highly sensitive technology delivers radiation only during optimal positioning, and shuts off automatically when the patient coughs or exhales. Unlike older DIBH technology, this system is non-invasive and does not require the patient to breathe into a device during treatment. 

     

  Our radiation oncologists can prescribe hypofractionated doses in both the prone and supine (i.e., laying on back) positions. This can condense a traditional course of 6 weeks of radiation into 3 weeks, when clinically appropriate.

  We can also deliver inverse-planned intensity modulated radiation therapy (IMRT) in order to target breast cancer aggressively. IMRT shapes the radiation dose to the target while reducing the high radiation received by the heart and lungs.

  Dr. Hasan is the primary breast radiation oncology representative and collaborator at the Multidisciplinary Breast Tumor Board.  Intra- and inter-departmental protocols currently open include an Accelerated Partial Breast Irradiation protocol, BEAM-ON (breast oligometastasis) protocol, NRG protocol for higher risk hypofractionated breast treatment, partial breast re-irradiation, and an IRB approved prospective multi-institutional data collection protocol. Dr. Hasan is also the lead radiation oncology collaborator for the National Breast Cancer Database at University of Chicago. Her clinical research includes looking at dosimetric outcomes for breast treatment using RTOG contouring guidelines, racial disparity in breast cancer outcomes, the role of MRI in detecting mammographically occult disease, the technical feasibility and dosimetric analysis of inverse planned IMRT for locally advanced breast cancer, and outcomes in breast and chest wall re-irradiation. Finally, Dr. Hasan has just opened an Inovio clinical trial for the use of a therapeutic vaccine for cervical cancer.

  

  

• Genitourinary (GU) Malignancies

  Dr. Stanley Liauw oversees the genitourinary (GU) cancer program and the gastrointestinal (GI) cancer program within the Department of Radiation and Cellular Oncology, at the University of Chicago. His clinical research includes describing prognostic factors associated with biochemical outcome (statin use, and PSA kinetics on hormonal therapy), prognostic factors associated with late toxicity of treatment (anticoagulation therapy, and prior history of transurethral resection of the prostate), and biochemical outcomes in various treatment settings (brachytherapy, IMRT, post-prostatectomy). A number of translational and scientific research projects have been pursued within the department of Radiation and Cellular Oncology in collaboration with Ralph Weichselbaum. The prostate SPORE grant at the University of Chicago (in collaboration with Northwestern University) includes three intradepartmental aims: a phase I/II clinical trial of radiosensitizing gene therapy for high risk prostate cancer, an immunohistochemical study identifying potential markers of radioresistance, and preclinical studies aimed at enhancing radiosensitization by modulation of NFKB activation. A separate project, which has received funding through the Prostate Cancer Foundation (a 3-year Young Investigator Award to Dr. Liauw), involves the study of the lipid biosynthesis pathway to improve radiotherapeutic outcomes, and the possible role of statins in the management of prostate cancer.

  

• Thoracic and upper Gastrointestinal (GI) Malignancies

  Dr. Renuka Malik serves as lead physician for thoracic and upper gastrointestinal malignancies as well as oligometastatic tumors.  Her practice widely incorporates extracranial stereotactic body radiotherapy (SBRT), intensity-modulated radiation therapy (IMRT) and image-guided radiotherapy (IGRT).  Dr. Malik collaborates with medical oncology and cardiothoracic surgery in patient selection and treatment on national CALGB, NRG, and ACOSOG protocols and serves as institutional PI for CALGB 31103: “A phase I study of accelerated hypofractionated RT with concomitant chemotherapy for locally advanced NSCLC.” With the increasing volume of inoperable early stage lung cancers and oligometastatic patients who require SBRT or highly conformal hypofractionated RT, a collaborative approach with interventional pulmonary to improve tracking with fiducials and staging with EBUS has improved patient selection, setup, and treatment delivery.