Radiation Oncology Disease-specific Research

Breast Cancer

Our aim is to provide personalized care for breast cancer. Recent work has focused on understanding the heterogeneity of breast cancers as it relates to the risk of local/regional recurrence. This has prompted a prospective study of substituting hormonal therapy for radiation in women who are likely at low risk for disease recurrence. 

At the other extreme, we have a prospective Phase I trial studying the radiation sensitizer cisplatin concurrent with radiation for patients at greater risk for recurrence. We are also focused on ways to improve quality of life in women undergoing radiation. We are about to launch a prospective randomized study looking at condensing radiation after mastectomy into a 3.5 week course in an attempt to improve long-term reconstruction success, optimize the cosmetic result, and minimize the burden of treatment. For patients with non-invasive disease, work is focused on creating web-based individualized risk estimates of various treatment options in order to assist patients and clinicians in decision making. Additional work has focused on understanding the cost-effectiveness of various treatment strategies for early-stage disease.

Central Nervous System Cancers

Our research focuses on improvements in radiotherapy for cancers of the central nervous system, using combination therapy with targeted radiosensitizing agents. In order to increase the control of malignant primary tumors and brain metastases, we design and participate in a variety of protocols that use targeted biological drugs or chemotherapy to sensitize tumors to radiation.

Gastrointestinal Cancer

As part of the Dana-Farber/Harvard Gastrointestinal Cancer Center, we participate in a large number of clinical trials with the goal of improving outcomes for patients with cancers of the gastrointestinal tract. Many of these trials combine new types of chemotherapy and/or biological therapy with radiation. Available technologies include intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT). Currently active protocols involve a variety of innovative approaches, including improved cancer imaging, identifying new ways to predict and minimize the risk of long-term radiation complications, shorter courses of treatment for selected patients with rectal and pancreatic cancer, and novel treatments for liver cancer. Our pre-clinical research program in pancreatic cancer focuses on critical aspects of the biology of pancreatic cancer in order to develop novel therapeutic approaches, including new modes of radiosensitization.

Genitourinary Cancer

Our research focus is on improving the cure rate and quality of life for patients with cancers of the urinary tract and male genital tract, including prostate, bladder, testicular and renal cell cancers. 

Current treatment protocols include an international randomized trial co-led by our team evaluating the role of the powerful androgen blocker enzalutamide with radiation and standard androgen ablation in patients with high-risk prostate cancer; a study of radiation plus 6 months of enzalutamide for intermediate-risk prostate cancer; brachytherapy for men who have had a cancer recurrence after prior radiation; and novel anti-androgens for men receiving radiation after prostate cancer surgery. We also have a national protocol open for men with high-grade non-muscle invasive bladder cancer who wish to pursue chemotherapy and radiation. 

In the area of translational science, we are working to develop molecular signatures of prostate tumors that can be used to design more individual therapies for men diagnosed with prostate cancer. 

We have a strong interest in the care and medical management of men with testicular cancer. We are investigating new strategies that decrease exposure to potentially unnecessary CT scans, as well as potentially unnecessary radiation and chemotherapy. We are working to create a treatment summary for all testicular cancer patients that can be sent to primary care doctors with recommendations for future testing, such as early testing of cholesterol or more rigorous evaluation for hypertension. We are also interested in the genetic predictors of treatment-related morbidity and in the quality of life for men with testicular cancer following diagnosis and treatment.

Gynecologic Cancers

Our clinical and research focus is to provide the highest quality of care for patients with gynecologic cancer by achieving high rates of cure while minimizing the risk of long-term side effects related to radiation therapy. Advanced imaging modalities such as PET-CT and MRI are routinely integrated into the radiation planning process to deliver highly conformal treatments using intensity-modulated and volumetric adaptive radiotherapy (IMRT and VMAT). For patients who are candidates for brachytherapy, image-based application is performed using a combination of ultrasound, CT and/or MRI. Our clinical research focuses on patient outcomes, including quality of life, for advanced external beam and brachytherapy techniques. We also have an active translational research program to evaluate molecular determinants of recurrence and radiotherapy response. In collaboration with our medical oncology colleagues, we will be investigating the potential impact of abdominal and pelvic radiotherapy with novel immunotherapy agents in clinical trial.

Current treatment protocols examine the use of MR-guidance and other 3D imaging approaches during brachytherapy, in order to improve imaging and reduce the risk of radiation damage to adjacent normal tissues. Other research studies focus on the epidemiology of endometrial cancer, the effects of radiation therapy on gynecologic malignancies, and quality-of-life improvements through novel techniques in gynecologic radiation oncology.

Head and Neck Cancers

In collaboration with our colleagues in medical and surgical oncology, we are investigating the use of systemic therapy and immunotherapy in combination with radiation for patients with advanced disease and following surgery. Systemic therapy includes standard chemotherapy agents as well as targeted agents and investigational treatments. All of our studies use state-of-the-art, intensity-modulated radiation therapy (IMRT). We are also investigating the use of stereotactic body radiotherapy (SBRT) in the treatment of head and neck cancer.

Lymphoma

Our group maintains one of the largest databases in the country on more than 2,000 patients treated for Hodgkin lymphoma in the last 50 years. The database provides valuable information on the efficacy of different treatment approaches and the various late effects of treatment. In addition, we are dedicated to optimizing treatment for patients with newly diagnosed disease and the follow-up care of survivors of lymphoma. Studies included examination of the role of radiation therapy for specific lymphoma types, optimal radiation dose and treatment volume, novel techniques such as the deep-inspiration breath hold technique and intensity-modulated radiation therapy to reduce doses to lungs and cardiac structures, and prospective screening trials for late effects in lymphoma survivors.

Soft Tissue and Bone Sarcomas

The Sarcoma Program is internationally-recognized for research in sarcoma in terms of basic science, laboratory investigation, and clinical trials, offering patients many new drugs and approaches. We are one of the few high volume sarcoma centers in the US and are very experienced with the nuances of sarcoma patient care. We work closely with our colleagues in pathology, radiology, surgical oncology and medical oncology to define the optimal role of radiation therapy as part of patient management (i.e., pre-operative vs. post-operative radiotherapy, intra-operative radiotherapy implants, or no radiotherapy). The unique expertise in our department positions us to offer innovative treatment techniques such as Intensity Modulated Radiation Therapy (IMRT), volumetric modulated arc therapy (VMAT), brachytherapy, surface applicator therapy, and stereotactic body radiotherapy (SBRT), in addition to 3D-conformal therapy. Projects in development include the optimization of radiation techniques and doses for the treatment of primary and recurrent retroperitoneal sarcoma, the development of strategies to minimize the risk of wound complications, definition of clinical characteristics and patterns of failure for specific histologic sub-types of sarcoma, and optimal integration of radiation therapy and systemic sarcoma treatment.

Lung Cancer

Our primary research goal is to improve radiation treatment and outcomes for patients with cancers in the lungs and chest. Current clinical studies include developing and refining new techniques, such as stereotactic body radiation, for delivering high doses of radiation therapy to tumors in the lung, while minimizing the effects to normal tissues. We collaborate on multiple clinical studies in non-small cell lung cancer, small-cell lung cancer, metastatic cancers in the lung, and mesothelioma. In addition, we are investigating advanced imaging technologies to improve the precision of radiation therapy planning and delivery to tumors with motion. Other ongoing research includes laboratory-based and translational studies to identify targeted drug treatments that may improve the effectiveness of radiation therapy for lung cancer, as well as studies on patient communication, costs of care, and comparative effectiveness of radiation technologies.

Pediatric Cancers

Our team of pediatric radiation oncologists and physicists are developing improved radiation treatment approaches that will maximize the effectiveness of treatment and maintain your child's quality of life. We are actively involved in a wide variety of research projects. These include exploring the unique genetic make-up of tumors, combining targeted agents with radiotherapy and employing new radiotherapy techniques. In collaboration with our pediatric oncology colleagues, we are breaking new ground in translational research for pediatric cancers.

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