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Nine providers in the UAB Department of Radiation Oncology are among this year’s top-performing physicians and advanced practice providers (APPs) honored for excellence in patient experience.

The Office of Patient Experience and Engagement (OPXE) along with UAB Medicine executive leadership recognized 410 top-performing providers in 2023.

The awards distinguish top ambulatory providers who scored an average of 95% or higher in patient care satisfaction rankings that measure the following elements of patient-provider communication:
• Listened carefully
• Demonstrated care and concern
• Provided clear explanations
• Included patient in health care decisions
• Overall care rating, 0-10

“These providers have demonstrated an unwavering commitment to caring for our patients with excellence, empathy, kindness, and compassion,” said Chris Brainard, AVP of Patient Experience and Engagement. “Delivering an exceptional patient experience is one of the many reasons that UAB Medicine is a leading health care organization.”

Congratulations to the following Radiation Oncology providers for achieving outstanding patient care scores:

Hunter Boggs, M.D.
Chris Dobelbower, M.D., Ph.D.
John Fiveash, M.D.*
Kimberly Keene, M.D.*
Adam Kole, M.D., Ph.D.*
Samuel Marcrom, M.D.*
Jeffrey Peacock, M.D.
Christopher Willey, M.D., Ph.D.
Mehran Yusuf, M.D.

*Indicates achievement of highest score possible

Samantha Simiele, Ph.D.The UAB Department of Radiation Oncology welcomed Samantha Simiele, Ph.D., as assistant professor in medical physics and chief of brachytherapy on Oct. 1, 2023. Simiele came to UAB from the University of Texas MD Anderson Cancer Center where she was an assistant professor from 2019 to 2023.

Originally from Richland, Washington, Simiele earned her Bachelor of Science in Radiological Health Sciences from Purdue University. She went on to earn her master’s degree and doctorate in Medical Physics from the University of Wisconsin – Madison, and completed her Medical Physics residency at the University of Michigan.

Her research interests are brachytherapy and brachytherapy education.

Please join us in welcoming Dr. Simiele to UAB.

The UAB Department of Radiation Oncology is pleased to announce the promotion of four faculty members, including three radiation oncologists and one medical physicist, effective Oct. 1, 2023.

One faculty member was also awarded tenure.

Please join us in congratulating these individuals and thanking them for their dedication to the department and to the UAB medical community. 

M. Chris Dobelbower, M.D., Ph.D. — Promoted to Professor, tenured, Radiation Oncology
Dobelbower is the Medical Director for Radiation Oncology at the Kirklin Clinic at Acton Road. He joined the department faculty in 2007 after graduating from the UAB Radiation Oncology Residency Program. He is the disease site leader for Lung cancers and his research interests include the treatment of thoracic malignancies including thoracic radiosurgery using fiducial-guided Stereotactic Body Radiation Therapy (SBRT), adaptive radiation and proton therapy.

Samuel Marcrom, M.D. — Promoted to Associate Professor, non-tenure, Radiation Oncology
Marcrom is Associate Medical Director of Brachytherapy, Associate Director of the UAB Radiation Oncology Residency Program, and Director of Medical Student Clerkship. He is an Associate Scientist at the Center for Clinical and Translational Science (CCTS). Marcrom joined the department faculty in 2020 and is a graduate of the UAB Radiation Oncology Residency Program. He is the disease site leader for Gynecological (GYN) cancers and his research is focused on clinical outcomes and educational program development.

Andrew McDonald, M.D, M.S. — Promoted to Associate Professor; Awarded tenure, Radiation Oncology
McDonald is Director of the UAB Radiation Oncology Residency Program and member of the UAB Institute for Cancer Outcomes and Survivorship. He is an Associate Scientist at the O'Neal Comprehensive Cancer Center at UAB and an Associate Scientist at the Center for Clinical and Translational Science (CCTS). He joined the department faculty in 2017 after completing the UAB Radiation Oncology Residency Program. He is the disease site leader for Genitourinary (GU) cancers and his research is focused on improving quality of life in cancer survivors and clinical trials.

Dennis N. Stanley, Ph.D. — Promoted to Associate Professor, non-tenure, Medical Physics
Stanley is Chief of Adaptive Therapy in the Department of Radiation Oncology. A Diplomate of the American Board of Radiology for Therapeutic Medical Physics (DABR), Stanley joined the department faculty in 2018 after graduating from the Medical Physics Residency Program at the University of Texas Health Science Center at San Antonio. His areas of interest are Adaptive Radiotherapy, Brachytherapy, Total Body Irradiation, and Special Procedures.

Markus Bredel, M.D., Ph.D., professor and Sharon A. Spencer Distinguished Endowed Chair in Translational Radiation Oncology, has been awarded a pre-RO1 grant through The O’Neal Comprehensive Cancer Center at UAB. Bredel was named a spring 2023 O’Neal Invests awardee for his project, Haploinsufficiency of NFKBIA Subverts Dynamic Chromatin Regulation during Gliomagenesis.

O’Neal Invests provides UAB investigators with funding to conduct research on novel ideas with considerable promise and potential impact on the field of cancer care. Pre-R01 grants are for $160,000 over two years.

Read more about the spring 2023 O'Neal Invests recipients here.

Joseph Harms, Ph.D.

Joseph Harms, Ph.D., assistant professor of Medical Physics in the UAB Department of Radiation Oncology, is one of six researchers selected to receive a New Era of Radiotherapy grant from the Radiation Oncology Institute (ROI). The award is intended to stimulate research on emerging challenges and cutting-edge methods that are transforming the practice of radiation oncology.

Harms’ research will focus on developing a new detection system to be used with proton FLASH radiation therapy (RT) to measure the radiation dose and how fast the dose is delivered (dose rate).

FLASH RT is an emerging technology that uses ultra-high dose rates to treat cancer and has been shown to reduce radiation damage in healthy tissues.

“Currently, there is no way to verify dose rate from FLASH RT treatment plans, and many of the commonly used radiation detectors do not function at the very high dose rates of FLASH,” Harms said. “The system that we will develop with this grant uses an ultra-fast camera in the treatment room focused on a scintillator, a material that emits light when it is exposed to radiation. The measurement of this light is then converted to the radiation dose, allowing for real-time verification of the dose and dose rate.”

Joel Pogue, Ph.D.The UAB Department of Radiation Oncology welcomes Joel Pogue, Ph.D., as assistant professor in Medical Physics.

Pogue joins the department after completing his two-year medical physics residency at UAB.

Originally from McKinney, Texas, Pogue earned his Bachelor of Science in engineering physics from Southern Arkansas University and his master’s degree in medical physics and doctorate in biomedical physics both from East Carolina University.

His research interests are adaptive radiotherapy, dosimetry, and treatment planning.

Outside of UAB, he enjoys long-distance running, reading, chess, and movies.

Pogue resides in Birmingham with his wife and their daughter, son, and golden retriever.

Pictured from left: Deborah Della Manna, Researcher V; Veronica Brown, RN-Oncology II; and Crystal Parsons, Patient Encounter and Scheduling Manager, with their UAB Medicine Service Awards.

Several employees, including three faculty members, who work in the UAB Department of Radiation Oncology, were recently honored with UAB Medicine Service Awards and UAB Service Awards.

The UAB Medicine Annual Service Awards were created to recognize employees for years of faithful service and acknowledge their special contributions to UAB Medicine. Awardees were honored with service pins at a ceremony on June 29, 2023.

The UAB Annual Service Awards proudly honor those employees who have made a significant career commitment to the University of Alabama at Birmingham. The program is designed to recognize and express appreciation to employees at each five-year milestone who have completed five or more years of service to UAB. Those with more than 20 years of service to UAB were honored at a reception on April 11.

Congratulations to the recipients whose service to UAB Medicine and UAB through 2022 ranged from five to 35 years!

UAB Medicine Service Awards

5 Years

Marcia Feltman, RN-Oncology
Andrew McDonald, M.D., Assistant Professor
Jaquan Reid, Certified Medical Assistant

10 Years

Martha Chadband, Medical Dosimetrist
Ameila Craig, Certified Medical Assistant
Michael Beard, Radiation Therapist

15 Years

Michael Dobelbower, M.D., Ph.D., Associate Professor
James Courtney, RN, Cinical Care Coordinator

20 Years

Crystal Parsons, Patient Encounter and Scheduling Manager
Veronica Brown, RN-Oncology II

25 Years

Tashica Glenn, Medical Records Specialist
Deborah Della Manna, Researcher V

35 Years

Sharon Spencer, M.D., Professor

Learn more about the UAB Medicine Service Awards.

UAB Service Awards

5 Years

Andrew McDonald, M.D., Assistant Professor

15 Years

Kara Bishop, Medical Physics Residency Program Coordinator
Michael Dobelbower, M.D., Ph.D., Associate Professor
Honjun Wei, Researcher

20 Years

Tracey Cotton-Bickham, Radiation Oncology Residency Program Coordinator

35 Years

Patricia Hicks, Laboratory Manager 

Learn more about the UAB Service Awards.

The UAB Department of Radiation Oncology welcomed five new residents, including four radiation oncology trainees and one medical physicist trainee, on July 1, 2023.

John Hoyle, M.D.; Luke Moradi, M.D.; Katelyn Ragland, M.D.; and Andrew Simpson, M.D., join eight other current residents in the Radiation Oncology Residency Program.

John Hoyle, M.D.

John Hoyle, M.D. - PGY2

Hoyle is from Memphis, Tennessee. He majored in mechanical engineering at Vanderbilt University and completed his master’s degree in biomedical engineering at UAB. Hoyle earned his medical degree at the UAB Heersink School of Medicine in 2022 and completed his internship year at Brookwood Baptist Health System in Birmingham, Alabama.

Luke Moradi, M.D.  - PGY2

Luke Moradi, M.D.Moradi, of Birmingham, Alabama, earned a bachelor’s degree in biomedical sciences from UAB, followed by a medical degree at the UAB Heersink School of Medicine in 2022. He also completed his internship at Brookwood Baptist Health System in Birmingham.

Katelyn Ragland, M.D.

Katelyn Ragland, M.D. - PGY3

Originally from Knoxville, Tennessee, Ragland earned her bachelor’s degree in bioengineering at Clemson University and medical degree at the University of Arkansas for Medical Sciences. She completed her internship in Arkansas prior to transitioning to UAB to complete her residency.

Andrew Simpson, M.D. - PGY2

Andrew Simpson, M.D.Simpson, of Bowling Green, Kentucky, received his bachelor's degree in agricultural biotechnology from the University of Kentucky. He earned his medical degree from the University of Kentucky in Bowling Green and completed his internship at the Medical Center in Bowling Green.

Jingwei Duan, Ph.D. - PGY1

Duan joins one other current trainee in the Medical Physics Residency Program.

Jingwei Duan, Ph.D.Duan grew up in a coastal city in south China and earned his bachelor’s degree in physics at South China Normal University in Guangzhou. He then received his master's degree and doctorate in medical physics at the University of Kentucky, where his research focused on improving and automating radiotherapy workflow using deep learning techniques.

Learn more about the Radiation Oncology Residency program.

Learn more about the Medical Physics Residency Program.

The UAB Department of Radiation Oncology honored its 2023 graduating radiation oncology and medical physics residents at a dinner celebration and awards ceremony June 16 at the Birmingham Museum of Art.

Join us in congratulating radiation oncology graduates Kevin Lee, M.D., Ph.D.; Jared Maas, M.D.; Craig Schneider, M.D., Ph.D.; and medical physics graduate Joel Pogue, Ph.D. We thank them for their contributions to our department, our patients, and the UAB community over the years and wish them success in their new employment across the country.

Dr. Lee will be employed by Gadsden Regional Cancer Center, Gadsden, Alabama; Dr. Maas will be employed by Legacy Health, Portland, Oregon; and Dr. Schneider will be employed by Franciscan Alliance, Greenwood, Indiana. Dr. Pogue will join the UAB Department of Radiation Oncology as assistant professor. 

Awards

Annual departmental awards were also presented to faculty, staff, and residents during the graduation celebration. Congratulations to all the winners who were recognized for academic achievement, quality improvement, education, resident support and mentorship.

The O’Neal Comprehensive Cancer Center (CCC) at UAB announced the 2023 class of NextGen Scholars including two awardees sponsored by Christopher Willey, M.D., Ph.D., UAB Department of Radiation Oncology Associate Vice Chair of Translational Research and Hale-Stephens ROAR Endowed Professor. Willey is also a senior scientist at the CCC.

The NextGen Scholars Awards support the training of future scientific leaders in cancer research. Manoj Kumar, Ph.D., and Lauren Nassour-Caswell are two of three scholars named this year.

“We are so thankful that the O’Neal Comprehensive Cancer Center and the Young Supporters Board selected Lauren and Manoj for the prestigious NextGen Scholars awards,” Willey said. “These funds will help support two exciting projects investigating the devastating primary brain malignancy, glioblastoma. These two named awards honor Jacob Baker and Mary Ann Harvard, who were Young Supporters Board members who succumbed to cancer. We are humbled and grateful to receive these awards.”

Manoj Kumar, Ph.D.

The winner of the 2023 Jacob Baker NextGen Scholar Award is Manoj Kumar, Ph.D., currently a postdoctoral fellow in the UAB Department of Radiation Oncology. Kumar’s proposal investigates new ways to treat temozolomide (TMZ) and radiation-resistant glioblastomas. Surgery, TMZ chemotherapy and conventional radiation therapy are currently used to treat glioblastoma, but many forms of glioblastoma have become resistant to TMZ and conventional radiation therapy, creating a need for new treatment options. Kumar’s research will investigate the role of FLASH radiation, an innovative ultra-high dose radiation therapy with the potential to improve the therapeutic index for glioblastoma and other cancers, in treating TMZ and radiation-resistant glioblastoma.

The UAB Department of Radiation Oncology has launched its new TrueBeam advanced radiotherapy system at UAB Medicine’s Kirklin Clinic at Acton Road.

Clinical staff began treating cancer patients with this new cutting-edge radiation delivery system on April 3, 2023, after a three-month installation and commissioning process.

TrueBeam is Varian Medical Systems Inc.’s top-of-the-line radiotherapy technology, which can be used to treat tumors anywhere in the body where radiation treatment is indicated. It delivers a precise and fast beam of radiation to the tumor while sparing surrounding healthy tissue.

“We are proud to offer the latest cancer-fighting technology to our patients at UAB Medicine’s Kirklin Clinic at Acton Road,” said James A. Bonner, M.D., chair of the UAB Department of Radiation Oncology. “Working with the most-advanced diagnostic imaging tools and treatment systems available is what our patients expect and it allows us to provide them with the best possible care.”

In 2010, UAB was among the nation’s first cancer centers to implement TrueBeam at the Hazelrig-Salter Radiation Oncology Center in downtown Birmingham. This technology drastically reduced standard radiation treatment times from 40 minutes to less than 1 minute for select patients and opened the door to new treatment plans.

Now, patients can benefit from the advanced cancer-fighting technology at the convenient Acton Road clinic right off Interstate 459.

“It will provide patients with more options for where they can be treated with this leading-edge technology,” said medical physicist and assistant professor Jean-Guy Belliveau, Ph.D., who oversaw the commissioning of the TrueBeam at Acton Road. Patients will also benefit from shorter treatment times made possible by advances in technology including the latest safety features and automation, Belliveau explained.

Flexible treatment options, advanced imaging, high-precision dosage control, streamlined treatments, and built-in patient safety features are some of the primary benefits of TrueBeam.
Belliveau said the TrueBeam’s advanced digital automation will also allow for a more streamlined workflow for the department’s physicians, medical physicists, dosimetrists, and therapists alike. Less manual intervention will mean less downtime for maintenance and faster processes for quality assurance, he explained.

“This allows us to automate a lot of the workflows we do. It allows us to treat patients faster,” Belliveau said.

The TrueBeam replaces Varian’s Clinac EX linear accelerator at Acton Road. Belliveau said the new technology will also enhance efficiencies between the Acton Road and UAB clinics.
“If one TrueBeam is down, a patient could feasibly be treated at the other location without burdensome interventions, he explained.

The new TrueBeam treatment room at the Kirklin Clinic at Acton Road (April 2023).

ROAR presents check from gala proceeds to Chair James A. Bonner, M.D., on April 7, 2023. Photo by Frank CarnaggioRadiation Oncology Accelerated Research (ROAR) held its 12th annual James Bond Gala: “Research to a Cure” on January 28, 2023, at The Club in Birmingham.

More than 350 people from the local community and beyond came out to support cancer research, raising nearly $400,000 that will go directly to fund the department’s research efforts.

“We are so impressed by the amazing support and generosity of our local community,” said ROAR President Donna Conklin. “This gala was one of our most successful to date and we are proud and honored to present a check of $388,000 to the UAB Department of Radiation Oncology.”

ROAR is a 501(c)(3) nonprofit led by volunteers with a mission to raise money for cancer research programs in the UAB Department of Radiation Oncology. Funds raised from the annual gala are matched dollar for dollar by the department and used to fund cancer research conducted by faculty and researchers. In 2022, the ROAR gala brought in $300,000 for the department.

Jeh Jeh Pruett of WBRC Fox 6 in Birmingham was the emcee for this years's gala, which included silent and live auctions, dinner and dancing, awards and recognitions, and a tribute to this year’s honoree Marilyn Mitchell Waggoner, cancer survivor, civic leader, and wife of Alabama State Senator Jabo Waggoner.

“Marilyn Waggoner is such a strong, motivating and inspirational, woman,” said ROAR Gala Chair Julie Kim.” We are truly blessed to honor such an amazing person and role model at this year’s gala.”

Waggoner, who was diagnosed with Stage 3 triple negative breast cancer in 2013, shared her personal story and message with gala attendees, “Get early detection and regular health checkups,” she said.  

Waggoner and the ROAR officers presented UAB Department of Radiation Oncology Chair James A. Bonner, M.D. with the 2023 gala proceeds at a check presentation on April 7 at the Greystone Country Club in Birmingham.

“The ROAR group continues to do a remarkable job raising funds for our research program,” Bonner said. “ We are always impressed by the planning that goes into making this annual gala such an exciting and successful event for our department and our community. We cannot thank them enough for their continued support.” 

Planning for next year’s gala is already underway. The 13th annual ROAR gala will be held January 27, 2024, at The Club.

The Department of Radiation Oncology faculty members gather at the 2023 ROAR Gala. Photo by Frank Carnaggio

 Lewis Shi, M.D., Ph.D. Lewis Zhichang Shi, M.D., Ph.D., was appointed as first holder of the Koikos-Petelos-Jones-Bragg ROAR Endowed Professorship for Cancer Research at UAB by the University of Alabama System Board of Trustees during its Feb. 3 meeting. 

Shi is associate professor and director of radiobiology in the UAB Heersink School of Medicine Department of Radiation Oncology. He came to UAB in 2018 from Case Western Reserve University, where he was an assistant professor, following his appointment as a research faculty member and instructor at the University of Texas MD Anderson Cancer Center, where he worked on cancer immunotherapy for a number of years with Padmanee Sharma, M.D., Ph.D., and Nobel Laureate James P. Allison, Ph.D.

At UAB, Shi has established an outstanding research program in the Department of Radiation Oncology investigating the interaction of T-cell metabolism and radiotherapy, resistance to immunotherapies, and fundamental mechanisms underlying the role of the immune system in cancer therapies.

“We were so excited when Dr. Shi elected to come to UAB even though he had offers throughout the country,” said Department of Radiation Oncology Chair James A. Bonner, M.D. “He has worked extremely hard to become a strong collaborator with numerous UAB investigators. He is truly a team player and embraces all aspects of our tripartite mission (education, research, clinical care).”

Shi has served UAB’s scientific community in numerous other ways, including as a core member of the Protocol Review Committee in the O’Neal Comprehensive Cancer Center, a reviewer for junior faculty grants, and as a faculty member for the Biomedical Scientist Training Program (PSTP).

He was recently recognized as the winner of the UAB Heersink School of Medicine’s Featured Discovery in October 2022, which celebrates important research from Heersink faculty members. Shi was chosen for his melanoma research published in Nature Communications.

Ten providers in the UAB Department of Radiation Oncology were honored for outstanding patient care in 2022 and received a Patient Experience Excellence Award from UAB Medicine.

The award recognizes UAB providers who score an average of 95% or higher in patient care satisfaction rankings and who achieve top scores on the following metrics:

• Listened carefully

• Demonstrated care and concern

• Provided clear explanations

• Included patient in health care decisions

• Overall Care Rating, 0-10

“This is an outstanding level of performance and demonstrates your dedication to providing exceptional care and support for your patients and their families,” Reid Jones, chief executive officer of UAB Medicine, wrote in a letter to recipients. “We sincerely appreciate your service, sacrifice, and commitment to your patients, day in and day out. Providers like you help make UAB Medicine a leader in patient experience and known as an organization that patients and their families trust to provide them the best possible care.”

Radiation oncology providers recognized include:

• Drexell Hunter Boggs, M.D., associate professor

• Markus Bredel, M.D., professor

• Michael C. Dobelbower, M.D., associate professor

• John Fiveash, M.D., professor and senior vice chair

• Rojymon Jacob, M.D., professor

• Kimberly Keene, M.D., professor

• Samuel Marcrom, M.D., assistant professor

• Andrew M. McDonald, M.D., assistant professor

• Christopher Willey, M.D., professor

• Eddy Shih Hsin Yang, M.D., professor

Eddy Yang, M.D., Ph.D.Eddy Shih-Hsin Yang, M.D., Ph.D., will step into the role of chair of radiation medicine in the University of Kentucky (UK) College of Medicine on Feb. 1, 2023.

Dr. Yang most recently served as professor and vice chair for translational sciences in the University of Alabama at Birmingham (UAB) Department of Radiation Oncology. He also served as the deputy director and associate director for precision oncology at the UAB Hugh Kaul Precision Medicine Institute, and was co-leader of the Experimental Therapeutics Program at the O’Neal Comprehensive Cancer Center at UAB.

Yang came to UAB in 2010 after completing residency at Vanderbilt University. As a physician scientist, Yang was instrumental in creating an exceptional educational research program that has allowed UAB to train the next generation of physician scientists in the field of radiation oncology.

Yang was also the Radiation Oncology Accelerated Research (ROAR) Southeast Cancer Foundation Endowed Chair since 2012. 

During the 12th annual ROAR gala on Jan. 28, 2023, UAB Department of Radiation Oncology Chair James Bonner, M.D., honored Yang with the Radiation Oncology Scholar Award for his dedication and devotion to the advancement of the science of radiation oncology during his impactful practice at UAB Medicine.

At UK, Yang will continue his research work in the areas of genitourinary, breast, and head and neck cancers, and will hold the distinction of Markey Cancer Foundation Endowed Chair in Radiation Medicine.

Lewis Shi, Ph.D. Lewis Zhichang Shi, Ph.D., Associate Professor in the UAB Department of Radiation Oncology, has been awarded a Clinic and Laboratory Integration Program (CLIP) grant from the Cancer Research Institute (CRI).

CLIP grants provide up to $200,000 over a two-year period to support investigators like Shi who are studying critical topics at the intersection of laboratory and clinical research, known as translational research.

Shi’s CLIP project is titled, “Discovering and targeting tumor-intrinsic metabolic checkpoints to overcome immunotherapy resistance.”

“This CRI grant will allow me to tackle a major mechanism of resistance to immunotherapy in colorectal cancer, melanoma, and bladder cancer, a pressing unmet medical need,” Shi said.

Shi’s recent research on immunotherapy resistance in melanoma patients, “Selective suppression of melanoma lacking IFN-γ pathway by JAK inhibition depends on T cells and host TNF signaling,” was recently published in Nature Communications and recognized as the latest “Featured Discovery” by the UAB Heersink School of Medicine. Shi is also a scientist in the O’Neal Comprehensive Cancer Center at UAB.

Read Shi’s CLIP investigator profile here.

UAB Radiation Oncology is excited to announce its new Stereotactic Body Radiation Therapy program for breast cancer patients using adaptive radiotherapy technology.

The majority of women who present with early-stage breast cancer are a candidate for a lumpectomy, which is removal of the breast tissue and sparing of the uninvolved breast. Traditionally, four to six weeks of radiation therapy to the whole breast was required afterward to decrease the chance that the tumor would recur. More recently, for appropriately selected patients, a shorter course of partial breast radiation allows treatment to be completed over five courses. In addition, less of the normal breast is exposed to radiation, which reduces short- and long-term side effects compared to patients getting whole breast radiotherapy.

UAB Department of Radiation Oncology Associate Professor Hunter Boggs, M.D., recently published UAB’s experience with using sterotactic body radiotherapy (SBRT), which is a precise form of radiation treatment to deliver five treatments to the lumpectomy cavity. 

“The ability to reduce the surrounding dose to the uninvolved breast resulted in excellent short-term cosmetic outcomes in our study. We are still collecting data regarding long-term side effects,” said Boggs. “However, one of the issues that we would find is that the fluid collection, called a seroma, left at time of lumpectomy will shift and often shrink as the treatments progressed. The area of breast tissue surrounding the seroma is the target area of treatment for partial breast irradiation after a lumpectomy. If we could find a way to shrink our daily treatments to better pinpoint and target the fluid collection, we would be able to further decrease the amount of normal breast treated. We know that reducing the amount of radiation to the uninvolved breast results in improved side effects from treatment.”

Using an advanced imaging algorithm, Ethos is able to visualize the patient anatomy of today and create a custom radiation plan for that day. This is an example of the imaging utilized by the Ethos system with the seroma outlined in blue.

Adaptive Therapy with Ethos

Enter adaptive therapy, utilizing a linear accelerator system called Ethos by Varian, which was first implemented by the radiation oncology department in August 2021. Ethos is a first-of-its-kind treatment machine that uses advanced imaging and an artificial intelligence (AI) system to assist in plan creation and delivery. “The Ethos is a complete game changer for radiation oncology,” said Assistant Professor Dennis Stanley, Ph.D., lead physicist for the adaptive program. “Utilizing the advanced features of the Ethos allows us to better target tumors but, more importantly, better protect healthy tissues like the breast and heart. With this system we can treat your tumor as it is right now.”

“We draw out the lumpectomy cavity at time of the planning scan,” Boggs explained. “With nonadaptive therapy, we were locked into treating the same volume regardless of how the breast changes from day-to-day. However, with adaptive therapy, we can scan and redraw the lumpectomy cavity in real time while the patient is laying in the treatment position. If the breast and lumpectomy cavity are sufficiently different than our initial scan, we can replan immediately and see if our new plan will result in less dose to the normal breast and other critical organs nearby such as the heart and lung. We do this before every treatment."

According to Boggs and Stanley, UAB is the first institution in the world to treat patients with partial breast stereotactic techniques using daily adaptive replanning. “We have treated a handful of patients using this technique and we plan to examine our cosmetic outcome information over the coming months and years,” said Boggs.

“From a technical standpoint, this treatment option offers tremendous advantage, especially for our breast cancer patients; we look forward to developing this treatment technique even further,” said Stanley.

Along with the advanced treatment techniques, Ethos utilizes an optical-based surface imaging system, called IDENTIFY, to verify patient positioning and monitor patient movement.

Next Steps

Regarding next steps, Drs. Boggs and Stanley and the breast radiation oncology team are interested in exploring reducing the number of treatments required for a partial breast treatment.

“We have opened a clinical study examining the use of partial breast radiation delivered in a single treatment,” Boggs says. “We think that this will be an attractive option for patients who are looking to reduce the physical burden of coming in for a number of treatments. The adaptive technique will be perfect for this type of treatment given the need to precisely understand the shape of the lumpectomy cavity as well as the breast position prior to the single course of treatment.”

For more information about adaptive radiation therapy for partial breast irradiation, please contact 205-934-5670.

UAB Department of Radiation Oncology researchers have identified potential targets to help overcome therapy-resistant tumors in patients with glioblastoma (GBM), the most common and devastating form of primary brain cancer. 

UAB Department of Radiation Oncology Hale-Stephens ROAR Endowed Professor Christopher Willey, M.D., Ph.D., with co-authors, recently published the research, “An in vivo model of glioblastoma radiation resistance identifies long noncoding RNAs and targetable kinases” in the peer-reviewed journal JCI Insight.

“This project is focused on a real clinical problem we face in treating glioblastoma and that is acquired therapeutic resistance,” Dr. Willey said.

The current standard of care for this disease is surgery, if possible, followed by radiation and chemotherapy.

“Unfortunately, the tumor pretty much universally recurs and the median survival is only 15 months from diagnosis,” Dr. Willey said.

While there is much research on radiation resistance for GBM, Dr. Willey said most tumor models used in studies have never actually seen therapy before. “There is a lack of acquired therapeutic resistance models, particularly radiation, and we sought to improve upon that,” he said.

The new article explains how researchers used a patient-derived xenograft program, or PDX, for this disease to generate some acquired radiation resistance models that they then profiled to try to identify potential pathways of resistance.

Researchers were successful in generating phenotypically and molecularly diverse models of GBM tumor recurrence, particularly related to radiation.

They also identified alterations in long noncoding RNA transcripts (lncRNAs) in the acquired radiation-resistant PDX lines, which were associated with several gene expression signatures (e.g., cell cycle, stemness, and DNA damage response) suggesting that lncRNAs could potentially regulate pathways that lead to radiation resistance.

“And particularly important, kinomic profiling from these models reveals potential targets for therapeutic development for GBM recurrence,” Dr. Willey said.

Watch Dr. Willey’s Author's Take video for JCI Insight. Look for a summary of this article in the September 2022 "JCI This Month" print digest.

Co-authors from the UAB Heersink School of Medicine include: Christian T. Stackhouse, Department of Radiation Oncology and Department of Neurosurgery; Joshua C. Anderson, Nicholas J. Eustace, Chuan Xing, Hasan Alrefai, Kevin J. Lee, and Eddy S. Yang, Department of Radiation Oncology; Zongliang Yue, Jelai Wang, and Jake Y. Chen, Informatics Institute; Catherine P. Langford and G. Yancey Gillespie, Department of Neurosurgery; Fady M. Mikhail, Department of Genetics; Ryan E. Bash and C. Ryan Miller, Division of Neuropathology, Department of Pathology; and Anita B. Hjelmeland, Department of Cell, Developmental, and Integrative Biology.

Other co-authors include: Xiangqin Cui, Emory University Rollins School of Public Health Department of Biostatistics and Bioinformatics; James R. Rowland IV, The Ohio State University Department of Physics.

UAB Department of Radiation Oncology Chair James A. Bonner, M.D., and Associate Professor Lewis Zhichang Shi, M.D., Ph.D., recently published research with new implications for treating melanoma patients.

The article, “Selective suppression of melanoma lacking IFN-γ pathway by JAK inhibition depends on T cells and host TNF signaling” published in Nature Communications discusses the pressing issue of resistance to immunotherapy drugs called immune checkpoint blockers (ICBs) in melanoma patients.

Immune checkpoints are a normal part of the immune system that occur when proteins on the surface of immune cells (T cells) bind with their partner proteins on other cells such as tumor cells. This binding signals to the T cells not to destroy the cancer cells. ICBs work by blocking the binding, which allows the T cells to kill the cancer cells.

Melanoma, the most serious form of skin cancer, was largely considered incurable prior to the era of ICBs, yet accumulative data show only a subset of melanoma patients actually benefit from ICBs, limiting their clinical use.

Initial research from Dr. Shi (while working at The University of Texas MD Anderson Cancer Center with Padmanee Sharma, M.D., Ph.D., and Jim Allison, Ph.D.) on therapeutic resistance to ICBs in melanoma cells identified a lack of certain signaling genes (IFN-γ). Strategies to overcome this mechanism of resistance have remained largely unexplored until now.

Upon relocating to UAB in 2018, the Shi group, teaming up with Bonner group and other research teams within the department, set out to uncover therapeutic targets to treat ICB-resistant melanomas lacking functional IFN-γ signaling. They started by creating a new melanoma model that lacked IFN-γ signaling and was completely resistant to ICBs.

Researchers demonstrated that melanomas lacking IFN-γ signaling have reduced infiltration and effector function of tumor-infiltrating T cells (TILs) but exhibit an unusually active mTOR-JAK1/2 axis, a pathway essential for cell survival.

Their findings led them to employ Ruxolitinib (Ruxo), an FDA-approved JAK1/2 inhibitor to treat myeloproliferative neoplasms (MPN), a type of blood cancers. They found inhibiting activated JAK1/2 with Ruxo induced selective suppression of IFNγR1^KO melanomas, in a precision medicine fashion.

“Since Ruxo is clinically approved, our study justifies further testing of Ruxo in patients with advanced melanoma that are resistant to ICBs, particularly those with impaired IFN-γ signaling,” Dr. Shi said. “We are actively soliciting clinical interests in exploring JAK1/2 inhibition as a strategy to overcome ICB resistance in melanoma patients, a pressing unmet medical need.”

Read the full article with results in Nature Communications.

Read Dr. Shi’s related “Behind the Paper” post, “Overcoming immunotherapy resistance in melanoma defective of IFN-g signaling” in the online Nature Portfolio Cancer Community.