UPMC Radiation Oncologists: Changing Standards of Care, Improving Costs for Cancer Patients

By: Courtney McCrimmon

It is unusual for one academic institution to have more than a single article published simultaneously in a high-impact research journal, so even the authors were surprised to learn that UPMC researchers wrote three of the articles published in the most recent edition of The International Journal of Radiation Oncology, Biology and Physics, the most prestigious publication in the radiation oncology field.

“I don’t think we realized it until after they all went online,” said Beant S. Gill, M.D., lead author of one of the articles and a radiation oncology resident at UPMC CancerCenter and the University of Pittsburgh Cancer Institute (UPCI).

Dr. Gill is one of three UPMC residents to contribute to the March issue under the mentorship of Sushil Beriwal, M.D., medical director of radiation services at Magee-Womens Hospital of UPMC, and Dwight Heron, M.D., director of radiation services for UPMC CancerCenter. His article, “MRI-Guided High-Dose-Rate Intracavitary Brachytherapy for Treatment of Cervical Cancer: The University of Pittsburgh Experience,” is the largest study conducted in North America to show that the use of MRI-guided brachytherapy (a radiation therapy that inserts radioactive implants directly into the cavity through an applicator) leads to higher cure rates and fewer side effects for patients with advanced cervical cancer.

“Image-based brachytherapy is one of the most cutting-edge capabilities we have to treat cervical cancer,” said Dr. Gill. “Patients in our study had advanced cancer and received chemotherapy as well as external beam radiation therapy in conjunction with their brachytherapy treatment. Cervical cancer is an aggressive disease, but image-based brachytherapy provides us with an effective way to cure patients while limiting their risk of side effects.”

For an article discussing a prospective clinical trial exploring the effectiveness of stereotactic body radiation therapy in addition to targeted chemotherapy for patients with recurrent head and neck cancers, John A. Vargo, M.D., found that this approach, which has been pioneered at UPMC, was a feasible re-treatment strategy for a challenging group of patients.

Beyond treating a wide-variety of cancers, radiation therapy is also regularly used as a pain control measure for certain cancers. Malolan S. Rajagopalan, M.D., a resident at UPCI and UPMC CancerCenter, evaluated the cost-effectiveness of two different approaches to palliative radiation therapy. The results identified patients in whom utilization of specialized techniques would be cost effective.

Rajagopalan Malolan (010)

“We live in an era where identifying treatment strategies that improve patient outcomes at a reasonable cost is more important than ever,” said Dr. Rajagopalan. “Understanding which patients will benefit from certain treatments is important for the patient and her health care team.”

In addition to this publication, Dr. Rajagopalan was also the lead author of a study published in the March edition of Practical Radiation Oncology.

Dr. Rajagopalan worked with Dr. Heron and Dr. Beriwal, as well as John C. Flickinger, M.D., to find out if the use of shorter courses of post-surgical radiation for breast cancer patients, a treatment approach that has produced excellent patient outcomes, could be increased if recommended through a clinical pathways program.

“This study is practice-changing,” said Dr. Beriwal. “Despite significant research proving that these shorter courses of external beam radiation treatment produce equivalent patient outcomes, radiation oncologists have been slow to change their treatment recommendations. Once the treatment option became the standard in the pathway program, practice patterns altered.”

According to both Drs. Heron and Rajagopalan, clinical pathways could be a potentially powerful tool in standardizing patient care and changing practice patterns.

“It’s enormously exciting to watch the work our residents are accomplishing,” said Dr. Beriwal. “The Radiation Oncology Department at UPCI, in conjunction with the large network of patients UPMC CancerCenter treats, allows them to tackle research that directly impacts best practices and patient care.”