The Radiation Oncology Department has made several important research contributions over the past decade. The real-time radioactive seed implant technique employing intraoperative planning was pioneered at Sinai. The finding that a minimum D90 dose of 140 Gy for I-125 seed brachytherapy was associated with improved biochemical survival for prostate cancer remains a seminal paper in the field and appropriately focused attention on implant quality as a predictor of treatment outcome.
Other important findings reported by the Sinai brachytherapy group are the largest and most comprehensive report on sexual function after prostate brachytherapy and the excellent outcomes reported after prostate brachytherapy combined with external beam radiotherapy and/or hormonal therapy for intermediate to high risk patients with prostate cancer. The prostate database continues to mature and important questions related to this modality remain to be answered. The department has contributed to other areas of prostate cancer research including the use of chemotherapy for high risk patients, analyzing the prognostic impact of endocrine abnormalities and determining the role of surgical staging for patients undergoing radiotherapy.
The radiobiology section is actively investigating the potential role of screening for ATM mutations predictor of complications after radiotherapy. ATM is a gene that plays a central role in cell response to radiation. ATM homozygous mutants are extremely sensitive to radiation damage and have increased cancer susceptibility. While ATM heterozygotes demonstrate increased susceptibility to breast cancer, until recently, there was little evidence of radiation sensitivity. Using a novel high pressure liquid chromatography assay, patients were treated with breast radiotherapy and prostate brachytherapy were screened for ATM mutations. For both breast and prostate cancer, complications after radiation were more frequent in patients harboring ATM mutations. The impact of ATM mutations in breast cancer is currently being evaluated by an international cooperative group (WECARE).
The department’s commitment to research is demonstrated by the recent addition of two physician-scientists, Jamie Cesaretti, M.D. and Johnny Kao, M.D. Dr. Cesaretti and Kao have both been awarded Physician Research Training Grants from the Department of Defense to support their laboratory research.