Dr. Wong works with Christina Runge-Samuelson, PhD, Medical College of Wisconsin audiologist, to study ways to minimize hearing loss caused by cisplatin. The two tested a large group of patients and are analyzing the data. “Once we analyze the data, we hope to come up with therapeutic interventions to decrease that risk,” Dr. Wong said.
Stuart Wong, MD
Their work will be incorporated into a study with the Radiation Therapy Oncology Group (RTOG), a national research cooperative. Dr. Wong is co-chair of RTOG’s head and neck committee.
RTOG will examine the most effective way to treat patients with HPV-positive, oropharyngeal carcinoma with the fewest side effects. Hearing loss was incorporated into the study after Dr. Wong discussed the research with an RTOG colleague. Dr. Runge-Samuelson is co-investigator for the hearing test portion. “This is probably the most important study of our era in this field,” Dr. Wong said.
Pioneering Radiation Treatments
The challenge with any cancer is getting radiation to the tumor while avoiding healthy tissue around it. That becomes even more difficult in the head and neck, which contain so many vital structures. Early in 2000, Dian Wang, MD, PhD, and Christopher Schultz, MD, Medical College of Wisconsin radiation oncologists, pioneered the use of positron emission tomography (PET) combined with CT scans to improve the accuracy of intensity modulated radiation therapy (IMRT). PET/CT combines the two technologies in one machine and the patient has a PET and a CT scan in one session.
“The tumor target is outlined in the PET/CT images,” Dr. Wang said. “This way, the tumor target is precisely treated with high dose radiation while the dose to the adjacent normal tissues is minimized.” The key, Dr. Wang said, is using the highest quality PET/CT technology and performing scans with the patient in the same treatment position used for IMRT planning.
“Another important innovation is CT-based validation of daily treatment delivery,” Dr. Wang added. “Every day we do a CT scan before the radiation treatment. The CT scanner is part of our treatment machine.” TomoTherapy® is one example of this approach, also known as image guided radiation therapy (IGRT). It allows physicians to adjust the patient’s treatment position each day to ensure the most accurate radiation delivery to the tumor.
Dr. Wang is also excited about innovations involving targeted agents — drugs that can help make radiation more effective, which can mean lower doses of radiation and reduced toxicity. Targeted agents focus on the tumor tissue, rather than affecting everything as chemotherapy drugs do. “Our team is actively pursuing this area of research,” he said. “This type of treatment is critical to the future.”
Lasers, Endoscopes and Robots
“There’s been a technology explosion in the past five years,” said Becky Massey, MD, Medical College of Wisconsin otolaryngologist and microvascular surgeon, “Now, rather than traditional approaches, we use endoscopes and lasers. Even robotic-assisted technology is on the horizon.”
The endoscope provides visualization for lasers, delivered to the treatment site through flexible wires. “It’s much easier to get the laser where you want it to be,” she said. “Now, we can accomplish positive cancer outcomes without removing the larynx (voicebox). Patients have an option for minimally invasive surgery that cures their cancer while preserving quality of life. All of our treatment approaches are moving toward the goal of the best possible cure with fewest possible side effects.”
Becky Massey, MD, explains options to a patient undergoing head and neck cancer treatment.
Robotic-assisted surgery for head and neck cancer may have value for select patients in the next five years. It could eventually provide better access for tumor removal with less structural damage, but right now, “like any technology, just because it’s available doesn’t necessarily mean it’s helpful,” Dr. Massey said. “We carefully consider the benefit to our patients before we offer a treatment.”
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