Beaumont doctors present research at 54th annual American Society of Radiation Oncology meeting

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Researchers present breast cancer, Alzheimer’s and prostate cancer findings Editor’s note: Beaumont Radiation Oncology physicians and researchers submitted 41 abstracts for the 2012 American Society of Radiation Oncology meeting in Boston, with a 100 percent acceptance rate. Beaumont’s research contributions to ASTRO include 10 oral presentations, three digital poster discussions and 28 posters. In addition, three Beaumont residents won ASTRO research awards.

Beaumont research sheds light on risk of prostate cancer spread or death in high-risk patients treated with radiation therapy

How aggressively should you treat men with advanced forms of prostate cancer? That’s an important question for physicians and especially for patients, whose very survival may depend upon the answer.
Research by Beaumont Health System radiation oncologists presented at the 54th annual American Society of Radiation Oncology meeting in Boston on Oct. 30 provides important information to help physicians and patients make critical treatment decisions.

The research found a highly significant connection between the degree of neuroendocrine cells present in prostate tumor biopsy samples and the risks of the cancer spreading (metastasizing) or of the patient dying of prostate cancer.

“This finding may help guide clinicians in deciding whether or not to treat aggressive forms of prostate cancer - and whether to treat aggressively with radiation treatment combined with hormone therapy,” says Daniel Krauss, M.D., lead investigator, Beaumont Health System radiation oncologist, and associate professor of radiation oncology, Oakland University William Beaumont School of Medicine.

“This will also help patients better understand the future risks associated with their prostate cancer and help them feel more comfortable with whatever treatment decisions they make,” adds Dr. Krauss.
The study looked at 289 prostate cancer patients with a Gleason Score greater than 7 treated with radiation therapy at Beaumont.

The Gleason Grading System is a tumor scoring system that looks at microscopic tumor patterns. A pathologist examines a prostate biopsy tissue sample through a microscope and assigns a Gleason grade and score. Cancers with a higher Gleason score of 8-10 are more aggressive and have a poorer prognosis. Most prostate cancer cases have Gleason scores in the range of 6-7.

In the study, the pathologist used a common biopsy staining technique, chromogranin A or CgA, that is available in all pathology departments to look for neuroendocrine differentiation in biopsy tumor cells. Neuroendocrine differentiation comprising greater than 1 percent of the tumor cells was found to be a powerful predictor of metastases or mortality in patients treated with radiotherapy.

“This is a new finding,” says Dr. Krauss. “Although it has been looked at in the past to a very limited degree, this association is not well known and this is not something that at this point is considered in prostate cancer management decisions. Further research will need to be conducted to define new treatment approaches for patients found to have neuroendocrine differentiation on their prostate biopsies.”

Beaumont Radiation Oncology physicians and researchers submitted 41 abstracts for the 2012 ASTRO meeting with a 100 percent acceptance rate. Beaumont’s research contributions to ASTRO include 10 oral presentations, three digital poster discussions and 28 posters. In addition, three Beaumont residents won ASTRO research awards.

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A Beaumont research first: radiation therapy for Alzheimer’s disease

Radiobiologist Brian Marples, Ph.D., and a team from the Beaumont Research Institute are thinking “inside the box.” The radiation oncologists may be the first in the world to use image-guided radiation, a proven treatment for cancer, to treat Alzheimer’s disease.

The team has had success in reducing brain plaques associated with Alzheimer’s in mice using low dose radiation treatments. Brain plaques are one of the key pathologies associated with Alzheimer’s disease.

Dr. Marples will discuss their findings at the Oct. 28-31 American Society of Radiation Oncology’s 54th annual meeting in Boston.

According to the Alzheimer’s Association, Alzheimer's disease is the most common type of dementia. It causes problems with memory, thinking and behavior. About 5.4 million Americans have Alzheimer’s and by 2050 it’s estimated the number could surge to 16 million. The hallmarks of Alzheimer’s are the deposits and accumulation of brain plaques, known as beta-amyloid plaques and the formation of tangles of protein. These abnormal structures are believed to kill and damage nerve cells, leading to cognitive deficits.

Before the Beaumont study, most research looking for new therapies to treat Alzheimer’s has focused on the development of new medications or pharmaceuticals and these drugs have not provided long-term relief of symptoms.

Explains Dr. Marples, “Currently there is no cure for Alzheimer’s and current pharmaceuticals have had limited success because of the blood brain barrier. These medications are not suitable for all Alzheimer’s patients. They have limitations. Furthermore, they are costly and time-consuming to develop.”

In contrast to prescribed medications, radiation therapy, or RT, is an established procedure. Adds Marples, “Radiation therapy can be done safely, quickly and inexpensively to treat large numbers of patients given the abundance of RT centers in the U.S. Potentially, RT could be used to treat Alzheimer’s patients with mild or severe dementia, without further impairing their cognitive function.”
The Beaumont research team believes modest treatments of image-guided RT targeted to the brain will be effective at reducing beta-amyloid associated with Alzheimer’s while not producing further cognitive deficits.

Says Dr. Marples, “Our experiments, which are still in the early stages, have used two different mouse models. Modest dose RT treatments reduced the number of plaques and extent of tangles in these models; this suggests RT could be a new treatment for Alzheimer’s.”

Much more research has to be done before human trials are considered. The following questions need to be addressed:

  •     Why is there a marked reduction in plaques?
  •     How often and what dose intensity is needed?
  •     Can irradiation prevent the accumulation of plaque?
  •     How can cognitive deficit be measured?

“The use of ionizing radiation therapy as a treatment for Alzheimer’s is entirely novel and unconventional,” adds Dr. Marples. “Regretfully, there is reluctance by many in geriatric medicine specialties to consider RT because of an out-dated assumption that it will produce serious cognitive harm, regardless of the dose. Clinical data exists which show modest brain irradiation can be used without significantly affecting cognition in some cancer patient and pediatric populations. Modern image-guided, dose-sparing RT delivery techniques minimize the dose to critical structures, thereby lessening the potential for cognitive impairment.”

Before RT can be implemented in a clinical setting, the cognitive and behavioral effects of beta-amyloid reduction, as a key regulator of Alzheimer’s progression, need to be determined. The underlying mechanism needs to be defined to ensure the approach can be safely implemented.

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Two-day breast cancer treatment offers same results as five-day

A breast cancer comparison study presented Oct. 30 at the American Society for Radiation Oncology, or ASTRO, shows that two-day radiation therapy treatment produced results similar to five-day treatment in those with early stage breast cancer.

Principal investigator Peter Chen, M.D, radiation oncologist, Beaumont Health System compared clinical outcomes using Accelerated Partial Breast Irradiation, or APBI. APBI is used to treat only the part of the breast at highest risk. This technique delivers a radioactive seed, about the size of a grain of rice, to the area while minimizing radiation exposure to normal surrounding breast tissues.

Beaumont is the only hospital in Michigan and one of few in the nation offering the two-day radiation therapy treatment for early-stage breast cancer.

Dr. Chen and a team of researchers reviewed data of 114 patients who were treated between June 2000 and January 2011 with either a two-day or a five-day APBI schedule. The results of the comparison showed no significant differences in cancer recurrence, survival rate or spreading of cancer to other organs or lymph nodes. The results showed nearly five years after, the two-day regimen clinical outcomes were equivalent to the five-day plan.

“This comparison has shown a true benefit to using time-compressed, precise radiation therapy to treat breast cancer,” says Dr. Chen. “Women who may already have full schedules with managing professional and family life will have the opportunity to receive therapy in fewer days with quicker recovery as compared with traditional radiation therapy treatments which take 6 ½ weeks.”
Marilou Thomas of Clinton Township was the first patient in the nation to receive the two-day treatment March 2004. She is free of breast cancer. Thomas explains she was happy to try a medical treatment to help advance breast cancer treatment.

“Being the first person [to try the accelerated treatment] makes me feel wonderful because I can help somebody else [with cancer],” says Thomas. “I made up my mind, I am going to beat this; it’s not going to beat me.”

The American Cancer Society estimates about 226,000 new cases of invasive breast cancer will be found in U.S. women in 2012. As a result of detecting and treating cancer earlier, breast cancer death rates have been decreasing. According to American Cancer Society, there are more than 2.9 million breast cancer survivors in the United States.

About Beaumont Radiation Oncology
Beaumont’s Radiation Oncology department is ranked among the nation’s best for advanced technology, innovative treatment and research. Advanced radiation treatments developed at Beaumont include adaptive radiation therapy, image-guided radiation therapy, high-dose rate brachytherapy and hyperthermia therapy. Find out more at cancer.beaumont.edu/radiation-oncology.

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Angela Blazevski
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