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under the microscope MANHASSET — Adaptive radiotherapy (ART) can be beneficial with only one or two applications within a six-week treatment period, according to findings by researchers led by a senior investigator at the Hofstra North Shore-LIJ School of Medicine and The Feinstein Institute for Medical Research. The National Cancer Institute sponsored the first-of-its-kind clinical trial, which focused on ART for head and neck cancer. Trial Examines Role of Radiotherapy in Head/Neck Cancer Physicians often use radiotherapy to treat head and neck cancer. A type of radiotherapy that is commonly used is intensity-modulated radiotherapy, or IMRT. IMRT allows physicians to “sculpt” radiation and have it bend around healthy tissue and target the tumor so the radiation adapts to the anatomy of each patient. Although IMRT is a preferred mode of cancer treatment, its Achilles heel is that it is based entirely on computed tomography (CT) or magnetic resonance imaging (MRI) performed before a treatment period begins. Since typical radiation treatment periods for head and neck cancer take six to seven weeks, standard IMRT cannot compensate for common changes that occur in a patient’s body during treatment. Such changes could include weight loss, tumor shrinkage or gradual movement of normal tissues. By not compensating for these changes, there is increased risk of toxicity or even missing the tumor. For the new trial, investigators started patients on standard IMRT. Then, they took CT scans while patients were lying in the radiation treatment room each day so they could monitor changes in tumor and normal tissues during the course of treatment (six weeks). Through computerized techniques, the investigators “adapted” David Schwartz, MD 32 Summer 2012 By Emily Ng (thus the name “adaptive radiotherapy”) according to significant tumor or body changes. “ART keeps radiation treatment tightly fitted to a patient’s body, almost as if it were being shrink-wrapped,” noted David Schwartz, MD, vice chair of radiation medicine at the North Shore-LIJ Health System and a senior investigator at the Feinstein. “It is as individualized as our current treatment can realistically be.” “What was most encouraging about the trial findings was that ART appears effective with only one or two additional replans. This means that ART does not have to be overly burdensome or expensive to make a difference. This is something that is feasible, and could eventually make a real-world difference in many clinics.” The findings of this trial were recently released online in advance of publication in the International Journal of Radiation Oncology *Biology* Physics. Above: Intensity-modulated radiotherapy, or IMRT, allows physicians to “sculpt” radiation and have it bend around healthy tissues and target a tumor.
MANHASSET — Two researchers at The Feinstein Institute for Medical Research have received novel research grants from the Lupus Research Institute (LRI) to study potential diagnostic and therapeutic options for lupus and why the disease turns the body’s immune system against itself. A total of $3.6 million was committed to the novel research program by LRI. Meggan Mackay, MD, and Thomas Rothstein, MD, PhD, received the grants. Dr. Mackay and her Feinstein colleagues will use brain imaging to investigate the relationship between certain autoantibodies (proteins made by the immune system that are directed against one or more of the individual’s own proteins) and brain dysfunction in lupus patients. Previous research in mice has shown that antibodies directed against the NMDA receptor in the brain alter the function of brain cells, causing memory and behavioral problems. They will use a new radiochemical tracer that binds to NMDA receptors in the brain so they can visualize receptor activity of lupus patients with and without the autoantibodies. If successful, the technology will be developed as a new method to evaluate brain involvement in lupus. The technology might also help monitor a patient’s response to treatment for brain disease. Dr. Rothstein will study B1 cells. B1 cells are a small subpopulation of B cells, which are responsible for producing natural antibodies that protect against infection and help dispose of cellular debris. Dr. Rothstein and his team were the first to identify B1 cells in humans, and they will continue to study whether B1 cells produce harmful autoantibodies in lupus. If B1 cells do produce harmful autoantibodies, Dr. Rothstein will explore if therapies could be developed that target B1 cells without damaging healthy B cells, which are needed to respond to vaccination and defend against many microbial pathogens (various species of bacteria, viruses and protozoa). Meggan Mackay, MD, and Thomas Rothstein, MD, PhD Lupus Grant for Feinstein Researchers By Emily Ng An Invitation to Participate in Discovery The Feinstein Institute for Medical Research’s new Recruitment Registry matches people who want to participate in clinical research with North Shore-LIJ researchers. Volunteers of any age, race, ethnicity or health status (including North Shore-LIJ staff) are invited. Participation ranges from a survey that you can do at home to a clinical trial that may involve a treatment on-site. One example of a current clinical trial is the Genotype and Phenotype (GaP) Research Registry Program. The GaP Registry allows scientists to study healthy individuals and learn about the role of genes (or DNA) in many different illnesses. More than 4,000 volunteers have enrolled; the long-term goal is to enroll 20,000 volunteers. Learn about promoting a healthier future by calling 1-877-GO-NSLIJ (1-877-466-7545) or visiting FeinsteinInstitute.org/Feinstein/Recruitment+Registry. The New Standard 33
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