b'Redefining Research & CareDr. Robert Timmerman (right), a pioneer of stereotactic radiation, with RadiationBrain neurosurgeon Dr. Bruce Mickey uses a microscope to identify and remove Oncology Department Chair Dr. Hak Choy.cancer cells that have traveled to the brain and formed metastases.A Global Leader in Stereotactic Radiotherapy Treating Cancer at the DestinationUT Southwesterns Radiation OncologyOligometastasis: tumors that have spreadof SBRT for kidney cancer. Program is a world leader in the use ofto one or a few sites, but not widelyThe UT Southwestern team recentlyof the brain. The team carefully strategizesImportantly, life expectancy was increased SBRT for kidney cancer. The Kidney(NCT02956798) (see page 34)published its experience with avant-gardeAdept UT Southwestern teams navigateto minimize injury to healthy brain tissue,from a few months (historically) to over 19 Cancer Program has pioneered the useOligoprogression: metastatic cancers thatstereotactic radiation for kidney cancer intricate procedures.using minimally invasive procedures, suchmonths in those patients presenting with of SBRT for tumor thrombi as well as forare mostly stable but progressing at onethe largest in the world. This involved 175as laser interstitial thermocoagulation.brain metastases. oligoprogression. Beyond conventionalor a few sites (NCT03696277) (see pagemetastases beyond conventional brainTreatment of kidney cancer in the brain,When metastases are multiple,As such, UT Southwestern kidney uses for bone and brain metastasis,51) metastases. Analyses as far as two yearsbones, or lungs requires special exper- neurosurgeons work closely with radi- cancer experts generally recommend SBRT is being deployed for:Metastatic cancer in combination without found that radiation effectively stoppedtise. At Simmons Comprehensive Canceration oncologists such as Dr. Robertaggressive care of patients with brain Small renal masses: tumors thatimmunotherapies to prime the immunethe growth of the metastases. (StrakaCenter, an array of skilled physiciansTimmerman to determine the optimal timemetastases. Results such as these likely measure about 1.5 inches or lesssystem for an attack (NCT03065179) (seeet al., J Clin Oncol, 2013; Hannan et al.,works closely with patients to ensure opti- to perform open surgery or use radiation. (NCT02141919) (see page 30) page 47)Cancer Biol Ther, 2015; Wang et al., Int Jmal patient care and outcomes. The team utilizes highly advanced technol-Tumor thrombi: tumor extensions inRadiat Oncol Biol Phys, 2017; Zhang et al.,While metastases to the brain haveogies such as the Gamma Knife Icon for the vena cava (NCT02473536) (seeNo other program around the world hasInt J Radiat Oncol Biol Phys, 2019; Freifeldtraditionally been regarded as infre- radiation, the only cancer treatment center page 32)such a developed repertoire of clinical trialset al., Kidney Cancer, 2019)quent (generally seen as occurring inin North Texas to do so.about 10 percent of cancer cases),This cutting-edge care is improving UT Southwestern investigators havesurvival rates for patients whose kidney HOW CAN RADIORESISTANCE BE CONQUERED? found that 20 to 30 percent of patients willcancer has spread to the brain.develop brain metastases over the courseRecently, investigators reported With support from the Kidney CancerUsing this platform, his lab is ableof their disease.their experience in the treatment of 56 Program and SPORE, scientistto evaluate how different kidneyDrs. Bruce Mickey and Toral Patel arepatients diagnosed with brain metasta-Benjamin Chen, Ph.D., is studyingtumors respond to doses of radiationpart of a team of neurosurgeons that treatsses at UTSW early on in the course of why some renal tumors are resis- comparable to those administeredmore patients with brain tumors thantheir cancer (at presentation or during tant to radiation. Dr. Chens lab hasto patients using SBRT. Through theany other institution in North Texas. Thetheir first drug treatment). They found leveraged the tumorgraft platformidentification of sensitivity and resis- surgical team regularly employs comput- that stereotactic radiosurgery effectively Dr. Alex Bowman, who completed his fellowship (see page 67) to study how humantance markers, Dr. Chen hopes toTumors from patients growing in mouseer-assisted neuronavigation and advancedtreated the brain metastases with con- training in oncology and kidney cancer at kidneys, such as the one on the left (see kidney cancer responds to radiation.better tailor radiation to tumors. normal kidney on the right), are used byapproaches, such as awake craniotomytrol rates over 85 percent at two years.UT Southwestern, where he was chief fellow, the Chen lab to study radiation response. with brain mapping to identify and protectIn some patients, as many as 26 brainwas a first author in a report reviewing how the Kidney Cancer Program cares for patients with critical language, visual, and motor regionsmetastases were radiated in one session.brain metastases. 52 53'