Radiation Reimagined: How MSK Experts in Radiation Oncology Are Transforming Care for Metastatic Cancer

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Radiation oncologist Josh Yamada

"When we are able to deliver high doses of radiation safely within tumors, it is actually a much more effective way to kill tumor cells than giving small amounts of radiation over an extended period of time," says radiation oncologist Josh Yamada.

With potent, knifelike beams that can sear cancer cells yet spare healthy tissue, there’s a growing arsenal of weapons pioneered by Memorial Sloan Kettering’s radiation oncologists to reach tumors that have recurred deep inside delicate regions of the body.

Radiation oncologist Josh Yamada and his colleagues are helping people with two particularly important advances developed at MSK: high-dose radiation and computer software called ECHO. This algorithm exquisitely fine-tunes radiation doses, resulting in a level of precision that Dr. Yamada says reduces possible side effects and produces better outcomes. It’s used on about 8% of MSK patients now, but it’s expected to treat 80% of them in the next decade, says Dr. Yamada.

“When we are able to deliver high doses of radiation safely within tumors, it is actually a much more effective way to kill tumor cells than giving small amounts of radiation over an extended period of time,” says Dr. Yamada.

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‘I’ve Got This’

MSK patient Tim Willis is a strong example. He came to Dr. Yamada in the fall of 2017 because cancer that started in his kidney had spread, causing tumors on his spine.

Tim was deeply worried about pain and paralysis but remembers, “Once Dr. Yamada gave me his medical assessment, he actually put his hand on my knee and said, ‘Just so you know, I’ve got this,’ which still gives me shivers.”

Six months later there was no evidence of disease in Tim’s spine. “I reclaimed my life,” he says. “I feared being debilitated after this treatment. But it was the exact opposite. The quality of life has been absolutely outstanding.”

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New Tech for Best Treatment

So far, about 1,000 spine tumors have been treated at MSK with the help of ECHO. Creating this high-precision software took seven years, with a team lead by MSK’s Linda Hong and Masoud Zarepisheh. Joseph Deasy, Chair of MSK’s Department of Medical Physics and Enid A. Haupt Chair in Medical Oncology, compares the technology to switching to a self-driving car to navigate tricky paths.

“ECHO is much more like an automated process that drives the car for you. The limitation with radiotherapy treatment up until now was that there was no way to tell that you actually had the best plan. ECHO gives us the best plan.”

And because ECHO automates so much of the planning process, Dr. Yamada believes it can help people far outside MSK. “In American hospitals, and especially in lower-resource countries, ECHO can reduce costs and allow medical teams with lower skill levels to give very precise radiation.”

Patient and doctor talking, both wearing masks

Tim Willis (left) and radiation oncologist Josh Yamada at an appointment in March 2021.

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Life-Changing Pain Relief

At MSK, new approaches to using radiation therapy can also relieve the physical pain that can make day-to-day living uncomfortable and continuing therapy more difficult — especially when cancer spreads to the bones.

That’s an area of intense focus for MSK radiation oncologist Jonathan Yang. He explains, “Cancers that spread to the bone are about 100 times more common than cancers that originate in the bone. They often cause acute pain and fractures and can be very frightening and disabling for patients already dealing with their primary cancer.”

That was the situation facing Jacqueline Hickey. She had repeatedly fought off lung cancer since she was first diagnosed at age 40 in 2007. When the cancer returned in 2018, her personal physician suggested Memorial Sloan Kettering.

A combination of chemotherapy and radiation helped. But eventually the cancer spread to her left rib. Jacqueline recalls, “It just hurt so bad, especially lying down at night. I got so sleep deprived.” During the day, her activities were also severely hampered by pain.

Jacqueline was leery of pain medications. As a mother of four, she explains, “I want to be able to focus. I have one child still at home and my firefighter husband often has to work 24-hour shifts. I don’t want to be conked out.”

VIDEO | 03:00
The ECHO treatment plan, developed by the medical physics team at MSK, is revolutionizing the way radiation treatment is delivered to cancer patients. This groundbreaking innovation allows physicians to guarantee pinpoint accuracy through A.I.-powered calculations, effectively killing cancer cells quicker and less intrusively than ever before.
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Bone Metastasis Clinic Makes Life Easier

Jacqueline found help at MSK’s Multidisciplinary Bone Metastasis Clinic, established in 2019, where patients can see all the specialists they need on the same day.

Led by Dr. Yang, interventional radiologist Ernesto Santos, and orthopedic surgeon Max Vaynrub, the clinic also includes specialists in rehabilitation medicine and pain management.

To help Jacqueline, the clinic team decided to use cryoablation and stereotactic body radiotherapy (SBRT) — the same treatment used on the spinal tumors of Tim Willis — which uses targeted, focused external beam radiation to maximize the radiation dose to the tumor while minimizing damage to the normal tissue. Cryoablation involves inserting small needles into the bone metastases, freezing and killing the bits of tumor.

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New Outlook

“It’s unbelievable the difference it has made,” says Jaqueline. “Now, I’m back to sleeping, going out walking, and being able to function and run a family.”

And she has a message for other people with bone metastases. “There are so many new things coming out, and it’s exciting — if one thing doesn’t work, there’s always something else they can try,” says Jacqueline. “Even with stage IV lung cancer, I’m never giving up.”

Although Tim Willis recently needed another round of treatment for more spine tumors, he shares Jacqueline’s attitude. “When people hear that I’m a stage IV patient,” he says, “they kind of step back and say, ‘Oh, I’m sorry.’ And I say, ‘No, I feel so much better than I look on paper.’”

MSK News Summer 2021
This special issue focuses on metastasis: What's available now — and on the horizon — for patients like Ilene Thompson facing advanced disease. Read about this important work in our summer issue.
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