Week 1

Ever heard of an emergency cancer case? As I prepared to leave the Radiation Oncology clinic one afternoon this week, a patient was referred for a spinal cord compression. This is the most common of the few emergencies a RadOnc department sees and is a compression of the spinal cord caused by a vertebral mass that can produce various neurological symptoms including pain, neuropathy, and paralysis. This patient had multiple myeloma, a non-solid-tumor forming cancer of the plasma cells. Treatment for this type of cord compression is only palliative, but it can be as effective as morphine for alleviating the associated pain.

They had previously received radiotherapy, which can pose problems for additional radiation therapy if the area previously treated is near the current region of interest. Clinicians have to consider dosages of radiation received by the tissues surrounding the lesion as well as the radiation these same tissues may have received as part of previous treatments. If the target area was previously irradiated, the patient would be referred for surgery instead.

Ordinarily, when a patient comes to RadOnc for treatment, they get a CT or MRI, which is used to make a simulation. The patient must be positioned very precisely and their position is recorded using tattoos on the skin and measurements on the machine. In the simulation, a CT reconstruction is used to segment out vulnerable tissues and organs whose radiation exposure must be carefully considered. A dosimetrist, physician, and physicist then work together to design a treatment plan that uses precise physics to direct radiation in the direction and at the depth of the mass. The patient then begins their first of many daily treatments roughly seven to ten working days after they came in for imaging.

Considering the methodical process that involves the precise and thoughtful work and coordination of many people to get a patient from imaging to treatment, it was amazing to see all of these people put together a plan short-handed, at the end of a shift, and begin treatment the same day, all to alleviate this patient’s symptoms.

Apart from enlightening clinical experiences like this one, I have also been exposed to a type of cancer treatment that I previously had not considered when thinking about translation of my own research. Academically, I focus so much on molecular therapeutics for cancer, that I have not fully considered other clinical treatment strategies, like radiation, to inform my work.