Week 7

In this last week, I tried to identify stromal modifications made by radiotherapy that can elicit different cell behaviors in an attempt to better understand how patient-specific microenvironmental factors could be used to identify patients who might be radioresistant. Identifying such factors would help improve efficacy of treatment in areas the have low alpha/beta ratios like prostate cancers.

In the clinic, I was able to attend surgery with Dr. Spector and see what I would characterize as the most comprehensive demonstration of biomedical engineering’s contributions to medicine that I have seen thus far. In order to repair a mandibular defect left by the removal of a facial tumor, the doctors used a fibular flap to rebuild his mandible and bulk the surrounding tissue. In this one surgery, in addition to the normal technology found in the OR, they used a patient-specific surgical plan that used CT to create an alloy bracket in the shape of his mandible and cutting guides for the fibula. The fibula was isolated from the lower leg and cut into 3 segments, which were attached to the metal bracket and fused to the remaining pieces of the mandible.  They then microsurgically attached blood vessels from the flap to vessels in the neck using an anastomosis device and attached a doppler probe to the vein to monitor blood flow during the first 48 hours. This probe enables them to make sure that the flap maintains a sufficient blood supply to ensure its survival. The probe itself is no doubt a biomedical triumph, but additionally, it is embedded in a biodegradable polymer strap that hydrolyzes and degrades over 48 hours allowing for probe removal without disturbing the new vessel. The entire operation took close to 11 hours to complete and the patient looked unbelievably good afterward.

Reflecting on my immersion experience, I have learned a few things that I had not learned in previous hospital experiences. Most notably, I have seen the complete wholistic approach that doctors must take to addressing patient issues. When a patient comes into radiation oncology, even though it is a referral-based service, they are considering every aspect of a patient’s health when trying to develop a treatment plan or help with discomfort from treatment. Though specialists truly are extremely specialized, they have so much broad knowledge about human biology and general medicine as well as practices that more closely affect their own like medical oncology and surgery. This knowledge is applied systematically, almost as in solving a mystery, to ultimately figure out what is going on and how to fix it.

I am grateful to Dr. Formenti and everyone in Radiation Oncology for showing me the ropes. I learned so much about clinical cancer care that I could never have learned outside of the hospital.