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Advancing Cancer Care

Reprinted from the September, 2004 issue of M.D. News, Baltimore-Annapolis edition. Reprinted with permission of Sunshine Media/Lund Media Associates (elund@lundmedia.com)

University of Maryland Greenebaum Cancer Center
Department of Radiation Oncology
by Martie Callaghan

Dr. Regine and a colleague review a patient's films.

Shooting hoops was a great escape for William Regine during medical school. In fact, he figured he would stay connected to that sport and others by specializing in orthopedics... until he engaged in a little one-on-one with the chief resident of Radiation Oncology at Syracuse. “We were playing basketball and got to talking,” he recalls, “and it dawned on me that I really enjoy challenges; I like having the ball in my hands. I like having the potential to make a life-altering impact on patients.” And he is doing just that.

Taking the Lead

Dr. Regine, professor and chair of the department of radiation oncology at the University of Maryland School of Medicine and chief of radiation oncology at the University of Maryland Medical Center, received his medical degree from the State University of New York Health and Science Center at Syracuse and completed his residency at Thomas Jefferson University Hospital in Philadelphia. He completed radiation oncology fellowships at Thomas Jefferson and at the University of Florida. He accepted his first faculty position at St. Jude’s Children’s Research Hospital and came to the University of Maryland from the University of Kentucky, where he was a professor of radiation medicine and neurosurgery and vice chairman of the department of radiation medicine for eight years.

The offer of a job at the University of Maryland presented Dr. Regine with the challenge to lead the radiation oncology program in becoming one of the nation’s elite. “When I look at the commitment and goals of the institution, clearly the University of Maryland Greenebaum Cancer Center (UMGCC) and Department of Radiation Oncology have a lot to look forward to in terms of growth and expansion of what is already a great program,” he says. “It’s a fantastic place and full of people across different areas who are truly committed to what they do. They are already elite when it comes to the passion and desire to take care of the patients.”

Clinical research is Dr. Regine’s strong suit and a major component of the work in the Department of Radiation Oncology. “We offer patients access to the latest and greatest,” he says, “which they often can get only by participating in clinical trials.” The department is one of less than 30 in the country that boast full membership in the Radiation Therapy Oncology Group (RTOG), a National Cancer Institute (NCI) sponsored group. This designation is earned by actively participating in clinical trials sponsored by the NCI and by passing rigorous quality assurance reviews of treatment delivery, equipment, etc. “We tell patients that we put ourselves under the microscope,” Dr. Regine says, “and we welcome that opportunity.”

Reaching the Community with Telemedicine

Beneficiaries of the cutting-edge technology offered by the University of Maryland Greenebaum Cancer Center can be found beyond the Center’s walls through a new telemedicine program. Community partners are linked to the downtown medical center, via teleconferencing equipment which allows real-time grand rounds, conferences, seminars and patient second opinions.

Patients receiving cancer treatment at any of the selected community cancer centers now have access to the same clinical trials and novel treatments that are currently available at major academic centers. Participating sites include the Central Maryland Oncology Center in Howard County, Montgomery General Hospital’s Helen P. Denit Center for Radiation Therapy and North Arundel Hospital’s Tate Cancer Center.

Dr. Mohan Suntha, vice chairman of the University of Maryland Greenebaum Cancer Center’s Department of Radiation Oncology and associate professor of radiation oncology at the University of Maryland School of Medicine, stresses that the quality of care and technology are just as good at the community sites as they are at the Center. “When a patient walks in the door at Montgomery General Hospital or North Arundel Hospital, we are committed to ensuring that they get the same access to clinical trials that they would if they came to the Cancer Center in Baltimore,” he says. “Telemedicine has allowed us to integrate community programs under the umbrella of the University of Maryland Greenebaum Cancer Center and our overall cancer vision to provide the best cancer care for Marylanders.”

Cutting-Edge Advancements

Dr. Suntha received his medical degree from Thomas Jefferson Medical College and completed his residency and fellowship at the University of Maryland Medical Center. His special interests include head and neck cancer, lung and esophageal cancer, all of which are among the types of cancer that can be treated with Intensity Modulated Radiation Therapy, or IMRT. Considered by many physicians to be the most advanced radiation available, IMRT uses varying beam intensities to send a higher dose of radiation to the tumor site from the most favorable paths, thereby minimizing damage to surrounding normal tissue and delicate organs such as the eye or spinal cord. “Physicians at the University of Maryland have patented a radiation delivery technique called Direct Aperture Optimization (DAO) which maximizes IMRT efficiency by dramatically reducing the treatment time,” says Dr. Suntha. DAO also increases patients’ comfort and helps to ensure that they remain still so that the most effective dose of radiation is received right at the site of the tumor.

Since the 1950's, technology has been evolving to do stereotactic radiosurgery (SRS) for tumors or benign disorders in the brain. In 1992, the University of Maryland was the first site in the mid-Atlantic region to have a Gamma Knife unit which delivers treatment with the precision of a scalpel but without using a scalpel. The “bladeless knife” emits 201 finely focused beams of radiation directly into the brain at the exact location of the target.

In the absence of exposing the brain, the risks of infection and hemorrhage are eliminated. The University of Maryland has treated more than 2,000 patients with Gamma Knife technology. “Just last year, the FDA approved some systems that allow us to do intra-cranial technology extra-cranially, that is, to all parts of the body, whether chest, abdomen or pelvis,” Dr. Regine says. “It was just a matter of the technology evolving and catching up. The extra-cranial stereotactic radiosurgery delivers an even higher dose of radiation and with more precision – like in the intra-cranial world in other parts of the body. We are using and evaluating the extra-cranial SRS and we already have a protocol which includes patients with head and neck, thoracic, abdominal and pelvic malignancies.”

Perhaps the newest treatment which the University of Maryland has begun to employ is the delivery of radiation through radioactive micro beads called SIR-Spheres®. Primarily used in patients with liver tumors, the most common application is with colorectal cancer patients who develop liver metastasis. This technology allows the delivery of radioactive particles through the arteries that feed the liver and is preferentially taken up by the tumor deposits in the liver, thereby giving a very high dose to the liver spots and minimal exposure to healthy liver tissue.

“Other hospitals have acquired the technology, but we are the only one in the area with an active program,” Dr. Regine says. In light of this and other cutting-edge developments, the University has made use of a multidisciplinary conference and developed the Liver Directed Therapies Program, which consists of radiologists, pathologists, medical oncologists, radiation oncologists and surgical oncologists. The group meets once weekly to review patient information and determine candidacy for SIR-Spheres® and other cutting-edge therapies. “Even if a patient is not a good candidate, we have other things that include extra-cranial SRS, chemoembolization, radioablation therapy and surgical resection,” says Dr. Regine, “...a full armamentarium to deal with any scenario, whether primary or metastatic.”

According to Dr. Regine, the technologies used in the field of radiation oncology will continue to evolve. “I think we will be able to deliver more therapeutic doses of radiation and do an even better job of sparing healthy tissue,” he says. “We are going to see the best of all worlds.... Radiation and chemotherapy will continue to enable our surgeons to do less of the extensive and potentially disfiguring resections and will allow them to do more minimally invasive surgical procedures in dealing with cancer, as radiation becomes increasingly more precise.”

For more information about the University of Maryland Medical Center’s Department of Radiation Oncology and the University of Maryland Greenebaum Cancer Center, call 1-800-373-4111 or 410-328-6080.

This page was last updated on: August 31, 2007.

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