The Target - Fall/Winter 2023

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TABLE OF CONTENTS

Message from the Chair Our department continues to grow in all areas while we proceed as trailblazers in cancer technology and treatment – all of which we cover in this issue of “The Target.”

Patient Spotlight 3 A Beacon of Hope in the Fight Against Pancreatic Cancer 6 Technology: Upgrading HDR Brachytherapy 8 Technology: Upon Further RefleXion 10 Technology: Markerless Radiation Erases a Reminder and Improves Breast Cancer Therapy 12 Clinical Trial 14 Basic Research 15 Education Highlights 17 New Faculty Q&A 19 Awards & Recognition 27

Impressively, our department is one of only a handful of facilities in the world with the RefleXion treatment platform, a technology combining PET and CT with a medical linear accelerator. As we discuss on page 8, this unique approach is known as biology-guided radiotherapy (BgRT) and utilizes PET signals that correspond to a patient’s specific biological processes to offer many patient benefits. We also highlight new technology for our gynecological brachytherapy patients that offers a multitude of benefits, including improved treatment accuracy and efficiency, as well as treatment plan optimization.

We are thrilled that UT Southwestern’s Pancreatic Cancer Program has secured a significant grant by partnering with the Canopy Cancer Collective. Like us, this group is actively engaged in diverse quality improvement projects geared toward improving pancreatic cancer patients’ well-being and longevity, with the overarching goal of driving innovation in cancer care.

In these pages, we also report on two recent R01-funded projects that aim to change how we treat certain cancers. One study examines how to immunologically target colorectal cancer and combine radiotherapy and chemotherapy with immunotherapy, facilitating the development of a new and more effective treatment strategy for patients. The second will enable us to gain access to what we currently cannot see for precise cancer treatment in the liver. We also describe findings from a recently completed clinical trial on daily adaptive radiotherapy that has achieved treatment of the tightest volumes of head and neck cancer to date through daily volume reduction.

We are immensely proud of these combined efforts and look forward to the next steps in advancement.

Our Clinical Providers 28

Robert Timmerman, M.D., FASTRO, FACR Chair, Department of Radiation Oncology Effie Marie Cain Distinguished Chair in Cancer Therapy Research

Edward Wright Sr.

Patient Spotlight: Edward Wright Sr.

By Mary Whitmore

In 2012, Edward Wright Sr., D.Div., was living in California and about to take a vacation when his physician called to say he was concerned about Dr. Wright’s PSA level, which had jumped from 1.5 to 5.5 over the past year. He was told more tests would be needed but was assured there was nothing to worry about.

He was sent to a radiologist and later met with a team of specialists who said he needed a biopsy.

The result of that showed a small tumor about the size of the tip of an ink pen.

They gave him two treatment options: to remove his

prostate or to conduct active surveillance. The latter meant a physician would monitor the tumor closely, watching to see how it progressed, which is what Dr. Wright decided to do.

Dr. Wright, a U.S. Navy veteran, moved to Dallas in 2015 and continued the tumor’s active surveillance.

In 2017, his physician at the Dallas VA expressed concern over another increase in his PSA. He was referred to UT Southwestern Harold C. Simmons Comprehensive Cancer Center, where he met with Raquibul Hannan, M.D., Ph.D., Chief of Genitourinary Radiation Oncology Service, and Tamara Dickinson, M.S.N., APRN, AGPCNP-BC, CURN, CCCN, a nurse

THE TARGET / PATIENT SPOTLIGHT

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Edward alongside his UT Southwestern care team including Dr. Raquibul Hannan and Tamara Dickinson.

practitioner who specializes in genitourinary cancer.

From the start, Dr. Wright expressed confidence in his team. “It is so important for a patient to feel comfortable and at ease with their care team – even more so in cancer care,” Tamara says.

The recommended course of treatment was stereotactic ablative radiotherapy (SAbR), a procedure developed by the UT Southwestern Department of Radiation Oncology. SAbR uses powerful doses of radiation to precisely destroy tumors while sparing healthy nearby tissue. Before treatment, Dr. Wright’s PSA count was 10.5; his count is currently 0.52.

As a cancer survivor, Dr. Wright became passionate about educating the community on the importance of early screenings, so he started a foundation in February 2022 called We Can Win: Real Talk About Prostate Cancer, which encourages men, especially Black men, to get screened for prostate cancer.

Since its inception, We Can Win has held an annual symposium that seeks to bring men of color together, along with physicians and health care providers, prostate cancer patients and survivors, and caregivers, to discuss the importance of early detection and screening, as well as available treatment options.

According to the American Cancer Society’s Cancer

Action Network, “Black men in the U.S. have among the highest documented prostate cancer incidence rate in the world, are over twice as likely to die from prostate cancer, and are more likely to be diagnosed at an advanced stage compared to nonHispanic White men.”

It has become Dr. Wright’s mission to inform and educate.

“A simple, threesecond test can help save your life,” he says.

Dr. Wright has partnered with Zero Prostate Cancer – a nationwide nonprofit organization dedicated to prostate cancer education, testing, research, and patient support – to help spread awareness not only in local communities, but to Congress and legislators as well.

“Being able to join Zero in Washington, D.C., and to advocate for funding for better research, education, and cost reduction or elimination has made this journey worthwhile,” Dr. Wright says.

“The partnership with them has been great, and we share the same passion for eliminating this deadly disease. No man should have to go at it alone....

Together, we can win.”

Dr. Wright also has forged a relationship with Phi Beta Sigma Fraternity Inc. - The Gulf Coast Region to become part of its men’s health initiative, which has thousands of members across the country.

“Being a member of this ‘Band of Brothers’ has allowed me to share the mission of We Can Win with thousands across the globe,” Dr. Wright

says. “Our motto, ‘Culture for Service and Service for Humanity,’ gives us a platform that crosses racial barriers and allows us to be effective in the work that we do for all men, ensuring that good information is being disseminated in the community.”

Tamara says, “Edward and his mission for this often-undereducated population should be an inspiration to us all.”

Dr. Wright is an ordained bishop and a middle school teacher. He earned his Doctor of Divinity in Christian Theology at Sacramento Theological Seminary and Bible College and recently completed a bachelor’s degree in cybersecurity at Colorado State University Global.

Throughout his cancer diagnosis and his mission to spread awareness, his wife, Shajuana, has been there and supported him every step of the way.

“This disease is not a ‘one-man show.’ We need our significant others and our family engaged to help us get through the difficult times,” Dr. Wright notes.

To learn more about Dr. Wright and his foundation, visit wecanwinpc.org. We Can Win’s next event will be held on Saturday, May 25, 2024, in DeSoto, Texas.

Raquibul Hannan, M.D., Ph.D. Professor and Chief of Genitourinary Radiation Oncology Service

Tamara Dickinson, M.S.N., APRN, AGPCNP-BC, CURN, CCCN Nurse Practitioner

THE TARGET / PATIENT SPOTLIGHT

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A Beacon of Hope in the Fight Against

Pancreatic Cancer

By Todd Aguilera, M.D., Ph.D. Picture yourself embarking on a challenging mountain climbing expedition despite having no prior experience.

You’re not alone; a dedicated team of experts stands ready to assist. Each specialist excels in their respective fields, from selecting the right gear to offering guidance on food, water, clothing, and safety tools. As the journey unfolds, these experts prove indispensable, saving your life when needed most. This scenario mirrors the essence of the UT Southwestern Interdisciplinary Pancreatic Cancer Program, where whole-personcentered care takes precedence.

for the program. Todd Aguilera, M.D., Ph.D., Assistant Professor of Radiation Oncology and CoDirector of the program, notes, “With this support, we’ve been empowered to work together, optimize, and transform care thanks to Canopy’s unwavering commitment. We’ve fostered an environment where our team can see our vision materialize.”

Our Pancreatic Cancer Program’s vision is to build a future where all patients have improved survival, are empowered to overcome adversity, achieve the highest quality of life, and are fully supported to thrive alongside their providers.

Earlier this year, the team invested four months in crafting a strategic road map for the next five years, complete with a mission and vision statement and identification of four differentiators they believe sets UT Southwestern apart. This road map is serving as the program’s guiding light throughout this critical journey.

Pancreatic cancer presents a formidable challenge.

Even tripling the current five-year survival rate leaves substantial progress to be made. The key to achieving this goal is our program’s interdisciplinary culture.

Established in 2016, our program has already evolved and spurred advancements that have been further accelerated by our integration into the Canopy Cancer Collective in 2021. The nation’s first learning health network in adult oncology, Canopy unites 14 leading centers from across the country, offering a platform for sharing best practices, committing to quality improvements, and allowing data to lead the way.

Canopy’s support for the UTSW team has evinced in various ways, including a generous $500,000 grant that is bolstering our efforts. A pivotal step has been the recruitment of our first program-facing project manager, Minda Hill, B.S.N., RN, OCN, previously a nurse navigator

We envision a future where every patient receives comprehensive care starting at diagnosis. Our goal is to ensure that every patient feels at the center of their care, with a sphere of support that accompanies them throughout their journey with pancreatic cancer, referred to as “four-dimensional care.” Hill emphasizes, “If we can achieve this state of seamless 4D care, we may be surprised by the substantial impact it has on survival rates.”

As part of the planning, Hill assembled an advisory team made up of caregivers and patients to provide invaluable perspectives about the success of the care they received. Russ Jackson, whose wife, Terry, underwent extensive treatment, commended the program’s personal touch, saying, “Dr. Aguilera took me

back to see the linear accelerators where my wife would be treated. It helped alleviate much of anxiety for her and me. That’s what makes UTSW different – they reach out and have that personal touch that other institutions don’t quite have.”

Should the UTSW and Canopy teams collectively achieve their vision of revolutionized care, they will demonstrate the transformative power of interdisciplinary care, offering hope to patients with a disease that is desperately in need of a breakthrough.

Pancreatic cancer is a staunch adversary, but UTSW’s Interdisciplinary Pancreatic Cancer Program is determined to rewrite the narrative for those facing this diagnosis. As with the hypothetical mountain climbing journey where different experts handle various aspects of the expedition, our program strives to assemble a dedicated team of specialists to offer expert guidance for the challenge and to collaborate seamlessly to ensure the best possible care for every patient.

PROGRAM LEADERSHIP Todd Aguilera, M.D., Ph.D. Assistant Professor of Radiation Oncology and Program Co-Director/Lead of Strategy Salwan Al Mutar, M.D., M.S. Assistant Professor of Internal Medicine and Program Co-Director/Quality Improvement Champion Patricio Polanco, M.D. Associate Professor of Surgical Oncology and Program Co-Director/Lead of Program Growth Minda Hill, B.S.N., RN, OCN Pancreatic Cancer Program Manager

THE TARGET / FIGHTING PANCREATIC CANCER

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Members of the UTSW Radiation Oncology gynecological disease-oriented team with the Flexitron afterloader.

Upgrading HDR Brachytherapy

By Ryan Daugherty High-dose-rate (HDR) brachytherapy is a procedure where the patient receives a dose from a powerful radioactive source for a few minutes per treatment session, after which the source is removed. The radioactive source, stored in an afterloader unit, travels through special applicators that then deliver the dose to the site of the tumor.

Led by Kevin Albuquerque, M.D., FACR, Professor of Radiation Oncology, Director of Radiation Oncology

Accreditation, and Chief of Gynecological Radiation Oncology Service, the Department of Radiation Oncology’s gynecological disease-oriented team is among the few in North Texas treating patients with this method, particularly patients with vaginal, cervical, and recurrent endometrial cancers. While the treatment is highly effective, the department has been seeking upgraded technology that benefits both the patient and care team. The Elekta Flexitron® HDR afterloader, acquired in July 2023, allows for multiple benefits.

“These applicators are more beneficial for hybrid implants where you are doing standard tandem and ovoid and tandem and ring type implants, plus interstitial,” says Brian Hrycushko, Ph.D., Associate Professor of Radiation Oncology. “Overall, there are many benefits of this new HDR afterloader and applicator system, from improved needle placement to more accurate MRI guidance.”

According to Dr. Albuquerque, the Flexitron brings improvement to four key components of the treatment process: accuracy, reproducibility, customization, and adaptability.

In the previous model, needles were placed freehand during treatment and could go in many directions, risking damage to nearby tissue and suboptimal treatment to the tumor site. The Flexitron allows for treatment to be preplanned with the needles. The applicators also have predetermined needle positions and angles, so the physician does not have to spend extra time determining coordinates.

“You can imagine the challenge of placing many needles by hand and trying to create a plan off each individual needle,” Dr. Albuquerque says. “With the fixed geometries on these applicators, not only can we plan beforehand which needles will completely cover the tumor, but we can also place many more needles than before and replicate the positioning at each recurring treatment.”

Another significant difference is the material of the upgraded technology. While the previous model’s titanium applicators could possibly interfere with the MR simulator and images, the Flexitron’s applicators are plastic and thus more MR-friendly, allowing for clearer images when determining tumor size and shape.

The new treatment planning system has several features that make creating plans faster, including applicator modeling and different optimization algorithms to distribute the dose where needed. The Department of Radiation Oncology also has an initiative to implement artificial intelligence-(AI) based techniques throughout different areas, one of which is a model for brachytherapy procedures. In this model, created by Weiguo Lu, Ph.D., Professor of Radiation Oncology, AI-generated contours speed up and even remove steps from the process.

At the same time, physicist Zohaib Iqbal, Ph.D., Assistant Professor of Radiation Oncology, is, among others, creating a treatment plan whereby the AI contours can be created and then brought into the Flexitron system, increasing both the ease and efficiency of the entire process.

“We have a lot more control outside to help guide the physician when implanting devices inside the operating room,” Dr. Iqbal says. “It’s wonderful getting to work directly alongside the physician and to get that realtime feedback to improve the patient’s plan. That sideby-side aspect is rewarding and a unique part of the HDR process.”

Kevin Albuquerque, M.D., FACR Professor, Director of Radiation Oncology Accreditation, and Chief of Gynecological Radiation Oncology Service

Brian Hrycushko, Ph.D. Associate Professor

Zohaib Iqbal, Ph.D. Assistant Professor

Weiguo Lu, Ph.D. Professor

THE TARGET / TECHNOLOGY: HDR BRACHYTHERAPY

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A group of radiation oncology medical physicists with the RefleXion radiation treatment platform.

Upon Further RefleXion

By Ryan Daugherty The RefleXion X1 radiation treatment platform is the first to integrate PET/CT imaging with a medical linear accelerator.

Using a PET signal identifying the tumor while also depicting its biology, RefleXion treats patients with unique biology-guided radiotherapy (BgRT). The UT Southwestern Department of Radiation Oncology is one of a handful of centers worldwide with this treatment capability.

BGRT technology delivers treatment capabilities that greatly complement existing treatment platforms in the department.

Other treatment machines in the department, such as the Ethos (CT-based adaptive), Unity (MR-based adaptive), and other new adaptive treatment modalities, can image patients and utilize their anatomy to modify the treatment delivered on a specific day. MR also supplies some biological information about the tumor status. But in addition to measuring the tumor biological response, RefleXion can track tumor motion without any beacons or fiducial markers in real time, with tracking based on the signal from the tumor itself. It basically “reflects” the signal and shoots right back at the tumor with tumoricidal photons, allowing for a highly accurate and efficient treatment.

“It’s like the tumor lights its own tail on fire, allowing the system to keep track of its position for beam guidance at

any moment,” says Bin Cai, Ph.D., Associate Professor of Radiation Oncology and Director of Advanced Physics Service. “So, this machine not only gives you biological response information about the ongoing success of therapy but also utilizes this same biological signal to drive the delivery with tracking.”

In 2021, Aurelie Garant, M.D., Assistant Professor of Radiation Oncology and Director of the Brachytherapy Program, led an Investigational Device Exemption (IDE) trial to get the RefleXion technology approved by the Food and Drug Administration (FDA). The components of the trial included measuring the imaging accuracy of various aspects of the machine and verifying that it was safe to administer multiple administrations of intravenous radioisotopes, specifically a sugar-based isotope called F18 FDG. The department aimed to ensure that with this technology the PET scan signal would not fade to the point where the tumor could not be detected at the end of radiotherapy. The trial ultimately led to FDA approval for RefleXion to treat FDGguided therapy in the lung and bone, with other disease sites to follow. In combination with the hybrid technology, the trial highlighted a great collaboration between industry partners – the FDA and two large academic centers (UT Southwestern

and Stanford University) – Dr. Garant says.

“When we first sat down and met with the FDA, we were asked to meet several standards of all three types of technologies, and it took a lot of people, especially at UT Southwestern, to succeed at this important task in a reasonable timeframe,” Dr. Garant recalls. “Fortunately, we found the way to accrue quickly to the trial and make this machine accessible to patients.”

Other notable contributors to the trial included UT Southwestern’s Orhan Oz, M.D., Ph.D., Professor of Radiology and Chief of the Nuclear Medicine Division; Tu Dan, M.D., Assistant Professor of Radiation Oncology; and Arnold Pompos, Ph.D., Associate Professor of Radiation Oncology and Associate Vice Chair of Strategic Initiatives and Capital Investments.

PET scans are mostly performed with FDGs – sugar analogs – but they can also track other things related to metabolism or biomarkers, such as locations with low oxygen concentration or PSMA for prostate cancer. Another example is a PET tracer developed by Xiankai Sun, Ph.D., Professor of Radiology and Director of UT Southwestern’s Cyclotron and Radiochemistry Program, that targets PD-L1 expression within tissues, allowing improved immunotherapy personalization.

This is important for the Department of Radiation Oncology’s direction of personalized ultrafractionated stereotactic adaptive radiotherapy (PULSAR®), according to Robert Timmerman, M.D., Chair and Professor of Radiation Oncology. If functional aspects of tumors or the tumor microenvironment can be detected, this provides another way to assess the tumor’s biology and predict how each patient is responding, ultimately allowing personalization.

Most currently used cancer therapy delivers an entire course without interruption, followed months later by an assessment of success or failure. With RefleXion, the therapy can be administered in real time, de-escalating treatment for those responding and intensifying for those with resistant tumors.

“We are trying to move into more biologically oriented therapy, which is the key to the personalization of therapy that is in our mission statement,” Dr. Timmerman says. “Biology changes not only with just time and evolution of the tumor, but if you perturb it by treatment such as a big dose of radiation, the biology is going to change more markedly, and you want to measure that change to see if it was good or bad. That’s why RefleXion is a tool well-suited for this novel strategy.”

In the past, tumor movement was dealt with by using a “motion envelope” larger than the tumor itself, where the

tumor never strayed beyond. But this extra volume is made of normal tissues possibly injured by the potent treatment intended for the tumor. PET tracers move according to the movement of tumors and tissues they penetrate. There is hope that RefleXion will be able to overcome tumor motion and identify tumors that were undetectable by other imaging.

This brings the potential to treat multiple tumors that move either unusually or often, thereby expanding radiotherapy indications.

The RefleXion offers another strategy for personalizing each patient’s therapy: It has great potential for providing a choice of the PET tracer to steer toward unseen tumors or tumors with unknown characteristics and changing therapy by intensifying, deintensifying, or dose painting. For example, FDG could potentially give a higher dose in the highest consumption of glucose, which would most likely be the most proliferative part of the tumor and could be located on a specific side of the tumor.

The hope is for the department to gain experience using this method with bone and lung indicators and to eventually expand to other sites of the body and find additional tracers that can give information not given from FDG, such as PSMA and hypoxia markers. There is also excitement for its potential as an adaptive machine.

“We think this machine could eventually be a really useful surrogate for guiding adaptation,” Dr. Timmerman says. “For example, if the FDG is high in the first treatment but is low by the second treatment, we might be justified in lowering the dose for the second treatment. Investments in platforms such as RefleXion show our commitment to end the common onesize-fits-all therapies used for cancer.”

Robert Timmerman, M.D., FASTRO, FACR Chair and Professor

Aurelie Garant, M.D. Assistant Professor and Director of the Brachytherapy Program

Bin Cai, Ph.D. Associate Professor and Director of Advanced Physics Service

THE TARGET / TECHNOLOGY: REFLEXION

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Markerless Radiation Erases a Reminder and Improves Breast Cancer Therapy

By Asal Rahimi, M.D., M.S. and David Parsons, Ph.D. Breast cancer almost always leaves its mark on patients.

Along with surgical scars and changes in breast size and shape, medical tattoos or semi-permanent marker dots and lines were drawn on the patient’s chest to align radiotherapy beams, like checkpoints on a map.

Seeing those marks was a constant reminder for patients of the journey they never asked to take. Many reported feeling self-conscious wearing dresses or blouses that might reveal the dots or lines, adding further discomfort after enduring treatment.

We knew there had to be a better way. So in 2013, we embarked on a 10-year initiative to deliver markerless radiation therapy to our breast cancer patients, and today it has become the standard of care at the Department of Radiation Oncology at UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center.

Thanks to the determination and innovation of our medical physicists and radiation oncologists, every one of our patients gets access to markerless, surfaceguided imaging, along with other internal imaging, that

system, AlignRT developed by VisionRT, which uses three ceiling-mounted 3D cameras to beam a patterned light grid onto the patient’s chest. The system tracks thousands of points on a patient’s skin and matches them to the patient’s initial CT scan with submillimeter accuracy.

Radiation therapists monitor the system in real time and are alerted immediately if a patient moves as even slight movements such as breathing can move them 1-2 millimeters outside the radiation field. When this happens, the radiation therapist can turn off the machine and instruct the patient how to adjust to realign with their personal map.

We’ve been using surface-guided technology for 10 years with deep inspiration breath hold in left-sided breast cancer, in which patients fill the lungs with air and hold it for a few seconds to remain still and to buffer the heart from incidental radiation beam exposure. Our research, published in the Journal of Applied Clinical Medical Physics, showed that using surface-guided breath-hold in left-breast treatment was at least as precise and, in some cases, more precise compared with standard breath-hold radiation therapy.

Now, we’re using the technology to its full capacity by eliminating the use of physical markings for patients with left- and right-sided breast cancer.

precisely zeroes in on their treatment site. Additionally, some patients qualify for adaptive radiation therapy, which allows us to make real-time adjustments to their radiation plan for changes such as tumor size and position, maximizing precision.

UT Southwestern is the only center in Texas and one of few in the world to use this innovative dual approach, inconspicuously and privately treating our patients’ breast cancer without marking them as under therapy.

How surface-guided radiotherapy works For each radiation therapy session, we index the patient’s body shape to the treatment couch, using their most recent CT scan as a guide. We do this so all the radiation therapy beams follow the geometry of their personal map, treating the cancer precisely and avoiding healthy tissue.

The map is generated by our motion-tracking video

The radiation oncologist and medical physicist work closely together to plan each patient’s care. Medical physicists have a critical role – they work behind the scenes, calibrating the machines for each patient’s treatment plan and making sure every patient gets exactly the right dose in the planned treatment field.

They manage the technology and delivery, while the radiation oncologist develops the treatment plan and works face-to-face with the patients.

Asal Rahimi, M.D., M.S.

Associate Professor, Associate Vice Chair for Program Development, and Chief of Breast Radiation Oncology Service David Parsons, Ph.D.

Assistant Professor and Program Director of the Medical Physics Residency

THE TARGET / TECHNOLOGY: MARKERLESS RADIATION

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DARTBOARD Clinical Trial

By Sepeadeh Radpour, M.A., M.S. DARTBOARD (STU2021-0401: A Prospective Randomized Phase II Study of Daily Adaptive Radiotherapy to Better Organ-at-Risk Doses in Head and Neck Cancer), an innovative, first-of-its-kind clinical trial, is now complete. This study ran from March 2022 through July 2023 and treated the tightest head and neck cancer volumes to date through daily volume reduction. This daily adaptation accounted for anatomical changes in the patient and the disease while concurrently reducing margins to 1 mm. Importantly, this study was the first to investigate daily adaptive radiotherapy for head and neck cancer patients, with the aim of minimizing toxicity and improving patientreported outcomes, especially those associated with salivary function. A total of 50 patients with stage I-IVB squamous cell carcinoma of the oropharynx, larynx, or hypopharynx completed the study, with patients randomized to two arms: arm 1 receiving involved nodal radiation therapy, arm 2 receiving near marginless daily adaptive involved nodal radiation therapy.

David Sher, M.D., M.P.H., Professor of Radiation Oncology, Vice Chair of Clinical Operations and Quality, Medical Director, and Chief of Head and Neck Radiation Oncology Service, led this project and recently presented the exciting findings of the study at the American Society for Radiation Oncology (ASTRO) meeting in October. The preliminary data are quite promising, with significantly less acute skin reaction and preliminary signals of improved dry mouth.

Study Schema

Only 8% of patients in the daily adaptive arm developed grade 2 or higher acute dermatitis versus 31% in the standard arm. Patients also experienced less sticky saliva, likely due to a lower dose of radiation being administered to the salivary glands. Patients in both arms did well from a swallowing perspective, with favorable results on the MD Anderson Dysphagia Inventory (MDADI) at six months post-treatment.

Treatment delivery time was excellent with this technique as well, with the treatment process taking an average of 33 minutes per patient and with an average door-in to door-out time of 39 minutes. Physicians were also efficient with their replanning, taking an average of 12.6 minutes to contour and 22 minutes at the console for these adaptive radiotherapy cases.

The study results will continue to mature over the next year and Dr. Sher expects the final results in mid-2024.

However, even the preliminary data have shown how daily adaptive radiotherapy with reduced margins can improve acute quality-of-life scores.

“Standard radiotherapy paradigms knowingly treat a rim of normal tissue to account for daily setup error, and that naturally leads to an unnecessary dose to important normal organs,” Dr. Sher explains. “But with daily adaptation, there’s almost no radiation targeted to normal-appearing anatomy, and the less uninvolved tissue irradiated, the better for short- and long-term function.”

Reducing setup margins has already appeared to improve quality of life with certain prostate treatments, and if the favorable interim results of DARTBOARD are maintained with additional follow-up, daily adaptive radiotherapy with extremely narrow margins may be expanded to almost any disease site.

David Sher, M.D., M.P.H.

Professor, Vice Chair of Clinical Operations and Quality, Medical Director, and Chief of Head and Neck Radiation Oncology Service

Drs. You Zhang (left) and Todd Aguilera

Basic Research: R01s – Drs. Todd Aguilera & You Zhang

By Sepeadeh Radpour, M.A., M.S.

R01 Spotlight – Todd Aguilera, M.D., Ph.D. The number of locally advanced rectal cancer cases has been increasing for patients under 50 years old since the mid-1990s. With the five-year survival of high-risk locally advanced rectal cancer close to 71%, it is more important than ever to understand this disease and how it responds to treatment, so more effective approaches can be developed to combat it.

The standard of care currently comprises neoadjuvant radiation therapy and chemotherapy, with a push toward avoidance of surgery. Consequently, this thrusts immunotherapy into the spotlight as a potential therapeutic route for rectal cancer. However, there is still not enough known about its curative scope, which is why there has been an identified need for development of a tool that can help nominate ideal therapeutic techniques. To investigate this deficiency, UT Southwestern Medical Center has received a five-year NIH R01 grant titled “Early response to radiotherapy

and immunotherapy in rectal cancer: An integrated molecular, cellular, and spatial approach,” led by Todd Aguilera, M.D., Ph.D., Assistant Professor of Radiation Oncology, CPRIT Scholar in Cancer Research, and Damon Runyon Clinical Investigator.

“There is a critical need to pioneer new treatment combinations so patients can be definitively treated with radiation and systemic therapy, avoiding invasive surgeries,” Dr. Aguilera says. “This grant will allow us to further improve and elevate the integrated approach we have developed to assess early biopsy tissue after short-course radiation therapy. We are using multiple advanced technologies and computational methods to uncover the complexity of the therapeutic response.”

Dr. Aguilera’s lab is performing single-cell RNA sequencing and multiplexed immunofluorescence, as well as using deep learning techniques to study immunologic responses in tissues collected from the INNATE trial, which randomized patients to receive a

THE TARGET / BASIC RESEARCH: RO1s

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novel immunotherapy added to standard therapy. The endeavor’s hope is that these findings will shed light on how to immunologically target colorectal cancer and combine radiation therapy and chemotherapy with immunotherapy, facilitating the development of a new and more effective treatment strategy for patients with rectal cancer.

R01 Spotlight – You Zhang, Ph.D. In patients with primary and metastatic liver cancer, radiation therapy is becoming a front-line treatment technique with highly effective results. An advanced and specialized form of radiation therapy, stereotactic body radiotherapy (SBRT), is increasingly used for these cancers because it is more potent at killing cancerous cells and delivering superior tumor control and survival benefits. One drawback of using this technique is that often a largerthan-needed volume is treated with radiation, exposing healthy liver tissues to potential radiation damage. This is attributed to several reasons – in particular, breathinginduced motion – as well as difficulties in visualizing liver tumors from surrounding normal tissues in X-ray imaging that is used to locate the tumor.

To account for the uncertainties arising from these challenges, radiation oncologists tend to treat patients using a larger safety margin beyond the true tumor to prevent potential treatment misses at the cost of damaging surrounding normal tissues. Considering this, advanced imaging techniques that can localize the liver tumor and capture its motion are highly sought in radiation oncology to allow the radiation beams to precisely pinpoint the tumor and avoid surrounding tissues.

You Zhang, Ph.D., Associate Professor of Radiation Oncology, has received a five-year NIH R01 grant titled “Accurate 4D liver tumor localization for radiotherapy using contrast-agent-free X-ray imaging and liver biomechanical modeling” to investigate this issue. Dr. Zhang and his lab are currently in the fourth year of their research and are optimistic about their results.

“This proposal’s work will enable us to see what we currently cannot see for precise cancer treatment in the liver,” Dr. Zhang says. “A major challenge is that we currently cannot see these tumors because everything is so similar looking under X-ray imaging.”

This research aims to develop a technique where clinicians will be able to precisely locate liver tumors

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THE TARGET / BASIC RESEARCH: RO1s

and visualize how they change in location and shape over time, allowing for timely treatment plan optimization and adaptation to ensure the radiation matches with the tumor. Through techniques such as 2D-3D registration and biomechanical modeling, Dr. Zhang’s group can use limited information – for instance, a few X-ray projections – to reconstruct volumetric images of the liver (and the tumors within) and capture their motion automatically without the requirements of manual tumor identification.

“Previously, a big challenge of this technique was limited efficiency due to its computational demand, making realtime application challenging,” Dr. Zhang notes. “Now, using GPUs and artificial intelligence-driven efficiency enhancement, we can have images and motions solved in less than 500 milliseconds, opening many new potential avenues.”

Furthermore, Dr. Zhang is planning to push the limit of this technique to achieve real-time imaging by using a single X-ray projection to capture the volumetric motion of the liver, the tumor within, and all surrounding normal tissues and organs. He is planning to collaborate with physicist Weiguo Lu, Ph.D., Professor of Radiation Oncology, to bring this technology into proton therapy, which can potentially offer more precise cancer treatment than the more commonly used photon therapy. The caveat is that proton therapy’s precision is highly affected by tumor and organ motion.

Drs. Zhang and Lu are envisioning development of an on-the-fly proton therapy delivery system that combines real-time 3D imaging, motion tracking, and simultaneous plan delivery optimization and adaptation to yield the full potential of proton therapy. The combined system will allow the ultimate form of precision in liver cancer treatment by combining the most advanced X-ray imaging technique and the most sophisticated plan delivery and adaptation strategy.

Todd Aguilera, M.D., Ph.D.

Assistant Professor

You Zhang, Ph.D.

Associate Professor

Education Highlights MD Anderson Radiation Oncology Advanced Imaging Symposium On September 14, MD Anderson Cancer Center, alongside 13 faculty from UT Southwestern’s Department of Radiation Oncology, hosted a daylong symposium offering a comprehensive look at the current and emerging technologies in advanced imaging for diagnosis and radiation therapy for cancer, as well as the challenges and opportunities that lie ahead for further advancements.

At the symposium, participants explored the state-of-the-art computerized tomography techniques used throughout the radiation therapy continuum, from diagnosis to treatment delivery.

The symposium covered advanced image-guided treatment planning and radiation therapy guidance, including emerging techniques such as adaptive and PULSAR modalities. Topics discussed included: •

Anatomical and functional magnetic resonance imaging in the context of planning, treatment response, and delivery

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The use of PET imaging for both diagnostic and functional therapy guidance

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Advances made in imaging applications for radiation therapy using AI, and how AI can improve outcomes for cancer patients

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Innovative trial designs that incorporate imaging integration into clinical trials, highlighting both the challenges and opportunities

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How collaborative trials can advance the field and the importance of testing AI-based imageguided radiation therapy for clinical usability and outcome improvement

X-Ray-Guided Online Adaptive Radiotherapy Symposium On September 22, the Department of Radiation Oncology hosted a daylong symposium exploring the latest techniques and innovations in X-ray-guided online adaptive radiotherapy (oART). These new developments include current clinical implementations and future applications with more powerful AI guidance and imaging technologies. The symposium included presentations about oART treatments in a variety of disease sites, including a live treatment session, key planning topics, practical discussions about team building and billing, multimodality integration, and closing comments on the exciting future of the field.

The symposium was open to the full spectrum of practitioners, including radiation oncologists, medical physicists, dosimetrists, therapists, trainees, and other allied health professionals interested in oART technologies, with 138 people in attendance – 77 from outside institutions.

AI for Clinicians in Medicine Educational Workshop On August 24, the Department of Radiation Oncology’s Medical Artificial Intelligence and Automation (MAIA) lab hosted an AI for Clinicians in Medicine Educational Workshop. This four-hour event, led by a combination of medical physicists and physicians, was aimed toward clinicians seeking to get AI integrated into their clinic and getting involved in research and implementation. Topics included: • Major applications of AI in medicine • Workflow for development and implementation of AI in clinic • Barriers for clinical implementation/translation of AI

Spatial Biology Computational Workshop On October 29, Todd Aguilera, M.D., Ph.D., Assistant Professor of Radiation Oncology, in collaboration with Satwik Rajaram, Ph.D., and Andrew Jamieson, Ph.D., both Assistant Professors in the Lyda Hill Department of Bioinformatics, held a computational workshop on the spatial biology of the tumor microenvironment with their lab members. The workshop covered the significance of studying the tumor microenvironment and therapy responses in rectal cancer, multiplex immunofluorescence, and computational analysis for large-scale investigation.

“These emerging advanced techniques in the spatial biology of cancer should help unlock many mysteries of

therapy response,” Dr. Aguilera says. “Better yet, our team is learning so much from our dedicated patients on the INNATE trial who donated their tissue for scientific discovery.”

INNATE: Immunotherapy During Neoadjuvant Therapy for Rectal Cancer, a Phase II Randomized Multicenter Trial with and without APX005M, an Anti-CD40 Agonist

New Faculty Q&A Shahed Badiyan, M.D. Associate Professor of Radiation Oncology & Director of Clinical Adaptive Therapy

What inspired you to pursue a career in medicine and radiation oncology?

Growing up, I loved hearing stories from my uncle who was an infectious disease physician. After serving on the faculty at the University of Illinois Chicago for many years, he decided to move with his family to Papua New Guinea, a remote island country located off the coast of Australia, to develop a medical school.

Hearing his stories of all the people they were able to care for was inspiring and spurred my interest in becoming a physician. When I was in college, a family member was diagnosed with cancer and their diagnosis moved me to volunteer in the radiation biology lab here at UTSW during my first year of medical school. It was there that I discovered radiation oncology and fell in love with the field.

What are some of your research interests?

I am interested in investigating new technologies, such as adaptive radiation therapy, and new radiotherapy techniques, such as PULSAR, to develop novel treatments for cancer patients. I am thrilled to have the opportunity to return home to UT Southwestern and be the Director of Clinical Adaptive Therapy to pursue the development of adaptive radiotherapy and PULSAR at one of the leading radiation oncology departments in the country. I am particularly interested in understanding how to best utilize these treatments for the care of patients with esophageal cancers. The incidence of esophageal cancer has been rising in the United States, and this type of cancer often gets overlooked for research funding.

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What advice do you have for someone wanting to pursue a career in radiation oncology?

I encourage them to become a radiation oncologist. It is an incredibly fulfilling career. One gets to care for cancer patients, who are always so grateful, and utilize high-tech devices. The field is always changing as innovative technologies are developed, so there is never a dull moment.

Michael Dohopolski, M.D. Assistant Professor of Radiation Oncology

What inspired you to pursue a career in medicine and radiation oncology?

My inspiration to pursue a career in medicine – specifically radiation oncology – stemmed from my passion for leveraging the advancements in medical technology to provide care to patients in need. The combination of tech-driven treatment and the direct impact on patients in the realm of radiation oncology resonated deeply with me.

Why did you choose UT Southwestern?

I chose UT Southwestern because of the incredible community of individuals who work here. The environment is filled with smart, fun, and caring individuals, and I have been fortunate to have numerous mentors here who have provided guidance throughout my journey and whom I believe will continue to support me in the future.

What are some of your research interests?

My primary research interests lie in adaptive cancer treatment and the integration of machine learning. I am intrigued by the potential of personalized treatments that

adjust based on real-time patient responses and the capabilities machine learning offers in predicting and optimizing these treatment adaptations.

Yesenia Gonzalez, Ph.D. Assistant Professor of Radiation Oncology

What inspired you to pursue a career in medicine and radiation oncology?

During my high school physics and chemistry courses, I would flip through textbooks and started to develop an interest in the parts of the book concerning radiation. One of my teachers talked in passing about her husband being a nuclear engineer, so, around college application time, I applied to programs with nuclear engineering as my first choice. It turned out that reactors are not my cup of tea; instead, I looked at health and medical applications and eventually stumbled on medical physics. One internship later, I decided a medical physicist is what I wanted to be.

Why did you choose UT Southwestern?

I chose UT Southwestern for a variety of reasons. I have been here a while and am very familiar with it, and all the people I have met within the department are so friendly. On the other hand, the department is large and continuously growing, and there is so much technology available that we can learn to use, as well as many experts we can learn from.

What do you like most about your job?

I like knowing that what I’m doing is for the benefit of the patient. The people I talk to and work with every day also make the job very enjoyable.

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Margaret Kozak, M.D. Assistant Professor of Radiation Oncology

What inspired you to pursue a career in medicine and radiation oncology?

I knew for a long time that I wanted to become a doctor. When I was in elementary school, I used to tell my mom that I wanted to deliver babies. For a long time, I thought I would become an Ob/Gyn until my grandmother was diagnosed with uterine cancer when I was in college.

Up until then, cancer had been something foreign to me, and I threw myself into learning about it. I was fascinated with the molecular biology of carcinogenesis, but I also personally understood the emotional toll it took on patients and their families.

My best friend and college roommate worked in a cancer research lab and urged me to meet some of the medical faculty. I began shadowing a medical oncologist in the sarcoma clinic at UCLA, but it wasn’t until after college that my future crystallized. By then I was working in a cancer research lab at Stanford University, where I met one of the great leaders in radiation oncology.

After learning that I was pre-med, he emphatically stated that I should come to clinic with him. It was there in the basement of the Stanford Cancer Center that he showed me a linear accelerator, introduced me to contouring, and convinced me that radiation oncology was the best specialty on the planet. I was most drawn to the unique technical aspects of radiation treatment.

I was a child of the 1990s, raised in the heart of Silicon Valley, and came from a family of chemists, engineers, and programmers. So, while I was still choosing a “soft” science for my future, I was also entering a field that bridges cutting-edge technology with cancer biology and the humanitarian act of treating patients with serious diagnoses.

Why did you choose UT Southwestern?

The Department of Radiation Oncology here is one of the best in the country. It has a large and eclectic patient population and the widest array of technology of any radiation center in the world. I am excited to be on the pediatric/lymphoma/ sarcoma team and to work with my friend, colleague, and former fellow resident Dr. Kiran Kumar, whom I have known for many years. At the University of Iowa, I was treating pediatric and sarcoma patients but wanted to move to a larger center to further my research interests and help develop novel treatment approaches using the unique technology that UT Southwestern has to offer.

What do you like most about your job?

The best part of my week is seeing patients. I love hearing their stories, laughing – and sometimes crying – with them, and offering a helping hand. My patients are what give me inspiration and strength; they motivate me to keep working toward better ways to treat this disease. I also love the variety I have in my day-to-day as a radiation oncologist and the wide range of people whom I interact with to get a radiation plan out of the door. Any given week, I balance clinic with contouring challenging cases, discussing medical literature with colleagues and residents, and attending academic conferences. I get to work with physicists, dosimetrists, nurses, and radiation therapists, and I rely on all of them to help me do my job as best as I can. And, as a byproduct, I get to build and enjoy the friendships we form in the meantime.

Chenyang Shen, Ph.D. Assistant Professor of Radiation Oncology

What inspired you to pursue a career in medicine and radiation oncology?

I trained as an applied mathematician during my undergraduate studies and graduate THE TARGET / NEW FACULTY Q&A

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school. My academic journey took an exciting turn during my Ph.D. program when I had the opportunity to become a visiting scholar here in this department.

During my visit, I was profoundly inspired by how advanced technologies can be integrated to enhance cancer treatment and improve patient care in radiotherapy.

My quest to apply computational tools in meaningful, real-world contexts led me to pursue a career as a medical physicist to contribute to cancer care through both clinical practice and research.

After obtaining my Ph.D., I joined UT Southwestern as a postdoctoral researcher before pursuing clinical training as a medical physics resident, further deepening and broadening my expertise. Now, I am immensely grateful and enthusiastic about my current role as a faculty member, where I have the privilege of continuing to contribute to both patient care and cutting-edge research in the field of medical physics. This journey has been both rewarding and fulfilling, and I am eager to further advance the intersection of advanced computational technologies and medicine for the benefit of patients and scientific progress.

What are some of your research interests?

My research has been centered on developing computational tools and AI frameworks with applications to various aspects of radiotherapy with the aim of automation and quality enhancement.

More specifically, I am interested in developing novel optimization algorithms and AI models for radiation therapy imaging and treatment planning to enable full automation of radiotherapy workflow and functional adaptation.

Why did you choose UT Southwestern?

I have enjoyed working with all of my friendly, talented, and passionate colleagues at UT Southwestern since I was a postdoctoral researcher. UTSW provides toptier care to patients alongside groundbreaking research happening all around campus.

Given the opportunity to work with world-renowned, leading experts in health care, UTSW stands out as the perfect place to start off a career as a medical physicist and an independent investigator.

Justin Visak, Ph.D. Assistant Professor of Radiation Oncology

What inspired you to pursue a career in medicine and radiation oncology?

Becoming a medical physicist in academics offers a unique opportunity to bridge the gap between physical science and health care. Prior to college, I shadowed a medical physicist who gave me a firsthand glimpse into the field. One of the most intriguing aspects of this career is that it promises something different every day as the field dynamically progresses.

What are some of your research interests?

My primary research focus is on adaptive radiotherapy. Specifically, I am interested in working on projects that concern daily online X-ray- or MRI-guided adaptive radiotherapy. I am also interested in clinical implementation of novel treatment planning techniques and technology.

What advice do you have for someone wanting to pursue a career in radiation oncology?

My advice would be to seek out experienced medical physicists as mentors who can provide guidance and support throughout your early career. The field of radiation oncology is constantly growing, and it is important to see the day-to-day life of either a radiation oncologist or medical physicist.

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Narine Wandrey, M.D. Assistant Professor of Radiation Oncology

What inspired you to pursue a career in medicine and radiation oncology?

Ever since I was a little girl, I have wanted to be a physician. I have always loved taking care of individuals and have also had an interest in mathematics and science. The field of radiation oncology represents a balance of everything I have come to appreciate in medicine: empathy for patients who need hope, therapy involving technical skills of the mind and hand, and working with motivated individuals who view cancer as an opportunity to discover, in every sense of that term.

Why did you choose UT Southwestern?

I chose UT Southwestern because it equally emphasizes compassionate, patient-centered care and scientific progress. There is a palpability to the uplifting culture in the faculty and general workplace here, which makes it an exciting place to come to work every day. My family also hails from Texas, and it has been great to be back home.

What do you like most about your job?

The patients – always; it is a humbling privilege to treat and work with individuals battling cancer. I would not trade my job for the world.

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Awards & Recognition Todd Aguilera, M.D., Ph.D., Assistant Professor of Radiation Oncology and leader of the Aguilera Lab, was named a Cancer Moonshot Scholar.

Awarded by the National Cancer Institute (NCI), this program is funding $5.4 million to 11 total recipients and aims to advance cancer science while also diversifying the pool of early-stage investigators and approaches to research that the NCI funds. Dr. Aguilera and his team have received an R01 for their project “Early Response to Radiotherapy and Immunotherapy in Rectal Cancer: An Integrated Molecular, Cellular, and Spatial Approach.”

Prasanna Alluri, M.D., Ph.D., Assistant Professor of Radiation Oncology, received UT Southwestern’s CTSA Clinical and Translational Pilot Grant Award. This grant will support Dr. Alluri’s work on studying mechanisms of radiation-induced cardiotoxicity in patients receiving thoracic radiation. Dr. Alluri, along with Jacques Lux, Ph.D., Associate Professor of Radiology, also received a CTSA Team Science Pilot Grant Award, which will support their work on developing novel immunotherapies for patients with breast cancer.

Drs. Alluri and Lux were also awarded the 2023 Synergy Grant for Collaborative Research from the Dean’s Office. This grant will support their efforts to turn immunologically cold breast tumors into extraordinary responders to immunotherapy using a combination of radiotherapy and the inhibition of DNA mismatch repair pathway.

Dr. Alluri and Purna Joshi, Ph.D., Assistant Professor of Biological Sciences at The University of Texas at Dallas, received a Collaborative Biomedical Research Award (COBRA) from UT Dallas. This $125,000 grant will establish a new collaborative research program between the Alluri and Joshi labs to elucidate the role of adipocyte progenitors in treatment resistance in breast cancer.

Michael Dohopolski, M.D., Assistant Professor of Radiation Oncology, received a Radiological Society of North America (RSNA) Research Seed Grant for his work, “Identifying Residual or Recurrent Local Disease on Post‐Treatment PET Imaging in Patients with Head and Neck Cancer Using Reliable and Explainable Deep Learning Models.”

OUR CLINICAL PROVIDERS Todd Aguilera, M.D., Ph.D. Assistant Professor

Anundip Gill, M.S.N., APRN, FNP-C Advanced Practice Nurse

Kevin Albuquerque, M.D., FACR Professor and Director of Radiation Oncology Accreditation Chief of Gynecological Radiation Oncology Service Holder of the Ken Sharma Professorship in Radiation Oncology

Daniella Hall, PA-C Physician Assistant

Prasanna Alluri, M.D., Ph.D. Assistant Professor Mona Arbab, M.D., M.Ed. Assistant Professor and Associate Program Director of the Medical Residency Shahed Badiyan, M.D. Associate Professor and Director of Clinical Adaptive Therapy Shohreh Bahrami, APRN, FNP-BC Advanced Practice Nurse Xin Cai, M.D., Ph.D. Assistant Professor Tu Dan, M.D. Assistant Professor Neil Desai, M.D., M.H.S. Associate Professor and Director of Clinical Research Dedman Family Scholar in Clinical Care Tamara Dickinson, M.S.N., APRN, AGPCNP-BC, CURN, CCCN Advanced Practice Nurse Michael Dohopolski, M.D. Assistant Professor Aurelie Garant, M.D. Assistant Professor and Director of the Brachytherapy Program 28

THE TARGET / OUR CLINICAL PROVIDERS

Raquibul Hannan, M.D., Ph.D. Professor Chief of Genitourinary Radiation Oncology Service Rochelle Jackson, D.N.P., FNP-C Advanced Practice Nurse Terri Kelley-Griffis, APRN, FNP-C Advanced Practice Nurse Kanchandip Koshy, M.S.N., APRN, FNP-C Advanced Practice Nurse Margaret Kozak, M.D. Assistant Professor Kiran Kumar, M.D., M.B.A. Assistant Professor and Program Director of the Medical Residency Chief of Lymphoma and Pediatrics Radiation Oncology Services Xingzhe “Dillon” Li, M.D., M.P.H. Assistant Professor Astrid Medrano, M.S.N., APRN, FNP-C Advanced Practice Nurse Dominic Moon, M.D. Assistant Professor Asal Rahimi, M.D., M.S. Associate Professor and Associate Vice Chair for Program Development Medical Director of the Simmons Comprehensive Cancer Center Clinical Research Office Chief of Breast Radiation Oncology Service

Shay Rezaie, M.S.N., APRN, FNP-C, OCN Advanced Practice Nurse

Narine Wandrey, M.D. Assistant Professor

Nina Sanford, M.D. Assistant Professor Chief of Gastrointestinal Radiation Oncology Service Dedman Family Scholar in Clinical Care

Andrew Wang, M.D. Professor and Vice Chair, Translational Research & Commercialization Holder of the A. Kenneth Pye Professorship in Cancer Research

Amy Sessions, M.P.A.S., PA-C Physician Assistant

Zabi Wardak, M.D. Associate Professor and Medical Director of the Gamma Knife Program Chief of Central Nervous System Radiation Oncology Service

David Sher, M.D., M.P.H. Professor, Vice Chair of Clinical Operations and Quality, Medical Director, and Chief of Head and Neck Radiation Oncology Service Matthew Strunk, M.P.A.S., PA-C Physician Assistant Robert Timmerman, M.D., FASTRO, FACR Chair and Professor Holder of the Effie Marie Cain Distinguished Chair in Cancer Therapy Research

Kenneth Westover, M.D., Ph.D. Associate Professor and Director of Clinical Innovation and Information Systems Chief of Lung Radiation Oncology Service Daniel Yang, M.D. Assistant Professor Yuanyuan “Faith” Zhang, M.D., Ph.D. Assistant Professor

Department of Radiation Oncology 5323 Harry Hines Boulevard Dallas, Texas 75390-8546 Opportunity Employer. Women, minorities, veterans, and individuals with disabilities are encouraged to apply.

Photos by Brian Coats and Ryan Daugherty

Editorial Board

Rossana Berrios, M.B.A. Ryan Daugherty Kajal Desai, M.P.A. Kathy Harris Steve Jiang, Ph.D. Kelly Lizak Sepeadeh Radpour, M.A., M.S. Asal Rahimi, M.D., M.S. Ronnie Rittenberry David Sher, M.D., M.P.H. Robert Timmerman, M.D., FASTRO, FACR Andrew Wang, M.D. Mary Whitmore

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