The evolution of radiation oncology

EHM asked Dr. Sarah Donaldson, Professor of Radiation Oncology at Stanford University, about the evolution of treatment techniques in the field.

EHM. What have been some of the important recent developments in radiation oncology?
SD. One exciting development has been highly conformal radiotherapy. This provides the ability to locate tumors by very specific imaging tests, so to integrate imaging into radiation oncology delivery. Another is image guided radiotherapy, where we can see by metabolic function where the cancer is and then focus the radiation just to that area. Now there are even newer advances beyond the linear accelerator to use particle therapy to give more conformal treatment. Proton therapy is one type of particle therapy that is on the horizon right now.

Another important development that has impacted cancer care has been multi-disciplinary management, so to combine what the surgeon can do with what the medical oncologist can do and what the radiation oncologist can. We then work as a team to give risk-adapted therapy. Adapting the treatment to the stage and the specifics of the malignancy has allowed us to tailor the therapy and treat appropriately, so as not to treat everybody exactly the same way.

EHM. Hodgkin’s Disease is one of your clinical specialties. How has it evolved since you started in the field?
SD. The Hodgkin’s Disease story is wonderful because it is a success story. I happened to be in the right place at the right time at Stanford. The person in charge of the Radiation Therapy department when I came as a trainee was a giant in the field named Henry Kaplan. He was instrumental in the development of the linear accelerator; his specialty was lymphomas and he started early on with clinical trials in Hodgkin’s Disease.

Hodgkin’s Disease was at that time a uniformly fatal disease. Then the linear accelerator was built and we could define and give radiation to large areas of the body at high doses and kill Hodgkin’s Disease, and the cure rate started going up. Then chemotherapy was developed and treatment became combined modality: combining radiation and chemotherapy.

In 1969, as a first year resident, Dr. Kaplan asked me to write a protocol using low dose involved field radiation and chemotherapy for children with Hodgkin’s Disease. That was hugely successful because it not only spared children of toxicity but their survival rate increased. Across the country today, the overall survival rate is greater than 90 percent for the majority of children.

EHM. Please tell us about the exciting initiatives taking place in the department of radiation oncology at Stanford in the near future.
SD. Stanford is a wonderful place. It’s wonderful because it is a research intense environment. We have a full service hospital, so not only is there outstanding oncology but there is excellence in all aspects of medicine. It’s a very special place.

We’ve just been approved for NCI Cancer Center status and that is a huge milestone. We are very excited about that. And we have a new cancer center building that is a wonderful environment.

In radiation oncology, we are a full service department, with an outstanding training program. Our residency program is one of the best in the country.

From the technical aspect, we have got a very focused way of giving radiation that was invented at Stanford called the CyberKnife, which is a way of giving radiation in high doses to very small areas, such as brain tumors. With a CyberKnife, you can also treat other parts of the body as well. It is like using radiation in a way that you use surgery – this is a new application of radiation and it’s an exciting one.

Dr. Sarah Donaldson is Professor of Radiation Oncology at Stanford University, where she has worked for 39 years. Donaldson began studying nursing; her first job was working as a research assistant for a cancer surgeon doing surgical oncology. She graduated from Harvard Medical School and did her internship at the University of Washington in Seattle.