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Radiation Oncology Residency Research

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In order to foster scholarly activities, training faculty will provide mentoring and technical support for residents involved in research activities. Residents will be required to complete an investigative project(s) during their training program under the direction of faculty members. The results of such projects shall be submitted suitable for publication in peer-reviewed scholarly journals or presentation at scientific meetings.

Ongoing programs in research and outcome analysis are strongly supported by the H. Lee Moffitt Cancer Center and the Division of Radiation Oncology, Department of Interdisciplinary Oncology. Clinical, basic science, translational and behavior outcomes research are an integral part of the Division of Radiation Oncology. The Division of Radiation Oncology maintains a central research office.  All regulatory, research, nursing, and data management functions are coordinated within the program.  Regulatory staff acts as a liaison between the investigator and the IRB, coordinating all aspects of the research approval process which includes assisting in the writing of clinical trials and Informed Consents, the IRB application and approval process, and yearly reviews for each trial.  The research nursing staff supports the investigator in screening and enrolling patients to clinical trials, provides data management support, staff education and training, coordinates and implements protocol-related orders for study patients and prepares medical charts for audits.

Overview of the Radiation Oncology Research Endeavors:

Translational: Under the Leadership of Craig Stevens, M.D., Ph.D.

Dr. Stevens conducts research in radiotherapy for thoracic malignancies, the development of protocols to measure lung-tumor motion, noninvasive techniques to measure tumor hypoxia, and cell-surface markers using radioligands. There are opportunities to develop translational projects with a number of novel biological agents, such as HDACs.  The Division is actively working on predictive/prognostic genomic/proteomic based tests with which to personalize cancer care.  We are developing active research in medical physics.  These will initially involve normal tissue response modeling and 4D treatment planning, but will soon expand to biological imaging.  He has published numerous clinical articles in such peer-reviewed journals as the International Journal of Radiation Oncology, Biology and Physics; Lung Cancer; the Journal of Clinical Oncology; and The Cancer Journal.

Clinical Research: Under the Leadership of Andy Trotti, M.D.

As one of the longest-serving Moffitt physicians, Andy Trotti, M.D., is recognized for expertise in head and neck and cutaneous malignancies, and the adverse effects of cancer treatment. He has conducted original and collaborative group clinical trials in head and neck cancer at the Moffitt Cancer Center Moffitt for more than 17 years.

Under his leadership, in 1990 the Moffitt Cancer Center became a member of the National Cancer Institute-sponsored Radiation Therapy Oncology Group (RTOG), and continues today as one of a select group of active full members. Dr. Trotti serves as institutional principal investigator for RTOG studies. Several of Dr. Trotti's original pilot studies conducted at the Moffitt Cancer Center in the areas of fractionation, toxicity interventions, and combined modality therapy have advanced to become national multicenter trials. Dr. Trotti is co-chair of the RTOG Head and Neck Committee. Under his guidance, several of his radiation oncology colleagues at the Moffitt Cancer Center have participated in leadership roles within the RTOG, including the Quality of Life Committee, Outcomes Committee, Special Populations Committees, and Research Associates Committee. Fellow Radiation Oncology colleagues Dr. Babu Zachariah, James A. Haley Veterans Administration and Dr. Clement Gwede, Moffitt Cancer Center, are currently leading a phase III RTOG trial of octreotide in the prevention of radiation-induced diarrhea.

As part of the effort to measure outcomes, Darlene Johnson, M.B.A., and Dr. Trotti developed and validated a radiation-specific quality of life tool currently in use in two national RTOG trials. Dr Trotti and his Moffitt colleague, Dr. Javier Torres-Roca; were recently awarded a pilot grant to study genomic predictors of radiosensitivity in RTOG populations.

Dr. Trotti is co-chair of the Health Services Research (HSR) Committees for both the American Society of Therapeutic Radiology and Oncology (ASTRO), and the American Society of Clinical Oncology (ASCO). Dr. Trotti has a unique area of expertise: the recognition, reporting, prevention, and management of the adverse effects of cancer treatment. Dr. Trotti assisted the NCI in creating the current NCI dictionary for adverse events (CTCAE). This document has become the international standard for toxicity reporting. He has also led pivotal trials testing in iseganan and lisofylline in mucositis. Dr. Trotti is Co-Principal Investigator of a multicenter phase III randomized trial testing KGF for the reduction of head and neck mucositis sponsored by Amgen and the RTOG. Dr. Trotti and his colleagues were awarded a federal grant to develop electronic methods of grading and reporting toxicity in clinical trials (Safety Profiler).

Radiobiology: Under the Leadership of Philip Tofilon, Ph.D.

Work in the Radiobiology lab at the Moffitt Cancer Center is aimed at developing strategies for enhancing tumor radiosensitivity.  Towards this end, investigations are aimed at identifying the molecular determinants of tumor radiosensitivity using in vitro and orthotopic models with the ultimate goal of developing target based radiosensitizing agents. Fundamental studies of cellular radioresponse address the mechanism through which putative targets influence cell cycle checkpoints, chromatin structure and DNA damage and repair.  As a genomic approach to identifying novel processes involved in the regulation of radioresponse, the microarray-based analysis of polysome-bound mRNA is being used to investigate radiation-induced translational control of gene expression.  In addition, to develop more clinically relevant models, our studies address the cellular and molecular radioresponse of tumor stem cells grown in vitro and in vivo.

Basic Science: Under the Leadership of Javier Torres-Roca, M.D.

Dr. Torres-Roca's research interests center around two main themes: development of genome-based radiation sensitivity classifiers and discovery of genes predictive of radiation response. Since joining Moffitt in the summer of 2002, Dr. Torres-Roca has worked with colleagues at the Center to develop the first radiation sensitivity classifier that predicts the radiation sensitivity of tumor cell lines on the basis of their gene expression profiles derived from Affymetrix HU6800 microarrays (7,129 genes analyzed). The accuracy of this classifier is currently 60%. The researchers hope that continued development of this idea will lead to a diagnostic tool that helps in predicting the radiocurability of a tumor. This development process has led Dr. Torres-Roca and his colleagues to the identification of novel genes that are associated with radiation sensitivity. This research path may lead to identification of potential molecular targets that affect the radiosensitivity of a tumor cell, which may lead to development of new radiation sensitizers.

Health Outcomes and Behavior: Under the Leadership of Clement Gwede, Ph.D., MPH, RN
 
Clement Gwede, Ph.D., MPH, RN, is a member of the Health Outcomes and Behavior Program in the Cancer Prevention and Control (CPC) Division of the H. Lee Moffitt Cancer Center. He has a longstanding affiliation and ongoing interactions with clinicians in the Radiation Oncology Program regarding the translation of cancer control research into patient care settings. Dr. Gwede’s collaborations with the Radiation Oncology Program include studies of quality of life, toxicity and other symptom assessments/interventions. The overall goals of the research, collaborative in its design and execution, are focused on the reduction of the burden of cancer and cancer treatment-related effects on individuals and society. Consequently, the health outcomes and behavioral research in the Radiation Oncology Program focuses on two major scientific aims: identifying clinical practices and health outcomes that can inform efforts to improve the quality of cancer care; and developing and evaluating innovative approaches to improving quality of life for patients and their families throughout the disease and treatment course.

Dr. Gwede's research interests span the continuum of cancer care and include the following areas: prevention and early detection, symptom management and long-term quality of life, and methods of improving toxicity data collection and reporting, with an underlying and cross-cutting theme of reducing health disparities across the continuum of cancer care. Dr. Gwede investigated the perceived benefits, barriers, and harms associated with prostate cancer screening among underserved African American men, and documented notable historical, cultural, and behavioral factors. His research seeks to understand and improve not only decision making for screening and early detection, but also issues related to treatment decision making. Many men diagnosed with prostate cancer in its early stage are faced with multiple treatment alternatives, including various forms of radiation therapy. Moffitt Cancer Center’s findings about decisional difficulty, treatment priorities and expectations, and quality of life changes may facilitate informed decision making for future patients, family members, and clinicians. Research in symptom management and long-term quality of life in patients with cancer is evolving as treatment becomes more complex and aggressive, the number of long-term cancer survivors continues to increase, and the debilitating impact of cancer treatment-related effects is increasingly recognized. Thus Dr. Gwede and his colleagues focus their current research on radiation and/or chemoradiation-induced mucositis, pain, diarrhea, fatigue and their consequential effects during and after treatment.

This research includes intervention studies aimed at prevention and management of these specific symptoms using pharmacological/biological agents as well as behavioral interventions. Because quality of life in long-term cancer survivorship is a paramount consideration for patients and family members, a prospective evaluation of short and long-term quality of life in prostate cancer patients is underway. Finally, Dr. Gwede and colleagues are interested in improving the methods of collecting and reporting of toxicity data in clinical trials. The premise is that our appreciation of the impact of cancer treatment on an individual patient's functioning is dependent on collection of comprehensive and accurate data. The research at the Moffitt Cancer Center exploring the electronic collection and reporting of toxicity data using hand-held technologies is underway. The findings may facilitate development of standards in toxicity data collection and reporting in clinical trials and usual care, and may improve quality of care.

The Moffitt Cancer Center’s Cancer Control Research Interest Group (CCRIG) is the principal forum by which Cancer Prevention and Control investigators, other faculty, fellows, residents and staff routinely meet to share research ideas and discuss work in progress. The format of the biweekly CCRIG meeting is informal. The discussions involve research and funding opportunities as well as interim results of ongoing research studies. Ongoing and future cancer control research studies provide a platform for training of residents regarding the importance of health outcomes research, research design and the research process. The Radiation Oncology residents will be encouraged to participate in this forum and participate in these scholarly activities as an important component of their research training. In addition, Dr. Gwede and other cancer control investigators will be available to give lectures to residents on selected cancer control topics.

Research at the James A. Haley Veterans Administration Hospital: Under the Leadership of Vadim Kuperman, Ph.D.

The VA Research Program significantly influences the recruitment and retention of highly specialized clinical staff. Currently, there are 90 research investigators involved in 178 research projects concerned with a broad range of health problems, most of which are prevalent in the veteran patient population. The Research Service supports and enhances the Medical Center mission by administering VA -funded, peer-reviewed research grants which provide new knowledge leading to improvements in the prevention, diagnosis and treatment of diseases and disabilities.

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