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Promise and Progress - Cover Story Sidebar: The Frankenstein Project

The Time is Now: 2010-2011

Cover Story Sidebar: The Frankenstein Project

By: Valerie Matthews Mehl
Date: November 11, 2010


Todd McNutt and Team
Todd McNutt (left), Patricio Simari (center), and Binbin Wu (right) work on the Frankenstein Project.

Radiation Oncology is unique among the cancer specialties in that it is intrinsically dependent upon technologically-advanced equipment.  These devices deliver precisely targeted X-ray beams to destroy tumors.  The ever-evolving technology makes clinical research difficult.  In the few years it takes to complete a clinical trial, the technology has already evolved making the original question irrelevant.

Radiation oncology physicist Todd McNutt has developed his own system, called “Oncospace,” to more quickly improve clinical care.  The system uses anatomy, radiation dose distributions, toxicity, and outcome data of prior patients to improve the therapy for those about to be treated.

Working with collaborators from Johns Hopkins Computer Science and Physics and Astronomy Programs, McNutt and team have created an analytical database that pulls together radiation therapy data in a complex, computerized system.   It enables the analysis of the best outcomes, and conversely, those with less than favorable outcomes, to create the optimal treatment plan.

More and more, cancer research is data driven. McNutt’s computerized system is no exception. It surveys the data from prior patients to uncover similarities between tumors and their relationship to critical organs and tissue they want to spare from radiation. The system finds the set of critical organs from all patients in the system. This “Frankenstein method” provides up front information on how good of a radiation dose distribution can be achieved as well as any potential toxicity risks to the patient.  The information is then used to automate and ensure quality in radiation treatment planning.  Just as cancer gene sequencing uses data from millions of DNA samples to establish patterns in gene expression, McNutt’s model uses data from patients treated with radiation therapy to reveal patterns in patient outcomes.

“Todd’s work is one of the first demonstrations of how we can develop large data warehouses of patient information collected from previously treated patients and use it to make individualized treatment decisions for new patients,” says Theodore DeWeese, Director of Radiation Oncology and Molecular Radiation Sciences.

The goal with radiation therapy is to target the highest doses of radiation directly and precisely to tumors.  Lower doses of radiation are aimed at high risk tissue around the tumor and nearby lymph nodes that could potentially harbor small numbers of unseen cancer cells that if left untreated can allow the cancer to come back.

Equally important as hitting the tumor and high risk tissue around it with radiation, is not hitting the critical structures, organs, and normal tissue that could be irreparably damaged by radiation.  The spinal cord, brain stem, and esophagus are examples of critical structures. In head and neck cancers, the parotid gland is a critical structure. Damage to the gland, McNutt says, can permanently destroy the function of salivary glands.  The inability to produce saliva can substantially affect patients’ quality of life, causing them to have a chronically dry mouth and making it difficult to eat. 

McNutt’s Frankenstein method is currently being tested in head and neck and pancreatic cancers. There is early evidence showing that the method considerably improves treatment plan quality and sparing of critical organs.  As a result, they are planning to expand the approach to thoracic and other cancers.

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