Shaping the minds of future cancer researchers

Ross Mikkelsen“The more comfortable we become with being stupid, the deeper we will wade into the unknown and the more likely we are to make big discoveries,” wrote Martin A. Schwartz, Ph.D., in his popular essay The Importance of Stupidity in Scientific Research. Cancer researcher Ross B. Mikkelsen, Ph.D., member of the Radiation Biology and Oncology research program at VCU Massey Cancer Center, shares this sentiment with his students. He says, “researchers aren’t stupid because we make stupid mistakes, but because we don’t know what’s on the other side of an experiment. On the other hand, when you do find out what’s on the other side, you get a high that you can’t beat.”

Mikkelsen, professor and division chair of Molecular Radiobiology and Targeted Imaging in the Department of Radiation Oncology and associate director for the M.D./Ph.D. program at VCU School of Medicine, joined VCU over 25 years ago, only a year after the Department of Radiation Oncology was established. “I’m the oldest man in the department,” he says with a laugh. Before coming to VCU to conduct cancer research at Massey, Mikkelsen was studying another well-known illness, malaria, at Tufts University School of Medicine.

Mikkelsen’s lab currently conducts experiments aimed at gaining a better understanding of the underlying mechanisms of how tumor cells and normal cells respond to radiation. “The idea of my research is to increase the so-called ‘therapeutic ratio,’ or the act of increasing the number of tumor cells killed while decreasing the amount of toxicity to normal, healthy cells,” he says.

His research focuses on nitric oxide synthases (NOSs). Nitric oxide (NO) is a molecule that our body produces to help cells communicate with each other by transmitting signals throughout the body. Normal cells create NO, but it is potentially lethal to cancer cells. NOSs are a family of enzymes that foster the production of NO. So, Mikkelsen modifies NOS activities to kill cancer cells without harming the normal cells. “We are combining this research with radiation therapy in an effort to make the treatment more effective and safe,” he explains.

Mikkelsen has a 25-year record of funding from the National Institutes of Health to support his research, and his studies have been published in more than 30 academic journals. He has served as co-chairman for the Physical Imaging Review Panel for the Department of Defense Prostate Cancer Program and as member of many initiatives led by the National Cancer Institute and National Institute of Allergy and Infectious Diseases.

Moving forward, Mikkelsen predicts that the future of radiation therapy is in imaging and focused treatment. “Imaging is becoming so advanced, and in radiotherapy, we are getting really good at being able to focus the doses of radiation into the tumor site while minimizing the amount of normal tissue toxicity.  We are very fortunate to have excellent small animal imaging facilities here at Massey for our research,” he says.

When Mikkelsen is not working away in the lab, he is shaping the minds of future cancer researchers.  “I’ve worked with middle-schoolers—all the way up to my M.D./Ph.D. students,” he says. “Their excitement is infectious.” He recently worked with a 14-year-old, who, despite never having taken a high school chemistry class, was able to learn from Mikkelsen’s team and go on to win awards for his research. But, Mikkelsen says that his work is not all fun and awards. “I think a lot of students get discouraged because our work is so difficult. Unlike some other research where you know what the answer is and you’re working towards it; in basic science, you truly don’t know the answer. You have to keep your excitement going; otherwise, you won’t succeed.”

That enthusiasm has helped keep Mikkelsen succeeding for over 35 years. “Even after all this time, I still get excited about a new finding—just as my students do,” he says.

VCU Massey introduces new, high-tech radiation technology to improve cancer care

VCU Massey Cancer Center has made a significant investment in improving the region’s cancer care by becoming the only cancer care provider in Richmond to utilize the TrueBeam™ linear accelerator. This advanced machine made by Varian Medical Systems incorporates the latest image-guided radiation therapy technologies and higher dose rates to more accurately target patients’ tumors while sparing healthy tissue, reducing side effects and decreasing treatment times.

IMG_3608 350pxThe advanced capabilities of the TrueBeam™ system allow physicians to better treat complex cancers such as lung, liver, prostate and head and neck tumors that are close to vital organs and delicate tissue. With advanced imaging techniques, physicians can monitor and adapt to changes in a patient’s anatomy caused by the radiation therapy to personalize treatment plans based on each patient’s unique physiology. The optical camera system even allows physicians to see patient motion during treatments so they can monitor and adjust as needed.

“The TrueBeam™ system offers some very exciting and state-of-the-art features, but if you don’t know how to use them you may as well be using a normal linear accelerator. This is where our experts at VCU Massey Cancer Center set us apart from other institutions,” says Jatinder Palta, Ph.D., chief physicist in the Department of Radiation Oncology at VCU Massey Cancer Center. “We have pioneers in image-guided radiation therapy who have developed advanced radiation therapy techniques that are now being used nationwide. It is this experience that allows us to take full advantage of all of the benefits of TrueBeam™.”

Massey’s downtown location started using TrueBeam™ in June 2013, and the radiation oncology team is already pioneering ways to improve radiation therapy using its advanced features. Elizabeth Weiss, M.D., radiation oncologist at Massey, and Geoffrey Hugo, Ph.D., medical physicist at Massey, have received a grant to study image-guided radiation therapy in the treatment of lung cancers. Using advanced imaging techniques such as magnetic resonance imaging (MRI), positron emission tomography (PET) and computed tomography (CT) scans coupled with the advanced targeting abilities of TrueBeam™, they are monitoring changes in patients’ tumors throughout treatments in order to determine whether patients have better outcomes when their treatment protocol is adjusted to match the changes that are happening in their body. If successful, Weiss and Hugo will help develop new treatment protocols that could be adopted worldwide.

IMG_3655-350x233In addition to the incorporation of advanced imaging technologies, TrueBeam™ also offers a unique advanced motion package that allows doctors to more accurately compensate for movement caused by the patient’s breathing. In addition, TrueBeam™ can deliver much higher doses of radiation compared to other linear accelerators. The increased dose delivery combined with advanced imaging techniques can shorten a 10-minute treatment to just two or three minutes while delivering the same amount of radiation.

“Historically, physicians treated patients as if no physiological changes occur throughout the course of the radiation treatments,” says Palta. “We know this is not the case, and now advanced image-guided radiation therapy using equipment such as TrueBeam™ potentially opens a lot of possibilities for improving patient outcomes by personalizing treatment plans.”

In addition to its downtown location, TrueBeam™ is already in use at Massey’s partner clinic at Spotsylvania Regional Medical Center. Massey also plans to install the TrueBeam™ system at its Hanover facility and at Hunter Holmes McGuire VA Medical Center, where Massey provides cancer care to area veterans.

Prostate cancer trial aims to reduce radiation treatments

Radiation EquipmentVCU Massey Cancer Center has opened a Phase I clinical trial testing an innovative radiation therapy for patients with early stage prostate cancer that has the potential to drastically reduce treatment time. In comparison to the standard schedule of eight weeks of daily external beam radiation therapy, the new technique requires just four treatments, administered twice in the first week and twice in the fourth week.

“Many patients travel a significant distance to undergo radiation therapy at Massey,” says the creator of the innovative dosing schedule and lead investigator on the clinical trial Mitchell Anscher, M.D., Florence and Hyman Meyers Chair of Radiation Oncology and co-leader of the Radiation Biology and Oncology program at VCU Massey Cancer Center. “If successful, not only does this shortened dosing schedule mean less time out of work and less time in the clinic for patients, but we also estimate that it will cost at least $7,000 less than the standard eight-week treatment plan.”

The clinical trial shortens the treatment schedule by using a form of external beam radiation therapy called stereotactic radiation therapy. Stereotactic radiation therapy relies on precise imaging techniques, such as Massey’s Calypso 4D Localization System, to deliver a concentrated dose of radiation to the tumor with extreme accuracy. This approach allows physicians to deliver the same total amount of radiation over a much shorter period of time.

“Previous clinical trials and biological models suggest this approach could be an effective way to treat prostate cancer,” says Anscher. “We are testing the feasibility of this novel dosing schedule in hopes of developing a model that can be used by other treatment facilities with similar equipment.”

Approximately 250 patients are expected to enroll in the trial, which will be open at Massey and Hunter Holmes McGuire VA Medical Center, where Massey provides oncology care. Those interested in enrolling or learning more about the clinical trial should contact Massey’s Department of Radiation Oncology at (804) 828-7232 and reference clinical trial MCC-14712.

VCU Massey is currently conducting more than a dozen prostate cancer clinical trials and more than 150 total trials on a variety of cancers. View a complete list of all active clinical trials available at VCU Massey.