Cancer treatment is typically a multimodality approach, and within the spectrum of available therapies radiation therapy has a long track record as an effective method to reduce the cancer burden in a localized fashion. In many indications combinations of radiation and chemotherapy have become the standard of care during the past decades, usually for locally advanced stages of disease. Figure 1 below provides an overview over 8 indications representing >50% of cancer incidence in the United States.

In this context we are studying:

• the efficacy of sequential versus concurrent chemotherapy [1], and how it relates to patient and tumor characteristics (see Figure 2 and references [1-4])
• the efficacy of chemotherapy by itself in terms of cell kill and the trade-off between chemotherapy and radiotherapy in locally advanced disease. Does it depend on metastatic load (i.e. stage IIIA vs IIIB)?
• How to model the interaction of radiotherapy and chemotherapy and how to derive the necessary parameters from patient data [1]

For a 3-minute explanation of this topic, watch this video recorded at ASTRO 2017 on the website of the National Comprehensive Cancer Network: https://jnccn360.org/nsclc/videos/nsclc-therapy-sequencing-criteria/

 Project Opportunities: If you’re interested in working on these or related questions, have a look at our list of open projects --> here

References:

[1] Grassberger, C., & Paganetti, H. (2016). Methodologies in the modeling of combined chemo-radiation treatments. Physics in medicine and biology, 61(21), R344.

[2] Geng, C., Paganetti, H., & Grassberger, C. (2017). Prediction of Treatment Response for Combined Chemo-and Radiation Therapy for Non-Small Cell Lung Cancer Patients Using a Bio-Mathematical Model. Scientific Reports, 7(1), 13542.

[3] Grassberger, C., Scott, J. G., & Paganetti, H. (2017). Biomathematical Optimization of Radiation Therapy in the Era of Targeted Agents. International Journal of Radiation Oncology• Biology• Physics, 97(1), 13-17.

[4] Geng, C., Paganetti, H., & Grassberger, C. (2017). Tumor-Specific Modeling of Chemotherapy Combined With Radiation in Stage III NSCLC Suggests Novel Patient Stratification Criteria for Therapy Sequencing. International Journal of Radiation Oncology• Biology• Physics, 99(2), S35-S36.

[5] Manem, V. S., Grassberger, C., & Paganetti, H. (2017). Predicting Organ-Specific Risk Interactions between Radiation and Chemotherapy in Secondary Cancer Survivors. Cancers, 9(9).

[6] Grassberger, C., Manem, V., Eaton, B. R., Yock, T. I., & Paganetti, H. (2015). Predicting Secondary Breast and Lung Malignancy Risk After Combined Chemoradiation Treatment. International Journal of Radiation Oncology• Biology• Physics, 93(3), E508.

[7] Manem, V., Grassberger, C., & Paganetti, H. (2015). TH‐AB‐304‐10: Modeling Organ Specific Mechanistic Interactions Between Radiation and Chemotherapy. Medical physics, 42(6), 3703-3703.