Richard C. Zellars, MD
Associate Professor, Dept. of Radiation Oncology and Molecular Radiation Sciences
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
2009-2010 BCRF Project:
Partial Breast Irradiation and concurrent chemotherapy (PBIC) have many potential benefits: improved local control and importantly facilitation of therapy. This BCRF funded PBI and concurrent dose-dense AC trial is now closed and results (now published) show this combination of therapies is safe as there has been no severe acute or late toxicity. Based on these results, ECOG agreed to sponsor the development of a randomized phase II trial to evaluate PBI with concurrent vs. sequential chemotherapy. A daughter trial is currently open at Johns Hopkins evaluating concurrent PBI with various other chemotherapy regimens. This new trial will establish the safety of this combined modality therapy with other chemotherapy agents.
The goal of the SPECT trial, a second BCRF-funded project, is to assess changes in cardiac perfusion in women randomized to left breast / chest wall irradiation with and without an active breathing coordinator. This trial opened for accrual in June 2006 and patient participation has been exceptional with 52 of the planned 57 enrolled thus far. The results of this trial should be available by the end of the year.
The success of PBI is dependent on proper target localization. Although external landmarks are commonly used to calculate the position of internal targets, (e.g. lumpectomy bed), they may be unreliable in a non-rigid structure (e.g. breast), and thus call into question the accuracy of the radiation treatments. In a 3rd project, the researchers have developed new technology, ultrasound elasticity imaging, which may be superior to standard ultrasound methods for localization of the lumpectomy bed. They are enrolling patients in a recently IRB approved clinical trial to test this hypothesis. We have enrolled 10 of a planned 25 patients and published 4 papers thus far.
Cytokines are proteins and peptides that influence cellular activation, differentiation and function. They have been shown to influence breast cancer progression and radiation induced toxicity. Other factors known to influence cytokine expression are race and ethnicity. Based on these findings the researchers hypothesize that cytokine expression changes, in response to radiation and influenced by race/ethnicity, will be predictive of normal tissue toxicity and tumor-associated outcomes. Thus to test this hypothesis they have proposed a trial to evaluate cytokine expression before, during and after radiation for breast cancer. They will attempt to correlate expression changes to radiation induced toxicity and tumor-associated outcomes. They recently received IRB approval to begin enrolling patients.
Mid-Year Progress Report:
ECOG has agreed to sponsor the development of a randomized phase II trial to evaluate PBI with concurrent vs. sequential chemotherapy. A daughter trial is currently open at Johns Hopkins evaluating concurrent PBI with various other chemotherapy regimens. For the SPECT trial, enrollment is now complete and Dr. Zellars and his colleagues are analyzing the available data. The results of this trial should be available by Spring/Summer 2010. With regard to the trial testing ultrasound elasticity imaging, the researchers continue to enroll patients. For the cytokine expression trial, they have begun enrolling patients.
Bio:
Dr. Zellars is a graduate of The Johns Hopkins School of Medicine. He completed his residency at the University of Michigan in the Dept. of Radiation Oncology, where he was Chief Resident from 1995-96. He next accepted an appointment as an Assistant Professor of Radiation Oncology at the University of Texas Health Science Center at San Antonio. During his tenure there, Dr. Zellars also served as Clinic Director and Vice Chair. Most recently he held a position at Georgetown University Department of Radiation Medicine before returning to Johns Hopkins and the Sidney Kimmel Comprehensive Cancer Center, where he is now Associate Professor.
Dr. Zellars' primary research interests are the evaluation of putative prognostic factors for local failure and the development of new radiation therapy techniques, all with respect to breast cancer.
