Research Marries Practice: CyberKnife at the Dinner Table

When Shirnett Williamson, MD, PhD met Derrick Grant, PhD in the 1980s at McGill University, neither one had a medical degree, nor had they imagined their future would someday include debating radiosurgery techniques at the dinner table.

Williamson, who was honored this April by the American Cancer Society in New Jersey for contributions in her practice and for extensive community service, was majoring in computer science and anatomy at the time. She switched gears and pursued a residency in radiation oncology and today is director of Radiation Oncology for the Capital Health in New Jersey. She has also worked in the same capacity at the Charlotte Kimelman Cancer Institute in the US Virgin Islands. She has taught for the University of Pennsylvania and has authored many publications on her specialty. At Capital Health she is actively involved with treatments using the LINAc, CyberKnife, and brachytherapy.

After completing his PhD at McGill, Grant pursued a postdoctoral degree and research fellowship at the National Institutes of Health, then worked as assistant professor of medicine at Thomas Jefferson University in Philadelphia for 9 years. There, some of his oncology work included testing novel antiangiogenesis compounds to inhibit the growth and spread of tumors and the role of basement membrane components in the protection of endothelial cells from radiation. He worked as research director of the Charlotte Kimelman Cancer Institute in the US Virgin Islands, and now works for Capital Health as the clinical doctoral research coordinator for the CyberKnife oncology program.

The couple constitutes a living definition of translational oncology. They currently focus much of their research and practice around CyberKnife, a radiosurgery that treats tumors in the body with submillimeter accuracy. It uses image-guidance technology and computer-controlled robotics. The system tracks, detects, and corrects for tumor and patient movement throughout the treatment and does not require head or body frames to stabilize the patient.

Grant currently helps to develop and bring new CyberKnife protocols throughout the US and Europe to Capital Health. He is involved in a phase II study to determine the effectiveness of CyberKnife on patients with resected metastatic brain cancer. The trial is a multicenter study being done in with Don Stacy, MD who heads the CyberKnife program at the Community Cancer Center in Normal, Illinios.

External beam radiation after surgery is the current guideline suggested by the National Comprehensive Cancer Network for patients with brain cancer. However, radiation destroys nearby brain tissue along with the cancer cells, presenting a potential danger to the patient.

Unlike some researchers, Grant can hear, firsthand, how his research translates into clinical practice. “I have patients with brain metastases who would never have been able to survive, who have had it for 3 years. We just routinely watch these patients who are living longer lives,” Williamson said, while her husband, Grant, nodded in agreement.

Williamson spoke of one patient who has recently benefited from the CyberKnife research. This woman presented with adrenal metastases from lung cancer and had the metastases resected. “Her lung cancer was treated with chemotherapy and radiation, then she developed a brain metastasis,” Williamson said. “We gave her CyberKnife to the brain metastasis, and then she developed another brain metastasis, so we gave CyberKnife to that. Two years later, she is cancer free — you would never see that years ago.”

“Another gentleman that I am following who also had lung cancer and brain metastases, we treated with radiation and chemotherapy; the lung cancer went away. He developed a brain metastasis that was surgically resected, and then we treated the cavity with CyberKnife. It recurred again in the same area, and we treated it again with CyberKnife. He has been cancer free for 2 years.”

CyberKnife can be used for any focal tumor, and offers options to patients who are elderly or immunocompromised that cannot undergo surgery

CyberKnife can be used for any focal tumor, and offers options to patients who are elderly or immunocompromised that cannot undergo surgery. Capital Health recently closed a protocol with over 20 patients from a national multicenter trial with over 264 patients with early-stage, organ-confined prostate cancer. Patients were low and intermediate risk and received 36.25 Gy delivered in 5 fractions (out patient) of 7.25 Gy per fraction. According to Williamson, within 3 years on the protocol, PSAs dropped to 0.5 or below, and 90% of men have potency. The study showed a 1% grade 3 urinary toxicity and no grade 3 GI toxicity. The study is ongoing but not recruiting participants.

Williamson stated at the ACS gala in April that she enjoys seeing the results of her work with radiosurgery and, in many cases, watching patients with cancer throw away their pain medication when they no longer need it anymore. She attributes her success to the support of her mom, husband, and three children, who must sometimes tolerate dinner conversations that highlight the latest developments with CyberKnife.

Dr. Grant and Dr. Williamson Discuss How His Research is Translated Into Her Practice