Kenneth B. Roberts, MD

During my first ten years on the Yale faculty, I participated in clinical trials evaluating the efficacy of bioreductive alkylating agents as an adjunct to radiotherapy in cervix cancer. A Phase III study comparing radiotherapy alone with radiotherapy plus Mitomycin C for cervix cancer has been completed in Venezuela with results showing a significant improvement in disease-free survival with the addition of Mitomycin C, which is a hypoxic cell cytotoxin.

For several years, I had been collaborating with Interventional Cardiology and Medical Physics in a clinical program utilizing coronary brachytherapy to manage in-stent restenosis. Some current or upcoming clinical research projects include:

1) modifying radiation dose and volume in advanced stage Hodgkin’s disease based on response to initial chemotherapy (a cooperative group trial);

2) the effects of prostate edema during brachytherapy on modulating radiation dose delivery;

3) the changes in second malignancies seen after Hodgkins Lymphoma therapy with shift away from primary extended field radiotherapy to combined chemotherapy and low dose involved field radiotherapy

4) an examination of the economic forces that drive the use and demand for radiotherapeutic modalities, often with poorly developed evidence.

Regarding this latter concept, in the management of localized prostate cancer, brachytherapy is in a decline while Intensity Modulated and Image Guided Radiotherapy is in ascendancy for complex reasons. In early stage breast cancer, there is an increasing trend toward partial breast irradiation using 3D conformal radiotherapy or brachytherapy. Coronary brachytherapy had experienced a several year surge in usage and interest amongst cardiologists, but now is less frequently needed due to the efficacy of drug eluting stents, a complementary albeit expensive technology. Palliative radiotherapy in terminally ill cancer patients has become less frequently used, due in part to the capitated reimbursement for hospice care and the relatively high expense and inconvenience of radiotherapy versus medical therapy.