Michael D. Chuong1, Jin Ye Yeo2
1Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, USA; 2CCO Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. CCO Editorial Office, AME Publishing Company. Email: editor@thecco.net
This interview can be cited as: Chuong MD, Yeo JY. Meeting the Editorial Board Member of CCO: Dr. Michael D. Chuong. Chin Clin Oncol. 2024. Available from: https://cco.amegroups.org/post/view/meeting-the-editorial-board-member-of-cco-dr-michael-d-chuong.
Expert introduction
Dr. Michael D. Chuong (Figure 1) is the Vice Chair and Medical Director in the Department of Radiation Oncology at Miami Cancer Institute, Baptist Health South Florida. He is also the Vice Chair of Education and Clinical Research and Professor of Radiation Oncology at the Florida International University Herbert Wertheim College of Medicine. Dr. Chuong is an internationally recognized expert in radiation therapy for GI cancers and leads the GI radiation oncology service at Miami Cancer Institute. He is frequently invited to speak across the globe about his clinical expertise and research, especially related to proton therapy and MRI-guided radiation therapy.
Dr. Chuong has co-authored over 125 peer-reviewed manuscripts in prestigious journals such as JAMA Oncology and the International Journal of Radiation Oncology Biology Physics, for which he is an associate editor of the GI section. He is a principal investigator for multiple national and international clinical trials that are exploring advanced radiation therapy strategies and unique combinations of radiation therapy with novel therapeutic agents for GI cancers. As an active leader in the medical community, Dr. Chuong is the Protocol Monitoring and Review Committee Chair at Miami Cancer Institute, Disease Site Chair of the Proton Collaborative Group and the Particle Therapy Co-operative Group GI Sub-committee Co-Chair. He is also an active member of the NRG Oncology Non-Colorectal GI Subcommittee, NRG Pancreas Working Group, NRG Oncology International Liaison Committee, and RTOG Foundation Communications Committee.
Figure 1 Dr. Michael D. Chuong
Interview
CCO: You are an internationally recognized expert in radiation therapy for gastrointestinal (GI) cancers. What initially drew you to this specialty?
Dr. Chuong: I had an early interest in both gastroenterology and oncology, and being a radiation oncologist who specializes in gastrointestinal cancers was a perfect fit. I enjoy the diversity of gastrointestinal cancers and how each one is treated differently. There are also unique challenges for each type of gastrointestinal cancer, which provides a lot of opportunities to improve outcomes through research.
CCO: What are some advancements in this field that you find most exciting?
Dr. Chuong: Radiotherapy has historically played a limited role for most gastrointestinal cancers, and is typically used as either preoperative or postoperative therapy but rarely as a definitive treatment. This is partly due to limitations in available technology to safely deliver enough radiation dose to the tumor without causing significant toxicity. Recent advances in image guidance, especially using magnetic resonance imaging (MRI) and adaptive radiotherapy techniques, have greatly enhanced our ability to deliver ablative radiation doses safely even to the most anatomically challenging gastrointestinal cancers. Proton therapy is another advanced type of radiotherapy that can play a significant role in the treatment of gastrointestinal cancers, especially esophageal and liver cancers. These advanced technologies have resulted in improvements not only in local control, but also overall survival and are very well tolerated.
CCO: Your expertise includes proton therapy and MRI-guided radiation therapy. Can you explain how these technologies have transformed cancer treatment and the specific benefits they offer to patients?
Dr. Chuong: MRI-guided radiation therapy has emerged within the last decade and truly represents a paradigm shift in how many cancers are treated, especially those of the gastrointestinal tract. X-rays or computed tomography (CT) scans for patient positioning are typically not of high quality to allow for clear identification of tumors and surrounding organs in the abdomen and pelvis, leading to targeting uncertainty. In addition, conventional linacs cannot image the tumor during treatment delivery, which leads to additional uncertainty for tumors in the abdomen and pelvis that are likely to move during treatment, for example, from respiration. Lastly, conventional linacs cannot modify the radiation dose each day to account for internal anatomy changes. MRI-guided linacs overcome all these limitations and permit significant radiation dose escalation, typically in 5 or fewer fractions, over what can be safely delivered with a conventional linac for even the most challenging tumors that are encased by radiosensitive organs such as the intestine. Emerging clinical outcomes data demonstrate that ablative radiotherapy delivered on an MRI-linac is safe and can improve both local control and overall survival for certain tumors, including locally advanced pancreatic cancer. Proton therapy is another advanced technology that delivers less low-dose radiation to tissues around the tumor due to the Bragg Peak effect in which there is no “exit dose” distal to the tumor within the path of a proton beam. Large volumes of the body will receive absolutely zero radiation dose as a result of this, in contrast to X-ray therapy, which will deliver more low-dose radiation to a larger volume of normal tissue. This is highly relevant for treating tumors where low-dose radiation can lead to toxicity. For example, low-dose radiation can increase the risk of significant liver dysfunction and cardiopulmonary and bowel adverse events. Proton therapy can not only decrease the probability of these toxicities but also can more safely deliver higher radiation doses to the tumor for some tumors, thus increasing the probability of tumor eradication and potentially improving overall survival compared to what might be achieved with X-ray therapy. Proton therapy uses X-ray or CT guidance, although MRI-guided proton therapy systems are in development and will further improve efficacy and safety.
CCO: What are some areas of radiation therapy research for GI cancers that you believe have been overlooked or received insufficient attention?
Dr.Chuong: While radiotherapy is routinely used for rectal and anal canal cancers, it is more controversial for the treatment of upper gastrointestinal cancers. For example, radiotherapy is not a standard of care for treating locally advanced pancreatic cancer based on randomized trials showing no overall survival benefit over chemotherapy alone. Radiotherapy is also controversial for treating liver cancer, especially hepatocellular carcinoma. This is in part because of technical challenges in treating with doses high enough to be effective, including suboptimal image guidance using X-rays and CT scans, accounting for substantial tumor motion during treatment due to respiration, and accounting for day-to-day anatomic changes in the tumor and also surrounding organs such as the intestines. However, advances in technology, including both MRI guidance and proton therapy, have overcome many of these challenges, and clinical outcomes are emerging to show that radiotherapy should be a standard of care.
CCO: As a principal investigator for multiple clinical trials, what are some of the most promising studies you are currently involved in, and what potential impact do they have on the future of GI cancer treatment?
Dr. Chuong: I have a particular interest in expanding the indications for radiotherapy in the treatment of pancreatic and liver tumors. I was one of the PIs for the phase 2 SMART trial that was the first to demonstrate that ablative MRI-guided radiation therapy is not only safe, but also can achieve excellent local control and overall survival when compared to conventional radiotherapy doses. I am excited about the upcoming NRG GI011 trial, which is a phase 3 trial for locally advanced pancreatic cancer that aims to demonstrate that ablative radiotherapy improves 3-year overall survival after induction chemotherapy compared to standard-of-care chemotherapy alone or chemoradiation. I have a phase 2 trial that is enrolling at my institution for locally advanced pancreatic cancer, evaluating the efficacy of both ablative MRI-guided radiotherapy and tumor-treating fields, which is especially exciting given that the phase 3 PANOVA-3 trial demonstrating an overall survival benefit of tumor-treating fields over chemotherapy alone for locally advanced pancreatic cancer. That trial did not include radiotherapy, and thus, my phase 2 trial could provide evidence that “trimodality therapy” of chemotherapy, radiotherapy, and tumor treating fields is especially beneficial and perhaps one day a standard of care combination. Lastly, NRG GI012 is a phase 3 trial for advanced hepatocellular carcinoma that will randomize patients to immunotherapy with or without radiation therapy and compare overall survival. This trial was developed on the basis of RTOG 1112 being positive in favor of adding stereotactic body radiation therapy (SBRT) to sorafenib.
CCO: Your involvement in various committees demonstrates your active leadership in the medical community. How do these roles influence your clinical practice and research?
Dr. Chuong: I find it rewarding to be involved in leadership roles within the medical community and know that I am having an impact on how radiotherapy is perceived and used throughout the world. Many physicians within the field of oncology still view radiotherapy as having little to no relevance for treating some gastrointestinal cancers, and I have great interest in shaping national and international guidelines to include radiotherapy where there truly is a benefit.
CCO: How has your experience been as an Editorial Board Member of CCO?
Dr. Chuong: I have thoroughly enjoyed being an Editorial Board Member for CCO. CCO publishes highly impactful clinical research, which is well regarded in the oncology community, and it is a pleasure to provide input on shaping what the journal publishes.
CCO: As an Editorial Board Member, what are your expectations for CCO?
Dr. Chuong: My expectations for CCO are that we continue to attract submissions that are high-impact and clinically meaningful. This can be facilitated by reducing the time to final manuscript decisions and engaging high-quality reviewers to provide thoughtful and timely reviews.