Surgery in neuro-oncolgy with a focus on stereotactic radiosurgery
Veronica Chiang is jointly appointed as Associate Professor in Neurosurgery and Therapeutic Radiology at the Yale School of Medicine. Dr Chiang became the Medical Director of the Yale New Haven Hospital Gamma Knife Center in 2006 where currently over 300 patients are treated each year. She is predominantly interested in the management of brain metastases and now works closely with Medical Oncologists, Radiation Oncologists, Pathologists and Radiologists in the development of new treatment paradigms for patients with brain metastases as well as understanding the effects of these treatments on the normal brain.
Q You earned your medical degree at the University of Western Australia – what sparked your interest in neurosurgery and neuro-oncology?
All Australian medical students have the opportunity to do an away rotation in their final year. For personal reasons, and because I had never had the opportunity to see this subspecialty in Australia, I did a subinternship in neurosurgery in the USA. I was captivated by the unique cross between the neurosciences and the possibility of treating patients surgically. During my residency, I saw the morbidities associated with delayed recognition of brain metastases and then surgical management followed by whole-brain radiation therapy – standard of care at the time. After my residency, the use of Gamma Knife stereotactic radiosurgery, as a minimally invasive option, paired with the use of surveillance imaging provided an opportunity for neurosurgeons to prophylactically treat brain metastases before they became troublesome. As a junior attending, this common sense concept was an appealing paradigm, as well as being an opportunity to grow a career.
Q As Director of the Yale New Haven Gamma Knife Center, could you tell us a little about the research being undertaken there?
Research at the Yale Gamma Knife Center is divided mainly into three areas:
• Outcomes after radiosurgery
In the past, we have studied the efficacy of radiosurgery on local control of brain metastases and its effect on overall patient survival. We then studied the patient factors and associated treatments that affected outcome. Our research suggests that patient with certain tumor genetic mutations such as EGFR or ALK mutations in lung cancer and NRAS mutations in melanoma may make these tumors more susceptible to radiation. More recently we have developed a rationalized radiation dose protocol based on lesion size to standardize the dose administered across all patients in order to establish standardized outcomes. Based on this, we may then consider clinical trials to de-escalate radiation dose if patients are found to have susceptible tumor genetics thereby hopefully decreasing their toxicity risks.
Click here to view the full Ask the Experts article in our partner journal CNS Oncology.
