As part of our spotlight we spoke with Daniel B Brown from the Vanderbilt Cancer Center (TN, USA) about his work in the field of Interventional Oncology and minimally invasive surgery including the changes he has observed over his career and his hopes for the future of the field.
Can you tell us about your career to date?
I was interested in interventional radiology before graduating from medical school. I completed a 2 year fellowship at Penn State University (PA, USA) where I received tremendous mentorship from the faculty, resulting in an academic appointment at Washington University in St. Louis (MO, USA) in 1999. After developing a chemoembolization service, we expanded into thermal ablation and later radioembolization. We developed strong collaborative relationships there with the Transplant Surgery, Surgical Oncology, Medical Oncology and Urology. In 2007 I became the director of Interventional Radiology at Thomas Jefferson University (PA, USA). The practice there was wonderful with the largest treatment population of metastatic uveal melanoma in the world. Our collaborations with urology and hepatology led to development of a multi-specialty small renal mass center and hepatocellular carcinoma clinic, respectively. In 2013, my wife and I were recruited to Vanderbilt University (TN, USA). My role at Vanderbilt was specifically focused on developing a clinical and research service directed towards interventional oncology. Since moving to Nashville, the procedure volume has increased by over 500% and we are participating in NIH funded research on chemoembolization. Vanderbilt is also the prinicipal site for the Radiation-Emitting SIR-Spheres in Non-Resectable (RESIN) Liver Tumor Registry.
What sparked your interest in interventional oncology?
A lot of the patients we examined at Washington University had been told by multiple centers that there were no suitable treatment options for them. However, we were able to treat them. Witnessing the gratitude for extending survival with maintained quality of life, for diminishing pain, for treating symptoms related to carcinoid syndrome cannot be overstated.
What major changes have you observed in interventional oncology over the last decade?
Larger research projects are becoming the norm, which is a great development. Many techniques were initially published as retrospective, single-center studies. With more robust data being published, these procedures are gaining increasing traction in guidelines, including those of the National Comprehensive Cancer Center Network.
You have written performance guidelines for a number of the minimally invasive oncologic interventions, could you tell us a bit more about the current guidelines for hepatic malignancies?
Arterial and ablative therapies are the gold standard for unresectable hepatocellular carcinoma. They are also well-established for metastatic neuroendocrine tumors and are becoming increasingly accepted for colorectal cancer and less common tumors such as cholangiocarcinoma, metastatic sarcoma and melanoma. The guidelines I have been involved in have worked within existing paradigms including performance status and toxicity reporting using the common terminology criteria for adverse events. Utilizing these common tools is crucial as interventional oncologists strive to prove value of their treatments.
You have served on the Executive Council of the Society of Interventional Radiology, could you let us know a bit more about the society and your role?
I have been fortunate enough to serve in several areas for the Society of Interventional Radiology. A very enjoyable experience was working on the Annual Meeting Committee, which included running our Annual Scientific Meeting in 2014. It was surreal to observe something that took a year to put together, unfold in real time. Currently, I oversee post-graduate education. This broad division includes relationships with the American Board of Radiology, putting together stand-alone courses on focused topics in interventional radiology and ensuring access to self-assessment CME modules for members.
Can you tell our readers about your current research & other ongoing studies?
The growth of the RESIN registry has been phenomenal. It opened two sites in July 2016 and as of now, 27 sites are enrolling with 374 patients entered. At our current pace, we hope to have 1000 enrolled patients by January 2018. The amount of data we will be able to parse from this work will help to provide a better understanding of the role of Y90 for less common tumors and hopefully identify high-signal to noise areas in more common tumors where we can combine Y90 and systemic therapy in prospective studies.
Where do you hope to see the field of interventional oncology/minimally invasive treatments care in 10 years’ time?
The potential of combining Y90 and systemic therapy is underexplored. Creating new combinations of therapy has been crucial for medical and radiation oncology. An obvious example is the combination of oxaliplatin or irinotecan with traditional chemotherapy for colorectal cancer. I hope that further avenues of therapy can be identified. One area of interest for me is in patients who have progressed on two lines of therapy with colorectal cancer. There is a clear opportunity to improve outcomes in those patients.
Do you have any closing comments for our readers?
Interventional oncologists are eager to collaborate with other cancer specialists. A great number of the different specialists at Vanderbilt have bought into our practice model, which has improved patient care across the board. We have patients self-refer that I send onto medical oncology, urologic oncology or transplant surgery. I hope the other oncology specialists reading this can enjoy the same relationship with their interventional oncology practitioners.
Dr Daniel Brown focuses his clinical work on Interventional Oncology, a subspecialty which uses imaging to guide minimally invasive cancer treatments. He treats both primary and metastatic tumors to the liver with radioactive beads and chemoembolization. Treated tumor types include hepatocellular carcinoma, cholangiocarcinoma, neuroendocrine tumor, colorectal cancer, breast cancer, melanoma, and soft tissue sarcoma. He also treats liver, kidney, skeletal and lung tumors with ablative techniques, including cryoablation as well as radiofrequency and microwave ablation. Painful skeletal masses may also be treatable with vertebroplasty. Brown has authored over 100 articles and scientific abstracts and has written performance guidelines for a number of the minimally-invasive oncologic interventions done at Vanderbilt. His research has focused on the entire spectrum of interventional oncology.