Week 2

This week, I continued shadowing and learning about different treatment strategies used in radiation oncology. On Tuesday, I shadowed Dr. Jonathan Knisely's clinic, which specializes in the treatment of CNS tumors. Irradiating all tumors requires a great deal of precision to avoid damaging healthy tissue, but this is especially true when targeting tumors in the brain. As such, when patients come in for the planning stages of their treatment, they get fitted with a tight-fitting, cage-like face mask that completely restricts head movement while under the radiation machine. Wearing this can be rather unnerving for many, and it is not uncommon for patients to suffer from anxiety and panic attacks during treatment. Nonetheless, the head contraption is essential to avoid accidentally exposing healthy brain tissue to high doses of radiation. I also followed Dr. Knisely to the OR, where he performed a brachytherapy on a patient with a tumor near their brain stem. Specifically, after the neurosurgery team removed the tumor, radioactive material sealed inside titanium seeds was implanted into the tumor cavity to irradiate any possible remaining cancer cells in the vicinity and prevent tumor regrowth.

On Thursday, I tagged along with Sam to observe a couple of procedures in interventional radiology. One of the procedures involved threading a catheter through the patient's blood vessels to locate the vasculature that delivers blood to their liver tumor and make sure that they do not lead back to other vital organs. Radioactive beads were then injected and delivered straight to the tumor. This procedure was especially interesting, as I was able to see a new side of cancer treatment that I haven't seen before. There are definite advantages to this strategy over using radiation beams in some cases, such as when the tumor is in a particularly difficult spot that might expose to radiation if exposed to a radiation beam. 

On Friday, I returned to the Radiation Oncology department to shadow Dr. Ng's clinic. I was able to see a pancreatic cancer patient being given adaptive radiation treatment, which uses one of the most cutting-edge technologies to combine MR imaging with a linear accelerator to allow for live imaging of the area surrounding the patient's tumor while they are being given radiation treatment. This allows for the machine to continuously monitor the position of the tumor target and track its movement as the patient breathes while under the machine. As a result, the radiation beams will automatically turn off if the target gets out of range or if a nearby critical organ moves into range. Ultimately, this allows for much safer delivery of high doses of radiation to difficult targets like the pancreas, which have many critical organs in close proximity. 

Regarding research, I continued reading papers to learn more about the role of Fc gamma receptors (FcgRs) on the design and engineering of immunotherapies, as well as to help design experiments to determine the effect of radiation treatment on FcgR expression and engagement. One thing that really interests me is that the final outcome of FcgR engagement on an immune cell depends on the net engagement of activating versus inhibitory FcgRs. To this end, many immunomodulatory and anti-tumor monoclonal antibodies in development focus on engineering the Fc domains to achieve higher binding affinities for activating FcgRs. However, I believe that there could also be a way to enhance immune engagement by modifying the immune cell glycocalyx to allow for increased biophysical antibody-FcgR interactions. Overall, there are many interesting questions that can be asked in this regard that relates my lab's research interests to those of Dr. Marciscano's lab.

Besides clinical shadowing and research, I continued exploring new restaurants and areas in the city. We went to a Yankees game, ate dim sum in Chinatown, visited the Museum of Natural History, and tried a few ice cream shops.