Researcher Pilots New Process that Reduces the Length of Cancer Radiation Treatments

Joseph Zenga, MD, a head and neck surgical oncologist, the Donald S. Blatnik, MD and Sharyn B. Blatnik Professorship of Head and Neck Surgical Oncology and Reconstruction and assistant professor at the Medical College of Wisconsin (MCW), enters another zone when he conducts surgery on a cancer patient.

“I can operate for 12 hours and think about nothing else,” he says. “I don’t feel hungry; I don’t feel thirsty. There are no worries that go through my head about other things in my life.”

And once the surgery is completed, there’s no feeling quite like it, he shares. “It doesn't matter how long it is because you know you've done the absolute best you can do for that patient, and so that's extremely satisfying.”

At the same time, Dr. Zenga explains, advanced cancer medicine and the highest standard of care that’s delivered within the Froedtert & the Medical College of Wisconsin health network isn’t always enough.

“We don’t save everyone, and that’s the nature of cancer,” he says. “I know we’ve done the best job for that patient, but at the same time I’m worried for them.”

It can take months or longer to know whether a treatment is working or if the cancer will return, so Dr. Zenga keeps close tabs on his patients, which have multiplied over the years.

“The more patients you accumulate, the more people that you worry about, you know, on a day-to-day, month-to-month, year-to-year basis,” he says. The devastation and fear of losing patients to cancer is what drove him to research.

Now Dr. Zenga, who dreamed of being a doctor of general medicine before falling in love with the art of surgery, is using that research to help improve outlooks for cancer patients. His team’s main project involves the process of hypofractionated radiation – a reduction of the amount of days a cancer patient needs to undergo radiation therapy.

One reason why this research has lifesaving potential is because many patients don’t complete the radiation treatments they need to help fend off cancer, Dr. Zenga explains.

Information he reviewed from the National Cancer Database (NCDB) showed that 30 percent of cancer patients who needed radiation after surgery did not receive it. When he looked at outcomes for those patients compared to those who did get radiation, they had far worse rates of survival, even after controlling for other variables.

Obstacles to completing radiation therapy after surgery include pain or confusion about the treatment itself, side effects, adverse life events and even the fact that many have to travel a long way to receive the best of care, Dr. Zenga says. Those challenges grow for individuals with limited financial and other resources, he adds.

“There is a light at the end of the tunnel, but that tunnel is long, way longer than I want it to be, way longer than the patient wants it to be,” he notes. “Many of those concerns could be addressed by just shortening radiation.”

This innovative pilot treatment pioneered by Dr. Zenga and his MCW colleague, Musaddiq Awan, MD, assistant professor of radiation oncology, has the potential to reduce the length of radiation by weeks. Currently, it’s in the clinical trial stage, but early results have been promising. In addition to reducing the length of treatment, hypofractionated radiation also has helped to shorten the duration of the adverse effects of radiation, Dr. Zenga says. The next phase of the project will include more patients and an attempt to further reduce the length of radiation treatments.

In addition to his hypofractionated radiation study, Dr. Zenga works with other researchers to develop innovative cancer drug therapies. He attributes the success he’s had to the support he gets from MCW and the Froedtert & MCW health network.

“They really empower us to improve outcomes in multiple ways; one is research funding opportunities,” he says. “It really takes researchers like me to the next level in terms of our ability to improve patient care and to improve our research.”

Dr. Zenga also benefits from the team approach within the institutions.

“I have incredible collaborators across disciplines,” he says. “Everybody shows up every week, and that dedication is unbelievable. Every week I'm astounded by the progress we've made that we would never have made otherwise.”

The ultimate goal, he says, is to save the lives of patients he cares deeply for.

“You meet these people, and you develop this bond with them; they’re putting their whole lives in your hands, and you trust them to keep going and to not give up and that’s a bond that is unlike any other bond,” Dr. Zenga shares. “It’s more than a friendship.”