How to improve quality of life during and after radiotherapy? Sarcoma practice and research in large university clinics in Toronto and Berlin

 

Interview with Dr. Siyer Roohani

by Gabi Ott

 

Voices of Sarcoma: Dr. Roohani, recently you won an award of the German Sarcoma Foundation in support of your research. Would you please tell us what your project is about?

Siyer Roohani:  Currently, the standard radiation therapy for a sarcoma that has not metastasized takes 5 to 6 weeks, in daily doses of 1.8 to 2 Gy  to reach a total of 50 Gy; this is the so-called “conventional fractionation”. I am examining what is the impact of giving more dose per day and thereby reduce the overall duration of the radiation period to three weeks or less.[i] This is called “hypofractionation”. We have multiple clinical studies suggesting that this approach is comparable to the conventional fractionation in its effect to reduce the chance of the sarcoma relapsing in the same site.  Trials that directly compare patients treated with conventional fractionation in one group and hypofractionation in another group are ongoing and will bring more valuable insights. What interests me now is whether both treatment regimens are comparable in controlling the disease, how does hypofractionation impact the health-related quality of life of patients. How do they feel one or many years after the treatment? For example, to what extent do the side effects of radiation such as swollen legs or skin scarring affect their daily activities? These aspects of quality of life of cancer survivors become more and more important as therapies are increasingly successful, and patients live longer. And for this research, I received the research grant.

Voices of Sarcoma: Currently, you are working and researching in Canada in one of the largest sarcoma centres of the world. What are your tasks?

Siyer Roohani: I am a clinical scholar for the duration of six months at the Princess Margaret Cancer Centre in Toronto, which gives me the unique opportunity to collaborate with the sarcoma radiation oncology team here under the leadership of Dr. David Kirsch, a world renown expert in the field. It is an awesome experience. I get to treat patients but also to work scientifically. Weekly, we have an outpatient clinic for sarcoma patients with a multidisciplinary team of surgeons, radiation oncologists, medical oncologists and others. There are about 450 new sarcoma cases per year for consultation. That corresponds probably to almost a quarter of all sarcoma cases in Canada. Some patients come from far away to our clinic, they drive three to four hours. My task is to conduct patient consultations, develop a plan for the radiotherapy in consultation with the multidisciplinary team and to monitor the patients during their therapy. This way, I get to know the patient very well because I am responsible for her or him from the beginning till the end of therapy including follow-up care.

Voices of Sarcoma: And what is your scientific work about?

I am involved in several projects. For example, last year a landmark study led by Dr. Kirsch showed that adding immunotherapy treatment to standard radiation therapy and surgery significantly improves outcomes for patients with high-risk soft tissue sarcomas. Now, I am re-analyzing the data of that study with a specific look at the safety margins for the radiation therapy. My question is: What happens if we reduce the safety margins around the tumor to damage less healthy tissue but still kill the tumor effectively? This would reduce early and late side effects and thereby improve patient’s outcome. So far, we are seeing that it is possible to safely reduce the margins and thus reduce side effects. The study will soon be finalized and published.

Voices of Sarcoma: Where do you see the biggest differences between the sarcoma centres in Toronto and Berlin?

Cancer medicine here in Canada is more centralized, and specifically the clinic here is a very large apparatus. This has advantages but also disadvantages.  Everything is more formalized, there are established protocols that cannot be easily adjusted; decision making takes a while. That may be easier in Berlin, Germany.

But what is really nice here in Toronto is the multi-disciplinarity and the approachability of colleagues and superiors. Contacts are more easy-going and informal. For example, there is this world class surgeon, and I asked him whether I could watch an operation he was going to do.  And his spontaneous reaction was: “Hey, that’s a great idea, let's do it!” We do also have that in Germany, but generally interaction is a bit more hierarchical.

I also like the various events that are being organized to bring people together for learning and exchange: coffee talks about science, or lectures and seminars. Of course, we do have that in Germany, too, but here in the Princess Margeret Centre, it is a systematic approach to continuously create opportunities for people to discuss and exchange about many different aspects of cancer medicine.

Voices of Sarcoma: What are for you the most important insights from your work in Canada and Germany with regards to sarcoma?

 Siyer Roohani: Sarcomas are rare and need specialized care. Patients have often gone through an odyssey of doctor visits before they finally get in touch with a specialist. This long journey usually causes anxiety and insecurity. We need to work as a multidisciplinary team very closely together to treat sarcomas. Studies show that patients live longer when they are treated in a specialist centre with multidisciplinary teams. In rare cancers such as sarcomas, international collaboration and networks are crucial to bring together the globally available expertise in sarcoma research and clinical care. They are necessary to make progress in sarcoma diagnosis and care, to improve survival and quality of life for patients.

Voices of Sarcoma: Would you recommend a working stay abroad for other young researchers?

Siyer Roohani:  Absolutely!  I would recommend it 100%.  It is very enriching in many ways. You get to meet world class experts whose papers or presentations you have read before. You will understand how the people behind these studies work, what their challenges are, how they address them and what the issues are that may not be written down in a paper.  But not only the scientific aspects are important, also the clinical practice: You learn how these top experts prepare patients and care for them throughout their therapy. And then of course, just being and working in another country is an enrichment. The only downturn, I must say, is that it is very cold here in Canada in winter...

[i] Here is a recent article from Dr. Roohani discussing radiation therapy for sarcomas including the topic of hypofractionation: https://pubmed.ncbi.nlm.nih.gov/38478330/

Credits:  Photos provided by Dr. Siyer Roohani to SPAGN for publication.