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Connections: Motivated and moving forward

New members of the UC Davis Radiation Oncology Department

Jyoti Mayadev, M.D.

Jyoti MayadevA leader in managing breast and gynecological cancers, Mayadev is pioneering the use of brachytherapy in these areas. This technique, in which a source of radiation is placed inside the body, allows delivery of high doses of radiation close to the tumor. Her research examines the use of brachytherapy to improve the "therapeutic ratio" – maximizing destruction of the tumor while sparing healthy tissue. "Managing therapy and harm is a constant balancing act in radiation therapy," says Mayadev. "We closely follow all our patients after radiation treatment. If a cancer recurs, we can utilize our tools to deal with it."

Ruben Fragoso, M.D., Ph.D.

Ruben FragosoSpecializing in brain and central nervous system cancers, Fragoso is particularly excited about exploring therapies that may eliminate the need for surgery. He is an expert in the use of the gamma knife, which precisely delivers high-dose radiation and can allow the destruction of tumors deep in the brain that would otherwise be inoperable. Fragoso is conducting research on glioblastoma multiforme, an aggressive brain cancer with few treatment options. "My patients are my inspiration," says Fragoso. "It is very motivating to try to find ways to extend survival and offer a better quality of life for some of these devastating diseases."

Allen M. Chen, M.D.

Allen M. ChenAn expert in head and neck anatomy, Chen has developed an "atlas" for radiologists to better plan therapy. His nerve maps of the head and neck, which help radiologists avoid damaging critical nerves, have been adopted into standard guidelines issued by the national Radiation Therapy Oncology Group. Chen is skilled in using stereotactic body radiation therapy (SBRT), which delivers a single high dose of radiation from multiple beam angles using a coordinate system to precisely locate the tumor. SBRT is an alternative to surgery in early-stage lung cancers. "Radiation oncology is an exciting field because it is used in so many settings," says Chen. "Radiation now plays an important role in primary treatment, postoperative therapy and palliation for pain control."

Richard Valicenti, M.D., M.A.

Richard ValicentiSpecializing in prostate and other urologic cancers, Valicenti uses intensity-modulated radiation therapy (IMRT), an advanced high-precision radiation method. The accuracy of IMRT results from the use of computer-controlled linear accelerators to sculpt a three-dimensional radiation dose map to deliver precisely targeted radiation doses to a tumor. As chair of the department, Valicenti takes special pride in creation of a group of specialists who subscribe to a team approach. "Not only do we regularly consult with one another, but we call in experts from other departments and work closely with the patient’s primary-care physician and other members of the treatment team," Valicenti says. "Multidisciplinary approaches are critical to solving complex medical problems today."

Guitar Hero Contest

Muntadhar "Tony" AlJoher

With cheering fans in the wings, 8-year-old Muntadhar "Tony" AlJoher lit up the radiation oncology waiting room in July as he took on – and handily outplayed – Ruben Fragoso, assistant professor of radiation oncology, in a Guitar Hero contest. The young rock ‘n roll wizard was celebrating the end of a 30-visit series of radiation treatments for medulloblastoma, a brain tumor, diagnosed in May.

Cheering fans in the wings  Ruben Fragoso accepting defeat ... this time  

When Carol Foscarini developed bleeding last year, she knew that with menopause behind her, it was unusual. But neither she, nor her primary-care doctor or gynecologist expected the diagnosis her biopsy revealed: a very rare form of vaginal cancer.

Jyoti Mayadev and Carol FoscariniBecause the medical community has so little experience with this cancer, a UC Davis team immediately formed to conceive the best course of action. Jyoti Mayadev, assistant professor in the UC Davis Department of Radiation Oncology, came on board to oversee the radiation therapy component of the treatment plan.


"There are no standard guidelines to follow for such an unusual cancer," says Mayadev. "Mrs. Foscarini’s gynecologist, Anne Rodriguez, and I started to plan her treatment course very early, before her surgery and before I even met Mrs. Foscarini."

Mayadev was recruited last year to the Department of Radiation Oncology for her expertise in the management of women with gynecological and breast cancers. She believed that the best course for Foscarini after surgery would encompass externally delivered radiation – the ordinary path followed when getting an X-ray – as well as brachytherapy, in which a source of radiation is placed inside the body. Brachytherapy enables more direct delivery of rays to a targeted tumor.

Mayadev is one of several radiation oncologists who have joined the department in recent years. Modernized with new state-of-the-art equipment, the department has burgeoned under the leadership of Richard Valicenti, hired in 2009 as chair. Valicenti quickly set about assembling a professional team composed of some of the best young minds in the country, as well as acquiring the newest and most powerful tools available in radiation oncology.

"My goal has been to form a department with subspecialists in the major areas of cancer – doctors who are at the forefront of their specialty and who are able to deliver innovations and the highest standard of care to our patients," he says.

Ruben Fragoso"My patients are my inspiration. It is very motivating to try to find ways to extend survival and offer a better quality of life for some of these devastating diseases."

Valicenti’s efforts have paid off. The UC Davis Medical Center radiation oncology department has become one of the premier facilities in the country, with a dynamic staff and modernized quarters that could double for a space-age Hollywood set. The busy department serves 60 to 80 patients a day, and has three dedicated radiation machines capable of delivering high-precision radiotherapy.

Valicenti has emphasized creating a team that takes a multidisciplinary approach to patient care. The remodeled department contains a large work space where doctors and technicians can meet together at computer stations to plan therapy. According to Valicenti, everyone in the department works closely together to develop treatment plans, which can be incredibly complex.

"For every hour we spend face-to-face with a patient, we probably spend 20 to 30 hours planning his or her therapy," he says.

Richard Valicenti"Garnering a team with each member having expertise in a certain speciality area has been critical to maximizing use of the important innovations now available in cancer treatment."

The field of radiation oncology has developed exponentially in recent decades as technological advances in imaging, mapping and radiation delivery have spurred each other’s progress. Using sophisticated computer modeling programs, doctors can map and shape the delivery of radiation so that a tumor’s location can be precisely identified, accounting for changes of tumor size and shape during the course of therapy and even taking into account changes of position during breathing. Computer-controlled linear accelerators deliver varying radiation doses to multiple points, "sculpting" the radiation three-dimensionally to fit the tumor. High-intensity radiation beams can be delivered to small areas with little scatter, allowing for knife-like precision in destroying a tumor and avoiding damage to surrounding healthy tissue.

"The capabilities of radiation oncology today are phenomenal," Valicenti says. "Garnering a team with each member having a specialized expertise in a certain area has been critical to maximizing use of the important innovations now available in cancer treatment."

Research is another important component of the department. Each specialist has a particular research interest, and being a part of an academic center constantly promotes innovation.

Treatment Planning Suite

"The large patient volume and the opportunity to treat unusual tumors such as Mrs. Foscarini’s puts us in a unique position to conduct innovative clinical trials, especially ones that have the potential to lead to rapid clinical applications," says Valicenti, who is involved in a trial studying treatment of bone metastases from prostate cancer. "Participation in clinical trials also offers our patients access to promising therapies that are not available otherwise."

Despite the high-tech, ultra-modern feel to the facility – or maybe because of it – staff members pay particular attention to making patients feel comfortable. One treatment planning room has a wall and ceiling lined with screens hooked up to a selection of relaxation videos geared toward children or adults. Patients can watch Alpine scenery, waving palm trees or cartoon fairylands while they undergo a radiation therapy planning session, typically 30 to 40 minutes long.

"The videos were very helpful," says Foscarini, who also appreciated the background music. "I once told the technician that I’m of the age that enjoys Elvis, and the next day they had Elvis playing for me!"

Allen Chen and Sun Yi

Foscarini required daily intensive radiation treatment for six weeks, followed by a few more weeks of twice-weekly treatment.

"Everyone – from Dr. Mayadev and the other doctors to the technicians and receptionists – made me feel like family," she adds. "Although the reason I was getting treatment was certainly not positive, I actually looked forward to coming in."

Valicenti, who is rightfully proud of the transformed radiation oncology department, concurs that many components are essential to building a successful treatment facility – state-of-the-art equipment, expertise in different specialties, teamwork, and caring for patients’ needs.

"We never lose sight of our primary goal," says Valicenti, "to provide innovative cancer therapy with optimal care, maximizing longevity with the highest possible quality of life."

 UC Davis Cancer Center > Synthesis > Features
Fall / Winter 2010 Issue Cover
Fall / Winter 2010 Issue

An expansion for the future


Fall / Winter 2010


Motivated and moving forward

Radiation oncology department assembles world-class team

Jyoti Mayadev and Carol Foscarini

New treatment planning suite uses soothing sights and sounds to calm patients.

Allen Chen and Sun Yi