Your Guide to Bone Mets: Traditional & Innovative Approaches Using Radiation
In this second of three episodes on managing bone metastases in MBC, we bring you a broad review of the major interventions to treat and manage bone mets. We explain the differences among the specialties of Radiology (think x-rays and PET/CT scans) vs. Radiation Oncology and Interventional Radiology. The majority of patients with MBC have bone metastases and may have been treated with some form of radiation. For patients with "oligometastatic" disease, where the number of distant sites of metastatic spread is generally considered to be 5 or less, radiation treatment may be “curative”. It gets a little less clear in those of us with heavier tumor burden and more widespread disease. In that case, radiation is often offered for pain and neurologic considerations, such as preventing a tumor from pressing on the spinal cord. But, can different radiation strategies be helpful in disease management, beyond pain management? We ask these questions of both experts here – the first is Dr. Shalom Kalnicki, Professor of Radiation Oncology and Associate Director of the Montefiore Einstein Comprehensive Cancer Center in Bronx, NY. Our second expert is Dr Rory Goodwin, who leads the Duke Center for Brain and Spine Metastasis in Durham, North Carolina. He’ll talk about this innovative Center’s approach to managing bone mets, including offering some lesser-known treatment approaches like Cryoablation (freezing the tumor), and Radiofrequency Ablation (heating the tumor). We also address an emerging therapy called “Theranostics” which is when a radioactive tracer like the ones used in PET/CT scans is bound to a radiation treatment that can deliver a lethal dose directly to the bound cancer cell. So listen here and learn with us, and check out our show notes for the links to what’s covered in the episode.
Episode Notes:
Meet the Guests of the Episode
Pam Kohl
A North Carolina native, Ms. Kohl has over 40 years of experience working in government and non-profit management. She served as Executive Director of the Susan G. Komen, North Carolina Triangle to the Coast Affiliate which serves 29 counties in NC. In that role, Pam was a passionate spokesperson and advocate for equitable breast cancer support services in Eastern NC and the vital need for breast cancer research. Her passion for finding the treatments/cures for metastatic breast cancer led to the development of the new Komen Metastatic Breast Cancer Collaborative Research Initiative. Pam recently retired but is continuing her advocacy as a volunteer.
Pam was diagnosed with Stage 1 ER+ breast cancer in 2009. She had a lumpectomy, radiation and stayed on her endocrine therapy for 5 years. She had no family history and the Oncotype tumor analysis showed a very low risk for recurrence. In 2014 she was declared cancer free. However, in October 2016, she was diagnosed with breast cancer again and on January 31st 2017 she was diagnosed with State IV metastatic breast cancer. She is currently on an oral chemo drug and endocrine therapy and has bone scans and PET/CT scans every 12 weeks. Pam lives everyday knowing that it is breast cancer research that has prolonged her life and hopes that research will find the cures that will save her life.
Pam was born and raised in Greensboro NC, graduated from Guilford College where she received the 2017 Guilford College Alumni Excellence Award. She is also a recipient of the Order of the Long Leaf Pine, which is presented to individuals who have a proven record of extraordinary service to the state of North Carolina. In May 2019, she was awarded the Coastal Federal Credit Union’s Power of Sharing Lifetime Achievement award for her many years of passionate work and leadership in the non-profit sector.
Pam lives in Raleigh with her husband Tom Gongaware and she has two children, Max 32 and Sofie 29.
You can find her on Twitter @PamLKohl
Rory Goodwin, MD, PhD
Dr. Goodwin is the Director for Spinal Oncology, Surgical Director for the Duke Center for Brain and Spine Metastasis, Associate Program Director of the Neurosurgery Residency Program and an Associate Professor at the Duke University Medical Center. He attended the University of Florida where he majored in Neurobiological Sciences and Business Administration with minors in Chemistry and Economics. He obtained his M.D. and Ph.D. in Neuroscience from the Johns Hopkins University School of Medicine while also leading, founding, and participating in programs focused on future and current underrepresented minority students including serving as National President for the Student National Medical Association. He completed his Neurosurgery residency at the Johns Hopkins Hospital and has received research awards from the UNCF-Merck Science Initiative, the Burroughs Wellcome Fund, Robert Wood Johnson Foundation, and the NIH. Over the course of his training, he served as a Medical Officer for the Food and Drug Administration, Division of Orthopedic Devices, graduated from the Global Clinical Scholars Research Training Program at Harvard Medical School and also completed an in-folded Complex Spine Fellowship at The Johns Hopkins Hospital.
In 2023, Dr. Goodwin was awarded the CNS DEI Impact award and recently received the Duke School of Medicine Research Mentoring in Equity, Diversity, and Inclusion Award. Dr. Goodwin has over 200 peer-reviewed manuscripts as well over 200 conference abstracts and presentations. He has a research interest in translational biomarkers and clinical outcomes for patients diagnosed with spinal tumors, and genomic and proteomic predictors in brain and spinal oncology.
Shalom Kalnicki, MD
Dr. Kalnicki is a physician leader and radiation oncologist with a career that has focused on Cancer Service Line management for the last 18 years. Leading the Cancer Service Line for the Health System’s 11 Hospitals, he develops partnerships which express themselves through 14 multidisciplinary disease-based programs (screening, diagnostic, therapeutic and survivorship tracks), shared clinical and administrative resources, and centralized provider and patient support services. They establish clinical pathways (including clinical trials), improve timelines of care, track outcomes, prevent provider burn-out, and model value-based economic programs. As Chairman of Montefiore’s Cancer Committee, Dr. Kalnicki guides an interdisciplinary team of specialists focused on adherence to Commission on Cancer accreditation standards and who achieved the highest results in 2018. Their longtime personal interest in holistic cancer care translates into support programs minimizing the emotional and psychological impact of a cancer diagnosis on patients and their caregivers. As Professor and Chair of Radiation Oncology, he has been researching and implementing image-guided intensity-modulated radiation therapy, target motion management with 4-D radiation planning, functional radiation planning with PET-CT, as well as stereotactic body radiation therapy with its immunotherapy correlations.
