Residents will rotate with Drs. Howard and Tannehill to evaluate adult patients with hematological conditions, including benign lymphoproliforative disorders, leukemia and lymphoma as well as non-tumor conditions treated with radiotherapy. Residents will also be expected to become proficient in the evaluation of patients for treatment with total body irradiation in preparation for bone marrow transplant for both benign and malignant conditions. These patients will be seen primarily in a multidisciplinary context, together with hematologist, medical oncologists, and radiologists as necessary. Patients will be seen and evaluated as inpatients both at UW Hospital and occasionally at Meriter Hospital and the VA. The rotation will provide opportunities in enhancing the multidisciplinary knowledge in the management of these conditions. In addition residents will have ample opportunity to and are highly encouraged to become proficient in the application of advanced radiotherapy techniques such as 3-D radiotherapy, total skin electrons, total body irradiation, radiolabled antibodies, etc. In order to truly appreciate the multidisciplinary management of these patients, all patients with new hematological malignancies seen at UWHC are discussed at the weekly combined modality Hematology Conference, attendance at which is highly recommended; this will include radiology and pathology review every week. Additional optional learning opportunities include participation and/or observation at the monthly Clinical Research in Hematology Meeting through the Disease Oriented Working Group.
Typically, in an average 3-month rotation, residents will have contact with approximately 15 to 25 new hematological problems, and over 30 to 50 follow-up contact opportunities. In addition, in an average 3-month time span, residents will have the opportunity to participate in the evaluation of 10 to 15 patients for the utilization of total body irradiation in preparation for bone marrow transplant.
Goals and Objectives
Observe and understand the etiology, epidemiology, molecular genetics, pathophysiology, clinical presentation, natural history, treatment options, risks and benefits of various options and long-term sequalae of treatment, including pulmonary functional outcome for patients with various hematological conditions as listed above. Understand the educational, social, societal, quality of life and cost-effectiveness issues surrounding the management of the above patients. Understand the multimodality approaches to these conditions, and learn an appropriate physician behavior pattern that optimizes multidisciplinary interaction. The Cardiac Intravascular Brachytherapy service is housed under the Lymphoma service. Learn to evaluate these patients in a multimodal fashion with Drs. Wolfe and the angiography support staff in Cardiology; learn the natural history, treatment options, indications for the utilization of cardiac intravascular brachytherapy, risks, benefits and sequale of therapy for these patients. Understand the principles of cardiac brachytherapy and participate in the utilization of these treatment devices. Expect to perform 10 cardiac brachytherapy procedures in a 3 month time period. Become proficient in the technical aspects of radiotherapeutic management of hematological conditions, including routine radiotherapy, as well as specialized applications such as 3-D radiotherapy, the use of radiolabled antibodies, the utilization of total skin electrons as treatment for cutaneous T cell lymphoma, total body irradiation and Tomotherapy (once implemented). It is also expected that a basic foundation in the radiobiologic concepts underpinning these approaches will be developed. Understand and appreciate the opportunities for clinical and translational research in this patient population.