2 weeks Ago By Thilina Walpola
It gives me a great sense of pride and delight to write this. We all change as we traverse the pathway of our lives. I have had very little contact with Yuni after I left Sri Lanka until now, but Yuni will always remain my little cousin.
We moved in our different worlds outside of our home country with a trajectory that is remarkably similar.Yuni Dewaraja is the William Martell endowed Professor of Radiology (Division of Nuclear Medicine) at the University of Michigan, where she has spent her entire career. She received her PhD in Nuclear Engineering from the University of Michigan in 1995, specializing in the area of radiation detection and measurement.
With the recent Food and Drug Administration (FDA) approval of her invention, Yuni immediately becomes a trailblazer in her field, which opens a new chapter that will inevitably result in new ways of delivering radiation to patients with cancer. Truly, a gift to humanity.The diagnosis of cancer strikes fear into the hearts of patients.
Depending on the cancer site and type, there are four potential methods of treatment: surgery, chemotherapy, immunotherapy, and radiation therapy. Radiation is used as the primary treatment for tumors that are in places that are not amenable to surgical removal and for which there is no effective chemotherapy. It is also used as an adjuvant treatment after surgery to control residual tumor that surgery has failed to remove.
To the patient who hears that radiation is necessary for control of the cancer, there is often a sense of dread. At the present time, that sense of dread is often justified by side effects of treatment. This may change with Yuni’s invention.
Sad to say, this is the limit of my knowledge regarding radiation in the treatment of cancer. I do not treat cancer patients or use radiation. For the past few days, I have tried to understand what Yuni has been doing for the past twenty-five years and failed miserably; her work is beyond my comprehension.
I tried to decipher a Press Release about her work and had enormous trouble understanding the language of her academic world. Medicine is so specialized.Dr.
Yuni DewarajaFortunately, upon request, Yuni sent me a summary of her work yesterday. This was wonderful. She writes:“Radiation for cancer treatment can be delivered from external beams or as an internally administered radiopharmaceutical therapy, sometimes referred to as nuclear medicine therapy.
Radiopharmaceuticals are designed to specifically target cancer cells, while limiting uptake in healthy tissue. The specific area I work in is called Radiation Dosimetry, which is the measurement and calculation of the ionizing radiation that is absorbed by different tissues in the human body.“Early in my career, I was able to secure funding from the National Institute of Health to develop methods to perform personalized dosimetry calculations for patients undergoing nuclear medicine therapies.
We first worked on dosimetry calculations for radioimmunotherapy, where antibodies labeled with radioactive iodine (I-131) target and destroy non-Hodgkins’s lymphoma cells.“Accurate dosimetry was needed to determine how much of the I-131 can be injected without causing too much damage to the bone marrow. My group developed a software code to perform these calculations in a highly personalized manner starting with the patient’s own images.
The Positron Emission Tomography (PET) and the Single Photon Emission Tomography (SPECT) images show how the injected radiotracer is distributed in the body.“Computer Tomography (CT) images provide the density of the different tissue in the human body. Starting with these images, we used the Monte Carlo method to simulate how the radiation is transported throughout the body and where the radiation energy is deposited.
The Monte Carlo method is a numerical technique widely used in many fields for solving statistical problems. “Over the past 20 years, we have further developed our software, Dose Planning Method for Radiopharmaceutical Therapy (DPM_RPT), to expand its use in other therapies such as Lu-177 peptide receptor radionuclide therapy for neuroendocrine tumor and Lu-177 PSMA radioligand therapy for prostate cancer. An ongoing clinical trial at our university uses DPM_RPT dosimetry estimates to determine if additional external beam radiotherapy is needed to parts of the tumor that do not get enough radiation from radioembolization, a therapy where radioactive microspheres are implanted in liver tumors.
“Four years ago, I received an Academic Industry partnership grant from the NIH, where the goal is to work with industry to translate research findings and tools into clinical practice. Working with the technology transfer office of our university, we licensed DPM-RPT to our industry partner GE Healthcare’s MIM Software. The software was recently approved to be marketed in the USA.
Furthermore, to streamline the dosimetry process, DPM_RPT was coupled with other tools including Artificial Intelligence based contouring of organs such as kidney and liver on the patient images.” Yuni’s story is the successful first end-point to the work of an intensely dedicated medical researcher. It started off with entry into the prestigious PhD program at the University of Michigan.
To be selected, she must have been one of the best graduates. Here she learned the basic rules of research and stimulates students to develop specific and highly selective topics to work on. The more successful of these PhD graduates like Yuni are offered faculty positions to begin, plan and execute their ideas.
This initial research is funded by the university and carries with it collaborations with other like-minded scientists.Now comes the hard part. The researchers must immerse themselves completely in their research.
They must dedicate the rest of their lives toward producing results. They must obtain grant funding from various sources to continue.The majority of researchers never attain success.
Yuni is a golden exception, who was able to reach multiple objectives to get her research into the patient care world, transforming the lives of many patients now and into the distant future. Those who read about Yuni’s story must understand how exceptional her achievements are. Yuni’s research has led to over 150 publications in medical journals, and authorship of books.
Yuni’s parents were exceptional people. Her father became the Director of Archives of Sri Lanka. He may not have agreed, but I believe the major success in his life was to convince Lorna, my aunt, to marry him while they were students at Peradeniya.
Lorna punchiamma was a brilliant historian who went to Oxford University as a Rhodes Scholar from the University of Ceylon. She published numerous papers and books on various aspects of Sri Lankan history.Our families were close while my mother and aunt were alive and there are many stories.
I will tell you just one: I must have been in my teens. I do not know why (I think this was when Lorna punchiamma was doing her stint in England as a Rhodes scholar). Yuni and her sister Aruni were staying in our house in Fifth Lane.
My room had two beds added to accommodate the two little girls. One night we all went to sleep. In the middle of the night, Aruni wakes up and says she is thirsty and wants water.
I get the water and we all go to sleep. A few minutes later, Yuni awakes and says: Praki aiya, bayai (frightened by nightmares). I remember sitting with her until she fell asleep again.
Imagine: this little girl in Colombo turning out to contribute a miracle that has the potential to improve the treatment of millions of cancer patients all over the world.Yuni, the world is grateful to you and your family is proud of you.Parakrama Chandrasoma, MDEmeritus Professor of PathologyUniversity of Southern CaliforniaLos Angeles.
