Chair, EVMS Radiation Oncology
Unlike many medical students who chose their specialty during their third year, Mark Sinesi knew what he wanted to pursue even before he entered med school at Boston University. He had completed a doctorate in chemical engineering at Temple University, interested in research focused on chemical radio protection – that is, the development of molecules that would shield against radiation injuries. “And as I learned more and more about radiation and its biological effects,” he says, “I became more interested in clinical medicine. So when I went to medical school, it was with the specific intention of becoming a radiation oncologist.”
He knew it was a relatively small field – in fact, there are only 78 training programs in the entire country, and many of them turn out no more than one or two radiation oncologists a year. “Not everybody is interested in quantum physics and the other areas of physical science that we’re excited about in radiation oncology,” Dr. Sinesi explains. He went on to do his internship at Carney Hospital and his residency in radiation oncology at Tufts, and a fellowship in radiation biology at Colorado State University.
Since coming to Hampton Roads in 1990, Dr. Sinesi has treated cancer patients in almost every hospital in the region. He has served as Medical Director of the cancer treatment centers of Obici Memorial Hospital, Maryview Medical Center, Sentara Careplex Hospital, Ahoskie Medical Center and Outer Banks Hospital; and as Medical Director of the Department of Radiation Oncology of Sentara Norfolk General and Sentara Virginia Beach General Hospitals. Since 2005, he has held the position of Chair of the Department of Radiation Oncology at Eastern Virginia Medical School, where he also serves as Elective Supervisor in Radiation Oncology for M4 students, and offers medical student shadowing for M2 students looking to explore the field of radiation oncology.
As oncologists, Dr. Sinesi says, “We’re driven by scientific method, but also with a commitment to multidisciplinary cancer management. In the modern management of cancer, there are essentially three tools in the box: surgery, chemotherapy and radiation. The successful interplay of these three subspecialties guides us in designing a comprehensive management plan, which stacks the deck in the patient’s favor. We use conservative surgery, plus added radiation and/or chemotherapy whenever we can, as opposed to radical surgery.”
Because of the improvements in surgical techniques and chemotherapies, biologic therapies and others, he says, the job of the radiation oncologist is to wipe out that last little bit of cancer that might remain after the other therapies have done their work. Fortunately, modern techniques of radiation can greatly minimize collateral damage to surrounding tissue. “We use image guidance, either by PET, MRI or CT, that allows us to focus on our cancer target more accurately than ever before,” Dr. Sinesi explains. “The ultimate expression of that capability in our clinic is the CyberKnife®.”
The CyberKnife®, which was installed at Sentara Norfolk General Hospital in early 2008, provides continual image guidance software that allows the delivery of high radiation doses with pinpoint accuracy, while adjusting to a patient’s breathing cycle – thus automatically correcting for tumor movement. “With CyberKnife®, we can address small lung cancers or brain tumors that might otherwise require surgery,” he says.
There are radiation medicines for certain lymphomas, which have shown very high efficacy, as well as targeted radiation by the implantation of radioactive substances into the cancerous area. “Brachytherapy is one example,” Dr. Sinesi notes. “That’s allowing us to do a five-day breast cancer radiation rather than the customary six-week regimen.” But he cautions, “Not everybody is a candidate for the newer modalities. We always individualize treatment to each patient’s specific situation.”
He’s excited about a new type of brachytherapy being done at EVMS and Sentara Norfolk General: SIR sphere – selective internal radiation – a means of treating cancer in the liver, whether primary or having originated in another organ in the body. “Typically, these are rare cancers that are either incurable or very difficult to cure,” he says, for which the usual treatment would be chemotherapy that would produce a reduction in the patient’s overall malignant burden. When the patient went off the chemotherapy, the cancer would come back, and another cycle of chemotherapy would begin. Ultimately, after a few cycles, the patient’s bone marrow and immune reserves would wear out. There was no viable means of expanding the patient’s healthful, useful life span until the advent of SIR.
Dr. Sinesi explains the procedure: “SIR consists of the injection of radioactive microspheres directly into a tumor in the liver.” Still a relatively new procedure, SIR is done in collaboration with interventional radiologists. Using fluoroscopic guidance, the team threads a catheter through the femoral artery in the leg, into the liver and into the hepatic artery. “There are two benefits,” he says. “First, it chokes off the blood supply that feeds the tumor by blocking the arterial supply with the microspheres; and second, it’s delivering radiation directly to the tumor.”
It is in the hands-on treatment of cancer patients that he finds the most satisfaction. “I’m interested every day in helping people who have cancer to become cancer free, in a manner that’s as hard on the cancer and as easy on the patient as possible,” he says. “It’s brought home to me every day that this is both a humanitarian and a scientific endeavor.”
And, he adds, “It’s energizing; the most wonderful endeavor I could ever imagine. I am doing exactly what I was put on earth to do.”