Oncologists
11 years of experience
Video profile
Accepting new patients
South End
Radiation Oncology Boston Medical Center
830 Harrison Ave
Boston, MA 02118
617-638-7070
Locations and availability (3)

Education ?

Medical School Score
State University of New York Downstate (1999)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2012 - 2013)
Appointments
Boston University School of Medicine
Assistant Professor of Radiation Oncology, Boston University School of Medicine, Boston MA
Associations
American Board of Radiology
American Society for Therapeutic Radiology and Oncology

Affiliations ?

Dr. Hirsch is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Massachusetts General Hospital
    Medical Oncology
    55 Fruit St, Boston, MA 02114
    • Currently 4 of 4 crosses
    Top 25%
  • Boston Medical Center *
    Medical Oncology
    1 Boston Medical Ctr Pl, Boston, MA 02118
    • Currently 4 of 4 crosses
    Top 25%
  • Mass General Hospital
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Hirsch has contributed to 23 publications.
    Title Practical Management of Malignant Compression Fractures.
    Date March 2012
    Journal Journal of Neurointerventional Surgery
    Title Clinical Correlation of Previously Undetected Cancer-related Incidental Findings on Ct Planning Scans for Radiation Therapy.
    Date December 2011
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    The purpose of our study was to determine the management and cancer outcome of incidental cancer-related findings reported on CT radiation treatment planning scans.

    Title The Safety and Effectiveness of a Curved Needle for Vertebral Augmentation: Comparison with Traditional Techniques.
    Date February 2011
    Journal Journal of Vascular and Interventional Radiology : Jvir
    Excerpt

    To evaluate the safety and effectiveness of a curved needle compared with traditional (noncurved needle) techniques in a large single-center experience.

    Title Brachial Plexus Contouring with Ct and Mr Imaging in Radiation Therapy Planning for Head and Neck Cancer.
    Date November 2010
    Journal Radiographics : a Review Publication of the Radiological Society of North America, Inc
    Excerpt

    With the increasing use of intensity-modulated radiation therapy (IMRT) for the treatment of head and neck cancer, radiation oncologists are expected to have an in-depth knowledge of the computed tomographic (CT) and magnetic resonance (MR) imaging anatomy of this region to be able to accurately characterize tumor extent and define organs at risk for potential radiation injury. The brachial plexus is a complex anatomic structure in the head and neck adjacent to diseased nodes and elective nodal volumes (ie, nodal areas that are prophylactically treated because they are at high risk for micrometastatic disease) and should, therefore, be carefully identified and contoured at CT prior to IMRT planning. A number of multi-institutional protocols mandate contouring the brachial plexus as an "avoidance structure" (ie, a structure or volume that is at risk for complications of radiation therapy) in the planning of head and neck radiation therapy, and, although little information exists on the best method of doing so consistently, contouring may be facilitated with fusion CT-MR imaging software. With three-dimensional conformal radiation therapy, the brachial plexus is not routinely contoured; therefore, its dose limits are not evaluated in treatment planning. In contrast, with IMRT, tolerance doses can be set to limit the maximum dose to the brachial plexus to 60 Gy in most radiation protocols, although the true radiation tolerance dose in patients with head and neck cancer has been mentioned only sporadically in the literature. Additional studies will be required to determine if identification of the brachial plexus as an avoidance structure prior to radiation therapy planning improves treatment outcome in patients with head and neck cancer and reduces long-term toxicity in this structure.

    Title In Regards to Dennis and Duncan: Radiation Oncology in Undergraduate Medical Education: a Literature Review (int J Radiat Oncol Biol Phys 2010;76:649-655).
    Date September 2010
    Journal International Journal of Radiation Oncology, Biology, Physics
    Title Variations in Tumor Size and Position Due to Irregular Breathing in 4d-ct: a Simulation Study.
    Date May 2010
    Journal Medical Physics
    Excerpt

    To estimate the position and volume errors in 4D-CT caused by irregular breathing.

    Title Lung Dose-volume Parameters and the Risk of Pneumonitis for Patients Treated with Accelerated Partial-breast Irradiation Using Three-dimensional Conformal Radiotherapy.
    Date September 2009
    Journal Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    Excerpt

    There are no data on how complication rates after accelerated partial-breast irradiation delivered by three-dimensional conformal radiotherapy are affected by treatment technique. We therefore examined the risk of pneumonitis in relation to lung dose-volume parameters.

    Title Predictors of Successful Palliation of Compression Fractures with Vertebral Augmentation: Single-center Experience of 525 Cases.
    Date August 2009
    Journal Journal of Vascular and Interventional Radiology : Jvir
    Excerpt

    To determine the effectiveness of vertebral augmentation in relieving pain, differences in pain relief outcomes based on procedure type were investigated. Variables that potentially influence outcomes were identified.

    Title Treatment of Metastatic Carcinoma to the Hip with Ct-guided Percutaneous Acetabuloplasty: Report of Four Cases.
    Date July 2009
    Journal Journal of Vascular and Interventional Radiology : Jvir
    Excerpt

    Percutaneous acetabuloplasty (PA) is a promising treatment for painful metastatic lesions of the acetabulum. Four patients were treated with injection of the bone cement polymethylmethacrylate directly into the lesion. After the procedure, all four patients had improvement or relief of their pain and were able to resume weight-bearing activities. The procedure was well tolerated by each patient without morbidity. PA appears to be a reasonable palliative procedure for painful and fragile hips associated with metastatic bone disease.

    Title An Increase in Medical Student Knowledge of Radiation Oncology: a Pre-post Examination Analysis of the Oncology Education Initiative.
    Date March 2009
    Journal International Journal of Radiation Oncology, Biology, Physics
    Excerpt

    The Oncology Education Initiative was created to advance oncology and radiation oncology education by integrating structured didactics into the existing core radiology clerkship. We set out to determine whether the addition of structured didactics could lead to a significant increase in overall medical student knowledge about radiation oncology.

    Title Radioisotopes and Vertebral Augmentation: Dosimetric Analysis of a Novel Approach for the Treatment of Malignant Compression Fractures.
    Date September 2008
    Journal Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
    Excerpt

    PURPOSE: Vertebral compression fractures (VCFs), a major cause of morbidity and debilitating pain, often results from secondary tumor metastases to the skeleton. Vertebral augmentation is a palliative technique developed to treat VCFs and involves the injection of polymethyl methacrylate (PMMA) to augment the fractured vertebral body. The authors investigate the feasibility of radionuclide therapy coupled with vertebral augmentation to treat both the tumor metastases and VCFs. Six therapeutic radioisotopes, uniformly mixed in a PMMA bolus, were investigated for their dosimetric properties. METHODS AND MATERIALS: The MCNP5 Monte Carlo computer code was used to characterize the therapeutic dosimetric distribution within a cortical bone phantom for a 1 mm radial bolus of isotope-infused PMMA. Based on these data, the minimum activity required for a therapeutic treatment was calculated. RESULTS: The dosimetry from beta emitting Y-90, P-32, and Ho-166 decreased to 10% of its maximum therapeutic dose (R10%) after traveling 1.20 mm, 1.03 mm, and 0.97 mm, respectively, through cortical bone. Low photon energy I-125 had a slightly larger calculated R10% of 1.32 mm. Although F-18 and Tc-99m exhibited a more uniform distribution (R10%=1.72 mm and 1.94 mm, respectively), the lower dosimetric gradients resulted in significantly greater therapeutic implant activities relative to the other isotopes studied in this report. CONCLUSIONS: Radionuclide therapy coupled with vertebral augmentation is shown to be a feasible technique for the treatment of secondary skeletal metastases and its resulting side effects. Future studies will include a full clinical investigation to determine optimal treatment isotope(s).

    Title Body Mass Index and Prostate-specific Antigen Failure Following Brachytherapy for Localized Prostate Cancer.
    Date September 2008
    Journal International Journal of Radiation Oncology, Biology, Physics
    Excerpt

    PURPOSE: Increasing body mass index (BMI) is associated with prostate-specific antigen (PSA) failure after radical prostatectomy and external beam radiation therapy (EBRT). We investigated whether BMI is associated with PSA failure in men treated with brachytherapy for clinically localized prostate cancer. PATIENTS AND METHODS: Retrospective analyses were conducted on 374 patients undergoing brachytherapy for stage T1c-T2cNXM0 prostate cancer from 1996-2001. Forty-nine patients (13%) received supplemental EBRT and 131 (35%) received androgen deprivation therapy (ADT). Height and weight data were available for 353 (94%). Cox regression analyses were performed to evaluate the relationship between BMI and PSA failure (nadir + 2 ng/ml definition). Covariates included age, race, preimplantation PSA, Gleason score, T category, percent of prescription dose to 90% of the prostate, use of supplemental EBRT, and ADT. RESULTS: Median age, PSA, and BMI were 66 years (range, 42-80 years), 5.7 ng/ml (range, 0.4-22.6 ng/ml), and 27.1 kg/m(2) (range, 18.2-53.6 kg/m(2)), respectively. After a median follow-up of 6.0 years (range, 3.0-10.2 years), there were 76 PSA recurrences. The BMI was not associated with PSA failure. Six-year PSA failure rates were 30.2% for men with BMI less than 25 kg/m(2), 19.5% for BMI of 25 or greater to less than 30 kg/m(2), and 14.4% for BMI of 30 kg/m(2) or greater (p = 0.19). Results were similar when BMI was analyzed as a continuous variable, using alternative definitions of PSA failure, and excluding patients treated with EBRT and/or ADT. In multivariate analyses, only baseline PSA was significantly associated with shorter time to PSA failure (adjusted hazard ratio, 1.12; 95% confidence interval, 1.05-1.20; p = 0.0006). CONCLUSIONS: Unlike after surgery or EBRT, BMI is not associated with PSA failure in men treated with brachytherapy for prostate cancer. This raises the possibility that brachytherapy may be a preferred treatment strategy in obese patients.

    Title Educating Medical Students About Radiation Oncology: Initial Results of the Oncology Education Initiative.
    Date October 2007
    Journal Journal of the American College of Radiology : Jacr
    Excerpt

    PURPOSE: Multidisciplinary cancer care requires the integration of teaching across established educational boundaries. Because exposure to oncology and radiation oncology is limited in the undergraduate medical curriculum, the authors introduced an oncology education initiative at their institution. They report on the addition of structured multidisciplinary oncology education to the required radiology core clerkship. METHODS: An institutional-based cohort study of fourth-year medical students rotating through a required clerkship in radiology at Boston University School of Medicine was conducted, beginning with the class of 2007. An educational questionnaire measuring the perceived quality of oncology education before and after exposure to a structured didactic program was administered. RESULTS: Of the 149 fourth-year students, 121 (81%) have completed the didactics of the initiative. Although 68 of 121 (56%) students reported having limited exposure to cancer care in the clinical years, 107 of 121 (88%) were motivated to learn more about the subject, and 100 of 121 (83%) reported a better understanding of the multidisciplinary nature of cancer care after this oncology education initiative. One hundred ten of 121 (91%) felt that the radiology clerkship was an opportune time to receive oncology and radiation oncology teaching. As a result of the initiative, 32% of the students pursued advanced training in radiation oncology. Of students who before the initiative were not planning on taking oncology electives, 70 of 99 (71%) agreed or strongly agreed that the lecture motivated them to learn more about the subject, and 43 of 99 (43%) agreed or strongly agreed that the lecture motivated them to take oncology electives. CONCLUSIONS: Systematic exposure to multidisciplinary oncology education as part of a radiology core clerkship provides an excellent opportunity for the integrated teaching of oncologic principles and patient management. This type of experience addresses an important yet underrepresented component of undergraduate medical education.

    Title Chapter Resident Education.
    Date August 2007
    Journal Journal of the American College of Radiology : Jacr
    Title Palliative Radiation Therapy of Symptomatic Recurrent Bladder Cancer.
    Date May 2007
    Journal Pain Physician
    Excerpt

    BACKGROUND: Palliative radiation therapy (RT) is an established tool in the management of symptoms caused by malignancies. RT is effective at palliating both locally advanced and metastatic cancer, including related symptoms of pain, bleeding, or obstruction. Most data on palliative RT is in regard to its use in the treatment of painful bone metastases. There are also data that support RT palliation for locally advanced or recurrent rectal, prostate, and gynecological cancers. With regard to bladder cancer there is some evidence of the benefit of palliative RT for the control of urinary symptoms and hematuria; however, there is little evidence for the use of palliative RT for pain associated with locally recurrent bladder cancer. We report a case of locally advanced recurrent bladder cancer which was refractory to medical pain management, and was found to be highly responsive to palliative RT. CASE REPORT: An 80-year-old woman with recurrent bladder cancer and intractable pelvic pain refractory to oral and transdermal pain medications, received palliative pelvic RT to a dose of 50 Gy (5000 cGy) in 25 fractions with complete resolution of pain. The patient was originally found to have dysuria, frequency, and hematuria, secondary to an invasive high grade transitional cell carcinoma of the bladder with an adenocarcinoma component, AJCC pT2b N1 M0 Stage IV, for which she underwent a radical cystectomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial vaginectomy, and ileal conduit reconstruction. After undergoing 4 cycles of adjuvant chemotherapy, the patient did well for 5 months with no evidence of symptomatic, clinical, or radiographic recurrence of disease. Repeat staging CT of the abdomen and pelvis confirmed tumor recurrence in the left pelvis. The patient was treated with another course of chemotherapy and pain was managed with relatively low doses of opioid medication (25mcg transdermal fentanyl patch, and oxycodone 5mg bid). However at the fourth month, there was rapid escalation of severe pain with the patient becoming bed bound due to pain with an associated decrease in ambulation and anorexia. Ultimately a pain medication regimen of 200mcg transdermal fentanyl patch q2 days, oxycontin 20mg bid, oxycodone 5 - 10mg q 4 hours, ibuprofen 400mg q 8 hours, and gabapentin 600mg TID was not effective in controlling pain. The patient was then referred to Radiation Oncology 6 months after the pain initially began for evaluation. She received a total of 5000cGy over 25 fractions to a small pelvis field over 5 weeks and reported complete pain resolution. She was able to decrease pain medications, increase overall activity, and gain significant improvement in sleep quality and appetite even early on in the course of her radiation therapy. CONCLUSIONS: Palliative radiation therapy has been well studied in the setting of bone metastases and treatment of hematuria for locally advanced bladder cancer. There is little data that we are aware of on the use of RT for pain control with patients that have recurrent, locally advanced bladder cancer. We have presented a case in which an excellent outcome in pain control was seen for a patient with medically unmanageable pain. RT is an excellent option for pain management in recurrent bladder cancer and should be offered to patients whose pain is not otherwise optimally controlled. Palliative RT is an important component in the multimodality approach to cancer pain management and optimization of quality of life.

    Title Novel Approaches to Postoperative Radiation Therapy As Part of Breast-conserving Therapy for Early-stage Breast Cancer.
    Date February 2004
    Journal Clinical Breast Cancer
    Excerpt

    Breast-conserving therapy (BCT) consists of segmental mastectomy followed by postoperative radiation therapy (RT) to the whole breast. At least 6 prospective randomized trials have proven the equivalence of BCT to mastectomy. However, BCT remains underused and, most importantly, a sizable proportion of patients with invasive breast cancer fail to complete the recommended protocol of breast preservation by omitting postoperative RT. The inconvenience of complying with the standard 6-week radiation regimen, which includes approximately 30 daily visits, at least partially explains this lack of adherence. New clinical studies have generated preliminary evidence that more convenient, shorter radiation regimens might reveal equivalence to the current standard. Moreover, the availability of modern technology to deliver and target ionizing radiation by improving homogeneity of radiation dose has made it possible to safely explore the use of greater radiation doses per fraction. Finally, currently ongoing research trials will enable the identification of specific subsets of patients who are likely to be safely treated by partial-breast radiation (instead of radiation to the whole breast) with more accelerated regimens. This article reviews the available data and the current ongoing research on novel RT techniques and fractionation schedules in BCT for early-stage breast cancer.

    Title Head Injury Caused by Underwater Explosion of a Firecracker. Case Report.
    Date August 1972
    Journal Journal of Neurosurgery
    Title Tolerances for Cerebral Concussion from Head Impact and Whiplash in Primates.
    Date February 1972
    Journal Journal of Biomechanics
    Title The Tolerance of Man to Impact.
    Date October 1969
    Journal Annals of the New York Academy of Sciences
    Title Cerebral Concussion in the Monkey: an Experimental Model.
    Date September 1966
    Journal Science (new York, N.y.)
    Excerpt

    A statistically significant experimental model has been developed for reproducing head injury by impact in the monkey. Results with 80 monkeys subjected to occipital impact under specified conditions ( duration of phenomena, 1 to 10 milliseconds) enable the construction of curves relating the production of experimental cerebral concussion in 10, 50, and 90 percent of the monkeys to the average impulse of the blow in pounds-seconds, as well as to the average linear acceleration of the head. These curves are proposed as a baseline from which blows to various parts of the head, as well as nonimpacting impulsive loads, can be studied under various conditions of protection and according to varioucs time regimes.

    Title Screening for Atm Sequence Alterations in African-american Women Diagnosed with Breast Cancer.
    Date
    Journal Breast Cancer Research and Treatment
    Excerpt

    BACKGROUND: Women who are heterozygous for variants in the ataxia telangiectasia mutated (ATM) gene, ATM carriers, have been reported to be at increased risk for breast cancer compared with women who do not posses an alteration in this gene. Aside from BRCA1 and BRCA2, there are few data on breast cancer susceptibility genes in African-American women. The goal of this study was to determine whether there is evidence that ATM is a breast cancer susceptibility gene in African-American women. METHODS: One hundred thirty two African-American women were screened for ATM sequence alterations. Thirty-seven (28%) were women with a histological diagnosis of breast cancer (cases). These women were not selected on the basis of a breast cancer family history. Ninety-five (72%) were age-matched women who had not been diagnosed with breast cancer (controls). Genetic variants were identified using denaturing high-performance liquid chromatography (DHPLC). RESULTS: Twenty-three of the 37 (62%) cases possessed at least one ATM variant. Fifty-eight of the 95 (61%) (P = 0.54) age-matched controls harbored at least one ATM variant. For subjects specifically possessing missense variants, 46% of cases and 48% of controls had these types of sequence variants. In addition, 19% of cases and 34% of controls possessed multiple ATM sequence variants (P = 0.07). The most common polymorphisms were the 378 T-->A which was seen in 19% of cases and 27% of controls (P = 0.22), 5557 G-->A identified in 22% of cases and 18% of controls (p = 0.40), 2685 A-->G which was detected in 11% of cases and 6% of controls (P = 0.22), and 1254 A-->G which was found in 3% of cases and 9% of controls (P = 0.36). Hence, there were no significant differences in any of the genetic variants detected between the case and control subjects. CONCLUSION: We found no statistically significant differences in the overall frequency of ATM variants, nor any specific variant type or group, between African-American women who had been diagnosed with breast cancer compared with an age-matched cohort of African-American women who did not have breast cancer. ATM, therefore, does not appear to represent a breast cancer susceptibility gene in the general African-American population.

    Title The Evolving Management of Malignant Compression Fractures.
    Date
    Journal Pain Physician
    Title Percutaneous Sacroplasty.
    Date
    Journal Journal of Neurointerventional Surgery
    Excerpt

    The recognition of sacral insufficiency fractures continues to be poor, and diagnosis is often delayed resulting in significant morbidity. Percutaneous sacroplasty is an image guided procedure that is safe and potentially effective for treating the pain and disability related to these fractures. Several cohort studies reviewed here report successful outcomes using this procedure, with patients experiencing nearly full pain relief immediately and longitudinally. As with the well proven results from percutaneous vertebral augmentation within the thoracic and lumbar spine, sacroplasty reduces the cost associated with bed rest and physical therapy and allows patients to return to activities of daily living sooner than with conservative therapy.


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