Daniel Spratt, MD – Offering Mentorship, Purpose for Aspiring Radiation Oncologists

Daniel Spratt, MD, is the chair of the Department of Radiation Oncology at Case Western Reserve University and University Hospitals Cleveland Medical Center. He is renowned for his expertise in treating genitourinary (GU) malignancies, particularly prostate cancer. Dr. Spratt’s contributions to the field include extensive research, leadership roles, and mentorship, positioning him as a leading authority in prostate cancer treatment.

GU Oncology Now spoke with Dr. Spratt about his journey into radiation oncology, the evolving integration of radiation therapy with systemic treatments, the challenges in counseling patients in the modern era, and insights on mentorship and advising aspiring professionals to align their pursuits with a clear sense of purpose and intent.

Could you share your personal journey to becoming a radiation oncologist and highlight some pivotal moments in your career?

Dr. Spratt: My path to where I am today is not necessarily unique in the grand scheme of things, but it has its own unique twists. I did not originally aspire to be a physician. In fact, I was not academically inclined, and no one in my family pursued a career in health care. As a young adult, I was immersed in competitive athletics and transitioned into a career as a personal trainer after high school. My focus was far more on fitness than academics during my first year at the University of Hawaii, and I ended up dropping out to pursue personal training full time.

During this period, I had the privilege of working with 2 physician clients who inspired me to consider a different path—one where I could channel my drive into making a greater impact. This led me back to college at Georgia State, where I found my academic footing, completed my pre-med requirements, and gained acceptance to Vanderbilt Medical School.

Initially, I was set on becoming a neurosurgeon, driven by the allure of surgery’s definitive impact. However, as I progressed through medical school, I discovered that while I was fascinated by the academic aspects of medicine, the day-to-day clinical practice did not resonate with me in the same way. I found myself drawn to radiation oncology, a field that blends the academic rigor I enjoyed with the opportunity for prolonged patient interactions and the potential to deliver high-tech treatments with curative intent.

My residency at Memorial Sloan Kettering Cancer Center further solidified my passion for radiation oncology. Under the mentorship of Dr. Michael Zelefsky, I was exposed to the diverse array of cancers and patient experiences within the field. Engaging in research alongside renowned scientists like Drs. Charles Sawyers and Jason Lewis deepened my understanding of prostate cancer and set the stage for my future endeavors.

Joining the faculty at the University of Michigan allowed me to immerse myself in a multidisciplinary approach to prostate cancer care, collaborating closely with urologists and medical oncologists. Building upon this experience, I eventually took on the role of chair at Case Western Reserve University, where I continue to pursue my passion for advancing prostate cancer treatment and mentoring the next generation of radiation oncologists.

In summary, my journey—from personal trainer to radiation oncology chair—has been shaped by diverse experiences, influential mentors, and a relentless drive to make a meaningful difference in the lives of patients with cancer.

Your research spans both localized and advanced stages of prostate cancer. What are the main challenges you encounter in delivering effective radiotherapy across the prostate cancer continuum, and how do you address them in your practice?

Dr. Spratt: Unlike medications, which undergo strict regulations and have standardized dosages, technical specialties like surgery or radiation therapy require a nuanced approach. It is not just about the technology or the tool being used; the expertise of the team is paramount. To put it in perspective for my patients, I often liken it to the difference between a surgeon using a scalpel versus a da Vinci robot. While the technology matters, it is the team behind it that truly determines outcomes.

In any medical discipline, there is no substitute for high-volume expertise. It is about putting in the hard work, seeing countless cases, learning from both successful and challenging outcomes, and staying abreast of the latest research. In radiation oncology, the goal is to deliver the maximum dose to the tumor while minimizing exposure to surrounding healthy tissues. There is a delicate balance between tumor control and preserving quality of life (QOL) for the patient. In my practice, the priority is always on preserving QOL.

This principle applies across various types of cancer, including spine metastases and oligometastatic disease. Whether treating the spine or the prostate, meticulous attention is paid to protecting nearby critical structures, such as the spinal cord, brachial plexus, bladder, and rectum. While it might seem simplistic to say that radiation oncologists “just put circles on things,” akin to a surgeon wielding a scalpel, the reality is that it requires technical mastery and precision to ensure optimal outcomes for our patients.

How do you address the challenges of counseling patients who are considering various radiation treatments for their condition, ensuring that the treatment aligns with maintaining their QOL as the top priority?

Dr. Spratt: The cornerstone of counseling patients about treatment options lies in relying on high-quality evidence. Throughout my career, I have learned the importance of basing decisions on robust clinical trials rather than personal beliefs or anecdotal evidence. I have been humbled by instances where hypotheses did not pan out as expected, underscoring the value of conducting trials within a controlled setting.

When discussing treatments, particularly for localized prostate cancer, I draw upon the wealth of evidence available from nearly 60 clinical trials on prostate stereotactic body radiation therapy (SBRT) and other optimization studies. This extensive body of research provides a solid foundation for informing patients about the potential risks and benefits of different treatment approaches. As someone who has performed a significant number of prostate SBRT cases, I can offer patients a more accurate understanding of what to expect, steering clear of personal biases or overly optimistic claims.

Physicians may sometimes fall into the trap of recalling only the successes and positive outcomes, inadvertently overlooking patients who experience recurrence or adverse effects. By relying on long-term, high-quality evidence, I aim to provide patients with a realistic perspective on treatment outcomes. While not every patient scenario may perfectly align with the evidence from randomized trials, it serves as a crucial starting point from which to tailor discussions and decisions based on individual circumstances.

Given the evolving landscape of prostate cancer treatment, how do you envision the role of radiotherapy in combination with oral drugs evolving in the coming years?

Dr. Spratt: The utilization of radiation therapy has seen a remarkable expansion in its indications over the past decade, as reflected in the National Comprehensive Cancer Network guidelines. This trend is particularly pronounced in prostate cancer, where the use of radiation has extended across various disease stages, from localized to recurrent to oligometastatic disease. Moreover, there is growing evidence, including randomized data, supporting its efficacy even in the setting of castration-resistant disease. I anticipate this trend to continue its upward trajectory.

This expansion is facilitated by advancements in technology, notably in imaging modalities such as prostate-specific membrane antigen positron emission tomography and magnetic resonance imaging, which allow for more precise targeting of radiation. Combined with improvements in radiation delivery techniques, including highly accurate image guidance, we can now administer high doses of radiation with enhanced convenience and effectiveness. This has given rise to the concept of metastasis-directed therapy, where multiple metastatic sites are targeted with radiation—a strategy supported by ongoing trials, some of which are treating up to 10 sites.

Compared with chemotherapy, which often falls short of achieving a cure in most solid tumors, radiation therapy offers the potential to selectively target visible cancer cells with reduced systemic side effects. This paradigm shift is underscored by numerous randomized, phase 2 trials and ongoing phase 3 trials across GU oncology, including bladder cancer, where the addition of immunotherapy to radiation therapy is being explored in large-scale trials.

My belief is that the integration of radiation therapy with systemic therapy will continue to expand across various cancer types, driven by advances in technology and growing evidence supporting its efficacy in improving outcomes for patients.

Lastly, as a leader within a prominent program, you provide mentorship to aspiring radiation oncologists and junior faculty members. What advice would you offer to young professionals aiming to make contributions in the GU oncology field?

Dr. Spratt: One of the key principles I often emphasize is the importance of aligning your pursuits with a clear sense of purpose, driven by genuine intent. I once delivered a talk on this topic, titled “Purpose With Pure Intent,” where I distilled insights from my own journey thus far. While I continue to learn and grow, certain principles have guided me along the way.

First and foremost, it is crucial to understand and embrace your purpose. It goes beyond mere passion or ambition; it is about identifying what truly motivates and sustains you. True purpose transcends superficial goals like promotions or financial gains. Instead, it is about a deep-rooted belief in making a meaningful impact. This clarity of purpose is what fuels the extra effort, the early mornings, and the late nights.

Equally important is maintaining pure intent in your endeavors. If your actions are driven solely by the desire for recognition or advancement, you risk losing sight of ethical boundaries and compromising your integrity. However, when your intent is anchored in a genuine desire to serve others—whether it is patients with cancer or the advancement of evidence-based medicine—you are more likely to navigate challenges with integrity and humility.

In my own journey, advocating for evidence-based medicine and prioritizing patient well-being has served as my guiding star. While academic debates and discussions are inevitable, I strive to remain steadfast in my commitment to what is right, guided by a sense of purpose and genuine intent.

To young professionals—whether residents, fellows, students, or junior faculty—I urge you to discover your purpose and wholeheartedly devote yourself to it. When your actions are driven by authentic intent, your dedication will be unmistakable, and the impact you make will be profound.