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David Manfield Brizel

Leonard Prosnitz Distinguished Professor of Radiation Oncology
Radiation Oncology
Box 3085 Med Ctr, Durham, NC 27710
05135 Morris Bldg, Durham, NC 27710

Overview


Head and neck cancer has constituted both my principal clinical and research foci since I came to Duke University in 1987. I designed and led a single institution phase 3 randomized clinical trial, initiated in 1989, which was one of the first in the world to demonstrate that radiotherapy and concurrent chemotherapy (CRT) was more efficacious than radiotherapy alone (RT) for treating locally advanced head and neck cancer. CRT has since been established as the non-surgical standard of care for locally advanced head and neck cancer. Reduction of treatment-induced toxicity has also been a major interest of mine because more intensive therapeutic regimens improve efficacy but also increase morbidity. I was the principal investigator of the pivotal multinational randomized trial of amifostine in head and neck cancer, which established proof of principle for pharmacologic radioprotection and led to FDA approval of this drug for protection against radiation induced xerostomia in the treatment of head and neck cancer in 1999. I have also investigated role of recombinant human keratinocyte growth factor KGF in the amelioration of mucositis in both preclinical and clinical settings.
I have an ongoing commitment to the study of in situ tumor physiology and biology. I was one of the initial investigators to initiate direct measurement of tumor oxygenation in humans on a systematic basis. This work revealed a prognostic relationship between tumor hypoxia and local-regional failure and survival in head and neck. Parallel studies of tumor oxygenation in soft tissue sarcomas resulted in the first published literature to demonstrate that hypoxia at a primary tumor site was associated with a significant increase in the risk of subsequent distant metastatic recurrence after completion of treatment. We have also demonstrated that elevated lactate concentrations in head and neck cancer primary tumors is associated with an increased risk of metastatic failure in patients undergoing primary surgical therapy for head and neck cancer.
These interests and accomplishments provide the foundation for my present efforts, which are devoted to the development of functional metabolic imaging, both MRI and PET. We are using imaging to characterize the inherent, non-treatment induced variability of several physiologic and metabolic parameters in both tumors and normal tissues and to measure treatment induced changes in them. The long- term intent is to improve our abilities to predict treatment outcome, to better understand the relationships between physical dose delivery and the risk of toxicity, and to choose more customized treatment strategies for our patients that will increase the chances of cure and decrease the risks of serious side effects

Current Appointments & Affiliations


Leonard Prosnitz Distinguished Professor of Radiation Oncology · 2010 - Present Radiation Oncology, Clinical Science Departments
Professor of Radiation Oncology · 2002 - Present Radiation Oncology, Clinical Science Departments
Professor in Head and Neck Surgery and Communication Sciences · 2010 - Present Head and Neck Surgery & Communication Sciences, Clinical Science Departments
Member of the Duke Cancer Institute · 1987 - Present Duke Cancer Institute, Institutes and Centers

Recent Publications


NCCN GuidelinesĀ® Insights: Head and Neck Cancers, Version 2.2025.

Journal Article J Natl Compr Canc Netw · February 2025 The NCCN Guidelines for Head and Neck Cancers address tumors arising in the oral cavity (including mucosal lip), pharynx, larynx, and paranasal sinuses, as well as occult primary cancer, salivary gland cancer, and mucosal melanoma (MM). The specific site o ... Full text Link to item Cite

Clinical commissioning and introduction of an in-house artificial intelligence (AI) platform for automated head and neck intensity modulated radiation therapy (IMRT) treatment planning.

Conference J Appl Clin Med Phys · January 2025 BACKGROUND AND PURPOSE: To describe the clinical commissioning of an in-house artificial intelligence (AI) treatment planning platform for head-and-neck (HN) Intensity Modulated Radiation Therapy (IMRT). MATERIALS AND METHODS: The AI planning platform has ... Full text Link to item Cite

Long-term risk of carotid stenosis and cerebrovascular disease after radiation therapy for head and neck cancer.

Conference Cancer · January 1, 2025 BACKGROUND: Recipients of radiation therapy (RT) for head and neck cancer (HNC) are at significantly increased risk for carotid artery stenosis (CAS) and cerebrovascular disease (CVD). We sought to determine (1) cumulative incidences of CAS and CVD among H ... Full text Link to item Cite
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Recent Grants


Computational tumor phenotyping to interrogate treatment resistance and immune dysregulation in head and neck cancer

ResearchCo Investigator · Awarded by National Institutes of Health · 2024 - 2029

BMX-001 as a Radio-Protector in Head and Neck Cancer Therapy Phase I and Phase II

ResearchPrincipal Investigator · Awarded by BioMimetix Pharmaceutical, Inc. · 2017 - 2022

Patient Reported Outcomes and Financial Toxicity in Head and Neck Cancer

ResearchMentor · Awarded by Radiation Oncology Institute · 2018 - 2022

View All Grants

Education, Training & Certifications


Northwestern University · 1983 M.D.