Three Fred Hutch radiation oncologists honored as ASTRO fellows

In a rare achievement, three radiation oncologists from Fred Hutch Cancer Center have been named fellows of the American Society for Radiation Oncology (ASTRO) in the same year: Smith Apisarnthanarax, MD, Ralph Ermoian, MD and Lia Halasz, MD. Fellow status recognizes ASTRO members who have contributed significantly to the field of radiation oncology through research, patient care, education and leadership.  

“This honor reflects that our faculty are not only doing good things here at Fred Hutch, but they are also performing meaningful service to the larger field,” said Ramesh Rengan, MD, PhD, FASTRO, senior vice president and director of the Fred Hutch Radiation Oncology Division.  

“Each of the 2026 fellows is a world-class radiation oncologist and thought leader and has made important contributions in different ways. They exemplify how diversified our team is,” said Rengan, who is a professor in the Radiation Oncology Division and a member of the Immunotherapy Integrated Research Center. 

ASTRO is the leading professional organization for physicians, nurses, radiation therapists, physicists and other health care providers who specialize in radiation therapy. Of the society’s more than 10,000 members, fewer than 600 have been named ASTRO fellows.  

Changing the game for patients with liver tumors 

Every radiation oncologist strives to make treatment as safe and effective as possible for patients, protecting healthy tissues while eliminating cancer cells.

There are many types of radiation therapy that are used to treat many cancer types. 

When tumors develop in the liver, this can be an especially difficult needle to thread.  

“It’s an extremely high-risk, high-stakes organ,” said Apisarnthanarax, medical director of radiation oncology at Fred Hutch and professor, vice chair of faculty affairs and clinical research director in the Department of Radiation Oncology at University of Washington School of Medicine.  

“While treating the cancer, we have to be careful not to overwhelm the liver with radiation because this can put the patient’s life at risk,” he explained. Much of his work has focused on improving liver tumor outcomes, including with precisely targeted proton therapy. “Our department treats among the highest number of liver patients in the country with protons. We’ve helped pave the way,” he said. 

For about a decade, Apisarnthanarax and his team have been exploring novel methods to use imaging to not only visualize the liver but also evaluate its function, quantify the health of different areas of the organ and map these areas in three dimensions. With this kind of information, physicians may be able to more accurately determine if someone is a good candidate for radiation therapy and then design a personalized radiation plan that spares their healthy liver tissue.  

“We’ve just finished our first prospective study, using functional liver imaging before, during and after radiation therapy to observe what the imaging can show us. We discovered we can image and measure radiation injury to the liver at very early timepoints, much earlier than can be detected with conventional assessments,” said Apisarnthanarax. “This could allow us to fine-tune a patient’s radiation plan very early on during a treatment course for the best outcomes. 

“Our next step is to conduct a therapeutic clinical trial applying what we’ve learned,” he said. “We really want to transform how we treat liver cancer patients with radiation.” 

Apisarnthanarax was vice chair of ASTRO’s first-ever working group to develop clinical practice guidelines for radiation oncologists treating liver cancer. He has reviewed manuscripts for ASTRO’s International Journal of Radiation Oncology, Biology, Physics; served on a variety of ASTRO subcommittees; and assisted ASTRO’s work with the U.S. Department of Veterans Affairs (VA) to elevate care for gastrointestinal and liver cancers in the VA health care system. 

The next generation is in good hands 

A critical part of radiation oncologists’ role is communicating with patients about the type of radiation therapy they need, why and what it will be like, said Ermoian. “We describe to them a treatment that may seem foreign, maybe scary, and we need to do it with accessible language,” he explained — which is one reason he’s as dedicated to training the next generation of physicians as he is to providing patient care. 

Ermoian has long been involved in educating medical students and radiation oncology residents. He is a professor in the Radiation Oncology Division at Fred Hutch and a professor in the Department of Radiation Oncology and adjunct professor in the Department of Pediatrics at UW School of Medicine. 

“Since we’ve created new electives at UW for medical students, the number of students doing coursework in radiation oncology has dramatically grown,” said Ermoian. “We’re excited to have so many do a rotation with us — even those who are not ultimately going into radiation oncology, because they become more familiar with the field and how it can benefit patients.”  

While radiation oncology is highly technical, it’s not only about physics. At its heart is still the physician-patient relationship. Radiation oncologists are oncologists first, said Ermoian, who happen to use radiation. 

“Whether they are going on to be surgeons, medical oncologists, dermatologists or family physicians, hopefully students learn through their rotation with us that the time we physicians spend with patients is about explaining their care clearly, answering their questions and helping them feel informed and empowered,” he said. 

Clinically, Ermoian focuses mainly on treating childhood brain tumors and sarcomas through both Fred Hutch and Seattle Children’s, often with proton therapy. Proton therapy is as effective as traditional photon-based radiation therapy but with fewer or less-intense long-term side effects, making it a particularly important option for young people, whose bodies are still developing.  

He has been involved in research through Children’s Oncology Group, participated in writing the National Comprehensive Cancer Network practice guidelines for treating pediatric nervous system cancers and served as a section editor on pediatric sarcoma for International Journal of Radiation Oncology, Biology, Physics. 

From side effects to access barriers, making care better for patients

Like Ermoian, Halasz combines enthusiasm for education with research and clinical care. A professor in the Radiation Oncology Division at Fred Hutch and the Department of Radiation Oncology and Department of Neurological Surgery at UW School of Medicine, she has run the UW Radiation Oncology Residency Program for nearly a decade and was recently named the Department of Radiation Oncology’s vice chair for education. 

An expert in brain tumors, her research spans topics from treating primary tumors and metastases in the brain to understanding barriers to radiation oncology care for American Indian and Alaska Native (AI/AN) people. 

“My research is very practical. It really comes from taking care of patients and figuring out how we can do better,” said Halasz, who holds the Gerlich Family Endowed Chair in Neuro-oncology at UW Medicine and is co-medical director of the Alvord Brian Tumor Center at UW Medical Center – Montlake. 

She’s currently leading a clinical trial to reduce neurological side effects for patients with breast or lung cancer that has spread to the thin tissues covering the brain and spinal cord. Patients in the trial will receive proton beam radiation with “hippocampal avoidance,” treatment designed to reduce the amount of radiation that reaches a part of the brain involved in memory, learning and spatial navigation. 

In collaboration with researchers from Washington State University, she co-leads the INROADS project, backed by a Kuni Foundation Discovery Grant, to increase AI/AN access to radiation therapy. Based on interviews with patients, referring providers and radiation oncology staff, the research team is developing a toolkit to overcome the real-life barriers patients face in getting care. 

Halasz was vice chair of the multidisciplinary taskforce that developed ASTRO’s first clinical practice guidelines for treating lower-grade glioma; has served as an editor for the central nervous system section of the International Journal of Radiation Oncology, Biology, Physics; and has been part of the scientific committee planning ASTRO’s national meeting. 

“Radiation oncology is a relatively small field with such dedicated doctors and researchers,” said Halasz. “I appreciate that by selecting fellows, ASTRO recognizes people who are actively striving to move the field forward and make care better for patients.”