Frederick M. Dirbas, MD
Frederick M. Dirbas, MD
Associate Professor of Surgery (General Surgery)
dirbas@stanford.edu

Bio

Dr. Dirbas is originally from Brooklyn, NY. He graduated from Stanford University with a B.S. with Departmental Honors in Chemistry in 1981. While in college, Dr. Dirbas worked as a lab tech under Dr. Bruce Reitz in Dr. Norman Shumway's lab during initial studies of cyclosporin A as an immunosuppressive agent for preclinical studies of heart/lung transplantation. He then completed his M.D. training with A.O.A honors at Columbia University's College of Physician and Surgeons (now the Vagelos School of Medicine). Dr. Dirbas received the Whipple Award as the top surgery student in his medical school class. Internship and residency then followed at Stanford Hospital (now Stanford Health Care). During his professional development years Dr. Dirbas spent two years at the National Institutes of Health. He studied immunosupression for cardiac transplantation with Dr. Thomas Waldmann by performing heterotopic heart transplants in cynomologous monkeys then administering Anti-tac conjugated to Yttrium90. Dr. Dirbas returned to Stanford and as a chief resident and became more interested in surgical oncology. Accordingly, he then pursued a 2 year surgical oncology fellowship with Dr. John Niederhuber who later served as the head of the NCI. After completing this second fellowship, Dr. Dirbas worked as a staff surgeon at the Palo Alto VA Hospital and at Stanford Hospital for 4 years. At the Palo Alto VA he served as a surgical oncologist and ICU/critical care attending while at Stanford he served as a breast cancer surgeon and trauma surgeon (during this period Stanford achieved recognition as a Level I Trauma Center). In these early years at Stanford Dr. Dirbas routinely contributed tumor tissue to the pioneering work in the Brown/Botstein labs which led to the initial reports of molecular profiling of breast cancer. Dr. Dirbas became an assistant professor in 1999. In 2002 he initiated and served as PI for Stanford's Phase I/II studies in accelerated, partial breast irradiation, including intraoperative radiotherapy (IORT) and 3D conformal radiotherapy making Stanford an early adopter of this technology. From 2010 to 2017 Dr. Dirbas served as the physician leader of Stanford's Breast Cancer Clinical Care Program: in 2017 an anonymous poll by Medscape of its members ranked Stanford in a tie for #7 in the U.S. as the place that Medscape members would most likely recommend or breast cancer care. During this period Dr. Dirbas contributed significantly to the development of Stanford's Women's Cancer Center, Stanford's South Bay Cancer Center, and design elements of Stanford Cancer Hospital while maintaining an extremely busy clinical practice. Dr. Dirbas became a board member of the School of Oncoplastic Surgery. He took a partial sabbatical from 2019 to 2021 to renew research efforts. He is currently a Co-investigator on Dr. Aaron Newman's NIH R01 grant studying breast cancer stem cells in the triple negative lineage. Dr. Dirbas initiated Stanford's interdisciplinary research program investigating the merits of FLASH radiotherapy for breast cancer. Dr. Dirbas received a pilot grant from the Stanford Cancer Institute, and more recently a 2-year grant from the California Breast Cancer Research Program for FLASH RT. Dr.Dirbas is also the PI on a research agreement between the Stanford Cancer Institute and Beyond Cancer to develop a Phase II study for use of ultra high concentration gaseous nitric oxide for treatment of solid tumors. Dr. Dirbas is chair of Beyond Cancer's scientific advisory board. He is currently vice chair of the Breast Disease Site Working Group for the Society of Surgical Oncology. In October 2024, Dr. Dirbas was appointed the John and Ann Doerr Faculty Scholar in Breast Surgery. Dr. Dirbas continues to maintain an active breast surgery practice at the Stanford Cancer Center with the unique background training in cardiovascular surgery, immunotherapy, trauma surgery, ICU/critical care, and surgical oncology.

Publications

  • Primary breast arteriovenous malformation in a patient with Cowden syndrome and bilateral ductal carcinoma in situ: a case report ANNALS OF BREAST SURGERY Anderson, T. N., Thompson, C. N., Hovsepian, D. M., Josephs, S. C., Dirbas, F. M. 2024; 8

    View details for DOI 10.21037/abs-23-81

    View details for Web of Science ID 001391316400005

  • Surgical Perspectives on the Updated ASTRO Guideline on Partial Breast Irradiation for Breast Cancer. Annals of surgical oncology Park, K. U., Showalter, S. L., Dirbas, F. M., Society of Surgical Oncology Breast Disease Site Work Group, Laronga, C., Boughey, J. C., Agnese, D., Amin, M., Barrio, A. V., Botty van den Bruele, A., Burke, E., Dirbas, F. M., Fayanju, O. M., Kantor, O., Kumar, S., Nguyen, T. T., Park, K. U., Plichta, J., Showalter, S., Singh, P., Tranakas, N., Weiss, A., Woodfin, A. A. 2024

    Abstract

    This is an executive summary of the most recent American Society for Radiation Oncology (ASTRO) guidelines on use of partial breast irradiation in early-stage breast cancer.In the conscientious pursuit of "right-sizing" the management of patients with early-stage breast cancer, there has been an emphasis on judicious de-escalation of therapy. A component of this paradigm shift is partial breast irradiation (PBI), an approach characterized by targeted radiation therapy (RT) to lumpectomy cavity margins rather than to the whole breast (i.e., whole breast irradiation [WBI]) after breast conservation surgery (BCS). The American Society for Radiation Oncology (ASTRO) recently completed a revision of its evidence-based guidelines for the application of PBI.1To accomplish this, recent PBI data were reviewed by panel members, including representatives of the American Society for Radiation Oncology (ASTRO), in collaboration with the American Society of Clinical Oncology (ASCO), and the Society of Surgical Oncology (SSO), which provided representatives and peer reviewers. The guideline was approved by the ASTRO Board of Directors and endorsed by the Canadian Association of Radiation Oncology, European Society for Radiotherapy and Oncology, Royal Australian and New Zealand College of Radiologists, and the Society of Surgical Oncology.The recommendations focused on indications for PBI as an alternative to WBI and technical considerations specific to PBI. This editorial provides a summary and comments on the updated ASTRO PBI guidelines, offering insights into the implications of these findings for clinical practice and multidisciplinary decision-making while underscoring technical considerations for optimal incorporation of PBI into patient care.

    View details for DOI 10.1245/s10434-024-15639-5

    View details for PubMedID 39003374

  • Single-cell transcriptional diversity is a hallmark of developmental potential. Science (New York, N.Y.) Gulati, G. S., Sikandar, S. S., Wesche, D. J., Manjunath, A. n., Bharadwaj, A. n., Berger, M. J., Ilagan, F. n., Kuo, A. H., Hsieh, R. W., Cai, S. n., Zabala, M. n., Scheeren, F. A., Lobo, N. A., Qian, D. n., Yu, F. B., Dirbas, F. M., Clarke, M. F., Newman, A. M. 2020; 367 (6476): 405–11

    Abstract

    Single-cell RNA sequencing (scRNA-seq) is a powerful approach for reconstructing cellular differentiation trajectories. However, inferring both the state and direction of differentiation is challenging. Here, we demonstrate a simple, yet robust, determinant of developmental potential-the number of expressed genes per cell-and leverage this measure of transcriptional diversity to develop a computational framework (CytoTRACE) for predicting differentiation states from scRNA-seq data. When applied to diverse tissue types and organisms, CytoTRACE outperformed previous methods and nearly 19,000 annotated gene sets for resolving 52 experimentally determined developmental trajectories. Additionally, it facilitated the identification of quiescent stem cells and revealed genes that contribute to breast tumorigenesis. This study thus establishes a key RNA-based feature of developmental potential and a platform for delineation of cellular hierarchies.

    View details for DOI 10.1126/science.aax0249

    View details for PubMedID 31974247

  • Role of epithelial to mesenchymal transition associated genes in mammary gland regeneration and breast tumorigenesis. Nature communications Sikandar, S. S., Kuo, A. H., Kalisky, T. n., Cai, S. n., Zabala, M. n., Hsieh, R. W., Lobo, N. A., Scheeren, F. A., Sim, S. n., Qian, D. n., Dirbas, F. M., Somlo, G. n., Quake, S. R., Clarke, M. F. 2017; 8 (1): 1669

    Abstract

    Previous studies have proposed that epithelial to mesenchymal transition (EMT) in breast cancer cells regulates metastasis, stem cell properties and chemo-resistance; most studies were based on in vitro culture of cell lines and mouse transgenic cancer models. However, the identity and function of cells expressing EMT-associated genes in normal murine mammary gland homeostasis and human breast cancer still remains under debate. Using in vivo lineage tracing and triple negative breast cancer (TNBC) patient derived xenografts we demonstrate that the repopulating capacity in normal mammary epithelial cells and tumorigenic capacity in TNBC is independent of expression of EMT-associated genes. In breast cancer, while a subset of cells with epithelial and mesenchymal phenotypes have stem cell activity, in many cells that have lost epithelial characteristics with increased expression of mesenchymal genes, have decreased tumor-initiating capacity and plasticity. These findings have implications for the development of effective therapeutic agents targeting tumor-initiating cells.

    View details for PubMedID 29162812

    View details for PubMedCentralID PMC5698470

  • Five-year results of a prospective clinical trial investigating accelerated partial breast irradiation using 3D conformal radiotherapy after lumpectomy for early stage breast cancer BREAST Horst, K. C., Fasola, C., Ikeda, D., Daniel, B., Ognibene, G., Goffinet, D. R., Dirbas, F. M. 2016; 28: 178-183

    Abstract

    Accelerated partial breast irradiation (APBI) is emerging as an alternative to whole-breast irradiation. This study presents the results of a prospective trial evaluating 3-dimensional conformal radiotherapy (3D-CRT) to deliver APBI for early-stage breast cancer.Patients with unifocal stage 0-II breast cancer measuring ≤2.5 cm without lymph node involvement were eligible. After lumpectomy, 3D-CRT APBI was delivered to the lumpectomy cavity + margin (34-38.5 Gy in 10 fractions over 5 days).141 patients with 143 breast cancers (2 bilateral) were treated with 3D-CRT APBI. Median age was 60. Median tumor size was 1.1 cm. At a median follow up of 60 months (range, 5-113), the 5-year and 8-year cumulative incidence rate of a true recurrence is 0.9%. The 5-year and 8-year cumulative incidence rates of an elsewhere failure are 2.4% and 4.4%, respectively. The 5-year and 8-year overall survival is 100% and 94%, respectively. Among the 62 patients with follow up >5 years, 95% had excellent/good cosmetic results.Our experience with 3D-CRT APBI demonstrates excellent cosmesis and local control. Longer follow up will be necessary to evaluate long-term efficacy and toxicity of 3D-CRT APBI. CLINICALTRIALS.NCT00185744.

    View details for DOI 10.1016/j.breast.2016.06.001

    View details for Web of Science ID 000379683300027

    View details for PubMedID 27322859