Moving Forward :: Advanced Technology Allows For Precise Treatment of Lung Cancer
In the span of about six months, John Wash saw his world turned upside down. In June 2008, he was diagnosed with lung cancer. After surgery to remove the tumor, Wash began the road to recovery. Initially, all signs pointed to a hasty comeback for the 78-year-old.
Tests showed the cancer had not spread to his lymph nodes, which indicated the tumor was likely only in his right lung. John and his wife JoAnne faced recovery with a positive attitude and a determination to beat the odds.
But during recovery, that positive attitude was tested. After experiencing pressure on his ribs in January 2009, John had an X-ray. The X-ray indicated he likely had cancer in his left lung. Further screening confirmed the diagnosis, and set a team of physicians at the John Stoddard Cancer Center in motion.
Identifying the Best Option
A team of four physicians discussed a plan of care for John, including Ronald Grooters, M.D., thoracic surgeon with The Iowa Clinic; Thomas Buroker, D.O., medical oncologist with Medical Oncology and Hematology Associates; Robert Goebel, M.D., radiation oncologist with John Stoddard Cancer Center; and Andrew Nish, M.D., interventional radiologist with Iowa Radiology.
Dr. Grooters performed the initial surgery to remove the cancer from John's right lung and indicated that further surgery would not be an option in talking with Dr. Buroker. Then, after reviewing the scans of John's lung, Dr. Buroker talked with Dr. Goebel to discuss radiation treatment options.
"This was a complex case because of John's recent cancer surgery," Dr. Buroker says. "A second surgery was not a possibility. But we felt the tumor was small enough that we could treat it with an advanced technology in use at the Stoddard Cancer Center."
Dr. Goebel recommended Stereotactic Body Radiotherapy (SBRT). This technology allows the tumor to be treated with a high-dose of radiation while not harming as much healthy tissue as possible.
"A clinical trial began by the Radiation Therapy Oncology Group (RTOG) about five years ago has shown that SBRT is now an acceptable treatment for certain early stage lung cancers in patients who are not candidates for surgical treatment due to other health-related reasons," Dr. Goebel says. "This is not a treatment that is available just anywhere. You have to have advanced technology to perform the treatment and physicians who have specialized training."
Shortly after the new diagnosis, John was fitted with a set of small metal markers inserted directly into the tumor by interventional radiologist, Dr. Nish.
"Lung cancer has a tendency to move as the patient breathes during treatment," Dr. Goebel says. "We consulted with Dr. Nish to place the markers so we could track the tumor's position and motion at each treatment session."
By using SBRT, radiation can be delivered in much higher doses and much more precisely than traditional radiation therapy. This allows treatments to be completed in a shorter time-frame.
John had SBRT treatment in April and his progress has been steady. In addition to SBRT, John had six treatments of chemotherapy - once every two weeks for three hours per session.
"I feel very good now, and people tell me I look great," he says. "I'm not losing any weight and I haven't had any troubles so far. I've got my wind back and I can finally take a deep breath again. I cannot tell you how good that feels."
"We have seen John's tumor shrink, as we would have expected," Dr. Buroker says. John has regular scans to track how the tumor is reacting. Lung cancers are typically slower to shrink after treatment than other cancers. "This is exactly the result we had hoped for."
Dr. Goebel says SBRT, while complex, assists the John Stoddard Cancer Center in offering another option for difficult-to-treat cancers. Other diagnoses that have responded well to SBRT include brain, spine, liver and pancreatic tumors.
"It allows us to focus radiation just where the tumor is," Dr. Goebel says. "In that respect, it limits damage to healthy cells, resulting in fewer side effects for the patient."
A True Team Effort
A few months removed from treatment, John feels fortunate to have been cared for at Stoddard. In addition to his physicians, John also had the opportunity to work with Carissa Thompson, RN, BSN, OCN, care coordinator at Stoddard. Stoddard Care Coordinators serve as patient advocates before, during and after treatment to offer education and support.
"I tell everyone that I had the best doctors and nurses around," he says. "They were all excellent and all worked together to take care of me. They have helped me remain positive that everything's going to be okay going forward."
"We are very fortunate to share a good relationship among the providers in Des Moines," Dr. Buroker says. "We have a group of providers who are very interested in developing skills to deliver advanced treatment. It takes time and energy to gather that type of expertise and to deliver it to patients in need."
A New Option for Difficult-to-Treat Cancers
Initially developed in the 1990's, Stereotactic Body Radiotherapy (SBRT) has been refined during recent years to treat patients with specific localized cancers who are not viable candidates for surgery.
The term stereotactic refers to the ability to very precisely deliver high doses of radiation to a tumor. Because of the accuracy in delivering the radiation, the chances of killing tumor cells, while sparing healthy cells, is very high. In preparing for the treatment, detailed images of the tumor are collected.
To perform the treatment, Image Guided Radiation Therapy (IGRT) and advanced X-ray is required. Using IGRT, the tumor's location is checked with a CT scan and X-ray prior to each treatment, and treatment is delivered with the Trilogy Linear Accelerator. Trilogy incorporates the extra imaging tools required to perform IGRT. With some cancers, like John Wash's lung cancer, small gold seeds are implanted in the tumor to allow providers to image the tumor more clearly.
This technology has been in use at John Stoddard Cancer Center for more than a year and in clinical trials has shown success in treating a range of localized tumors, including those in the lungs, brain, spine and pancreas.