Ron Hoffman can still snack on potato chips.

He can eat a stack of them without needing much-if any-water to smooth the process, and as anyone ever treated for cancer in the mouth or neck area might tell you, this constitutes a major victory.

Hoffman, 57, the principal at Charles City (Iowa) Middle School, felt a strange lump in his throat and was diagnosed with left tonsil cancer in the fall of 2002. He was dismayed to learn that traditional treatment options for the condition include surgery to remove part of the jawbone and sometimes part of the tongue, followed by radiation treatments over the affected area.

After discussing the situation with his wife, Vicki, his school's nurse, and Donald Maschka, M.D., an otolaryngologist at the Mason City Clinic (and a 1992 University of Iowa Roy J. and Lucille A. Carver College of Medicine graduate), Hoffman received a consultation in the Department of Otolaryngology-Head and Neck Surgery at University of Iowa Hospitals and Clinics.

"My jaw dropped," Hoffman said, describing his first meeting there with head and neck oncology specialist Gerry Funk, M.D. After an examination and other preliminary work, Funk indicated radiation therapy would be a viable alternative to the more invasive procedure. "Prior to that appointment, my world was falling apart. I was expecting major surgery and scars, if I lived. But after meeting with Dr. Funk, a weight was lifted from my shoulders," Hoffman said.

As with all head and neck cancer patients seen at UI Hospitals and Clinics, Hoffman's treatment approach was managed by Holden Comprehensive Cancer Center's Multidisciplinary Tumor Board, including specialists from otolaryngology, medical oncology, radiation oncology, radiology, nuclear medicine, pathology, and hospital dentistry. Radiation combined with chemotherapy was the board's recommendation, with the radiation to be given by a sophisticated treatment called intensity modulated radiation therapy (I.M.R.T.).

"Some describe the I.M.R.T. process as 'painting a picture,'" said radiation oncologist Min Yao, M.D., Ph.D. "By modulating [or varying] the radiation intensity, different radiation doses can be 'painted' to different areas-higher doses to tumors and less to healthy tissues. This increases tumor control, reduces side effects, and helps patients maintain a high quality of life."

Because I.M.R.T. is less sweeping than standard delivery techniques, with radiation brushed "between the lines" into specifically defined areas, accurate drawings are critical during treatment planning. Guided by an imaging technology known as positron emission tomography (P.E.T.) and input from the tumor board, Yao mapped out an optimum radiation delivery plan.

"Our I.M.R.T. results have been among the best in the nation," Yao said. "With standard radiation, this type of cancer has a 50 to 60 percent survival rate nationally. Our results have been 80 to 90 percent, so far." And with the Department of Radiation Oncology having recently moved into the new Center of Excellence in Image-Guided Radiation Therapy, a larger facility housing some of the most advanced technologies in the world (see related story on page 8), Yao said, "We're going to be even better."

Hoffman said the radiation treatments, given five days a week for seven weeks, weren't hard to tolerate, though there was some discomfort afterwards. "Basically, the whole inside of your throat is sunburned. I tried to tough it out, but Dr. Yao was always a step ahead, offering pain medication, a feeding tube, or anything else he suspected I would need. He and his team were always helpful, always gracious."

During his treatments, Hoffman and either his wife or a friend drove from Charles City to Iowa City and back each day, about four-and-a-half hours on the road. "I tried to work at least a half day throughout that time," he said. "One day I was presented a stack of gas cards, a gift from past and current administrators at the school. I just lost it. It's very heartwarming, the unexpected support you get when dealing with cancer. I was amazed at the outpouring from students, staff, parents, and the community."

Hoffman has been cancerfree going on three years and said, "It doesn't seem that different from before. My mouth is a little dry, but doctors have been very surprised by the amount of saliva I still have. That's fully attributed to the I.M.R.T."

For more information about I.M.R.T. treatments or the Center of Excellence in Image-Guided Radiation Therapy, patients may call UI Health Access, and physicians should call UI Consult, at the numbers listed below.

Our I.M.R.T. (intensity modulated radiation therapy) results have been among the best in the nation. With standard radiation, this type of cancer has a 50 to 60 percent survival rate nationally. Our results have been 80 to 90 percent."

-Min Yao, M.D., Ph.D.

BACK AT SCHOOL
Thanks to multidisciplinary care, Ron Hoffman is back to work as principal at Charles City (Iowa) Middle School.