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The tumor nodule in Edward Boyd's lung was rising and falling with each breath he took.
"Moving targets" make radiation treatments considerably more difficult. When a tumor appears on a part of the body that moves involuntarily—such as the lung—doctors have to use larger margins around the tumor for radiation delivery. This results in possible damage to the surrounding, healthy tissue.
But University of Iowa Hospitals and Clinics is the first hospital in Iowa, and one of the first in the nation, to use a new technology that takes aim at the problem, making it virtually impossible for cancer to run or hide.
Boyd's health concerns began in 2003, when a sharp pain in the upper right arm led him to Rush University Medical Center in Chicago. There, doctors found and removed a sarcoma in the bone, diagnosed as malignant fibrous histiocytoma (MFH).
Since such cancers often metastasize, his case was followed closely. Within months, doctors discovered another nodule, this time in Boyd's lung.
"They wanted to do a full open lung procedure to remove the nodule. I decided to do research on the Internet for minimally invasive procedures," said Boyd, 58, a retired mechanical engineer from Sandwich, Illinois.
Boyd's Web search led him to Mark Iannettoni, MD, professor and head of the Department of Cardiothoracic Surgery at UI Hospitals and Clinics. Iannettoni believed the slow-growing nodule was non-cancerous.
After closely following its progression for a time, and discovering another nodule had formed in the lung, Iannettoni removed both nodules via thoracoscopic wedge resection, a minimally invasive surgery perfected by Iannettoni that generally allows patients to go home the same day. Boyd's first (older) lung nodule was found to have been radiologically stable and likely non-cancerous but the second was consistent with metastasis MFH.
After the procedure, "I was able to discontinue all pain medication and resume normal activities the day after I left the hospital. I had very minimal side effects with a little soreness in the chest area," Boyd said.
Soon after the surgery, follow-up examinations found that he had developed another lung nodule. Having so recently undergone surgery, Boyd wasn't an ideal candidate for another such procedure. The matter was discussed by a multidisciplinary group of UI Holden Comprehensive Cancer Center experts who review cancer patients' cases and recommend treatment strategies, and it was decided he was a good candidate for another pioneering procedure: non-invasive radiosurgery.
The Department of Radiation Oncology recently acquired the ability to perform 4-dimensional computerized tomography (CT) and respiratory-gated treatment. The technology was coordinated for patient care by John Bayouth, PhD, director of physics in the department .
"This two-part treatment started off with taking CT scans of the tumor in different phases of the respiratory cycle," said Sudershan Bhatia, MD, PhD. Bhatia, whose specialties include lung and gastrointestinal tumors, led the team that treated Boyd's tumor at the UI's new Center of Excellence in Image-Guided Radiation Therapy.
Next, physicists and dosimetrists computerized Boyd's respiratory motion and synched this rhythm with the multi-dimensional CT images, allowing the team to finalize a "prescription for radiation." With this intricate combination of detail, the nodule was accounted for at every instant of Boyd's unique breathing cycle.
During treatment, Boyd reclined on a table and wore a belt that measured his breathing patterns and triggered the radiation delivery machine. In lightning-quick intervals, sensors told the equipment when the tumor was in proper position for a radiation dose. The treatment rooms even provide music synched to each patient's breathing pattern to keep their respiration steady.
Before this technology was introduced, experts took images of tumors on parts of the body that move but weren't able to account for that movement—which can be up to several centimeters—so they were forced to make an unpleasant choice: expand the radiation delivery area and risk destroying healthy tissue, or reduce the radiation delivery area and risk missing parts of the tumor.
Now, however, the gating (turning off and on) of the radiation beam, synchronized with the breathing movement, minimizes the amount of normal tissue in the treatment field. Boyd's care went exactly as planned and that the prognosis is good.
"For this lesion, the treatment should control the tumor growth," Bhatia said. "In many cases, they completely regress."
For more information about 4-D therapy, patients and families should call the Department of Radiation Oncology at 319-356-2253. Bhatia and other experts are available to discuss this option.
For consultation or referral, physicians should contact UI Consult.
—Clancy Champanois
University of Iowa Hospitals and Clinics is the first hospital in Iowa, and one of the first in the nation, to use 4-D technology, which makes it possible to precisely direct radiation at a moving target without risking damage to nearby healthy tissue. |
