The goal is to pinpoint the tumor, spare healthy tissue and improve cancer control.
By Lisa Esposito: Patient Advice reporter at U.S. News & World Report
In early 2012, Carol Easthope, 73, of Marblehead, Massachusetts, learned she had bile duct cancer in her liver that surgery couldn’t help. “A very bleak diagnosis,” she says.
While her cancer was inoperable, it wasn’t untreatable, and she would need chemotherapy and radiation.
Easthope, with a long career in computer science and software development, carefully weighed her options.
She chose to be treated at Beth Israel Deacon Medical Center, where she’d given birth to her son in happier times.
Now, she would undergo radiation at the hospital’s CyberKnife Center.
Three Days of Radiation:
Radiation therapy for cancer is not an experience anybody asks for. But knowing how much the technology has advanced – to target the tumors more accurately, spare healthy tissue and reduce side effects – might help patients feel a little more optimistic.
In July 2012, Easthope underwent her first round of chemo to shrink the tumor and prevent cancer from spreading.
In August, she moved on to radiation. But first came the preparation period.
In preparation, fiducials – tiny gold seeds – were inserted by long needles into Easthope’s liver, to mark the tumor and serve as guideposts for the radiation beam.
Next, she was fitted with a soft body cradle to keep her in position and a special vest to allow the treatment to sync with her breathing and adjust for tumor movement.
She underwent several imaging scans, allowing the team to program the computer that would guide the robot arm delivering radiation.
In mid-September 2012, she had her first radiation treatment. Overall, it only took three 90-minute sessions over three days. In contrast, conventional radiation treatments can take less than 15 minutes, but sessions take place daily for up to six weeks.
Eastwood says she felt comfortable as she was lightly strapped into position. She had brought in an eye mask to block out flashing lights during treatment. She also had CDs for the sound system: Puccini, Indian sitar ragas and Streisand.
While she didn’t experience any side effects during treatment, afterward she felt extremely fatigued for several weeks.
Radiation Evolution:
“Most radiation is done with ‘external radiation,’ which is delivered from outside the body, with X-rays or electrons with a machine called a linear accelerator,” says Dr. Matthew Katz, medical director of radiation oncology at Lowell General Hospital in Massachusetts.
The technology keeps improving, Katz say, from the early 1990s when CT scans first allowed oncologists to treat tumors in 3-D to current techniques. One is intensity modulated radiation therapy or IMRT, which shapes the beams more precisely and sends stronger radiation doses to some parts of the body and weaker doses to others.
Continued improvements allow practitioners “to more accurately target common cancers better than before,” he says. “That accuracy ensures we’re more comfortable that the cancer is receiving treatment rather than the normal tissue, and in many cases can also lessen side effects.”
Then there are the high-dose, ultra-precise types of radiation (including the brands Gamma Knife and CyberKnife). “Stereotactic radiation was used originally for brain metastasis – cancer spread to the brain – where the accuracy needed to be within a millimeter,” Katz says. Now, he continues, it’s improving cure rates for inoperable early-stage lung cancer, and other uses are increasing. “All need more research,” he adds.
Tolerating Treatment:
Tiffany Tyer, a senior nurse practitioner in the department of radiation oncology at the University of Maryland Medical Center, works with patients undergoing IMRT.
As the body’s normal tissues work to recover, repair and regenerate after each daily treatment, fatigue is almost inevitable, Tyer says.
Hydration helps, and she advises patients to carry water to sip throughout the day.
And exercise helps patients maintain endurance, fostering their recovery.
Maintaining healthy nutrition and not losing significant weight during treatment are among the most important things patients can do to recover and heal, says Tyer, who connects patients with a dietitian before they start treatment.
Both chemo and radiation can lead to stomatitis, usually mouth sores, making it even harder to eat.
Dietitians can help with food choices, and medication can treat sores. After completing radiation,
Easthope developed stomach irritation, which the antacid Prilosec helped.
Radiation often leads to skin reactions similar to sunburn. “Keeping the skin clean and moisturized and supple helps prevent dryness, cracking and peeling,” Tyer says. Her favorite skin care recommendation is aloe, straight from the plant.
Hair loss can happen, usually temporarily, and it does upset some patients. “I always tell them, ‘In the short term, we’re going to make you feel worse,'” Tyer says. “But our goal is to make you better.”
Radiation Anxiety:
Sherry Soeder, a certified nurse practitioner in the radiation oncology department at Cleveland Clinic, describes short-term side effects a brain-tumor patient with a low-grade malignancy might expect, like headaches.
“Patients may develop side effects specific to the location of the tumor in the brain,” Soeder says. For instance, patients with right-brain tumors might experience weakness in the left side of their body.
Once patients fully understand and have consented to treatment, they go through a simulation session. They lie on a CT scan table while a mesh mask is made for them. The mask is wet and flexible, then dries out to “conform very tightly to their facial features,” Soeder explains. “So some patients have a sense of anxiety and claustrophobia, and we just try and talk them through that.”
Next comes a week of waiting for patients. “We’re going to be planning out all the beams of radiation so it completely covers the tumor and the margin around the tumor,” Soeder says. “But [so it also] avoids critical structures like the optic nerve.”
Patients often feel more anxious during this downtime as they anticipate treatment. “I tell most of our patients, we just need to get one or two treatments under their belt,” Soeder says. “Then they’ll relax – it’ll become more of a routine.”
During those weeks of outpatient treatment, some patients can continue to work once the neurosurgeon clears them. “I think that’s good – to have some piece of normal in your life during that time,” Soeder says.
Doing Well:
Easthope completed her last chemo treatment in February 2013, for which she is thankful. “Chemo is awful, and I often wonder if I’d do that again,” she says. In contrast, “CyberKnife is a piece a cake, as far as the patient goes.”
Two years out of treatment, her cancer appears to be in remission. She sees her medical oncologist every six months for blood tests and scans, and her radiation oncologist only once a year. Today, she says, “I feel marvelous.”
Is CyberKnife right for you? Talk with one of our CyberKnife and cancer experts.
At the CyberKnife Center of Miami our experienced physicians and nurses can offer you the best advice on treatment options.
For more information, please contact us at: 800-204-0455
“Our prime purpose in this life is to help others. And if you can’t help them, at least don’t hurt them.”
~ Dalai Lama