It’s Brain Surgery New Procedure At Sr. Caritas Cancer Center Raises The Bar In Cancer Treatment

Conceivably, the next patient to enter Mercy Medical Center’s Sr. Caritas Cancer Center for surgery to remove a brain tumor could walk out of the hospital the same day, fully treated, without ever encountering a scalpel.

 

The breakthrough surgical option – stereotactic radiosurgery — is the latest addition to the cancer center’s treatment repertoire. It allows for treatment of some types of tumors in the brain with intense, targeted doses of radiation, and requires no incision.

Mercy is the only facility in Western Mass. currently offering the procedure. The closest medical centers equipped with the same technology are located in Boston, Albany, and Southern Connecticut.

Frank Claudio, director of the Sr. Caritas Cancer Center, said the addition of the stereotactic radiosurgery procedure has been a primary goal since the center was first conceived.

“We feel it’s important to a cancer patient’s overall quality of life to receive treatment as locally as possible,” he said. “And the latest treatments are also something every patient should have.”

Claudio added that offering stereotactic radiosurgery to the center’s patients essentially allows them to take advantage of a procedure previously available in Boston hospitals, but without sacrificing a certain level of familiarity between physicians and other members of the treatment team, and patients.

“Because we’re smaller, we all have that personal involvement that you won’t see everywhere,” he said, “so in some ways we’re actually ahead of the game.”

On Target

The addition of the training and equipment necessary for the surgery also allows for stereotactic radiotherapy, which couples the technological aspects of stereotactic radiosurgery with more conventional radiation therapy methods to treat lesions that may be near critical structures in the brain.

The procedures are the latest non-invasive, radiation-based treatment options available at the center, and offer further proof that cancer treatments continue to move toward being more technologically driven. The center currently offers 3-D Conformal Radiation Therapy, the industry standard, and Intensity Modulated Radiation Therapy (IMRT), a radiation method that can pinpoint a cancerous area more accurately and reduce the spread of radiation to healthy tissue.

Like IMRT, stereotactic radiosurgery for brain tumors delivers precise, targeted doses of radiation to the affected area, and requires the use of a linear accelerator, or Linac – a radiation-treatment machine equipped to treat patients with the newest technology available.

The move to offer the surgery required the center to purchase a specific system in order to offer the procedure — the XKnife system, designed by the Burlington, Mass.-based company Radionics. In addition, the center’s staff had to undertake an extensive training program, including radiation oncologists, neurosurgeons, nurses, physicists, radiation therapists, and dosimetrists, all of whom are involved in the delivery of each treatment.

New Horizons

Dr. Alan Stark, medical director of the Caritas Center, added that although stereotactic radiosurgery is an addition to the radiation therapy repertoire at the center and not a completely new procedure, the delivery of just one dose requires hours of preparation.

“We have had similar experiences with radiation therapy like this in the past,” he said. “This is not ‘space age science.’ But there is so much work that must occur before the procedure takes place that offering this service requires a significant investment of time, money, and involvement.”

Although it eliminates the need for incision and has few side effects, Stark explained that receiving the treatment is not a quick process. One treatment usually requires an entire day to complete, as a patient receives a CT scan to determine where a tumor is located and the best way to treat it, the required dose is calculated, and a number of quality assurance tests are performed at all stages of the procedure.

“It’s a technology-based procedure that is people driven,” he said. “It requires hours of planning to ensure the tumor has been mapped correctly, and to make sure all of the equations are correct.”

The surgery will be used to treat some very specific, and often advanced, types of tumors, he continued, and will deliver the highest level of radiation the body can handle.

“We’re delivering a very large dose,” he said. “Every organ has a limitation as far as how much radiation it can receive, and the brain can handle the most. We would never deliver the same amount of radiation in one dose to any other part of the body. Up to three spots can be treated at one time, but those areas can’t receive the same treatment again.”

Most often, Stark explained, stereotactic radiosurgery will be used to treat selective brain metastases – the spread of cancer cells from other parts of the body to the brain – and malignant primary brain tumors, which have the ability to spread, invade, and destroy tissue.

Also, benign conditions such as arteriovenous malformation (AVM), a congenital disorder caused by the abnormal development of blood vessels, and tumors that are recurrent or otherwise unable to be surgically removed, will be treated.

Following the actual treatment, which takes about 30 minutes, a patient will be discharged and examined about two weeks after the surgery, in order to gauge how well the radiosurgery has worked. Stark said results aren’t seen immediately, but in many patients the results of the surgery can be seen after that two-week period as the body begins to absorb the cancer cells destroyed by radiation.

He added that as with surgical procedure, there are concerns involved, but the targeted radiation dose spares as much of the surrounding tissue as is possible with any current radiation therapy, and eliminates several specific risks associated with invasive surgery.

“There is some risk involved,” Stark said. “There is a chance of swelling, for instance. However, the benefits of the treatment far outweigh the risks associated with the tumor. And we accept certain risks, because these are major, life-threatening conditions. This is serious business.”

Forward Thinking

Eventually, Stark said he hopes the technology being used to offer stereotactic radiosurgery to patients with brain tumors can be further utilized to treat additional disorders that could not be optimally treated in the past, such as tumors in the spine.

“The idea is to continue to work toward offering the latest treatments,” he said. “That will always be a big part of our mission.”