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New Precision Technique Yields Rare Success Treating Lung Tumors

Tuesday, February 5, 2002

This new technology kills cancer cells with such precision that it leaves healthy, normal cells intact. It’s a great treatment option for some patients who have not responded to chemotherapy.

The first lung cancer patient in the nation to be treated using shaped-beam radiosurgery technology, a highly precise treatment originally designed to destroy brain tumors, had a handful of lung tumors disappear after two weeks of treatment. One year later, the five metastatic tumors that were destroyed have not returned to the lungs of the 25-year-old man.

Oncologists who treated the patient at the University of Rochester Medical Center, which was the first U.S. institution to begin testing the technology on cancers outside the brain, say the procedure could mark a significant step in treating patients otherwise considered untreatable. They emphasize, however, that more and larger studies are needed before the method should be considered as a possible standard treatment.

“This new technology kills cancer cells with such precision that it leaves healthy, normal cells intact. It’s a great treatment option for some patients who have not responded to chemotherapy,” says Paul Okunieff, M.D., radiation oncology chief at the university’s James P. Wilmot Cancer Center. “If this technique achieves the goals, its impact on incurable cancers could be huge.”

Okunieff is studying the use of radiosurgery on liver and breast cancers, as well as other forms of the disease.  So far, Okunieff has used Novalis shaped-beam radiosurgery to destroy primary tumors in the brain, prostate and liver, as well as metastatic tumors in the lungs, liver and abdomen. Other doctors around the country are conducting similar studies, extending the use of the Novalis system beyond the brain.

In the past year, 100 people patients with breast, lung, liver and colon cancer have been treated at the Wilmot Cancer Center, and results are positive – doctors witnessed 100-percent success in treating lung tumors, and 85 percent of liver tumors were destroyed.  More than half the patients have not seen new tumors since treatment, which is significant, Okunieff says.

He presented the case of Jarod Finlay, the 25-year-old who was first patient to undergo this treatment, to colleagues at the American Society for Therapeutic Radiology and Oncology (ASTRO) in San Francisco in November.

Finlay was 18 when he was diagnosed with head and neck cancer, which accounts for less than 10 percent of all cancers, or about 29,000 new cases per year in the U.S.  He was originally treated with surgery and radiation therapy and was cancer-free for seven years. In the fall of 2000, five tiny, metastatic tumors were discovered in his lungs.

The new lesions were too small for traditional radiation therapy, and his only option under conventional medical treatment was dreadful: Wait for the tumors to grow larger so they could be targeted with traditional radiation therapy.

Instead, he chose the new investigational technique and underwent 10 shaped-beam radiosurgery treatments over two weeks, beginning just before Christmas in 2000. Over the past year, follow-up scans indicate the tumors have disappeared.

Finlay, an avid skier, faces the chance of additional tumors growing in new places, but also hopes they can be treated as quickly an successfully as the others.

While traditional radiation therapy is an effective treatment for many tumors, the side effects include scarring around the tumor, where healthy tissue can be destroyed along with the cancer cells. In addition, sometimes very small tumors are impossible to reach using conventional technology.

The Novalis shaped-beam technology, developed over the past 15 years by BrainLAB Inc. of Munich, Germany, conforms the radiation beams to match the size and dimension of a tumor and then kills those cells, leaving surrounding tissue unharmed. It also accommodates the slight movements of internal organs during normal breathing and blood flow, monitoring the rate and scope of movement and shutting off if movement varies, sparing healthy tissue.

Okunieff expects to treat 200 patients in separate clinical trials of stereotactic radiosurgery on metastatic liver and breast cancers over the next several years. In addition to these studies, Rochester and several other cancer centers nationwide now use the system to treat brain tumors.

“Someday I hope treating all types of cancer will be as simple as detecting a tumor, determining its location, and with pinpoint precision, destroying it in just a matter of days,” he said.

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