Cancer treatment once available only in St. Louis comes to Swansea

Two metro-east radiation oncologists are tailoring cancer treatments for their patients and offering radiation technology that was once available only at cancer treatment centers in St. Louis.

The cancer treatment — stereotactic radiosurgery — has proven effective, according to Dr. Jason Lee and Dr. Susan Laduzinsky, radiation oncologists at the Memorial and St. Elizabeth’s Cancer Treatment Center in Swansea.

Stereotactic radiosurgery is a highly precise form of radiation therapy initially developed to treat small brain tumors and functional abnormalities of the brain. However, Laduzinsky said the technology can be used to treat a variety of cancerous lesions, including in the brain, lungs, prostate and liver.

Jeff Smith, 51, of Breese underwent stereotactic radiosurgery at the Swansea center after doctors found several spots of cancer in his brain. Smith was initially diagnosed with lung cancer after doctors found a mass in his lung, and then a CAT scan and MRI revealed the spots in his brain.

Lee, Smith’s doctor, in consultation with a neurosurgeon recommended Smith undergo stereotactic radiosurgery. “Those spots did really good with that,” he said.

Unfortunately, more cancerous lesions were found in his brain. He’s currently undergoing full brain radiation. “I feel good, just tired,” Smith said.

His doctors are monitoring the lung cancer as surgical removal wasn’t possible due to the close proximity of the mass to his heart. “It looks like it hasn’t spread anywhere else,” Smith said.

Laduzinsky encouraged the two Belleville hospitals to purchase the $4 million TrueBeam Linear Accelerator, which can used for both traditional radiation and stereotactic radiosurgery.

Laduzinsky started performing stereotactic radiosurgery, a non-surgical procedure where radiation therapy is given at much higher doses, about two years ago.

“This radiation is for smaller tumors. It gives a very high dose of radiation,” Laduzinsky said of stereotactic radiosurgery. “Standard radiation is a much lower dose, and we tend to give 10 to 40 treatments.”

Lee began doing stereotactic radiosurgery on small brain tumors when he started at the Swansea Cancer Treatment Center in February.

“Historically, technologies weren’t available to us to be able to aim at what we wanted to aim at in a precise fashion,” Lee said. “We have technologies (now) that can give us much more precise localization of both normal tissue structures as well as the target. Because of our ability to localize much more precisely, we can throw in a higher dose of radiation and really narrow the margin of which we need to feel confident we are hitting the target, so we can spare patients more toxicity because of that.”

Stereotactic radiosurgery relies on several technologies to improve accuracy of the treatment:

▪  Three-dimensional imaging and localization techniques that determine the exact coordinates of the target within the body.

▪  Systems to immobilize and carefully position the patient and maintain the patient position during therapy.

▪  Highly focused gamma-ray or X-ray beams that converge on a tumor or abnormality.

▪  Image-guided radiation therapy, which uses medical imaging to confirm the location of a tumor immediately before, and in some cases, during the delivery of radiation.

Patients who receive stereotactic radiosurgery have fewer side effects, and the treatment itself takes less time, according to Laduzinsky.

Smith said his treatment took between 15 and 20 minutes. “You have your head on a cushion. They put this mask on your face. They clamp it down so you can’t move or turn your head in any way. The machine is looking right at you, about 10 inches from your face,” he said. “You don’t feel anything.”

The side effects for standard radiation to the brain, Lee and Laduzinsky said, vary depending on the patients but could include mid- to long-term memory problems, fatigue, slower thoughts, hair loss and steroid dependence.

“Stereotactic radiosurgery really eliminates a lot of those problems,” Lee said. “There’s always some risk of toxicity for any treatment we give as doctors, but it’s markedly reduced. We can offer a treatment that significantly reduces the risks of something like those side effects while keeping the tumor under control.”

In some instances, the best option for a brain tumor patient might be radiation to the entire brain. However, Laduzinsky said stereotactic radiosurgery can be used if a smaller area of cancer starts to grow in the brain following the traditional radiation treatment.

Any patient who has cancer spots in the brain would be considered candidates for stereotactic radiosurgery, Lee said.

“The ideal patient may have metastasized cancer in only one spot of their brain — a small spot,” he said, “and nothing else in the rest of their body.”

Laduzinsky said the number of patients who can be treated with stereotactic radiosurgery has increased with the success of the treatment.

“Now, people are doing it with multiple brain lesions,” she said. “I think the latest is three or four, which they are saying is better than whole brain radiation.”

Radiation technology is a “very active area of research,” Lee said, “precisely what technique is best — surgery, radiate the entire brain or stereotactic radiosurgery.

“People are continuously looking back at prior experiences to determine how best to pick and choose what treatments,” Lee said. “It’s important for anybody who treats this to keep up on literature and find out what’s going on.”

All patients considered eligible for stereotactic radiosurgery will also be seen by a neurosurgeon.

“I think to do a good job of offering this you have to consider all options for each patient,” Lee said. “Just because you have a hammer doesn’t mean everything is a nail. Just because we can offer stereotactic radiosurgery doesn’t mean everybody ought to get it.”

Sometimes a patient is a candidate for both surgery and stereotactic radiosurgery, which is done to the cavity where the tumor was removed, Laduzinsky said.

The Swansea Cancer Treatment treats about 600 patients a year. A small fraction of those patients, Lee said, currently receive stereotactic radiosurgery.

Laduzinsky, who has worked at the center for 26 years, encourages more patients to consider stereotactic radiosurgery.

“It’s very quick, easy with very minimal side effects,” she said.

Stereotactic radiosurgery is covered by insurance as it’s considered standard treatment for cancer. Laduzinsky said it can actually cost patients less than traditional radiation since fewer treatments are needed.

Smith said stereotactic radiosurgery is “really nothing too traumatic. It’s nothing to be afraid of. There’s no pain at all.”

Smith thinks getting an MRI is worse than getting stereotactic radiosurgery. “It’s not bad at all,” he said. “I’m very happy with it.”

This story was originally published August 28, 2016 at 7:27 AM with the headline "Cancer treatment once available only in St. Louis comes to Swansea."