high tech Cancer fighter2

HEALTH
MONDAY, FEBRUARY 26, 2007
STATEN ISLAND ADVANCE
HIGH-TEC
CANCER
FIGHTER
Radiation Therapist
Dennis Damico, below,
respositions Paul Lewek
before the Dongan Hills patient
begins his TomoTherapy treatment.
TomoTherapy combines daily CT scans to check for any changes in size or location of a tumor
with the ability to target it with high doses of radiation while decreasing damage to the surrounding healthy tissues and organs
BY DIANE O’DONNELL
STATEN ISLAND ADVANCE
Paul Lewek takes off his
Mets baseball cap and settles
his lanky 6-foot-5 frame onto a
movable table connected to a
large donut-shaped machine.
For the 57-year-old retired
cop, this is day 11 of his 61⁄2
week Monday to Friday regimen of TomoTherapy, a relatively new approach to treating cancerous tumors. After
having his right tonsil and a
golf ball-size mass removed
from his neck in December to
battle advanced tonsillar cancer,
Lewek
shruggingly
accepts the routine.
Lewek is the first head-andneck cancer patient to be
treated with the more than $3
million,
state-of-the-art
machine at TomoTherapy of
Staten Island, housed in West
Brighton-based
Regional
Radiology.
The TomoTherapy Hi-Art
System
machine,
which
debuted on the Island last
month, is one of only two in
the New York City area and 71
nationwide. According to Patty
Kitowski, marketing communications manager of Madison,
Wis.-based
TomoTherapy
Incorporated, which created
the machine, there are 102 units
worldwide.
TomoTherapy combines
daily CT scans to check for
any changes in size or location
of a tumor with the ability to
accurately target it with high
doses of radiation while sparing healthy surrounding tissue
to a greater degree than was
previously possible. The
process is achieved through
Image Guided Radiation
Therapy (IGRT).
"We're able to acquire
images on a daily basis and
guide the patient's radiation
based on the images, which is
the most accurate way to give
radiation," says Dr. Hoon Lee,
a radiation oncologist at
TomoTherapy of Staten
Island. With conventional
radiation, treatment design
and delivery is based solely on
one CT scan.
PREPARING FOR THE SCAN
After lying on the table,
Lewek's head and neck are
placed on top of a custom-fitted
plastic mold. A white plastic
mesh mask is placed over his
face and fastened to the mold to
keep his head from moving.
Next, the Dongan Hills resident anchors his index fingers
into harnesses attached to a
foot platform to steady his
shoulders.
The table glides Lewek
inside the machine's spherical
opening, where a CT scan of
the tumor is taken.
Moments later, the latest
image is superimposed onto
the original one used to plan
the treatment weeks earlier.
"Everyday you can finetune the target of radiation
based on that day's anatomy,"
says Dr. Lee as he compares
the two scans on a computer
outside the treatment room.
Today's yellow scan is off by
3 millimeters compared to the
initial white one. The difference has been as great as 5
millimeters, but usually averages between 2 to 3 millimeters a day.
The minuscule discrepancies may seem irrelevant, says
Dr. Lee, but critical structures,
such as the eyes, optic nerves,
brainstem, spinal cord and
salivary glands are all in close
proximity to the tumor.
TREATMENT TIME
After radiation therapists
Rob Colavito and Dennis
Damico reposition Lewek on
the table, the patient is ready.
Both therapists leave the
room, which is enclosed by 6foot-thick reinforced concrete
walls to protect other patients
and staff from radiation.
During the treatment, the
radiation therapists watch
Lewek through two closedcircuit television monitors.
Inside the machine's donutshaped portal, a rotating ring
delivers pencil-thin beams of
high dose radiation to Lewek
in a 360 degree angle. Using a
more advanced form of
Intensity
Modulated
Radiation Therapy (IMRT),
the beams are adjusted in size,
shape and intensity to conform to Lewek's tumor.
STATEN ISLAND ADVANCE PHOTOS/IRVING SILVERSTEIN
Dr. Lee examines the CT scan taken minutes earlier against the original
treatment-planning scan to check for any changes to Paul Lewek’s tumor.
SOURCE: TOMOTHERAPY.COM
TomoTherapy's ability to
zap tumors differs from conventional radiation, which
typically attacks tumors from
one to four directions,
explains Dr. Lee, or the four to
seven fields usually afforded
by standard IMRT.
"You pretty much have 360
fields focusing in on that one
area," says
Dr. Lee. "So you're able to get a
very tight radiation just to the
area you want to give it and a
very low dose elsewhere."
LESS SIDE EFFECTS
TomoTherapy also cuts
down on Lewek's treatment
time — seven minutes compared to 45 for IMRT — and
side effects, says Dr. Lee.
Since the radiation can be
narrowly focused to Lewek's
tumor, there is less damage to
areas around it, such as the
parotid (salivary) glands, and
STATEN ISLAND ADVANCE/ALBERTO CERVANTES
less of a chance of xerostomia
(dry mouth) — a common
side effect for head-and-neck
cancer radiation patients.
For Lewek, the only drawback
to TomoTherapy, which is supplemented by chemo at
Richmond University Medical
Center, is the daily commitment.
"It's a little bit of pain in the
butt to come five days a
week," says Lewek, "but outside of that no problem, no
pain, no puss, no muss."
According to Dr. Lee,
TomoTherapy is ideal for
deep-seeded cancers, such as
prostate, lung, central nervous
system — which includes the
brain and the spine, gastrointestinal tumors and head and
neck tumors.
Currently,
the
West
Brighton facility is treating 20
TomoTherapy patients a day,
and expects to increase to 30
by next month, says Dr. Lee.
The machine can be used on
both children and adults.
TomoTherapy patient Paul Lewek, right, listens as Dr. Hoon Lee, a radiation
oncologist, explains the relatively new treatment procedure that debuted
last month at West Brighton-based TomoTherapy of Staten Island.
Another benefit of the new
radiation treatment is the possibility of retreating an area
should cancerous cells return.
Many radiation oncologists
are reluctant to give repeat
radiation to the same part of
the body that has already
received radiation for fear of
complications, such as excessive scarring or permanent
nerve damage.
"With TomoTherapy we are
finding that for certain
patients we may be able to
give a second course of radiation," says Dr. Lee.
"We are able to do this because
vital organs, such as the spinal
cord, can be completely avoided
using TomoTherapy."