Vero lets UF track tumors' travel in the body
Published: Saturday, December 29, 2012 at 6:21 p.m.
Last Modified: Saturday, December 29, 2012 at 6:21 p.m.
Tumors are not static things inside the body. Especially metastatic ones that, by definition, spread by hijacking the bloodstream to reach their next destination organ.
Until now, scientists have been unable to track tumors’ travel, but a new radiation technology is allowing them to watch tumor cells travel and multiply in real time and zap them en route.
The University of Florida Proton Therapy Institute is one of two places in the country to have a machine called Vero, which tracks the tumors and delivers high dosages of precisely targeted radiation therapy called SBRT — stereotactic body radiotherapy.
The latest technology grew out of high-tech scanners developed for security reasons after 9/11. Brainlab AG and Mitsubishi Heavy Industries Ltd developed Vero.
The technology and its technique are part of the UF Metastatic Cancer Program at Shands at both Jacksonville and Gainesville. The program is giving hope to patients who are often deemed untreatable, since cancer that has spread outside its original host organ is often incurable.
“We know we can save people’s lives using SBRT to destroy cancer that has limited spread, and we know advanced, modern medical imaging can help us by finding metastatic tumors very early while they’re still limited in size and spread,” said Dr. Paul Okunieff, professor and chair of the UF department of radiation oncology and director of the UF Shands Cancer Center, according to a UF news release announcing the Vero machine. “It isn’t always a terminal diagnosis.”
Okunieff has been using SBRT on metastatic patients for more than a decade, with successful results: 37 percent of women with metastatic breast cancer are disease-free after 12 years, he said.
Okunieff said it is best to treat newly diagnosed metastatic patients, but the technology can be used on many tumor types, notably the brain, where cancer is hard to treat because the blood brain barrier surrounding it keeps out most medications.
Insurance covers the treatment, and patients at the Proton Therapy Institute are put in a registry to track their results. Next year, the institute will enroll patients in a trial for prostate cancer patients.
Okunieff said people have come from around the country, and even from abroad, to be treated with this radiation technology at the institute.
For Piero Solimano, from Gulf Breeze, the technology has been a lifesaver. The 67-year-old has had four bouts of recurrent adenoma carcinoma over the past 20 years, leaving him with crippling bone and joint pain.
His latest bout with cancer started a year ago, when he developed a pain in his left hip.
“I thought I had pulled a muscle. One doctor told me it was a torn muscle … the other that I had inside joint inflammation. By February, the pain was already excruciating,” said Solimano.
It wasn’t until August that Solimano’s doctors at Shands in Gainesville finally diagnosed cancer in the nerves and muscles around his left hip. Surgery was too risky, and chemotherapy wasn’t something Solimano wanted to put his body through.
Instead, he went to the Proton Therapy Institute in October, where he underwent two two-week sessions of SBRT radiation therapy.
“It’s a new lease on life,” Solimano said. “I can ride a bike. I can sleep. Honestly, since the beginning of the year, I had not slept more than three hours in a row. Now I am sleeping eight hours. Day to day, I count my blessings like you wouldn’t believe.”
The therapy comes with minimal side effects, since the radiation is so precisely targeted to the tumor that surrounding tissue is spared. For example, a tumor on the liver might rotate on the diaphragm as you breathe, and doctors can stay on top of its movement.
“The ability to track the tumor allows us to treat a much smaller volume,” explained Dr. Roi Dagan, a radiation oncologist at the Proton Therapy Institute and an assistant professor in the UF department of radiation oncology.
The result of radiating a smaller area in the body is comparable to removing a smaller portion of breast tissue when a surgeon removes a breast tumor, Dagan explained.
And, just as a surgeon wants to avoid as much excision as possible, radiation oncologists want to minimize radiation exposure to tissue that doesn’t need it. Tracking tumors in real time allows for this, since doctors essentially follow the patient’s breathing and heartbeat.
“Breathing is very fast so you need to follow things fast. If you were 50 milliseconds behind (half a second), you would already miss (the tumor),” Okunieff said. “The common philosophy that tumors in the bloodstream are everywhere is not actually true. The reality is that only certain organs have tumors … most people have only two or three or four spots and not 200, 300, 400.”
The therapy has so far also shown some promise in treating even tumors untouched by the radiation.
“Even in spots that we don’t treat, the cancer disappears,” Dagan said, explaining that the radiation produces a robust immune response in patients. “It looks like high-dose radiation may be that extra jolt to start fighting the cancer.”
And long term, at least so far, the radiation therapy also has been effective in preventing a recurrence, the age-old death knell for cancer patients.
Importantly, that marks a paradigm shift in thinking of metastatic cancer as a chronic rather than terminal condition, said Dagan.
“We’ve simply changed the nature of cancer from a disease they die from to one they live with. It can be like having diabetes or heart disease.”
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