Phoebe utilizes radiosurgery to treat cancer

Photo by Avan Clark

Photo by Avan Clark

ALBANY -- Lisa Jenkins, a former veterinary technician in Shellman, is moving at a slower pace than she was before. Even so, she is still able to appreciate the good things in life.

She loves riding horses, which she raises along with donkeys on a small farm. She continues to ride despite her physician's concerns about her bumping her head.

Over the past several months, Jenkins has been enjoying her second chance at life after living through the treatment and removal of cancerous tumors from her brain followed by radiosurgery treatment.

"I still have headaches, but I feel OK," she said.

Her first surgery took place April 29, 2008, to remove brain tumors, which was later followed by radiation and chemotherapy -- leaving her weak and slow to bounce back. After new tumors appeared, she underwent a second surgery in July of 2009.

The TomoTherapy unit at Phoebe Putney Memorial Hospital then provided an option with fewer treatments and more accuracy in pinpointing the smaller lesions. Her neurosurgeon, Dr. James Metcalf, referred her to Dr. Charles Mendenhall, a radiation oncologist, following the second surgery. The option he suggested was radiosurgery, which involves using precise doses of radiation for tumors that might otherwise be inaccessible or inadequate for open surgery.

Patients who undergo the procedure have to remain very still to prevent radiation damage to the surrounding tissue, which was the most agonizing part for Jenkins.

"You have to be very, very still," Jenkins recalled. "Other than that, no bad experience."

A patient is first scanned using CT and MRI technology to ensure accurate positioning.

"We very carefully map out where the tumor is located," Mendenhall explained. "It takes 16 man-hours to plan a treatment."

The treatment itself, on the other hand, takes virtually no time at all. Jenkins' lasted 20 minutes. In her case, an MRI with contrast was fused with a CT image for preliminary positioning.

"The MRI is good for soft tissue," said Jessica Fuller, a physicist with Phoebe's radiation oncology department.

After Jenkins had the procedure, there was an 80 percent reduction in the frontal lobe tumor that was not resected, Fuller said.

Treatment is broken up into two parts. After the area is imaged, the first half of the dose is administered. Another round of imaging is then done, after which the second half of the dose is given to the patient.

Experts say radiosurgery is most appropriate if a patient has fewer than four lesions in the brain. It is also more reasonable for patients with smaller tumors or for those who do not have tumors in multiple parts of their body.

"It depends on the location and size, but we typically treat in a small margin around (the tumors)," Mendenhall said. "(Candidacy) depends on the size, number of tumors and overall situation with the patient. For someone with more than two tumors, it has been proven that radiosurgery does not improve patient survival."

Taking into consideration that fact and the cost of the procedure, Mendenhall said physicians need to be picky who they recommend it for.

"Unless we think the patient will be active for an extended period of time, radiosurgery is not warranted," he said. "Otherwise, we would do standard radiation therapy.

"The downside of radiosurgery is that it is expensive. We are supposed to exercise judgment for when we can use it and when it will help or when we are simply driving up the cost of health care. You have to do it for the patient instead of to the patient."

Phoebe has had the technology to perform the procedure for two years. The chances of controlling a brain tumor using radiosurgery is 85-95 percent, Mendenhall said.

A good example of the benefits of such a procedure can be illustrated in the case of a small lung lesion that would be an appropriate size for radiosurgery. Previously, the problem would have been treated with up to 20 treatments every weekday once a day. Now, the number of treatments for the same lesion would be reduced to a total of three to five every other day.

"It is a huge improvement over the standard treatment," Mendenhall said. "We can do it with much less risk because it is extremely precise.

"I see this as a growing field."

Those who have the procedure have little to worry about in regards to radiation exposure causing future cancers, experts say.

"The benefits outweigh the risks," Fuller said. "The younger you are, the more likely you are to develop cancer from the exposure of an imaging dose. Radiosurgery patients are older. Patients 50-60 years old are not going to get cancer from imaging.

"We are only imaging the location being treated, so you will get the doses anyway."

The treatment procedure is mapped out by a physician. It is administered by a licensed radiation therapist and later checked by the physician, and often a physicist.

"There are a lot of people involved," Fuller said. "It involves a lot of checks and balances for patient safety. We always try to adapt, but we have a quality assurance process that is incredible. The people here are very careful."

For radiation therapy, everything is based on five-year data. Since Phoebe has not had the technology for that long, and because there are so few candidates who qualify, it is hard to tell at this point just how effective radiosurgery is for cancer patients in Southwest Georgia.

But it has potential.

"National numbers suggest this is a very effective treatment choice," Fuller said. "Patients can get one to five treatments. It is especially good for people who live in rural areas where treatment is not close to home. Daily trips are tolling on a family."

Due to the fewer number of treatments and fewer side effects involved, it is good not only for those living far from the hospital, as was the case with Jenkins, but it also allows patients to continue to work while receiving treatment.

"It (the procedure) was better because it was a one-time thing," Jenkins said. "It (the cancer) has slowed me down a whole lot. I can't do as much as I used to do, but it has also taught me to live life to the fullest -- because you never know."

Now Jenkins has gone back to work at a child care center.

"I ran a day care before I was a veterinary technician, but I've gone back to day care because being a vet tech requires a lot," she explained.

Jenkins said she would recommend radiosurgery to the appropriate candidate.

"I would recommend this," she said. "You do have to be still, but it's not that hard."