June 24, 2005
Neurosurgeons, Radiation Oncologists Wrap Radiation Around Spine to Provide Cancer Pain Relief
Using the most advanced radiation technology currently available in the region, neurosurgeons and radiation oncologists at the Jefferson Hospital for Neuroscience and Thomas Jefferson University Hospital in Philadelphia have for the first time wrapped beams of radiation around a patient's spine, relieving pain from several cancerous tumors there while avoiding the spinal cord.
The technology, called shaped beam surgery, relies on sophisticated computers to tailor the shape and intensity of radiation beams to fit the exact size and shape of the tumor "“ all while sparing healthy tissue. It enables doctors to treat a range of hard-to-reach benign and malignant tumors in the brain and spine they couldn't treat before, often avoiding invasive surgery and speeding the patient's recovery.
Neurosurgeon David Andrews, M.D., professor of neurosurgery at Jefferson Medical College of Thomas Jefferson University and director of the Division of Neuro-oncologic Neurosurgery and Stereotactic Radiosurgery at Thomas Jefferson University Hospital, used shaped beam surgery to treat the patient, a 46-year-old woman from Levittown, Pa., who had two tumors on her spine that had spread from another cancer elsewhere in the body. One tumor was pressing on the spinal cord, causing considerable pain. Treating the tumors with standard radiation was impossible because she had already received spine radiation more than 20 years earlier for non-Hodgkin's lymphoma.
According to one of her physicians, neurosurgeon Ashwini Sharan, M.D., assistant professor of neurosurgery at Jefferson Medical College, the woman would have needed three separate surgeries, including abdominal surgery to reach the cancer in her lumbar spine, and back surgery to reconstruct her spine with medical screws.
He explains that cancer in the spine is almost invariably considered advanced metastatic disease, and patients usually have an uncertain prognosis. "The only other option besides radiosurgery is reconstructive spinal surgery. Recovery from a spine operation and reconstructive surgery is three to six months, and surgeons and patients with spine cancer must weigh the costs and benefits because of the trauma and pain involved with surgery. "The goal is to keep patients independent, pain-free and ensure a good quality of life," says Dr. Sharan. The patient, he notes, avoided a six-week hospital stay and was able to be at home and relatively pain-free.
"We can wrap doses around structures such as the spinal cord, and can create a very high dose of radiation and leave the cord untouched," says Dr. Andrews, who is director of the Radiosurgery Units at the Jefferson Hospital for Neuroscience. "There's no other technology out there that can do this." It is available now only at Jefferson in the Delaware Valley and in a small number of medical centers in the nation.
"Shaped beam surgery is a new tool for selected patients," says Walter J. Curran Jr., M.D., professor and chair of Radiation Oncology at Jefferson Medical College and clinical director of the Kimmel Cancer Center at Jefferson. He notes that the technology provides an improved ability to specifically target a tumor with real-time imaging.
"As oncologists continue to improve treatments and enable many individuals with metastatic cancer to live longer, more productive lives, expectations and quality-of-life issues become paramount," notes neurosurgeon James Harrop, M.D., assistant professor of neurosurgery at Jefferson Medical College and neurosurgery director of the Regional Spinal Cord Injury Center of the Delaware Valley at Thomas Jefferson University. More patients with metastatic breast cancer, for example, are living longer, healthier lives than ever before.
"As we move forward in using this technology for spinal cancer patients, we will continue to focus on treating the individual's pain," Dr. Andrews says. "One of the promises of this technology is more rapid relief of spinal cord pain and more rapid disease control."
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