Cancer Program Annual Report - Eisenhower Medical Center

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E I S E N H O W E R M E D I C A L C E N T E R cancer surgery have become the procedure of choice and standard of care at Eisenhower Medical Center for early stage lung cancer, by myself and my associate, Seemal Mumtaz, MD. With regard to morbidity and mortality, the results achieved have equaled or bettered those in major academic centers due to Eisenhower’s patient-directed approach and the attention to fine detail intra-operatively and post-operatively; improved by a team-centered focus on cancer treatment. Eisenhower Medical Center is proud to offer to our patients the only minimally invasive robotic lung cancer surgical program in the Coachella Valley to our patients. In doing so, we have continued to achieve excellent peri-operative, long-term results and survival for our early-stage patients with lung cancer. Stereotactic Body Radiation Therapy for the Management of Lung Cancer Robert Johnson, MD Radiation Oncology Eisenhower BIGHORN Radiation Oncology Center Non-small cell lung cancer (NSCLC) accounts for 80 percent of all lung cancer diagnoses. Early-stage NSCLC is traditionally treated with surgery. However, many patients have unacceptable operative risk due to premorbid conditions associated with smoking. Radiation therapy is the treatment of choice for patients with inoperable early-stage NSCLC. Conventional radiation techniques deliver between 30 to 35 daily treatments to the tumor over six to seven weeks. Unfortunately, the lungs are quite sensitive to the effects of radiation and the dose that can be safely delivered to a lung tumor with conventional techniques is often lower than the dose required to eradicate the tumor. As a result, the outcomes for patients treated with radiation therapy have traditionally been poor, with cure rates of 10 to15 percent. Stereotactic Body Radiation Therapy (SBRT) is a new method of treating early-stage non-small cell lung cancer, which has dramatically improved outcomes. Drawing upon the most advanced techniques of imageguidance and treatment delivery, SBRT allows for the treatment of small tumors with between three to six treatments, rather than the traditional 30 to 35 treatments. SBRT results in eradication of 90 percent of properly selected tumors, with overall cure rates approaching 60 percent. Treatment planning for SBRT requires precision. First, daily set-up on the treatment machine must be accurate and reproducible. Second, because lung tumors move as a consequence of respiration, respiratory motion must be accounted for. Patients are immobilized in a custom body mold and a CT scan is obtained. The planning scan, called a four-dimensional CT scan, is acquired while the patient is breathing freely. This four-dimensional data set allows the radiation oncologist to visualize the tumor throughout all phases of the patient’s breathing cycle. Multiple methods exist to address respiratory motion and the 7
E I S E N H O W E R M E D I C A L C E N T E R treating physician chooses the technique that is most appropriate for the patient. Treatment is then delivered with Intensity-Modulated Radiation Therapy (IMRT). This advanced modality of treatment delivery maximizes radiation dose to the target while minimizing dose to the surrounding normal structures. Eisenhower BIGHORN Radiation Oncology Center utilizes RapidArc ® technology, which allows for these complex treatments to be given in a matter of minutes. During the course of treatment, most patients experience few if any side effects. The main long-term side effect of SBRT is injury to the lung, called radiation pneumonitis. This occurs in approximately 15 percent of patients and is mild in most cases. Additional long-term side effects, including injury to the ribs, heart, and nerves, are rare with careful treatment planning. Patient selection is key to successful implementation of SBRT. Each of the three to six treatments delivers a large dose of radiation, which results in considerably more tissue damage than conventional doses of radiation. This higher level of tissue damage is the foundation for why SBRT results in higher cure rates. However, significant side effects may occur if large volumes of normal tissues are subjected to these large doses of radiation. Consequently, SBRT should be reserved for small tumors (< 4 cm), which limits radiation exposure to the surrounding lung. Additionally, tumors should be located at least 2 cm from the main airway, heart, and mediastinal vessels to avoid excess radiation of these structures. When these principles are followed, outcomes are excellent and side effects are tolerable. In summary, patients with early-stage NSCLC is a localized disease process, which can be cured with local therapy. Surgical resection remains the standard of care for management of this disease. However, SBRT is an effective option for medically inoperable patients or patients who do not wish to undergo surgery. Tumor Immunology: Breaking through the Cancer Barrier Davood Vafai, MD Medical Oncology For years, researchers have been perplexed by a cancer cell’s ability to elude an effective immune system response. They understood complex abnormality of the cancer cells and how the body’s white blood cells should destroy them. And, in the laboratory, their theory proved correct. The question became why can cancer cells survive in the body Recently, researchers discovered the answer. Cancer cells actually blanket themselves with a shield — an invisible barrier — to protect against an immune system attack. To understand the pathophysiology of an immune system attack of a tumor’s antigenic structure we first need to understand the mechanism of antigenic presentation to immune system cells. The antigenic recognition starts with both antigen presenting cells (APC cells) which would capture some of the membranous and cytoplasmic 8
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Cancer Program Annual Report - Eisenhower Medical Center

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