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Surviving Cancer - Leading-Edge Radiation Oncology Treatment Save Lives - 05/04/2007

Cancer is the last thing anyone wants to hear, but, says Candyce Shupenko, “A cancer diagnosis is no longer a death sentence. The sooner you find it, the better chance there is of a cure.”

Shupenko, 59, of Southington, should know. Two years after a diagnosis of vaginal cancer, she is cancer free and feeling good.

Shupenko recalls a routine visit to her gynecologist, Dr. Sharon Goldberg, in 2005. Finding something “suspicious,” Dr. Goldberg referred Shupenko to Dr. James Hoffman, who specializes in gynecological oncology.

It turned out Shupenko had vaginal cancer. Her particular disease, the location, and the fact that it was still at an early stage allowed doctors to treat Shupenko with high-dose radiation (HDR) as an outpatient. Dr. Hoffman worked closely with Dr. Neal Goldberg, a radiation oncologist and director of the Radiation Oncology Department at The Hospital of Central Connecticut.

Vaginal cancer is unusual, and it’s unusual to detect it at such an early stage. With early detection, Shupenko could receive High Dose Brachytherapy, which allowed treatment to be limited to the local tissues only.

“My initial reaction to the diagnosis,” says Shupenko, “was shock… I was hysterical.” But she says that her physicians presented all the options in a straightforward, compassionate way. That, coupled with the professionalism of everyone on the team, gave her strength and confidence.

Importance of Early Detection
Patients receiving a cancer diagnosis experience a torrent of emotions that include disbelief, anger, and intense fear. When patients are treated at The Hospital of Central Connecticut, they also experience the strength and confidence that come with outstanding physicians and advanced cancer treatments that include some radiation oncology treatment techniques not available anywhere else in Central Connecticut.

Saving cancer patients’ lives often begins with early and accurate diagnosis.Although the three individuals interviewed for this story are very different, one thing they share was an early cancer diagnosis. Their physicians were vigilant. In each of these instances, had the disease been allowed to grow unabated for another year or more, their disease process would have changed significantly and their treatment options would have narrowed. Treatment for cancer can include surgery, various medicinal treatments including chemotherapy, and various forms of radiation.

“If it wasn’t for that mammogram,” says Joan Martin, 55, of Southington, pausing a minute, “God only knows.” Martin, now a breast cancer survivor, is referring to the mammogram last year that illuminated a pea-shaped “density” too small to be detected by physical examination. Even now, Martin is incredulous — that she had it; that they found it; that she survived it. A follow-up ultrasound confirmed the mammogram results and she was immediately referred to a team of physicians. First, Dr. Akella Sarma surgically removed the tumor, confirming that it had not spread to the lymph nodes.

Dr. Barbara Fallon, Martin’s medical oncologist, who specializes in breast cancer, worked closely with Dr. Goldberg to design a treatment plan with six months of chemotherapy, followed by radiation. Martin’s regimen was “dose dense chemotherapy,” in which 24 weeks of chemotherapy are compressed to 16 weeks, increasing its effectiveness and shortening treatment. Because her cancer is sensitive to hormones, for the next five years she’ll take medications to deprive the cancer of estrogen. “By using chemotherapy, hormone manipulation and radiation, we maximize the chances that the cancer will not recur,” Dr. Fallon says.

Soon after completing chemotherapy, Martin began daily radiation treatments. First the cancer sites were digitally mapped. She had 34 treatments consisting of, first, Intensity Modulated Radiation Therapy (IMRT), and second, “boost” treatments using an electron beam, Dr. Goldberg explains. (See sidebar) “Using electrons allows precise positioning because of the unique characteristics of the electron beam,” he says.

“My treatment experience was very good,” Martin says without a hint of irony. “I met other people with similar problems. You came to feel like a family. I felt so sorry for myself until I saw what some other people were going through. You learn a lot going through cancer. You wonder why things happen. I made some good friends. I know I was one of the lucky ones.”

Advanced Treatment Options Close to Home
John Prendergast, 59, of Cromwell, was diagnosed with prostate cancer in October 2005. His urologist had been checking John’s PSA levels regularly for over three years. When one test came back high, a biopsy was performed, and it was positive for cancer.

“People posed the question to me about going to a ‘real cancer institute,’” Prendergast says. “After talking to my two doctors here, I felt very confident. They answered all of my questions. I always felt that I got the very best treatment possible here.”

Prendergast received Acculoc™ image-guided IMRT. Prendergast’s urologist placed the Acculoc markers at the affected sites in his prostate. These markers are inert and simply mark the site internally, much the way tattooing the skin guides external radiation, so the radiation can be targeted precisely.
The radiation therapy began in June 2006 and lasted 42 days, Monday through Friday. “For 8-1/2 weeks, this was my job,” says Prendergast. Like many cancer patients, he continued working at his “day job,” grateful he could work his treatments around his employment schedule.Nearly a year after treatment, Prendergast says he “feels fine” and his PSA level is normal.

“An Amazing Facility”
The American Savings Foundation Radiation Oncology Treatment Center at The Hospital of Central Connecticut is a comprehensive center incorporating multiple imaging and high-tech equipment and treatment modalities.

Radiation Oncology Department staff include board-certified radiation oncologists Dr. Goldberg and Dr. Alan Perlmutter, nurses, radiation therapists, patient aides and others. All are fully invested in helping patients through all aspects of their treatment, says Ann Allen, RTT, department manager.

Radiation therapy uses high-energy X-rays or particles to treat cancer, is highly concentrated and focused only on the treatment area. Treatment length can vary, but is generally two to eight weeks. Treatments can be external or internal (Brachytherapy).
Most successful cancer treatments depend on obtaining high-quality images to digitally map the cancer. State-of-the-art imaging provides the kind of extraordinarily precise data doctors need to make treatment decisions. The type of imaging used depends on the diagnosis and location of the cancer. When the cancer has been imaged and mapped, decisions are made about what type of targeted radiation to use. All patients must have a simulation session before treatment begins to determine exactly where to target radiation beams during future treatments.

“Our newest equipment enables us to scan patients without compromising image quality or positioning,” explains Allen. CT images taken during the simulation process are sent to the 3-D treatment-planning computer, which constructs three-dimensional images of the tumor to pinpoint its shape, size, and location. Multiple radiation beams are positioned to conform to the tumor, improving accuracy and sparing surrounding tissue. This equipment is so precise, it allows for the most subtle movements, such as breathing.

Many of the newest radiation treatments, despite variations, are based on one common principle — to precisely target radiation, so little or no healthy tissue is affected. The center utilizes IMRT — intensity modulated radiation treatment, IGRT — image guided radiation therapy, along with 3-D conformal treatment planning, and Brachytherapy for cervical, endometrial, breast (Mammosite®) and prostate cancer.

Dr. Goldberg emphasizes that since the facility was built from the ground up with the newest and most innovative technology, all the equipment was networked to work in perfect concert and maximize results.

Seamless communication between technologies is as important as the communication that goes on between physicians, patients, and other healthcare providers. Dr. Goldberg and Dr. Hoffman addressed things straight on, Shupenko says. “We lay out all the options, and we work as a team: to provide each patient with the care, and the cure, they want,” says Dr. Goldberg.
“There’s not enough I can say about them — my doctors and everyone at the radiation oncology center treats you with such respect and such caring,” Shupenko says. “The experience was probably as good as you can possibly have.” Coming from a cancer survivor, that’s saying a lot.

Radiation therapy options (sidebar)
Intensity Modulated Radiation Therapy (IMRT): Uses a computer-controlled machine to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. The radiation dose conforms to the shape of the tumor by modulating — or controlling — the intensity of the radiation beam to focus a higher dose to the tumor while minimizing radiation exposure to surrounding normal tissues.

Image Guided Radiation Therapy (IGRT): Images of the treatment area are taken from two directions before daily treatment. This compensates for any possible movement or variations of the tumor area at the time of treatment, further increasing the accuracy of the IMRT treatments.

Brachytherapy: also called internal radiation, involves placing a radioactive material inside the body, allowing the physician to use a higher total dose of radiation to treat a smaller area, in a shorter period of time than is possible with external radiation treatment. Brachytherapy can be permanently or temporarily implanted.

In Temporary Brachytherapy, the radioactive material is placed inside or near a tumor for a specific amount of time then withdrawn. Temporary Brachytherapy can be administered at either a low-dose rate (LDR) or high-dose rate (HDR).

Permanent Brachytherapy, also called seed implantation, involves placing and leaving them permanently. After several weeks or months, the radioactivity level of the implants diminishes to nothing. The seeds remain in the body, with no lasting effect on the patient.