Cancer Treatment Options

BRACHYTHERAPY – OUR PREFERRED CHOICE FOR PROSTATE CANCER

We strive to use the shortest procedures, such as the one-time 45 minute, minimally invasive treatment under general anesthesia where patients return to normal activities next day. Our Brachytherapy treatments have a better cure rate than IMRT for aggressive cancers.

Treatments involve placement of radioactive seeds, approximately the size of a small grain of rice into the prostate. Approximately 60 – 120 seeds are implanted through small needles into the prostate gland during this 45-minute outpatient procedure where you will be given general anesthesia to make you completely pain free during the procedure. The needles are placed through the perineal skin between the scrotum and rectum and not though the rectum, so the procedure is less irritating to the prostate than the biopsy. There are no stitches and no scar.

BRACYTHERAPY OUR PREFERRED CHOICE FOR LUNG CANCER AND ADENOID CYSTIC CARCINOMA (ACC)

We use CAT Scan Guided Seed Brachytherapy for Lung treatment which is minimally invasive outpatient method of treating all types of cancers in the lung, liver and pelvis. Treatment is performed as a 30-minute outpatient procedure and patients go home the same day and return to all activities the following day. Implanted cancers typically disappear and usually do not recur.

ACC is a difficult disease to treat after it has spread from the primary site to the lungs. Multiple thoracotomies to remove these metastases carry the risk of any surgical incursion into the chest as well as the risk of diminishing pulmonary gas exchange capability. This can result in poor exercise tolerance and even cause the patient to be house or bed bound due to severe lung insufficiency. Radiofrequency ablation is a fairly effective therapy but has a significant risk of pneumothorax due to the large size catheter and long treatment times. Additionally, RF cannot be used close to the heart for fear of damage to the muscle or conduction pathways responsible for keeping the heart beating. Current systemic therapies with multikinase inhibitor molecules have shown some promise, but for short times only and with often unacceptable side effects.

Implanting tiny radioactive sources through thin (18g or 20g) needles into the primary lung cancers or lung metastasis was started by our group in 1991 in Orange County California. We have now implanted several hundred patients, several dozen with ACC. In addition, we have also implanted metastasis of all types in the kidney, adrenal, liver and neck lymph nodes. We have had no operative deaths and only a handful of minor pneumothoraxes that required chest tube.

Accurately implanted lesions that receive sufficient radiations will resolve and not return at least 90% of the time. Smaller lesions are easier to sterilize completely, and larger lesions may require a second implant to touch up areas that were under dosed at the first seeding.

It is therefore always in the patient’s best interest to seek consultation for seeding when the chest tumors are as small as possible. Smoking cessation and regular aerobic exercise conditions the lungs for maximal gas exchange before and after the implants.

Typically, two or three of the largest lesions in each lung are implanted, one lung on one day and the other lung the following day. The patient can safely fly home even after both lungs have been implanted. The implanted patients pose no risk to family members, pregnant women, children or pets.

Modern CT scanners combined with fluoroscopy allow the targeted area to be images in real time as the needle is inserted toward the target. The physician can follow the needle tip in 3d to closely and safely approach tumors adjacent to nerves, blood vessels, the heart and bronchi.

Intent of seed implant therapy is to substantially reduce the tumor burden in the chest over several seeding sessions. By reducing the tumor burden, the chance of metastasis to other sites is sharply reduced thus likely prolonging survival. By treating metastatic ACC as a chronic disease with multiple implants separated by months or years, survival is likely prolonged, giving time for new investigational molecules to be brought to clinical use.

Dr Doggett was the second user in the USA to use a computer in the operating room to plan where to position the seeds, a technique known as intraoperative treatment planning. The seeds are arranged in a way to give off a uniform dose of radiation delivered exactly where it is needed and minimize radiation to normal tissues. The seeds remain in place after the procedure and lose their radioactivity over a period of time.