A Cancer diagnosis mobilizes patients and their families to find the best treatment possible. Everyone wants the combination of state-of-the-art technology, a team of experienced and knowledgeable physicians and the comfort of care that allows them to stay right at home without the need to travel to a distant facility. MIMA Cancer Center offers patients just this combination of care right in Brevard County.
“The MIMA Cancer Center is a comprehensive “one stop shop” from diagnosis to treatment,” says Dr. Nanialei Golden. “From the minute a cancer diagnosis is made, our case managers become involved with coordination of care between all Oncologic specialists. We have a weekly Tumor Board that reviews a patient’s medical history. It’s a collaborative effort between the Medical Oncologists, Radiation Oncologists, and Surgeons, and the patient’s primary care doctors. The Pathologists are present to review biopsy slides and our Radiologists provide critical information to aid in a consensus treatment plan for patients.”
The MIMA Cancer Center has the most versatile technology available. The Varian Trilogy linear accelerator has the capability to treat with advanced technologies such as: IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy), SRS (Stereotactic Radiosurgery), and SBRT (Stereotactic Body Radiotherapy). The high precision targeting allows for sub-millimeter accuracy and the efficiency of the device allows for most treatments to be completed in less than 30 minutes. The technology can monitor, track, and adjust for tumor motion. For example, lung and abdominal tumors move with the respiratory cycle. In effect, you are irradiating a moving target. The Respiratory Gating System can account for this and spare health tissue from being irradiated during the breathing cycle.
New advancements are taking place at MIMA Cancer Center all the time – most recently Body Radiosurgery.
Todd Scarbrough, MD, director of the MIMA Cancer Center, recently discovered a small metastatic lesion in the liver of a 64-year-old male patient who had been treated a year earlier for lung cancer. “We had three choices,” Dr. Scarbrough said. “We could do nothing. We could treat him with chemotherapy. Or we could use our new image-guided technology to deliver a very high dose of radiation directly to the tumor in what’s known as a ‘radiosurgical’ treatment. This requires us to target the lesion very precisely and compensate for any tumor motion.”
In the past, radiosurgical procedures have been used primarily to treat tumors in the brain, because the head can be effectively immobilized, which renders brain tumors motionless and facilitates accurate targeting.
"Body radiosurgery is a new procedure, made possible by technologies like the On-Board Imager,” said Dr. Scarbrough. Found on the TRILOGY radiation therapy unit – the world’s most advanced system – it helps ensure that the treatment beams accurately hit the tumor.
To position the patient for treatment, Dr. Scarbrough and his clinical team utilized two of the imaging modalities available with the On-Board Imager: radiographic kV X-ray imaging, and three-dimensional cone-beam CT imaging.
"Prior to each treatment, we used the On-Board Imager to take X-ray images of the liver and used them to calculate how to shift the patient to make sure the tumor was lined up precisely with the treatment beam," Dr. Scarbrough said. "We were amazed at how well the liver showed up on the radiographic X-ray images. We could see enough detail to make the necessary positioning corrections. We then generated a three-dimensional cone-beam CT image as a check, to verify that our calculations were correct in all three dimensions."
To address the problem of tumor motion due to respiration, MIMA clinicians used a CT scanner outfitted with Varian's RPM™ respiratory gating technology to generate the images used in treatment planning. "This enabled us to choose the optimal point in the patient's respiratory cycle for delivering each treatment," said Joseph Ting, PhD, chief medical physicist at the MIMA Cancer Center.
The novel radiosurgical procedure involved three treatments delivered every other day over a five-day period. "Our goal was to see if we could eradicate the liver lesion using a method that has essentially zero toxicity, sparing him the more toxic effects of chemotherapy," Dr. Scarbrough said.
At four weeks post-treatment, the patient was doing very well and had suffered no side effects. A CT scan showed that the liver lesion had regressed dramatically.
Virtually all cancer patients treated with conformal radiation therapy at MIMA now receive image-guided treatments. "We use every tool at our disposal to set up the patient more accurately for treatment," said Ting. "With image guided radiation, we are very confident we're targeting the right place."
Scarbrough and his MIMA colleagues recently completed a study of the toxicity outcomes of 240 patients who were treated for prostate cancer using TRILOGY image-guided radiation. Implanted seed markers had been used on a daily basis during treatment to correct for the setup/targeting errors inherent in external beam radiotherapy of the prostate.
“At a median follow-up of 1.4 years, 98-percent of our patients showed grade-0 rectal toxicity, and none showed grade-3 or greater toxicities of any sort,” said Scarbrough. If these outcomes hold over time, he said, then their seed marker-based image-guided radiation with TRILOGY will have yielded “some of the lowest toxicity rates of any of the definitive local treatments for prostate cancer; better than surgery, better than seeds, better than protons.”
The American Society for Therapeutic Radiology and Oncology (ASTRO) has invited Scarbrough to present his prostate cancer outcomes. The research will be premiered at ASTRO’s international meeting in Los Angeles in October of this year.
“What we’re doing right here in Melbourne is recognized around the world,” says Dr. Golden. “Physicians from around the country and as far away as China have come to MIMA to train on our technology and see our treatments. We have the diverse technology required to treat any cancer amenable to radiation therapy.”
MIMA has a close relationship with the American Cancer Society and in partnership with them, offer support services to assist the families and care givers, not just the patients. Some programs include ‘Look Good, Feel Better’ and ‘Road to Recovery’. Case Managers also lead support groups that helps strengthening patients resolve during their difficult journey through cancer treatment.
Additionally, The MIMA Foundation has created a new initiative in 2007 – The Patient Assistance Grant Program. Oncology and Neurology patients in Brevard County can apply for a grant to offset the cost of such things as day care, car fuel, and other non-medical expenses related to treatment.