• 10/23/2005
  • Milwaukee, WI
  • Kawanza Newson
  • Milwaukee Sentinel Jouranl (www.braneton.com)

Byron Liebner is a sun lover, and he has several tiny scars to prove it. But it’s the spot on his left forehead that he likes to talk about most.

The skin there is dry and red, like a bad sunburn, and is a visual reminder of the high doses of radiation he receives each weekday to prevent his cancer from spreading into his eye.

For the past five weeks, Liebner has had a mesh mask placed over his face to hold his head perfectly still and had his feet tied together to prevent wiggling so high-intensity radiation can be blasted into the nerve above his eye for 438 seconds. He’s scheduled for seven weeks of radiation.

“They have to be careful because it’s a delicate situation,” said Liebner, 84.

“They told me I could lose clusters of hair in the back because the radiation goes right through the head,” he said. “But I wouldn’t care if I lost it because I don’t have that much hair anyway.”

Surgery was not a feasible option for Liebner because his eyeball would have been removed, and he may have still needed radiation therapy later.

Throughout the United States, cancer patients are benefiting from technological advancements that increase the precision of radiation treatment to the tumor while decreasing damage to the normal tissue or organs surrounding it.

More precise treatment means patients can get higher doses of radiation over a shorter time span, and in some cases, it allows patients to have additional treatment if a tumor recurs.

However, though there are many radiological options available, it’s important that patients remember each option may not necessarily be the best treatment for them, said J. Frank Wilson, chair of radiation oncology at Milwaukee’s Froedtert and Medical College Cancer Center.

“Serious difficulties arise when the patient is aware of many options and has pre-selected what they think they need,” he said. “Patients should take all the time they need to make sure they’ve gotten the opinions they need and the information they need to make an informed decision.”

Liebner is treated with a targeted radiation treatment known as tomotherapy.

The tomotherapy machine was developed by Madison-based TomoTherapy Inc. and includes a computed tomography, or CT, scanner that allows doctors to determine a tumor’s precise location and monitor any changes it may undergo during the treatment.

Also, the machine houses a multi-leaf collimator, or a set of bars that quickly moves in and out to adjust radiation delivery while the patient lies on a couch that slowly moves toward the center of the machine. Thus, each radiation beam is hitting a slightly different point with varying intensity.

As a result, tomotherapy treatment takes slightly longer than standard radiation treatment, with set up about 30 minutes compared with 15, but experts say that the extra time ensures that the tumor receives the optimum dose of radiation each day.

“It’s truly revolutionary technology for delivering radiation therapy,” said Minesh Mehta, chairman of the department of human oncology at the University of Wisconsin Medical School.

“Clearly, there are many patients for whom this is a clear advantage and others a modest advantage,” he said. “But still, there are some where other technologies are just as good, so we use this on a very individualized basis.”

The University of Wisconsin Comprehensive Cancer Center and the Department of Human Oncology installed the world’s first clinical tomotherapy research system in February 2001. It was used to treat tumors in dogs seen through the University of Wisconsin Veterinary School. The first human patient received treatment using the system in May 2004.

“Traditional radiation works well for many tumors we treat, but when these tumors are located near critical structures or if they need re-irradiation or if it’s in a site that’s usually difficult to treat such as the head and neck, then tomotherapy works best,” said Beth Erickson, a professor of radiation oncology at the Medical College of Wisconsin and Liebner’s radiation oncologist.

For example, tomotherapy in the cervix spares the small bile duct and kidney from intense radiation, and using it for the pancreas limits the amount of radiation to the liver, stomach and small intestine, she said.

Liebner says that he’s doing fine, though each treatment causes his eye opening to become smaller. However, he’s not worried about losing his vision and says that he’ll continue to spend time with his wife, six children and 20 grandchildren.

“I’m a firm believer in the Lord Jesus and I go to him for guidance,” he said.

“He’s always been there for me and as long as I have him on my side, I have faith that he will see me through,” Liebner said.

According to the American Cancer Society, radiation therapy is one of the most common treatments for cancer and is used in more than half of all cancer cases. It can be used alone or in combination with surgery, chemotherapy or immunotherapy, also known as biologic therapy. Immunotherapy is an emerging form of cancer treatment that uses things such as vaccines or antibodies to stimulate a patient’s immune system to fight against the cancer.

It’s commonly believed that a patient can have one round of radiation therapy per lifetime, though there’s increasing evidence that repeat radiation with chemotherapy may be beneficial in patients with head and neck cancer, said Stuart Wong, a head and neck oncologist at Froedtert who is the lead investigator of a multi-center clinical trial testing this theory.

Radiation therapy can be delivered either externally, such as through tomotherapy, but also internally using radioactive implants that are placed inside the tumor.

For prostate cancer patients, internal radiation can be achieved through permanent placement of radioactive seeds. The seeds, which are about the size of a grain of rice, give off radiation that kills the cancer cells over several weeks.

There are two seeds commonly used – Iodine-125 or Palladium-103 – though some doctors are beginning to use Cesium-131 seeds, said Rakesh Jagetia, a radiation oncologist with Radiation Oncology Associations at St. Luke’s Medical Center in Milwaukee.

Each seed emits a different radiation dose; cesium delivers a higher dose of radiation over a shorter time period, he said.

For example, cesium will deliver about 90 percent of its total radiation dose in less than 33 days, Jagetia said. By comparison, iodine can take between nine and 12 months.

Over the past decade, several advancements have emerged that allow precise treatment of tumors.

Gamma Knife is used to treat inoperable tumors deep within patients’ brains. The knife involves no surgical incision, but rather 201 intersecting beams of low-level gamma radiation. The beams enter the patient’s head and intersect at one centralized point to destroy tumor cells. But, because the gamma rays are low level and come from different directions, surrounding tissue does not undergo the degree of damage seen with many other radiation treatments.

And more physicians are looking into “gating systems” that allow monitoring of tumor movement so that radiation is delivered only when it can be hit directly. The technique is highly effective for lung cancer, where breathing consistently moves the tumor in and out of the treatment field. However, the technique in this instance depends heavily on the patient being able to control their breathing, said Elizabeth Gore, an associate professor of radiation oncology at the Medical College of Wisconsin.

Experts say that though technology has greatly improved cancer care, it’s important not to lose sight of how those treatments affect the patient’s quality of life or chance of survival.

With that in mind, the next step is to learn more about the biology of tumors so physicians will know which tumors will respond best to radiation.

“Our ultimate goal is to use biology to improve outcomes,” Mehta said.