• 1/29/2006
  • Springield, IL
  • Dean Olsen
  • State Journal Register Online (www.sj-r.com)

Lying on his back on a hard table, Michael Robinson holds himself perfectly still, closes his eyes, quietly sings gospel songs to himself and seeks guidance from above.

During the next 10 to 15 minutes, a machine that looks like an oversized hair dryer from a beauty shop swivels around his head, buzzing and shooting high-energy X-rays into his mouth.

“I pray, ‘Lord, give me the strength to endure this, and please heal this,'” said Robinson, 56, of Jacksonville.

Robinson, an account technician for the Illinois Department of Human Services, began daily radiation treatment for cancer Jan. 9 at St. John’s Hospital. A routine checkup last year turned up what doctors later determined was a tumor on his right tonsil.

Robinson said he feels better knowing that the painless radiation therapy represents what St. John’s officials call a “giant leap” forward in treatment. For the past several months, St. John’s has treated about two dozen cancer patients with radiation beams that are mapped and focused by special equipment and computer hardware and software.

The hospital began offering intensity-modulated radiation therapy as part of radiation technology upgrades that cost St. John’s about $2.5 million, said Dr. Bruce Shevlin, a Springfield radiation oncologist.

Shevlin is working with Dr. James Wynstra, a fellow radiation oncologist, to lead the IMRT treatment team at St. John’s.

Memorial Medical Center is in the midst of a $4 million to $5 million technology upgrade that will allow it to offer IMRT by the end of the summer, according to Linda Jones, Memorial’s administrator of oncology, pulmonology and clinical research services. Dr. Saleem Mahmood, also a radiation oncologist, said he offers IMRT at his offices in Jacksonville and Litchfield.

IMRT allows doctors to be more precise in tailoring radiation treatment. They can zap certain types of cancer tumors from more angles with thousands of pencil-thin radiation beams rather than a single large beam passing through the body.

As a result, there’s less damage to surrounding tissue, Shevlin said.

The greater precision also can allow doctors to give higher radiation doses for patients with specific types of cancer, such as prostate cancer. That could increase cure rates, he said, although studies haven’t yet proven whether IMRT helps patients live longer.

At St. John’s, IMRT costs about twice as much as conventional radiation treatment, hospital spokesman Brian Reardon said.

Medicare pays hospitals and doctors between $1,790 and $1,860 for a week of IMRT treatments per patient, according to figures and estimates provided by St. John’s and Shevlin. That compares to $930 to $970 a week for conventional radiation treatment.

Dr. Stan Borg, chief medical officer for Chicago-based Blue Cross and Blue Shield of Illinois, said Blue Cross pays five to 10 times more for IMRT than conventional radiation treatment, although Reardon said the price difference isn’t as great in Springfield.

Borg said he isn’t convinced IMRT is better than conventional treatment cancer. But he said it is “at least as effective.”

Medical studies so far indicate that IMRT is most appropriate for head and neck cancers and cancers of the prostate gland, as well as cancers that require radiation treatment for curved surfaces such as the breast.

IMRT could become popular in treating other cancers if studies document success, so hospitals are keeping close tabs. One out of three Americans will be diagnosed with cancer at some point in their lives, and more than half of cancer patients will receive some form of radiation treatment.

Shevlin estimated that about 100 cancer patients will receive IMRT annually at St. John’s. He and Wynstra are part of University Radiologists, a four-member group practice that serves about 1,000 cancer patients receiving radiation treatment each year in Springfield. The group’s two other members, Drs. Parashar Nanavati and Thomas Shanahan, work at Memorial and expect to use IMRT with 100 to 150 patients annually, Jones said. The four doctors are the city’s only radiation oncologists.

Doctors need to be careful in using radiation to treat cancer in the head and neck, Shevlin said, because sensitive structures such as the spinal cord, brain, and jaw muscles can be permanently damaged by radiation. In the case of prostate cancer, he said radiation damage can cause the bladder and rectum to become more sensitive and bleed.

IMRT often can help preserve some salivary glands and prevent patients from acquiring permanent cases of dry mouth.

“It’s a major quality-of-life issue for them,” Shevlin said.

Robinson said the radiation treatment of his right tonsil and the base of his tongue probably will destroy salivary glands on his right side, but he hopes IMRT can salvage the salivary glands on his left side.

“You don’t really realize how much you need saliva,” Robinson said.

He doesn’t dwell on the fact that it’s unusual for someone like him – who hasn’t abused alcohol and hasn’t smoked in more than 20 years – to come down with a form of throat cancer.

Robinson said he has experienced some swelling at the back of his tongue from the radiation – an expected and temporary side effect. The IMRT treatments also cause fatigue but give him hope for beating the tumor.

“They think there’s an 85 to 90 percent chance of getting rid of it without surgery,” he said. “They say this is the latest technology around.”