• 2/26/2007
  • Staten Island, NY
  • Diane O’Donnell
  • Staten Island Advance (www.silive.com)

TomoTherapy combines daily CT scans to check for any changes in size or location of a tumor with the ability to target it with high doses of radiation while decreasing damage to the surrounding healthy tissues and organs

Paul Lewek takes off his Mets baseball cap and settles his lanky 6-foot-5 frame onto a movable table connected to a large donut-shaped machine.

For the 57-year-old retired cop, this is day 11 of his 6 1/2 week Monday to Friday regimen of TomoTherapy, a relatively new approach to treating cancerous tumors. After having his right tonsil and a golf ball-size mass removed from his neck in December to battle advanced tonsillar cancer, Lewek shruggingly accepts the routine.

Lewek is the first head-and-neck cancer patient to be treated with the more than $3 million, state-of-the-art machine at TomoTherapy of Staten Island, housed in West Brighton-based Regional Radiology.

The TomoTherapy Hi-Art System machine, which debuted on the Island last month, is one of only two in the New York City area and 71 nationwide. According to Patty Kitowski, marketing communications manager of Madison, Wis.-based TomoTherapy Incorporated, which created the machine, there are 102 units worldwide.

TomoTherapy combines daily CT scans to check for any changes in size or location of a tumor with the ability to accurately target it with high doses of radiation while sparing healthy surrounding tissue to a greater degree than was previously possible. The process is achieved through Image Guided Radiation Therapy (IGRT).

“We’re able to acquire images on a daily basis and guide the patient’s radiation based on the images, which is the most accurate way to give radiation,” says Dr. Hoon Lee, a radiation oncologist at TomoTherapy of Staten Island. With conventional radiation, treatment design and delivery is based solely on one CT scan.

PREPARING FOR THE SCAN

After lying on the table, Lewek’s head and neck are placed on top of a custom-fitted plastic mold. A white plastic mesh mask is placed over his face and fastened to the mold to keep his head from moving.

Next, the Dongan Hills resident anchors his index fingers into harnesses attached to a foot platform to steady his shoulders.

The table glides Lewek inside the machine’s spherical opening, where a CT scan of the tumor is taken.

Moments later, the latest image is superimposed onto the original one used to plan the treatment weeks earlier.

“Everyday you can fine-tune the target of radiation based on that day’s anatomy,” says Dr. Lee as he compares the two scans on a computer outside the treatment room.

Today’s yellow scan is off by 3 millimeters compared to the initial white one. The difference has been as great as 5 millimeters, but usually averages between 2 to 3 millimeters a day.

The minuscule discrepancies may seem irrelevant, says Dr. Lee, but critical structures, such as the eyes, optic nerves, brainstem, spinal cord and salivary glands are all in close proximity to the tumor.

TREATMENT TIME

After radiation therapists Rob Colavito and Dennis Damico reposition Lewek on the table, the patient is ready. Both therapists leave the room, which is enclosed by 6-foot-thick reinforced concrete walls to protect other patients and staff from radiation.

During the treatment, the radiation therapists watch Lewek through two closed-circuit television monitors.

Inside the machine’s donut-shaped portal, a rotating ring delivers pencil-thin beams of high dose radiation to Lewek in a 360 degree angle. Using a more advanced form of Intensity Modulated Radiation Therapy (IMRT), the beams are adjusted in size, shape and intensity to conform to Lewek’s tumor.

TomoTherapy’s ability to zap tumors differs from conventional radiation, which typically attacks tumors from one to four directions, explains Dr. Lee, or the four to seven fields usually afforded by standard IMRT.

“You pretty much have 360 fields focusing in on that one area,” says Dr. Lee. “So you’re able to get a very tight radiation just to the area you want to give it and a very low dose elsewhere.”

LESS SIDE EFFECTS

TomoTherapy also cuts down on Lewek’s treatment time — seven minutes compared to 45 for IMRT — and side effects, says Dr. Lee.

Since the radiation can be narrowly focused to Lewek’s tumor, there is less damage to areas around it, such as the parotid (salivary) glands, and less of a chance of xerostomia (dry mouth) — a common side effect for head-and-neck cancer radiation patients.

For Lewek, the only drawback to TomoTherapy, which is supplemented by chemo at Richmond University Medical Center, is the daily commitment.

“It’s a little bit of pain in the butt to come five days a week,” says Lewek, “but outside of that no problem, no pain, no puss, no muss.”

According to Dr. Lee, TomoTherapy is ideal for deep-seeded cancers, such as prostate, lung, central nervous system — which includes the brain and the spine, gastrointestinal tumors and head and neck tumors.

Currently, the West Brighton facility is treating 20 TomoTherapy patients a day, and expects to increase to 30 by next month, says Dr. Lee. The machine can be used on both children and adults.

Another benefit of the new radiation treatment is the possibility of retreating an area should cancerous cells return.

Many radiation oncologists are reluctant to give repeat radiation to the same part of the body that has already received radiation for fear of complications, such as excessive scarring or permanent nerve damage.

“With TomoTherapy we are finding that for certain patients we may be able to give a second course of radiation,” says Dr. Lee.

“We are able to do this because vital organs, such as the spinal cord, can be completely avoided using TomoTherapy.”