• 9/27/2006
  • Milwaukee, WI
  • Rebecca S. Smaga
  • www.gmtoday.com

On a morning just like any before it, Thomas Dobrient of Cedar Creek was shaving when something out of the ordinary caught his attention. On the left side of his neck, there was a lump.

“My wife and my mom decided I should get it checked out right away,” said Dobrient, 47.

It was September 2002. At Community Memorial Hospital in Menomonee Falls, WI, Dobrient’s general practitioner gave him antibiotics, saying it might be an abscessed tooth, but a week later the lump was no smaller. When they could not perform a biopsy, Dobrient was referred to Froed-tert Memorial Lutheran Hospital.

It was there, in a cramped office filled with two doctors, a few students, his wife and his mother that Dobrient first heard talk of “cancer.”

“It was really weird because we were in a really small room. It was pretty scary,” he said.

A biopsy confirmed a diagnosis of supraglottic larynx carcinoma and multiple metastatic nodes in the left neck. Dobrient had a tumor at the base of his tongue.

His wife, Sandy, remembers being overwhelmed by information. She said the doctors began painting a grim picture. Thomas might lose his tongue. He might never be able to eat or drink normally again. Then, they offered an alternative to immediate surgery.

“I was convinced there had to be a better way than cutting out my tongue,” said Dobrient.

Dian Wang, M.D., Ph.D., and assistant professor of radiation oncology at the Medical College, was Dobrient’s radiation oncologist. He offered Dobrient the option of undergoing six weeks of radiation along with chemotherapy to see if the tumor could be reduced before performing surgery.

“At that point, what choice do you have?” Sandy said of the decision.

As part of an ongoing study, Wang was using combined images from positron emission tomography (PET) and computed tomography (CT) in the planning and delivery of intensity-modulated radiation therapy (IMRT) for patients with head and neck cancer.

By combining the images from the PET and CT scans, doctors get a clearer idea of the dimensions of the tumor, allowing for more accurate delivery of radiation dosage.

“I always tell the patients, traditionally we’re just using CT scan as the basis for radiation planning,” said Wang. “Whatever I can see on the CT scan, I contour in tumor and lymph nodes for radiation planning. That’s not going to be accurate. PET scan is more sensitive, more specific than CT scan alone to define the tumor target.”

The technique requires cooperation from both the radiology and radiation oncology departments, since staff from both must be present, but Wang said the outcome for patients is worth the extra effort.

Always a smoker, Dobrient smoked his last cigarette on the car ride down to his first radiation treatment. His treatment plan included radiation every day and chemotherapy three times a week for six weeks.

It was a long six weeks.

“I lost 100 pounds. I lost my beard and my hair thinned out,” he said. “I didn’t want to eat. Everything tasted horrible.”

“He had no taste buds for a long time,” said Sandy.

Dobrient suffered constant dry mouth and developed a rash from the radiation, but after six weeks, the second scan showed the pay-off.

The cancerous cells had been shrunk to pinpoint size. No surgery would be needed. Instead, Wang prescribed another two-week regiment of radiation and chemotherapy.

By the end of the eight weeks, it was almost Christmas 2002, and Dobrient was thin and weak, but hoping it was all behind him. A third scan in April gave him and Sandy the news they were hoping for – a total resolution of abnormal cells at the base of the tongue.

Almost four years later, Dobrient is healthy, though not officially cancer-free.

“Two years is the big number. If you stay free for two years, there’s a 50 to 75 percent chance you’re in the clear,” Dobrient said. “After five years, they figure you’re done.”

“But the doctors won’t consider him cancer-free for seven years,” said Sandy.

Dobrient still has to visit the doctor once a year and there are still a few lingering effects from the chemo and radiation (he still gets dry mouth), but he knows how lucky he is.

“It’s all minor,” he said. “Obviously, they did the right thing. Men always think they’re indestructible, but you got to get yourself checked out.”

“You can’t take life for granted,” said Sandy. “You always say it’s not going to happen to me.”

Both Thomas and Sandy credit the Froedtert medical team, their families, friends and employers for being extremely supportive throughout that period. Thomas’ father started a prayer chain and his mother came along to every visit with notebook in hand.

“You’ve got to have support,” he said. “If you don’t have someone, they have so many resources at Froedtert, from financial to religious to dietary to legal, all you have to do is ask.”

As for the future of the Fused PET and CT Images used in IMRT at Froedtert, Wang recently published his findings in the International Journal of Radiation, Oncology, Biology, Physics.

Dobrient was one of 28 patients in the study, which found that overall using this technique resulted in better delivery of the radiation and lower recurrence rates.

“The results of the study are very encouraging,” Wang said. “Our radiation oncologists utilize this technique to improve patient care and tumor control.”

While it is not yet the accepted standard for radiation planning, Wang said most hospitals have the technology; they just have to make the effort for the benefit of the patients.