IMRT for Head and Neck Cancers

Head and Neck cancers are challenging to treat. Within a relatively small space lie several essential structures - the salivary glands, the parotid glands and the spinal cord. Intensity Modulated Radiation Therapy (IMRT) has proved to be a particularly useful tool. It delivers radiation so precisely, that even with important normal structures adjacent to the tumor, radiation to those tissues can be minimized therefore reducing toxicity.

Though the treatment for head and neck cancers is frequently curative, the long-term side effects can diminish quality of life. Dry mouth due to salivary gland damage is particularly distressing.

To prevent long-term dry mouth, the radiation and medical oncologists work as a team to deliver Amifostine, a chemoprotective drug within 30 minutes of treatment. It requires coordination of appointments and many phone calls between departments, but the team knows the results are worth it. Randomized trials have demonstrated that both acute toxicities (mucositis) and late toxicities are greatly reduced.

Tumor Ablation

An area of treatment in which research is constantly developing and refining new techniques involves Interventional Radiology. Some organ tumors are simply too difficult to surgically resect and may not be responsive to chemotherapy. In interventional radiology, eligible patients have a further option of having their tumor ablated using a method akin to a microwave. A probe is inserted into the tumor and heated until the tumor vaporizes. The Martha Jefferson Interventional Radiologists have been performing the procedure on liver tumors for a couple of years, but even in that short time, the method has improved, reducing the time for the patient to be on the table from near an hour to about ten minutes. They can also assist the surgeon prior to the removal of kidney tumors by performing pre-operative embolizations so that there is less blood loss during surgery. The ablation procedure has been used on small kidney tumors in lieu of a nephrectomy and most recently, on small lung tumors.

Exciting new technologies will continue to be embraced as they become available in the years to come, but in the longstanding tradition of Martha Jefferson, the focus will remain on the patient, on delivering personalized care that best meets the needs of each individual.

MOHS Surgery

The diagnosis of melanomas at Martha Jefferson increased by 60% in 2006 over the previous two years. Though the rate is not reflected in state or national statistics, it is clear that melanoma is on the rise nationwide, as are other skin cancers.

MOHS surgery, a technique used primarily for non-melanoma skin cancers, both removes skin cancers and preserves the healthy tissue around it. The procedure starts with the removal of the obvious tumor. Then the surgeon removes another thin slice of tissue from the same area. It is sectioned to create a map and examined under a microscope while the patient waits. If that tissue shows evidence of further disease, the procedure is repeated until the removed tissue is clean of any cancer cells.

Two dermatologists specializing in MOHS surgery are affiliated with Martha Jefferson and the laboratory boasts a dermatopathologist, a pathologist who specializes in diagnosis of diseases of the skin. Together with the other dermatologists, radiation and medical oncologists, they create a highly qualified team to care for people with both early stage and more advanced skin cancer.

Respiratory Gating

"Breathe in, breathe out" Cancerous tumors located in the chest and abdomen area of the body present a special challenge for radiation treatment. As a patient breathes, the tumor moves. Respiratory gating allows the radiation oncologist to better target some of these tumors, reducing the amount of radiation that goes to the surrounding normal tissue. It is most commonly utilized for treatment of lung, pancreas and liver tumors, though left-sided breast cancer patients may also be candidates. It has benefited patients at Martha Jefferson Cancer Center since early 2007.