Beads of hope for liver cancer

Microscopic spheres of radiation prolong remission, raise survival rates

Health

December 31, 2004|By Erika Hobbs | Erika Hobbs,SPECIAL TO THE SUN

This Christmas season was sweeter for Tanika Thompson and Lynn Neubauer, two Maryland women who thought they wouldn't live long enough to celebrate it.

Both received a diagnosis of liver cancer - Thompson in late 2003 and Neubauer last January - a lethal disease that had spread from other organs in their bodies. Both marked their lives in days and months, not years.

But a new procedure at the University of Maryland Medical Center that sends microscopic beads of radiation directly to tumors gave them both new leases on life. For Thompson, it meant shrinking her apple-sized tumor by half. For Neubauer, the treatment allowed her to have surgery that doctors initially ruled out.

"I haven't felt this good all year," said Neubauer, 58, of Stevensville. "I'm ready for my new life in 2005."

The procedure, called selective internal radiation therapy, or SIR-Spheres, is not a cure. But studies in Australia, where the procedure was developed, showed that it significantly increased the time liver cancerpatients spent in remission, as well as increased their survival rates. In some cases, the procedure shrank tumors more than chemotherapy did.

According to the National Cancer Institute, five-year survival rates in Americans with primary liver cancer - those whose cancer started in the liver - is less than 10 percent. Those with metastatic liver cancer - when cancer spreads from other organs - live slightly longer.

The American Cancer Society says there were about 19,000 cases of primary liver cancer diagnosed this year in the United States.

Symptoms of liver cancer often are vague, and include pain, fever and nausea. Thompson, a 30-year-old Baltimore mother of two boys, had severe abdominal pain for about four months before her diagnosis. Neubauer's cancer was caught with a routine blood test.

Once stricken, however, liver cancer patients grow very ill. Treatment includes surgery, chemotherapy and radiation. Often, the treatments are difficult for patients to tolerate, and sometimes, patients aren't candidates for treatment options. If a liver tumor is large and involves too much of the liver, for example, surgery is not an option because the patient must have enough normal organ tissue after surgery to survive without a transplant.

Often, by the time patients receive internal radiation, the technique is the only option left, said Dr. David Van Echo, a University of Maryland professor of radiation oncology.

Earlier this year, it seemed Neubauer was out of options. Chemotherapy wiped out her colon cancer, she said, but it didn't touch her liver tumors. Because she had two tumors on the left lobe of her liver and one large one on the right lobe, she could not have surgery.

She underwent the SIR-Spheres procedure in October, and within weeks, two tumors were rendered inactive. The third tumor shriveled considerably.

The spheres themselves are ceramic beads, about one-third the width of human hair, that are filled with a type of radiation, Yttrium-90.

About 20 million to 30 million of the microscopic spheres are injected and travel through the bloodstream to target liver tumors. They work two ways: by lodging into the tiny vessels that feed tumors, to cut off their blood supply, and by killing the tumor with strong doses of radiation.

The University of Maryland has used SIR-Spheres since last year, and has treated 30 patients. Although the procedure is available nationally and internationally, the university's Greenebaum Cancer Center is the only facility in the state to offer the procedure.

Nationally, about 1,000 procedures have been done since the Food and Drug Administration approved the procedure in 2002, said Charles Rowland, president of Sirtex Medical Inc., the American subsidiary of the Australian company that makes the spheres.

Unlike conventional external beam radiation, no healthy tissue is exposed in the internal radiation procedure, so doctors can use a stronger dose of radiation to kill the tumor. And, unlike chemotherapy, the spheres are well tolerated. Patients experience flulike symptoms but are back to normal activities within a week, said Michael Garofalo, a University of Maryland radiation oncologist.

Neubauer felt so good after her treatment that she went back to work and even took a short vacation with her husband. Last week, surgery to remove the remaining cancer was halted because doctors found new lesions on her liver.

But Neubauer is undaunted. "I know I'll get well," she said, "it's just that the journey is longer than I expected." Neubauer, co-owner of a family-run title company, is so optimistic about the SIR-Spheres procedure that she donated some of her tissue to further study the technique.

"This was a gift," she said, "and I have the opportunity to give the gift" of hope to others.

That's the goal - to improve lives, said Rowland. "We can't say it is curative, but ... there are cases in which we've seen patients live much longer than expected."

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