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Regional Oncology Update - Fall 2002

Over 600 People Attend ‘Strike Out Prostate Cancer’ Educational Program
On Sunday, August 11th, over 600 people attended ‘Strike Out Prostate Cancer’ at the Victory with Hall of Fame pitcher, Bob Gibson. After an educational presentation by urologists Phillip Gilson, MD, Bruce Romick, MD, and Paul Siami, MD and oncologists, Al Korba, MD, FACRO and Aly Razek, MD.

Bob Gibson addressed the audience and talked about highlights from his baseball career. Mr. Gibson told no one he had prostate cancer for a year. Despite the difficulty talking about himself, he encouraged men to play it smart and get a check-up. Mr. Gibson then signed autographs for every person who attended the ‘Strike Out’ program while a team of volunteers served baseball’s favorite foods; hot dogs, soft drinks, and popcorn, courtesy of Buehler’s Buy-Low, Colonial Bakery and Double Cola.

The ‘Strike Out Prostate Cancer with Bob Gibson’ was a collaborative effort of Evansville Cancer Center, the American Cancer Society, and the Tri-State area urologists. Our goals were to raise prostate cancer awareness, teach men the importance of taking charge of their health, and promote early detection of cancer and treatment.

Prostate Brachytherapy
Brachytherapy is the process of utilizing ionizing radiation produced from radioactive elements to deliver cytotoxic doses from sources placed near or within a target volume of tumor. It differs from beam or teletherapy in both the delivery system and intent to treat small volumes.

Understanding that the prostate presents both a relatively small volume and is positioned such that it is accessible and easily imaged, many radiation oncologists have taken advantage of the unique capabilities of brachytherapy to treat primarily or adjunctively relatively early tumors in this organ.

The process is a combined effort on the part of urologists skilled in the technique and the radiation oncology team skilled in the concepts, physics and technical considerations of brachytherapy.

Prostate brachytherapy may be utilized as monotherapy or adjunctively with external (teletherapy) beams. The decisions relevant to choice of approach are largely patient driven but should consider multiple inputs. Of significant importance is judging the extent of the tumor as it relates to the anatomy and physiology of the prostate and those target organs near and within the gland. It is of import that the bladder, rectum, urethra and small bowel do not sustain injury during and following a therapeutic intervention.

The probability of extra capsular extension is highly significant in guiding appropriate decision making by the patient and the therapeutic team. Treating less than the entire tumor bearing area will not serve the patient well if the therapeutic aim is curative. The utilization of various probability-based monographs such as the Partin Tables significantly aid in this determination.

Essentially, PSA, Gleason Score (an indicator of tumor differentiation and therefore aggressiveness) and bulk of disease are known to hold prognostic value as independent indicators of extra capsular disease. Should the risk of extra capsular extension be significant, the therapy team should adjust the approach such that the gland and the surrounding tissue receive tumoricidal radiation doses. This can be done with the integration of teletherapy and brachytherapy, teletherapy alone and perhaps, although not proven in large trials, high dose rate brachytherapy alone. The consensus amongst those of us who are involved in the brachytherapy at the Tri-State Prostate Cancer Center is that if a patient has at least two risk factors (PSA>10, Gleason>6, or bilobar disease) an approach integrating both teletherapy and brachytherapy is appropriate.

Brachytherapy as monotherapy is generally reserved for patients with a single elevated risk factor or who demonstrate a significant preference for that modality.

Once the decision has been made as to the approach it is then incumbent upon the team members to utilize their expertise and experience to deliver tolerable but sufficient radiation doses to the gland and the target volume of interest.

I will endeavor to explain in further correspondence the methodology employed to perform this task. Fortunately, we have been able to draw upon significant talent and expertise within our community to ensure our patients highly effective, safe, cost effective prostate cancer care in an outpatient, comfortable environment.

- Al Korba, M.D., FACRO

Who is a Medical Physicist and the Role They Play?
Just 20 years ago, many of the cures we consider common would have been miraculous. Much of our success comes from the sophistication of science and technology.

While radiation has been used for more than 100 years, today’s pinpoint accuracy significantly increases chances of survival. The person bringing this technical sophistication to radiation treatment is the Medical Physicist. Although never directly responsible for prescribing medical procedures, the health and welfare (even life) of many patients may directly depend upon the skill and dedication with which medical physicists carry out their work. This scientist works with the linear accelerator or radiation sources that make radiation – the medicine of treatment! Without the knowledge and skills of the Medical Physicist, the machine could miss the target or deliver the wrong dosage, limiting the ability to heal. Only a ten percent error in dose can double chances of disease recurrence. Accuracy is essential so that radiation therapy may control the tumor, relieve pain, and possibly save your patient’s life. Medical physics is one of our most precise health sciences.

TREATMENT WITH PRECISE EQUIPMENT

The medical physicist starts to work long before an individual patient is treated with radiation. This professional spends months preparing the complex equipment for treatment by measuring and analyzing the radiation coming from the treatment machines. He enters this information into a special high speed computer used for planning radiation treatments and verifies the radiation dose profiles for each beam to be same as that measured. All of this is done before a single patient is treated. He/she manages the quality assurance of all treatment machines to ensure accurate delivery of the radiation dose to the patient. These behind the scenes activities are part of the quality assurance measures undertaken on behalf of every patient. Such activities are essential for delivering the accurate amount of radiation prescribed by radiation oncologists to treat your patient’s disease.

THE Isodose PLAN FOR External beam TREATMENT

The medical physicist also manages the radiation dose planning before treatment. The medical dosimetrist is specifically trained to assist the medical physicist in radiation dosimetry. They use the computers containing the radiation data measured by the Medical Physicist. In preparing the treatment plan, the configuration of the body as shown on X-ray films or CT scans is fed into the planning computer. This allows the individual anatomy to be combined with the radiation beams of our treatment machines. The computer calculations produce a picture of the body and the distribution of radiation ordered. This process permits the radiation beams to be tailored specifically to the treatment site intended by the radiation oncologist. This precision in the treatment will maximize the effect on the diseased area while minimizing the damage to healthy tissue.

SPECIAL PROCEDURES

Many procedures involve a level of complexity that demand the immediate skills and judgement of the trained medical physicist as an integral part of the health care team.

Some of these special procedures are described briefly:

Low Dose Rate (LDR) Brachytherapy

In LDR Brachytherapy radioactive sources are placed into the body through a needle or tube applicator to treat certain localized cancers. The medical physicist oversees the tasks that determine the placement, strength, and length of time for the implanted radiation sources to deliver the dose prescribed by the radiation oncologist. Sometimes the radioactive materials are implanted permanently in the body – for example, small radioactive sources (size of a grain of rice and commonly called as seeds) are implanted to treat the cancer of the prostate. In some case the radioactive sources may be temporarily placed in the human body (temporary implants) for a few days – for example, treatment of gynecological cancers or the treatment of small melanoma tumors inside the eye using radioactive plaques.

• High Dose Rate (HDR) Brachytherapy

Another mode of brachytherapy, called high dose rate (HDR) Brachytherapy uses a computer controlled small but extremely intense, radioactive source to deliver the treatment. HDR Brachytherapy is becoming more and more popular as a radiation treatment modality for localized tumors. The treatment can be delivered on an out patient basis with less complications and practically no exposure to attending staff and other personnel unlike LDR brachytherapy.

Recent approval by FDA of Intravascular Brachytherapy for reducing restonosis and the MammoSite RTS for the treatment of breast cancer in specific cases has further increased the involvement of medical physicists in the treatment and care of the patients.

Due to the critical nature of HDR treatments, federal and state regulations require the presence of a medical physicist during any HDR procedures.

Developments in advanced technology in the last decade such as computer operated multi leaf collimators for a linear accelerator and the availability of dedicated and innovative softwares for precise radiation treatments has vastly improved radiation dose delivery to the tumor sparing other critical organs. Developments have made conformal Radiation treatment , Steroetactic Radiosurgery (SRS) and Intensity Modulated Radiation Therapy (IMRT) available options for radiation treatment of patients. All these procedures require highly skilled and trained medical physicist’s involvement in developing treatment plans desired by Radiation Oncologist for the treatment of a cancer patient.

In addition to all these activities medical physicists’ are involved in many other facets of patients’ treatment and radiation safety of the patient and staff.

A TEAM APPROACH

As part of your patient’s treatment team, the physics department at Evansville Cancer Center is just as concerned with your patient’s treatment as you. They will work closely with you to give your patient the highest quality of care. If you have any questions regarding radiation or the sophisticated equipment used for treatment at Evansville Cancer Center, please call any member of our physics team, Dr. S. Shah, Arnold Sorensen or John O’Donoghue at (812) 474-1110.

New Marketing Director at Evansville Cancer Center

Robin Lawrence-Broesch has been appointed the new Marketing Director for Evansville Cancer Center. Robin joined the Cancer Center in April 2002 with over 20 years experience in health care marketing. She worked at St. Mary’s Medical Center as Advertising Manager for over seven years where she won numerous awards for her advertising and marketing projects, including first place CHA Spirit award nationally for a film documentary entitled ‘Cry of the Poor’ which addressed poverty and homelessness in the Evansville community. Robin also worked at Welborn Clinic and Welborn Health Plans as their Communications Manager.

As Marketing Director at Evansville Cancer Center, she will function as liaison between the physicians in the community and the Cancer Center.

“My goal is to keep the physicians in our community abreast of new developments in the provision of oncology services, and to increase awareness of the delivery of services to their patients.”

For more information about Evansville Cancer Center and the services offered, call Robin at (812) 474-1110, extension #223.

Al Korba, M.D., F.A.C.R.O. - Medical Director

Dr. Al Korba is a Radiation Oncologist who has been practicing in the Tri-State since 1976.
He received his medical degree from the University of South Carolina and completed his residency in Radiation Therapy at the Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri. He was certified by the American Board of Radiology in Therapeutic Radiology in 1976.

Dr. Korba has been internationally recognized as a pioneer in the development of High-Dose Radiation. He is a frequently requested lecturer, and published papers in the nationally recognized ‘Journal of Bronchology’. Dr. Korba is a fellow of the American College of Radiation Oncology.

Saiyid M. Shah, PhD - Medical Physicist

Dr. Saiyed Shah is a Medical Physicist who received his Ph.D. degree in Physics from Texas Tech University. Dr. Shah has been working in this field since 1976 and has worked with our radiation oncologists since 1984. He is certified by American Board of Radiology and American Board of Medical Physics in Radiation Therapy Physics.

Dr. Shah has presented papers in numerous international meetings on HDR brachytherapy. He is also actively involved in the teaching of medical physics in developing countries through AAPM Scentific Exchange Program and was the Course Director for these courses in Pakistan and Turkey.




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