Surgeons at MD Anderson are using extreme
heat and cold as their weapons against some forms of cancer.
They’re finding that the minimally invasive treatments are working
as well as, if not better than, standard cancer treatments for many
patients. Recovery is dramatically quicker.
Quality of life is better. Patients are more satisfied.
Turning up the heat on spinal cord tumors
Instead of performing a standard surgery by making a large skin
incision with extensive muscle dissection and bone removal, Tatsui
inserts a small laser probe – about the size of a pencil lead –into
the tumor. Once in place, intense heat scorches the cancer cells. A
specially equipped MRI, located in the same operating room, allows
Tatsui to precisely control where the treatment is delivered. This
protects nearby vital organs and immediately verifies that the tumor
has been destroyed.
“We use the heat to kill the cancer cells, and the MRI mapping
allows us to precisely apply the laser only inside the tumor,
protecting the spinal cord and nerves,” Tatsui says. “Recovery from
this procedure is very quick – a day or two rather than weeks, which
allows patients to resume their chemotherapy quicker as well.”
The procedure, called laser interstitial thermal therapy (LITT), has
been traditionally used at MD Anderson to
treat hard-to-reach brain tumors. Tatsui has expanded its use to
include for the first time treatment of spinal metastasis with spinal
cord compression. He has adapted some of the instruments and
techniques to accommodate the procedure and their use next to the
MRI’s high power magnetic field.
It takes longer to prepare for the procedure than to destroy the
tumor. The probe is activated for about two minutes and generates heat
of between 123 and 185 degrees Fahrenheit. The MRI shows the heat
rippling out from the center of the probe, spreading inside the tumor
as it turns green, yellow, orange and finally red.
Tatsui has performed the procedure on more than 70 patients, some of
whom had limited or no options since they weren’t considered
candidates for standard surgery due to the advanced stage of their disease.
“LITT is a game-changer,” Tatsui says.
Treatment leaves breast cancer out in the cold
At the other end of the thermometer is cryoablation, which freezes
cancer cells to death.
Cryoablation is a treatment option for prostate, kidney, lung and liver cancer. Also it’s used for non-cancerous
breast tumors called fibroadenomas. Given its effectiveness for these
types of benign tumors, doctors wanted to test expanding the treatment
to breast cancer.
MD Anderson and other sites conducted a clinical trial that included women with
early-stage breast cancer whose tumors were 2 centimeters or smaller.
“At MD Anderson, 100% of all tumors in
trial patients were destroyed through cryoablation,” says Rosa
Hwang, M.D., the lead investigator for the clinical trial here.
“Everyone, including the patient, watches in real time as an ice
ball forms around the tumor and freezes it from the inside out. It’s
visually amazing,” Hwang says.
Rather than undergoing a traditional surgery to remove their tumors,
patients are treated in an outpatient room. Cryoablation is so
painless, the patient remains awake while the doctor uses ultrasound
imaging to guide a thin, needle-like device through the skin and into
the tumor. Once in place, liquid nitrogen at 40 degrees below zero
Fahrenheit freezes the cancer cells for six minutes. The cells are
frozen again for six minutes following a two-minute rest. The probe is
removed, and a Band-Aid-like bandage is placed over the tiny incision.
The entire procedure takes less than 30 minutes.
Recovery is instantaneous. Some women report going shopping or out
to eat directly from the procedure.For the clinical trial, patients
still had to have what was left of their tumors surgically removed and
examined to ensure all cancer cells were destroyed. Hwang says another
trial without the post-cryoablation surgery is in development. The
goal is to have cryoablation replace surgery as the standard of care
for patients with early-stage breast cancer.
“This is a huge advance, and I think it could be the wave of the
future,” Hwang says.
A longer version of this story originally appeared in
Messenger, MD Anderson’s quarterly
publication for employees, volunteers, retirees and their families.
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