Monthly Archives: June 2015

Skin Cancer and the Art of Treatment Design

Day 1 of Treatment and 2 weeks after treatment. The skin will continue to heal.

Day 1 of Treatment

After 8 treatments

After 8 treatments

12 weeks post treatment

12 weeks post treatment

 

 

 

 

 

IMAGES ARE OF A SKIN CANCER TREATED WITH LEIPZIG ROBOTIC RADIOTHERAPY

Despite the fact that most skin cancers are preventable, more than 1 million people will be diagnosed with a new skin cancer this year. If treated correctly and early, skin cancer can be no more than an inconvenience. However, if not treated correctly, it can become deadly.

When you think skin cancer treatment, you think dermatologist. Dermatologists will treat the majority of early skin cancers. But did you know that radiation oncologists have been successfully treating skin cancer for well over 100 years? My predecessors have mastered tried and true techniques however, with advances in technology, I have taken treating skin cancer to a whole new level. Much depends on the type of cancer as well as the location. It is best to know all of your options for treating your skin cancer.

ROBOTIC RADIATION

My team at First Dayton Cancer Care were the first in southwest Ohio to use new robotic technology coupled with basic principles of radiation therapy to treat skin cancer. Since its inception in 2003, myself and my team of experts has performed over 3,000 Leipzig Robotic Radiation treatments for early stage basal and squamous cell skin cancer.

The Leipzig Robotic Radiation treatment is an alternative to surgery that targets small skin cancers without pain or damaging surrounding tissue. This is a very superficial radiation treatment that causes no scarring and no incision. A patient simply experiences a ‘sunburn’ in the treatment area. Once new skin has grown, it is healthy and fresh just like a newborn baby.

Leipzig helps fight cancer in hard to reach areas such as ears, noses, lips, scalps and shins. Treatments only take a few minutes in 6 -10 visits. For people with diabetes, peripheral vascular disorders and those on blood thinners the Leipzig treatment is an amazing option. Since it is not surgery, there is no wound that needs to heal and no need to change any medications. This is a wonderful option.

TRADITIONAL RADIATION TREATMENT

Locally advanced skin cancers don’t stand a chance against tried and true electron beam therapy (EBT). EBT delivers powerful cancer-fighting radiation to the involved layers of the skin and spares the tissues and organs beneath. EBT takes advantage of the 100 year old radiation principle of fractionation -small daily doses over 4 to 6 weeks. Normal tissue surrounding the cancer have time to heal up after small daily doses of radiation – skin cancer cells do not.

I design a custom mold for each patient and then develop a treatment plan to pinpoint the radiation to the skin cancer. I can control the depth and the width of the radiation to ensure that we treat the cancer cells and surrounding margins but leave health tissue unharmed.

Treating skin cancer is a true art. As a physician I really need to understand my patient and their disease to design the best treatment plan for optimal cancer cure rates, but giving special consideration to the patient physical appearance afterwards. It is very exciting to have so many treatment tools at my disposal here at First Dayton Cancer Care.

June Is Men’s Health Month

PSA Screening: What You Don’t Know Really Can Kill You

Real-Life Consequences of PSA Testing

Know the Facts.

Know the Key Facts about Screening your Prostate.

The first key fact that no one can dispute: from 1992 to 2011 there was a 47% decrease in prostate cancer deaths with the start of PSA screening in the USA.  Yet in 2009 and again in 2012, the Federal Government,  embodied in the US Preventative Service Task Force (USPSTF), recommended against PSA testing to detect men with prostate cancer.  There were claims by the USPSTF about over diagnosis and over treatment, yet it seems to me that the patients were penalized, not the doctors doing the over diagnosis and doing the over treatment.

In my own clinic, many patients still seemed to be surprised that prostate cancer can be deadly-second only to lung cancer in cancer deaths among Americans.  In 2015, the American Cancer Society stated that over 220,000 men will be diagnosed with prostate cancer in the United States.  And 32,000 men will die from their prostate cancer.  That’s hardly a disease to be taken lightly.

More Men Now Diagnosed with High Risk Prostate Cancer

As I reported previously in my blogs, City of Hope Medical Center’s Dr. Timothy Schultheis found that from 2011 to 2013-following the USPSTF’s recommendations- the number of men found with intermediate and high risk prostate cancers increased significantly in the USA.  And that study had big numbers-Dr. Schultheis looked at 87,562 men diagnosed with prostate cancer from 2005 to 2013.

Dr. Catalona, a urologist and recognized expert on prostate cancer from Northwestern University School of Medicine, said “There is a price to be paid for not doing PSA testing.  We have learned from cancer statistics in the US and from randomized clinical trials in Europe that PSA testing can cut the prostate cancer death rate nearly in half.  The strategy for success is to detect the prostate cancer early, when it is curable.  If doctors and patients do not work together to ensure appropriate PSA testing and treatment in an organized and routine fashion, there will be more unnecessary suffering and death from incurable prostate cancer in the near future.”

So What’s A Man to Do?

The second key fact that no one can dispute: the majority of prostate cancer deaths are in men 70 years or older.  So it may be even more important to screen our senior men.  Now that the Federal Government issued its edict that PSA testing is no longer needed, it’s really up to men to advocate for their own health.  Men need to stand up to protect themselves. Ask your doctor about PSA testing.  Bring PSA testing up at your next check-up.  There are even some laboratories, right here in Dayton, where you can pay $30 and have the test done on your own, without a doctor’s order.

I agree that as a stand-alone, one time test PSA screening is less useful than thought over 25 years ago.  But when combined with physical examination, family history, and tracking any changes in the PSA level over time, it really can be useful and even lifesaving.  In fact, a change in the PSA level of only 0.75 ng/mL over one year may be worrisome for prostate cancer, especially in men younger than 60.

What you don’t know about your prostate and PSA level really can kill you.  Once again, the USPSTF’s latest recommendation seem to be extreme. They are watching out for the dollar and not for the individual man.

USING YOUR BODY’S OWN IMMUNE SYSTEM TO FIGHT YOUR LUNG CANCER

THE SCIENCE BEHIND THE SCENES

In late May, the American Society of Clinical Oncology (ASCO) held its annual meeting.  The “buzz” at that meeting centered around “immune checkpoint inhibitors” or drugs that take advantage of the fact that cancerous tumors have specific molecules on their surfaces that allow cancers to escape the body’s immune response.

Discovered over 25 years ago, these specific molecules are called PD-1 receptors or Program Death–1 receptors.  Recently, squamous cell lung cancers, representing 30% of all non-small cell lung cancers, were shown to express PD-1.  Nivolumab is a genetically engineered antibody, itself an immune system molecule, that disrupts PD-1 and restores the body’s own anti-tumor immune response to squamous cell lung cancers.

POSITIVE RESULTS WITH FEW SIDE EFFECTS

So what’s the buzz?  The study was fully reported in the May 31, 2015 issue of the prestigious New England Journal of Medicine. Dr. Julia Brahmer and her colleagues studied 272 patients with locally advanced stage III or stage IV squamous cell lung cancer in whom standard, platinum-based chemotherapy failed.  260 of these patients were randomly assigned to either docetaxel, a chemotherapy active against lung cancer, or Nivolumab, an immune checkpoint inhibitor.

There were a number of remarkable findings.  1).  The overall 1-year survival rate was 42% with Nivolumab versus 24% with docetaxel.  2).  The severe side effects with Nivolumab were much less-7% of patients had grade 3 or grade 4 side effects versus 55% with the docetaxel group.

 SO WHAT ARE THE PROS AND CONS?

The Pro’s

  1. Most experts in the field called the study a practice changer.  Nivolumab offers real hope for patients with locally advanced squamous cell lung cancer in whom standard chemotherapy failed.  I am sure the next step will be to use Nivolumab as a first line anti-cancer drug.
  2. Side effects with this immune checkpoint inhibitor are much less than standard chemotherapy.
  3. The lung cancer responses to Nivolumab appear to be long lasting, working long after the last dose was given.

The Con’s

  1. The cost of Nivolumab is significant. Dr. Leonard Saltz, a respected medical oncologist at Memorial Sloan-Kettering Cancer Center in New York City,  called the current cost of these drugs “unsustainable.”  A lot of negotiating among drug companies, insurance companies, and doctors needs to be done.

5 Things You Need to Know When Meeting with Your Cancer Specialist

The information you provide on your forms is important. Come to your visits prepared.

The information you provide on your forms is important. Come to your visits prepared.

To say a cancer consultation is stressful is putting it mildly.  You arrive 15 minutes early for the appointment. You have to dig out your insurance card and an id. You’ve filled out the 5 pages of medical forms that look just like the other forms you filled out at the other doctor’s offices.  You’re in no mood now to smile for the identification photograph.  Now you’re asked to get in a gown and sit in an exam room for another 20 minutes or more.  Feeling out-of-control yet?  Well,  there really are a few things you can do to help you get the most out of your visits.

1. Be Prepared 

Just like a Boy Scout- Be Prepared. More than you can imagine, a lot depends on how well you and your cancer specialist communicate.  And talk is a 2 way street. It’s not just telling the doctor what’s wrong and him/her giving you statistics. It’s also your listening to them and the doctor listening to you.  Let’s face it.  Talk isn’t cheap, and everyone is pressed for time. You have very little time to develop a good working relationship with your doctor. From day one, your preparation will help establish good communication that will carry through all stages of diagnosis, treatment and recovery.

So it’s a good idea to be upfront with your doctor and let him/her know about your other medical conditions, previous surgeries, other cancers and treatment, prescription medicines, over-the-counter medicines, and herbal supplements. Don’t assume “it’s all there in the record.”  Make a list and bring it with you.  You may not realize it, but how well you’re handling your diabetes may impact on how well your chemotherapy works on your breast cancer or how well your radiation works on your prostate cancer.

2. The Only Dumb Question Is the One That’s Not Asked  

And even more questions come up after the consultation. So write those down so that you can talk with your cancer specialist at the next visit.  It often takes time for you to process everything that you have been told. If you still have a lot of questions, rather than calling the office with one at a time, schedule a follow up visit. This way you can have ample time to ask and more importantly, to understand.

A list of questions may be a real help.  A consultation with a cancer specialist is always stressful – a thousand things are racing through your mind. That’s why it’s also key to bring a family member or a close friend with you.  That person can take notes for you to look at later. They often hear things that you don’t because you are focusing on something else that was said.

3. Not Everyone Learns the Same Way

Communication takes many forms and not everyone learns by reading.  Some people do best by watching a video, others by listening.  The Internet may be useful, but the information may not always be reliable.  If you don’t understand what’s going on, let your cancer specialist or other medical team members know about it right away.

4. Good information gives real power over your cancer.

Poor information not so much.  Your neighbor or friend at church may mean well, but it’s really hard to find 2 patients with exactly the same cancer, at exactly the same stage, and exactly the same medical problems. What works for someone else may not work for you. And remember, cancer care is still an art, but there is always a good deal of science.

5. Your Doctor Doesn’t Know It All

I strongly recommend getting to know other members of your cancer care team who are not doctors.  Registered nurses, nurse practitioners, physician assistants, licensed medical assistants, radiation therapists, chemotherapy nurses, and swallowing therapists are also your keys to success in diagnosis, treatment, and recovery.  These professional, knowledgeable team members can answer medical questions and help with personal guidance throughout this difficult time.

Not every physician is familiar with every available cancer treatment technique. Your physician may only know about the treatment offered at his facility first hand. An experienced physician will continue to explore any and all treatments available in his/her field of study, but do not assume this is the case. Seek a second opinion from someone outside of their group when possible. I often give second and third opinions. I will help a patient to understand all of their treatment options, not just the ones I offer. My goal as an oncologist is to find the best possible treatment for a patient to beat their cancer. I encourage people to call me anytime for another opinion.