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Beaming in on the brain


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Source: http://www.chicagotribune.com/technology/c...ack=1&cset=true



Beaming in on the brain

New radiation system tackles tumors while bypassing nearby tissue


By Marc Davis

Special to the Tribune

Published February 13, 2005


If it weren't for a unique method of removing residual brain tumor tissue, a treatment offered by Loyola University Health System, Craig Fedder might be blind.


Fedder, who lives in Aurora, knew he had a serious problem when, driving home one evening after work in January 2003, he was suddenly stricken with double vision.


"I was on the road, speeding along in the middle of traffic, when it happened," said the 60-year-old Fedder, training-development manager for the International Truck and Engine Co. in Warrenville. "I was really scared. I tried to drive with my hand over one eye. That didn't help. I thought I'd have an accident. I was lucky to make it home."


Fedder sought medical attention, and eventually an MRI and CT scan revealed a 2.8-centimeter benign tumor on Fedder's pituitary gland. The tumor created pressure against nerves that control eye movement and caused his double vision. His tumor was removed in a traditional surgical procedure in March 2003 by Dr. Thomas Origitano, a neurosurgeon at Loyola University Chicago Stritch School of Medicine. But Fedder still had a problem.


Microscopic residual tumor tissue remained in Fedder's brain and had to be removed or the tumor could grow back, causing a recurrence of his vision problems, Origitano explained.


The usual method of tumor tissue removal is a monthlong course of external beam radiation. Although the treatment can be effective, the side effects can be rough: fatigue, nausea, time lost from work. Most dangerous, however, is the potential damage to brain tissue.


"The danger of injury to adjacent [brain] tissue includes possible hearing loss, blindness, difficulty swallowing, even paralysis," said Dr. Bahman Emami, chairman of the department of radiation oncology at Loyola University Health System.


In Fedder's case, the potential injury to his optic nerve, which was being pressured by the tumor, could cause permanent blindness. If his brain tumor tissue were removed in the traditional way, there was a chance of damaging the optic nerve. With Loyola's new Novalis system of radiation, however, the risk was substantially reduced, Emami said.


"What's unique about this [Novalis] method is its ability to shape the radio beam to the contours of the tumor," Origitano explained. "This leaves as much healthy tissue as possible untouched. The patient's exposure to radiation is reduced, and side effects are not as severe. It's also now used as a surgical method which can treat smaller tumors, reduces treatment time and causes minimal bleeding. Patients recover more quickly and with fewer or less-troublesome aftereffects."


Fedder was scheduled for a course of treatment using the Novalis system in early 2004 at the Loyola University Health System, Maywood. Loyola is the only Chicago-area medical facility using the system, Emami said.


Before Fedder's treatment, a plastic mask was made of his face for use as a precision guide for aiming the beam.


"They put a roll of plastic mesh over my face," Fedder said, describing the mask-making process. "It was warm and pliable and took an impression. It was not uncomfortable."


The finished mask was attached with bolts to fixtures on both sides of Fedder's head that held it steady so that the radiation would target the same place every time.


The computer recognized the face and made appropriate targeting adjustments after two X-ray images verified the exact position of the patient's head. The radiation machine then rotated around Fedder's head, dispensing a precise dose of radiation to a pinpoint target. The radiation is a stream of fast-moving subatomic particles generated by a linear accelerator, a machine that uses electricity to generate the high-energy radiation beam. Emami supervised the treatment.


After the radiation, about a five-minute exposure, Fedder returned to work the same day.


The whole thing took about 30 minutes, Fedder said. "That includes the time it took for me to get ready. After it, I didn't feel woozy, sick or tired." Only near the end of his 25 days of radiation--five days a week, with Saturday and Sunday off--did Fedder start to feel some fatigue. He also lost hair on his head in two small patches. "But I started to feel normal again pretty soon, and my hair grew back quickly," he said.


The Novalis system is now being used for both initial brain tumor surgery and the radiation follow-up. The system may also soon be used to treat other types of tumors, including those of the breast and prostate, Origitano said.


As for Fedder, "I feel great now," he said. "I have no eyesight problems, I see Dr. Origitano once a year and everything was covered by insurance. I feel pretty lucky."



Copyright © 2005, Chicago Tribune

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