2009 Recap

How quickly this year has passed! It is hard for us to believe that this is the last blog post for our first year on the blogging circuit! We have enjoyed bringing this new venue of information and communication to you – our cancer center patients and interested community – and we hope that you have found it to be valuable too!.

It has been quite a busy and productive year for us at Holy Cross and the Bienes Cancer Center. We have continued to grow – both in terms of patient volume and size of professional staff. During 2009 we added new subspecialties and sub-specialists to our team including colorectal surgeons – Drs. Lescher, Basu and Schochet and added a new Hematologist/Oncologist Dr. David Drew who joined us in November from the National Cancer Institute. We added new technologies in our radiation oncology department including a new ultrasound based tumor localization system and a brand new linear accelerator with IGRT (Image-guided radiation therapy) and stereotactic radiosurgery capabilities. There is no cancer center in South Florida that has more technology than we do now! And we have maintained our high touch service along with the spirituality and faith based approach that we do with everything at Holy Cross. We continued to develop our disease specific focus for our physicians so that we have dedicated teams of physicians now who focus their practices on breast cancer, prostate cancer, gastrointestinal cancers, lung cancers and colorectal cancers. This specialization is allowing us to be the true leaders in our field that patients deserve and need.

Finally we have significantly expanded our clinical research program – opening the first community hospital based phase 1 clinical trials for cancer in South Florida. We are truly excited to be able to offer these new options to patients who have exhausted all other treatments.

Thank you for participating with us on our journey. 2010 promises to be even more exciting!

Tags: IGRT, image guided radiation therapy, phase 1 clinical trials, stereotactic radiosurgery
Posted in Breast Cancer Surgery, Gastrointestinal Cancer, General Medical, Lung Cancer, Prostate Cancer, Radiation, Research and Genetics, Spirituality |

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Radiotherapy for Prostate Cancer

In 2008, approximately 186,000 American men were diagnosed with prostate cancer, resulting in about 28,600 deaths. The optimal therapy for prostate cancer is unclear. Management options include radical prostatectomy (RP), external-beam radiation therapy (EBRT), seed implant, or active surveillance.

The choice of treatment is determined by numerous factors such as patient age and performance status. Also important are tumor factors such as prostate specific antigen (PSA), T-stage and Gleason score. The higher the PSA and Gleason score, the less likely the prostate cancer is confined to the prostate.

Unlike most other cancers, there are no randomized studies comparing surgery to radiotherapy (RT)  in prostate cancer, making the optimal treatment decision difficult. Studies from multiple academic centers show equivalent results regardless of therapy. Although many urologists claim that surgery is the “Gold Standard” and has the longest tract record of success, no data exits to corroborate this claim. Guidelines from the American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) do not claim superiority to either surgery or radiotherapy. In addition, the surgeon generally considered the father of the modern radical prostatectomy, Patrick Walsh from Johns Hopkins University, has stated, “patients with localized prostate cancer now clearly have two good options for treatment: surgery and radiotherapy.”

For the most part, young, healthy men are typically encouraged to undergo surgery, whereas older patients (or those who are not good surgical candidates) tend to be recommended RT or observation. Over the past decade, two major advances in therapy have led to better cure rates and less side-effects in men undergoing radiotherapy for prostate cancer: dose escalation using newer highly conformal techniques (intensity-modulated radiation therapy, or IMRT), and combined-modality treatment with hormone therapy.

Considering that outcomes between surgery and radiotherapy are equivalent, it makes sense to avoid an invasive procedure unless if offers superior results. Cure rates associated with RT have at least equivalent to those of RP and will only continue to improve. In light of this, patients with newly diagnosed prostate cancer should consider high-dose radiotherapy with IMRT or seed implant prior to deciding to undergo surgery for prostate cancer.

Posted in Prostate Cancer, Radiation |

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Clarity Image Guided Radiotherapy System

Dr. Goyal is enjoying a few well deserved days off and asked me to fill in for him today to share with you an exciting new development in our radiation oncology department. We are pleased to announce that the Bienes Cancer Center is the first in South Florida to have the Resonant Medical Clarity Image Guided Radiotherapy System in our facility. I am including some wording directly from Resonant’s website:

Guiding Innovation in IGRT

Resonant Medical develops, manufactures and commercializes 3D ultrasound image-guided adaptive radiotherapy products. Our goal is to help cancer centers make significant improvements in radiation therapy planning, verification and delivery – to advance patient care.

We design high-performance products based on next-generation technologies that exceed the technical and clinical requirements of our customers while respecting the realities of operating cancer centers. Our commitment to manufacturing high-quality, safe and reliable medical equipment is demonstrated by our stringent quality system and ISO 13485 certification.

Presently, multiple aspects of our innovative technologies are being validated in real clinical settings, and we enjoy frequent collaborations with clinics and academic institutions across the continent.

Our radiation oncology physicians, Dr. Lav Goyal and Dr. Irina Grosman, plan to use this new technology initially for patients with certain types of breast cancer and certain patients with prostate cancer. Eventually they expect to be able to use this sophisticated system for many other types of cancers as they treat patients using radiation therapy.

For more information on our newest development please visit Resonant’s website.

-Bienes Cancer Center Executive Director, Maureen Mann

Tags: 3d ultrasound, breast cancer, breast cancer treatment, clarity image guided radiotherapy system, Prostate Cancer, prostate cancer treatments, radiation oncology, radiation therapy, radiotherapy, resonant, resonant medical
Posted in General Medical, Prostate Cancer, Radiation |

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Trials try to Light the way to a Cure

Clinical trials are the only road to new standards of care in medicine. Without their scientific rigor, we would not be able to move forward to improve and hopefully someday, eliminate diseases.

There are many different types of clinical trials in cancer care. Here at the Bienes Cancer Center, we do mainly treatment, screening and prevention trials. I want to share an example of a National Cancer Institute funded prevention trial that we are participating in.

The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is a clinical trial to see if one or both of these dietary supplements prevent prostate cancer. Over 35,000 men were enrolled across the USA, Canada and Puerto Rico. The study was based on findings from two separate studies in the past for cancer prevention. One looked at the use of vitamin C in multiple cancers and it indicated a reduced incidence of prostate cancer with this vitamin. The other study was testing the use of vitamin E in the reduction of many cancers and it also showed a reduced incidence of prostate cancer.    

The Bienes Cancer Research department has enrolled 121 men into this study since its inception in 2001. Each subject was randomized to combinations of Vitamin E, selenium or placebo. The men took their pills daily, came into the clinic for annual PSA tests and digital rectal examinations by our physicians. They also received phone calls every six months to gather more health related information. Recently, another component has been added to gather information about the incidental findings for any men in this trial who happened to have had a colonoscopy.

The pills were stopped in August 2008 because the data showed that taking vitamin E and selenium alone or together does not prevent prostate cancer. The data also showed that vitamin E may slightly increase the chance of getting prostate cancer. Selenium may be associated with a slightly increased risk of developing diabetes mellitus. However, these findings are not statistically significant and may be due to chance alone.

These men will remain on trial for another 2-3 years as we gather more health related findings. Although this trial did not reach its goal of a 25% reduction in prostate cancer, it has shown that the previous findings concerning vitamin E & C in the prevention of prostate cancer were not verifiable. Six men, who were not having regular prostate exams and PSAs, were found to have early stage prostate cancer. To read more about this trial, please visit the NCI website. 

If you have been or are enrolled in this trial, we would love to hear about your personal experience and any thoughts you have about this or other prevention trials.

Tags: cancer prevention, clinical trials, National Cancer Institute, Prevention, Prostate Cancer, Screening, SELECT, Selenium, Treatment, vitamin C, Vitamin E
Posted in Prostate Cancer, Research and Genetics |

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