Radiosurgery Technique to Make O.C. Debut Today : Medicine: Woman’s cancerous brain tumor will be attacked in procedure newly available at 2 hospitals.
A 32-year-old woman whose cancerous brain tumor could not be completely removed with traditional surgery expects to have it destroyed today by radiation in the first such operation in Orange County.
Described as “surgery without a knife,” the stereotactic radiosurgery will be offered beginning this week at Hoag Hospital in Newport Beach and at Western Medical Center-Santa Ana.
Orange County thus will claim two of about six centers in Southern California with the newest generation of technology which, with the use of computers, allows lesions in the brain to be removed in about 20 minutes by a concentrated beam of radiation. The patient stays alert during the entire process and generally has few remaining problems, except perhaps a headache, and can go home the same day.
Hospital officials explain that the XKnife System recently installed at both hospitals allows physicians to project a CAT scan or MRI image of the patient’s brain on a computer screen and literally draw lines around the tumor that they want to destroy. They can also define via computer any vital structures such as the optic nerve that they want to avoid hitting with the beam of radiation, which is about 5,000 times the strength of a chest X-ray.
Dr. Michael Sukoff, a neurosurgeon who will direct the program at Western Medical Center, said experience with radiosurgery during the last two years in the United States indicates that it will eliminate the need for about 30% of open surgery for brain lesions.
Sukoff said it is most effective for metastatic disease, cancers that spread to the brain from other parts of the body, and for recurring cancers that originate in the brain. It does not work when many tumors are present or when the tumors are especially large or irregularly shaped, physicians who use the technology say.
Radiosurgery, Sukoff said, is an alternative to surgical removal of a brain tumor with a knife or the surgical implanting of radioactive beads in the head.
Radiosurgery “will prolong lives and save some, and it is less emotionally and physically traumatic. Also it can be done at much less cost than conventional brain surgery,” Sukoff said.
Dr. W. Michael Shea, a radiation oncologist who was recruited from UC San Diego to launch Hoag’s program, said the $13,000 cost of radiosurgical treatment is about a third the average cost of conventional brain surgery, which requires the patient to be anesthetized during surgery and then hospitalized for four to seven days.
Shea also noted that radiosurgery can be used in some cases to remove tumors that are otherwise inoperable. It is also used, he said, when a tumor will not respond to conventional radiation.
Officials at Hoag and Western Medical Center estimated that each hospital will treat about 50 patients a year.
Officials at the hospitals contend that they will have enough patients to remain busy, but Shea said he hopes that the surgery will not be offered by many more hospitals.
“It would be ideal to have it limited to a few institutions, not only so it would be more cost effective, but so the surgical teams gain experience. You need a critical mass of patients to maintain expertise,” he said.
But UCI Medical Center intends to offer radiosurgery later this year, said Dr. Martin Colman, acting chair for the UCI department of radiation oncology. Colman said he believes that it is appropriate for the teaching hospital, which already has a large number of brain cancer patients and a neuroscience research and training center.
The county’s first radiosurgery patient, Jill Savage, a financial manager at Allergan Inc. in Irvine, is scheduled to arrive at Hoag about noon today. A metal headset will be attached to her skull with pins. After three-dimensional pictures of her brain and the headset are taken by magnetic resonance imaging, she will rest while a team of physicians study the pictures. They will use the headset projected on the computer screen as a grid to plot the coordinates of the inch-wide tumor, remaining from former surgery, that they want to kill.
When the computer is properly programmed, the beam will be aimed at Savage’s head to give the tumor a lethal dose of radiation. Twenty minutes later, about 6:30 p.m., Savage can go home, in time for dinner.
