Radiation Oncology Division
Wheeling Hospital is the internationally recognized leader in transperineal ultrasound guided conformal prostatic brachytherapy, or radiation treatment of prostate cancer through prostate implants. Drs. Gregory S. Merrick, director of the Schiffler Cancer Center, and Wayne Butler, chief physicist, serve as guiding forces in the development and implementation of national standards in the care of prostate implant patients. Merrick is also executive director of the Urology Research Institute. www.urologicresearchinstitute.org. The Urologic Research Institute and the University of Washington have developed multiple phase III prospective randomized trails that have been completed or conducted exclusively in Wheeling and Seattle. The results of these trials under the direction of Merrick and Dr. Kent Wallner have redefined patient selection and the use of external beam radiation and androgen deprivation therapy in brachytherapy patients. Their work has elucidated etiologies of urinary, bowel and sexual function and provided long-term data regarding the efficacy of prostate brachytherapy. Their work has resulted in approximately 150 joint scientific manuscripts and two textbooks.
Merrick has developed an innovative approach for the diagnoses of prostate cancer. This new biopsy approach - or mapping biopsy -not only improves the ability to diagnose prostate cancer in men who are not easily diagnosed, but helps determine which patients are best suited for 'watchful waiting' or other treatments.
Intensity modular radiation therapy (IMRT) is the most effective way to deliver radiation from outside the patient in order to increase dose to disease sites and decrease dose to the surrounding normal tissue. IMRT requires extremely sophisticated computer software to help determine the direction of the optimal radiation beams, the weight of the beams, and modifications of the beam intensity pattern to deliver the maximum dose possible to the malignancy while minimizing radiation to the normal surrounding tissues. IMRT only became possible in recent years because of improvements in imaging technology to better distinguish tumor and healthy tissue and by improvements in patient positioning devices to allow us to reproducibly focus on the target with sub-millimeter accuracy.
IGRT (Image Guided Radiotherapy)
The latest evolution in cancer care focuses on the fourth dimension of time. Long appreciated by radiation oncologists, tumors move with respiratory effort and muscular contraction and relaxation. Until now, a large margin of normal tissue was built into the volume irradiated in order to accommodate for tumor movement. Today, and available at very few qualified centers, radiation oncologists can visualize the tumor as it moves inside the body, allowing for sharper radiation dose delivery with the theoretical benefit of irradiating less normal tissue. The Schiffler Cancer Center became the first center in the tri-state area, and one of the only community hospital-based programs nationally, to introduce IGRT to its patients. To date, malignancies of the prostate, skull base, brain, pancreas, and small bowel have been effectively treated with this technology, and plans are to evaluate its use in the management of many other cancers.
Because of inherent tumor movement, scientists have demonstrated that identifying a tumor in time and space, by means of an implanted radio-opaque metal marker, allows for improved visualization of the target for radiotherapy. Prostate cancer patients are now regularly undergoing fiducial implantation, and lung cancer patients will soon be offered the same technology. The Schiffler Cancer Center is the only facility in the region implanting fiducials into tumors.
Calypso Beacon Implantation
Called the GPS for tumors, the Calypso System is based on the knowledge that tumors move with each breath a patient takes. This system works by triangulating a radio-emitting frequency coming from a beacon placed inside the tumor. The radiation beam then follows the movement of the tumor, irradiating the target plus a very small amount of normal tissue. This technology is the most advanced currently available to treat cancers with radiation while sparing normal tissues, thus reducing both short- and long-term side effects. The Schiffler Cancer Center is one of only 15 centers nationally offering the Calypso Beacon System, and the staff is participating in careful data analyses of the system to determine its efficacy. Because of the extremely complicated nature of this system and the level of expertise required by physician and support staff, the company has indicated that only 32 sites will be using Calypso by fall 2008 and 52 sites nationally by fall 2009. The only other sites in the greater area utilizing this technology are the Cleveland Clinic and Fox Chase Cancer Center (Philadelphia).
National Protocols/Clinical Trials
After in-depth evaluation of the hospital's personnel, equipment and procedures, Wheeling Hospital was granted membership in the Radiation Therapy Oncology Group (RTOG) and the Gynecologic Oncology Group (GOG). These affiliations, the result of the Cancer Center's relationships with Fox Chase Cancer Center and West Virginia University Medical Centers, allow Wheeling Hospital doctors to enter patients into more than 50 national protocols and clinical trials. (Protocols are experimental treatments that may prove more effective than current treatments.) In the past, in order to be considered for such treatments, patients had to be evaluated at major medical centers in Pittsburgh, Cleveland or Columbus. Wheeling Hospital has also become a regional referral hospital for cancer cases. The hospital also is involved with the Sel
enium and Vitamin E C
ancer Prevention Trial (SELECT), a research study to determine if selenium and vitamin E can help prevent prostate cancer. SELECT is funded by the National Cancer Institute and coordinated by the Southwest Oncology Group.