Robotic surgery, heated chemo are weapons being deployed in ovarian cancer fight

05/23/2014 12:00 AM

05/24/2014 11:45 PM

In 2007, ovarian cancer survivor Leonor Rivacoba received the bad news. The cancer was back, and this time, it was in her liver, chest and abdomen. She was given three to four months to live.

A friend referred her to Dr. Fahed Fayad, a radiation oncologist at the CyberKnife Center of Miami. Using robotic surgery, he delivered radiation beams directly to the cancerous tumors.

“It’s like the heavens opened,’’ said Rivacoba, a 62-year-old married grandmother and office manager for Sazón Goya, a division of Goya Foods, where she has worked nearly 40 years. She is also personal assistant to Frank Unanue, president of Goya Foods of Florida.

With CyberKnife, a machine with a robotic arm applies high doses of radiation directly to the tumor and limits radiation to healthy tissue. CT scans are taken prior to the procedure to determine the location, size and shape of the tumor. Each treatment lasts between 30 and 90 minutes.

Before being treated by Fayad, Rivacoba had undergone surgery to remove her spleen and had undergone a bowel resection. She had become resistant to chemotherapy, Fayad said.

Rivacoba received the CyberKnife radiosurgery treatments before or after work. By 2010, Rivacoba was cancer-free and remained so for three years.

“That was stunning,” said Fayad of the three-year cancer remission. “My theory is that when we ablated all the tumors, her body developed immunity against the tumors. Not saying the immunity is durable… but slowed down her cancer for three years.

“It is something we have not seen before,” Fayad said. “We cannot ignore it.”

In December, the cancer returned to Rivacoba’s body and she underwent surgery to remove part of her left lung. She is currently undergoing chemo and recently had a scan of her breast, which showed she was cancer-free.

Ovarian cancer is the fifth-deadliest cancer for women, according to the American Cancer Society. The disease is responsible for more deaths than any other cancer of the female reproductive system. About 21,980 women will receive a new diagnosis of ovarian cancer this year, according to ACS estimates. About 14, 270 will die from the disease.

Ovarian cancer tends to strike older women. About 50 percent of women diagnosed with ovarian cancer are age 63 or older, according to ACS. The disease is more common in white women than African American women. The risk of a woman getting ovarian cancer is 1 in 72, and her chance of dying from the disease is 1 in 100.

Baptist Health Center for Robotic Surgery offers a treatment for recurrent ovarian cancer patients that combines robotic surgery with heated chemotherapy. After a patient has undergone robotic surgery to remove cancer, heated chemotherapy is infused into the belly of a patient while still in the operating room, said Dr. John Diaz, who specializes in gynecologic oncology.

“We can give higher doses of chemo into the belly than we could into the veins because we are eliminating some of the toxicities,” Diaz said. “The chemotherapy is in direct contact with the area where the cancer tends to recur, which is in the belly.”

With some patients, cancer begins to grow back while they are recovering from surgery and before starting chemotherapy, Diaz said. Ovarian cancer patients usually have three weeks of recovery after a robotic surgery. Injecting heated chemo while still in the operating room allows for maximum penetration into the cells.

Clinical trials have shown that non-heated chemo injected into the belly gave patients initial remission, but about half will have a recurrence of cancer, Diaz said. Fifteen patients have undergone the surgery with heated chemo at Baptist since 2011 and data is being collected to determine their outcome.

“We know that it is safe and feasible,” Diaz said. “We are not yet sure if it is better than the standard surgery. We think it is but we don’t have that data yet.”

At the University of Miami Sylvester Comprehensive Cancer Center, a clinical trial is under way to measure the response recurrent ovarian cancer patients have to receiving small amounts of radiation to the abdomen about six hours after chemotherapy. The trial is trying to determine if the treatment would hinder ovarian tumors’ propensity to become resistant to chemotherapy, said Dr. Aaron Wolfson, professor of radiation oncology at the University of Miami Miller School of Medicine.

“The theory is the body doesn’t resist the small amount of radiation,” said Wolfson, who is awaiting his first patient for the clinical trial that began in April. “But it has a big effect on making the chemotherapy work the second or even third time around.”

In 2010, Wolfson published the findings of a similar study regarding high-risk patients with endometrial cancer, which begins in the lining of the uterus. The 12 women involved in the five-year study tolerated the radiation treatment well. There was a 50 percent survival rate, which is usually 15-20 percent for standard treatment, Wolfson said.

Wolfson said his long-term goal is to apply the success of the radiation treatment to recurrent ovarian cancer patients. He hopes to study the results of the treatment over the next three tofour years.

“It is a high-risk group,” Wolfson said. “They have recurrent ovarian cancer and can’t have any more surgery. We are hoping that this treatment will at least be an initial attempt to see if this will work in this group of patients and we will go from there.”

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