When the headaches started, Ashley Santiesteban thought little of the pain. She’d always been a healthy kid, the 17-year-old Homestead girl said, so she would take some ibuprofen or another anti-inflammatory, and then everything seemed fine.
Until last month.
A seizure wrenched her from sleep in the middle of the night, landing her in the emergency room at Homestead Hospital. There, doctors found a mass on the left side of her brain. To her father, Juan Santiesteban, it was a horrifying moment: His daughter, this high school junior whose greatest concern the day before diagnosis was whether she’d ace her math test, now needed brain surgery.
Enter Baptist Health Neuroscience Center in Kendall — which acquired an intraoperative magnetic resonance imaging (iMRI) for use during brain surgery. The machine, which is suspended from the ceiling on rails and rolled into the operating room, produces high-resolution images that detail where the cancer is, and whether any more of a mass needs to be removed.
Given Ashley’s gumball-sized tumor and its placement, Dr. Vitaly Siomin, a neurosurgeon and medical director of the Brain Tumor Program at the center, believed this technology would be highly effective in helping a case like Ashley’s.
Baptist Health is one of several medical centers in South Florida that are attacking cancer using the latest technological innovations. Local oncologists and neurosurgeons say the increased exactness of where the treatment meets the problem, thereby reducing or eliminating injury to surrounding tissue, is one of the most exciting aspects of what they call “medical breakthroughs.”
At the Sylvester Comprehensive Cancer Center at UHealth-the University of Miami Health System, Dr. Lorraine Portelance touted Sylvester’s new MRI-guided radiation therapy. The radiation oncologist and vice chairwoman of the radio oncology department said doctors treated Sylvester’s first patient with this technology eight weeks ago. The machine integrates MRI technology, radiation delivery and software to locate, target and track the location and shape of tumors while delivering radiation.
“Now we can acquire images while the radiation beam is on, so we are looking at the tumor while treating it,” Portelance said, adding Sylvester is one of four facilities in the country to use this type of machine. The others are located in California, Missouri and Minnesota.
Over at Cleveland Clinic Florida, the Weston facility offers the Varian Edge Radiation Therapy, a radiosurgery technology that targets tumors in a shorter treatment course, said Dr. John Greskovich, the clinic’s medical director of radiation oncology.
The Edge is designed for malignant and benign tumors that are typically difficult or impossible to treat surgically, he said. While complex radio-surgery can take up to 60 minutes or more, the Edge procedure can last as little as 15 minutes.
“The Edge is a non-invasive technique to perform cancer surgery that saves patients from undergoing the knife. We are hoping the Edge will improve our [cancer cure rate],” he said.
For Dr. Minesh P. Mehta, deputy director and chief of radiation oncology at Miami Cancer Institute at Baptist Health South Florida, the cancer-fighting technology he is most excited about is headed to the Miami Cancer Institute (MCI) in 2017. The Proton Therapy Center at MCI will be the only one in South Florida and one of fewer than two dozen in the country. Mehta described the treatment as “painting” the radiation onto the tumor.
Proton therapy, like the treatments at Sylvester and the Cleveland Clinic, uses a pinpointed precision that doctors say reduces the risk of blasting healthy tissue. Nearly two-thirds of all cancer patients receive radiation; the key is to use a high-enough dosage to extinguish the tumor while minimizing radiation to other areas of the body.
“With pencil beam scanning proton therapy, we can effectively paint the radiation dose in and around the tumor almost on a dot-by-dot or spot-by-spot basis,” he said.
Using an example of oral cancer, Mehta said with regular radiation treatments the beam can also hit the mouth’s lining, causing sores and can lead to painful eating and swallowing. There’s also a risk of interior mouth burns and adverse effects on speech. Following radiation treatments for breast cancer, for example, patients can be at greater risk for developing cardiac disease, if heart tissue was compromised during the procedure.
Another side effect from less-precise radiation beams (think the difference of the head of a pin and a magic marker) is it can lead to a second cancer, Mehta said.
Back at the Baptist Health Neuroscience Center, Siomin talked about the six patients, including Ashley, who have undergone treatments using the intraoperative magnetic resonance imaging (iMRI) for brain surgery.
It is a technology that allows doctors to remove tumors completely, as it gives them a very accurate image of what remains following the surgery. So, if, following the surgery, the MRI shows residual components of the tumor, Siomin may go back in and remove the matter while the patient’s skull is still open.
In the past, the patient would be closed up and in ICU while the doctor reviewed the MRI. If the surgeon saw cancer that had not been removed during the surgery, then the patient would have to endure additional surgery so the doctor could remove the rest of the tumor he saw on the image.
For Siomin’s patient, Ashley, her brain surgery led to roughly a week-long hospital stay and what Siomin believes to be a great minimizing of the tumor. Ashley is doing well, and will be closely followed with MRI scans, Siomin said. While having a brain tumor probably sounds horrifying, including Ashley’s dad, Ashley seems unruffled by it all.
“It made me happy to get rid of it. Now I feel perfectly fine — no more headaches.” she said, giggling. Her main concern, again, is math class.