Close to home

Before the recent arrival of two sophisticated cancer-treatment regimens in the Rio Grande Valley, patients frequently had to travel outside the region to obtain them.

Brownsville resident Antoinette Connaughton has been able to get radiation treatments for uterine cancer close to home - something that helped ease her anxiety.

"It's a good feeling to know that when we need help, the help is here," said Connaughton, a retired school administrator. "(The treatment) was so convenient for me. I didn't have to interrupt my lifestyle."

One of the therapies is called high-dose rate brachytherapy, typically used to treat cervical, uterine, prostate and lung tumors. In this type of therapy, radioactive material is placed in and around a tumor for a few minutes at a time and then withdrawn.

The doctors plan the procedure in advance, mapping the tumor site using a CT scan and computer software. Next, they insert small cylinders into the body, using three-dimensional images to pinpoint where the radiation needs to go. The radioactive material is then deployed remotely through a computer-controlled device, and then removed after about 15 minutes.

In about four to five sessions, the therapy is complete.

"This treatment is a lot more precise (than other types of radiation)... and it's an outpatient procedure," said Dr. Carlos Gonzalez-Angulo, radiation oncologist at South Texas Cancer Center in Brownsville. The center is part of Texas Oncology, a statewide network of cancer centers.

Texas Oncology recently purchased a mobile brachytherapy unit that the Valley's cancer centers will share, Gonzalez-Angulo said. The procedure is already offered in McAllen, but this is the first mobile unit that will be used throughout the Rio Grande Valley, he said.

The Valley's cancer centers already offered low-dose rate brachytherapy, which is still the standard radiation treatment for some types of cancer, doctors said. With low-dose therapy, though, each treatment lasts hours or days, and the patient must stay in the hospital overnight, according to the American College of Radiology.

High-dose therapy is more convenient for patients because it's outpatient, and the short bursts of radiation allow nurses and staff members to have more contact with the patient, Gonzalez-Angulo said. Staff members only have to stay out of the room for a few minutes to avoid radiation exposure, rather than for hours.

A handful of patients in Brownsville and Harlingen have received the treatment so far, clinic officials said.

Gonzalez-Angulo predicted that eventually, the cancer centers would need another mobile unit to keep up with demand.

According to figures from the Texas Cancer Registry, about 18 women per 100,000 in the region had uterine or unspecified reproductive cancer from 2000 to 2004. About 71 per 100,000 men and 32 per 100,000 women had lung cancer. The expected number of cases has stayed nearly the same in the last few years, according to the registry.

However, more and more patients in the Valley will seek this treatment, Gonzalez-Angulo predicted.

Another treatment that's new to the Valley is a radiation therapy that uses precise X-ray beams to attack tumors in the brain. A group of neurologists in Harlingen has performed the procedure, called stereotactic radiosurgery, on about five patients, they said. Before now, those patients would have been required to seek treatment in Houston or elsewhere in the state, said neurologist Dr. Jose Dones.

The region generally sees about 110 cases of brain cancer per year, according to figures from the Texas Cancer Registry.
Radiosurgery starts with a great deal of planning, Dones said. The doctors use three-dimensional images of the brain to map the course of treatment. The patient next is fitted with a helmet-like frame so the head will be immobile and the radiation dose delivered exactly to the right site.

The linear-accelerator device that emits X-ray beams is calibrated to the millimeter so the aim is perfect, Dones said.
"With the brain, you have to be precise," he said.

During the procedure, several beams converge on the targeted area, like a "guided missile," he said. The actual procedure can take up to 30 to 45 minutes, he said.

This procedure is more precise than whole-brain radiation and minimizes exposure of healthy tissue to radiation, Dones said.
"We can double or triple the amount of energy we can deliver (to the tumor) without the side effect of hitting other structures," he said.
A variety of brain tumors and pituitary-gland tumors can be treated this way - including tumors that are lodged deeply in the brain and might be inoperable, he said.

Radiosurgery is an expensive venture - the device and corresponding software cost about a half-million dollars, officials said. But the neurologists decided the cost was worth it, Dones said. The doctors predicted that about 100 patients a year would benefit from the treatment.

Both procedures should be covered, at least in part, by Medicaid, Medicare and private insurance, the doctors said.

Dones said it made sense to bring more cutting-edge cancer treatments to the Valley.

"We're giving hope to people that they can live longer, cancer-free," Dones said. "I think everybody deserves that."