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Children's Health Channel
Reported January 16, 2013

Zapping Cancer In Kids--Doctor's-In Depth Interview

Carol Marquez, MD, Associate Professor of Radiation Medicine at OHSU, talks about how TOMO HD therapy helps kill cancer.

Can you explain to me what we’re going to see?

Dr. Marquez: You’re going to see a machine that looks like a CT scan; you know a donut kind of shaped thing. Our other machines, by comparison are coming from a single beam and we can move it to come from different directions while the patients stay still on the table. We just move the machine around and move the table around to kind of get it to cover all around the target. For the TOMO therapy, it’s a donut and the beam is going to kind of come all the way around and the patient is going to slide through the donut. If you’ve ever seen a CT scan, you know the donut is not a very thick donut it’s a cake donut. The TOMO therapy is a raised donut; it’s a very long tube that the patient is going to go through. As they go through it the beam is going to be circling around them and delivering this dose of radiation. By using essentially so many different beams, we get that nice shaped dose distribution.

How many beams are there?

Dr. Marquez: There’s just one beam, but it’s spinning around the patient.

Tell me a little bit about Lilly.

Dr. Marquez: She’s just a really cool little kid. I have to say I will always remember my informed consent with Lilly. She was I don’t know nine or ten at the time of my initial discussion with her when I came to see her. I took her history. She could tell me everything that had happened in her oncologic history. Then I had to tell her about why I was going to give her radiation and what the possible side effects were. When I came to the side effect part she said, “okay let me get out my book.” So she gets out her book and she begins to start listing all of the side effects. Well that’s unusual; it’s unusual for an adult to be able to comprehend the side effects and to really listen with that intensity. For a nine or ten year old to do it, it’s unheard of. Usually they want to check out at that point. They don’t want to listen and they don’t really want to get that detailed, but not Lilly. She wanted to write down every single one and at some point it got to be too much, because it’s too much for anybody; it’s way too much for a ten year old.  Hearing the side effects was a lot for her to manage. She had to put her book down and just pause. It really hits you because she was so adult and composed.  She is still incredibly mature, noble, and graceful. She was just like, okay you need to stop for just a second and not tell me all those bad things that can happen. She put down her book and waited a little bit and she was like okay, what’s next. I’ll never forget that.

Does that just amaze you?

Dr. Marquez:  Totally, utterly amazed me. Everybody is different; everybody manages how they deal with the stress of their treatments differently. This kid was just really a joy to have under treatment. She was fun, interactive, always upbeat, always looking on the upside of everything, and just a total pleasure to take care of. Everybody is a pleasure to take care of in their own unique way, but she just really enjoying everything.

So what are the side affects you told her about?

Dr. Marquez:  There were short term and long term side effects.  She wasn’t worried about the short term effects. The long term side effects are the ones that were really concerning for her. Any time anyone is exposed to radiation there’s a small risk of that radiation causing a new type of cancer and that was a risk for Lilly, still is a risk for Lilly.  That was just a lot to hear for her because I told her that’s a risk you’ll have for the rest of your life. That’s a hard thing to have to hear; that you may fight it and beat it now, but you may still have a problem with this in the future that’s totally out of your control. Also she didn’t balk at the fact that her treatment was going to impact her lung function. She was not going to be a star athlete, but that one didn’t bother her that much. She was like can I still sing and dance?  Yes. So those were some of the long term side effects.

How long ago did she have treatment?

Dr. Marquez:  She had her treatment I think a year ago now.

What is her prognosis?

Dr. Marquez: Her prognosis is still limited; I mean she still has the disease. When she came to me, the disease had already spread to her lungs, so there is still a risk that she will succumb to this disease. We’re just watching her very closely now. She successfully finished all of her treatment and she did remarkably well.

So what makes this HD?

Dr. Marquez:  It’s just the next generation of it.  It’s able to do a couple of different things that other TOMO. We can use it in any kind of IMRT, anal tumors or lung cancers. We just have variety of tumors that we see, so really it can be used on just about anything. I don’t treat any of my breast patients on it though.

What was Lilly diagnosed with?

Dr. Marquez:  She has a metastatic Ewings sarcoma.

And what does that mean?

Dr. Marquez:  So she had a tumor of the bone and on her spine. That was the other thing about the TOMO; we were able to consolidate all of her treatments. We did a really extensive treatment volume on her. We treated both of her whole lungs and then her spine. We were able to kind of get all that done in one treatment plan and that was what the TOMO kind of helped us with.

What is a normal treatment plan for TOMO?

Dr. Marquez:  It really depends. The number of treatments is determined by the type of tumor, whether or not they’ve had chemo, and whether or not they’ve had surgery. So it really depends.

How many did Lilly have?

Dr. Marquez: Lilly had twenty eight treatments, daily treatments.

Right in a row?

Dr. Marquez: Yes, in a row. She had treatment every Monday through Friday, five days a week, twenty eight treatments total. It can cause fatigue, swallowing difficulties, and appetite loss for a lot of people. She didn’t get that nauseated, although she could have.  She had to stay still. Her treatment probably lasted at least fifteen minutes for her treatment time and prior to each treatment she had to have a CT scan on the table. We do a CT scan to make sure she’s in a perfect position. So that adds another five to ten minutes on the table, the whole time with her arms up. So she would lie on the table every day never missing a beat and usually asking me if she could go to school, because she’s just that kind of kid.

 

END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

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First to Know by clicking here.

 

If you would like more information, please contact:

 

Elisa Williams
Associate Director of Communications
Knight Cancer Institute, Oregon Health & Science University
(503) 494-8231
willieli@ohsu.edu

 

 

To read the full report, Zapping Cancer in Kids, click here.

 

 

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