Tuesday, March 16, 1999
Cancer center gains weapon
Hot-blooded procedure adds 'last piece'
BY TIM BONFIELD
The Cincinnati Enquirer
Georgia Sayers retired years ago from a 25-year career teaching first grade in Park Hills. Now, she's serving as an educator again — this time as a cancer patient.
Last week at University Hospital, Mrs. Sayers became the first Tristate patient to receive an unusual treatment for melanoma called hyperthermic isolated limb perfusion.
“Everything went very well. The perfusion went smoothly. We'll have to wait and see over the next several weeks to see how the lesions respond,” said Dr. Jeff Sussman, a surgical oncologist at University Hospital's Barrett Cancer Center.
Melanoma — the most serious and fastest-growing type of skin cancer — is highly curable when caught early enough. But for some patients, like Mrs. Sayers, the disease can spread so fast that radical procedures are needed.
The perfusion therapy that Mrs. Sayers received will be needed by less than 5 percent of melanoma patients. Doctors say the fact that such a treatment was available in Cincinnati, rather than requiring travel to an out-of-town cancer center, is one of several signs that local cancer care is becoming more sophisticated.
“As far as melanoma goes, there's nothing that M.D. Anderson (a famous cancer center in Texas) offers that we don't offer here,” Dr. Sussman said. “This is the last piece.”
A year ago, the Barrett Cancer Center launched a multidisciplinary melanoma clinic that involves teams of dermatologists, plastic surgeons, surgical and medical oncolo gists.
The clinic offers high-tech lymph node mapping to trace where melanoma cells are spreading. It also has expanded the numbers of patients involved in clinical trials from almost none to more than three dozen in the past year.
Beyond melanoma, UC recently installed an “X-knife” system to treat brain tumors and is nearing completion of the curvy-walled Vontz Center for Molecular Studies, where several cancer-related research projects will be based .
Beginning April 1, the Barrett Center will get its first full-time director in six years: Dr. Kenneth Foon, formerly director of the University of Kentucky's Markey Cancer Center.
The expanding commitment to cancer care couldn't have come at a better time for Mrs. Sayers.
The retired teacher, now 85, discovered she had melanoma two years when her po diatrist became concerned about a sore on the bottom of her foot. Dr. Andrew Lowy, a surgical oncologist at the Barrett Center, removed the growth and did tests to make sure the disease had not spread elsewhere.
Things were fine until a month ago, when two small growths appeared on Mrs. Sayers' leg. The growths were multiplying fast — within three weeks doctors counted at least nine.
“You could see them just popping out on my leg,” Mrs. Sayers said.
It was clear to the doctors that surgery to cut out the growths would not keep up with the disease. To prevent the cancer from attacking other vital organs, the doctors were considering amputating Mrs. Sayers' leg — which no one involved wanted to happen.
Enter hyperthermic isolated limb perfusion.
In this procedure, doctors use a tourniquet to cut off blood flow to the leg, then they route the blood that's still in the leg through a series of machines.
During the four- to six-hour process, the machines supply oxygen for the blood to keep nourishing leg tissues, heat the blood to more than 104 degrees and then use the blood to carry a powerful dose of chemotherapy through the entire leg.
The high temperatures and che motherapy work in concert to kill the cancer. The blood supply to the leg has to be rerouted because the high doses of medication would damage other organs and such a high fever for the entire body would be dangerous.
The perfusion technique has been done for several years at other cancer centers, but the Barrett Center didn't have the equipment. Now, the center expects to do six to 12 cases a year, Dr. Lowy said.
The “response rate” for perfusion therapy is about 80 percent, which means that many patients see their tumors shrink by at least 50 percent. The therapy actually cures melanoma in about a third of patients.
Even without a cure, the therapy can improve quality of life by preserving limbs and reducing pain, Dr. Lowy said.
It will be about three weeks before Mrs. Sayers finds out how well the treatment worked. Meanwhile, she said she wasn't too worried about being the first local patient to try the therapy.
“Well, it was the only thing for me,” she said. “I have a lot of faith and trust in God and a lot of trust in Dr. Lowy.”
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