“Knife-less Surgery” Used by Team of Harbin Clinic Physicians to Successfully Treat Inoperable Brain Tumor

A team of Harbin Clinic doctors have used tiny beams of radiation to successfully destroy a tumor (cancer) deep in a patient’s brain that previously would have been considered inoperable. The Rapid Arc Radiotherapy surgery made no incision in the patient, required only a few minutes to perform, caused the patient no pain, and the patient went home immediately following the procedure.

Harbin Clinic Radiation Oncology has commenced treating cancer patients with Rapid Arc radiotherapy, a fast, precise form of treatment using advanced technology from Varian Medical Systems.

While Harbin Clinic has been treating inoperable brain tumors with stereotactic radiosurgery (SRS) for years, the new Rapid Arc treatment is two to eight times faster than conventional forms of radiotherapy and establishes Rome and Harbin Clinic’s cancer program as a comprehensive center for the treatment of what were formerly called inoperable brain tumors and other difficult to reach cancers.

Performing the procedure were Radiation Oncologist Dr. Matthew Mumber and Neurosurgeon Dr. Andy Stevens. The doctors used a frameless approach to stereotactic radiosurgery in combination with pretreatment CT based image guidance. The treatment was delivered on the Varian linear accelerator radiation treatment machine using the Varian Rapid Arc planning and delivery system. This combination resulted in one of the most technologically advanced radiosurgical treatment processes available in the world.

At Harbin Clinic, patients receive care from world-class cancer doctors in partnership with other Harbin Clinic specialists who have similar expertise in their fields. Teams of clinical experts work together to determine the best treatment options for individual patients based on the particular aspects of their cancer. The new brain tumor surgery program is a partnership between Harbin Clinic’s Radiation Oncology and Neurosurgery Departments.

According to Dr. Stevens, with advanced stereotactic navigation and microdissection techniques, open resection is used to treat a majority of brain tumors. The Harbin Clinic neurosurgeons, Drs: Stevens and John Cowan, Jr.routinely perform complex brain surgery to treat brain cancer and conditions effecting the brain and spine.

“However, despite advanced surgical techniques, some brain tumors are classified inoperable because of their location or size,” Dr. Stevens explained. “While open surgery may not be an option, the Harbin Clinic approach to stereotactic radiosurgery provides us with a tool to reach and often eliminate these brain tumors without damaging other parts of the patient’s brain,” he said.

Patients with inoperable tumors have traditionally received a series of radiation treatments. The goal of radiation therapy is to shrink or destroy the cancer over a period of time. According to Dr. Mumber, “Traditional radiation treatments may also be used as companion therapy with stereotactic radiosurgery and traditional surgery.” Harbin Clinic’s radiation oncologists, Drs. J.C. Abdou and Matt Mumber all have expertise in the treatment of brain tumors with radiation therapy.

The RapidArc System creates a micro fine high intensity radiation beam which is used like a scalpel to perform radiosurgery deep in the brain without creating an incision. The procedure is performed by the Radiation Oncologist based on a radiation plan developed in partnership with the Neurosurgeon. “RapidArc makes it possible for us to deliver highly-precise intensity-modulated radiotherapy (IMRT) treatments quickly,” said J.C. Abdou, M.D. “These treatments target tumors accurately while sparing the surrounding healthy tissues. Because they’re fast, RapidArc treatments are also easier on the patient. It’s hard for people to hold still for long periods of time. By delivering doses more quickly, we can simultaneously improve the quality of care and make our patients more comfortable.” RapidArc technology may also be used for treating other cancer sites including prostate, gastrointestinal, gynecologic, and cancers of the head and neck.

According to Drs. Mumber and Stevens, most of the work is done several days before the surgery. “We use Computed Axial Tomography (CAT) Scanners and Magnetic Resonance Imaging fused together in order to optimally target tumors,” Dr. Stevens said.

Dr. Mumber explained that the radiation plan may take several days and many hours to complete. Patients first come to the Harbin Clinic Radiation Oncology facility for the CT and MRI scanning performed in the treatment planning position. Data from the scans are then stored in the Varian treatment planning system and a team of dosimetrists and physicists work with the physicians to develop an individualized and highly targeted plan. The patient returns to the facility for the procedure after the plan is developed and tested.

“It is a true partnership,” Dr. Mumber said. “The two departments (Radiation Oncology and Neurosurgery) work together developing computer models defining the radiation procedure. Tumors are usually not centric balls but rather odd shaped clusters with many tentacles. The final plan is comprehensive and complex addressing the entire tumor.”

The procedure takes approximately 5 minutes and usually destroys the tumor. The patients feel no discomfort, and since there is no incision, they are able to go home right after the treatment. Additional radiological services and/or medical oncology treatment may also be used depending on the specific needs of individual patients.

According to Drs. Mumber and Stevens, this new procedure should successfully treat many patients who have been diagnosed with what has been considered inoperable brain tumors. It is anticipated that a growing number of patients from outside the area will be referred to the Harbin Clinic cancer program for this service.

“The real strength of our program – what makes it special – is the partnership and cooperation among Harbin Clinic specialists,” Dr. Mumber said. “Harbin Clinic’s Radiation Oncology and Medical Oncology Departments (which are now in separate buildings) will move to the new Cancer Center (currently under construction) early this coming year. This will further enhance the ability to Harbin Clinic physicians to work together, providing better medical services to our patients.”