Lung cancer patient Denise Dopico shares her personal story.
Respiratory Gating: Breathtaking Precision
Timing radiation beam delivery with the patient’s natural breathing cycle raises the prospects of better outcomes.
Denise Dopico says her life took a little detour in December 2003. After a busy day of last-minute holiday shopping, the 44-year-old mother of four was relaxing at her home in West New York, New Jersey, when her left arm twitched briefly. At first she thought it was the way she was sitting, but when her whole body began twitching she went straight to her local hospital. With no other symptoms, Dopico says she could hardly believe the test results: small-cell lung cancer with brain metastasis and an average survival outlook of three to five months.
"I thought my life was over, that I would suffer dementia and then die," Dopico says. "But a friend of my brother told me about some great cancer doctors at the Holy Name Hospital." After unsuccessful chemotherapy, Dopico was referred to Charles Vialotti, MD, medical director and head of radiation oncology at the Holy Name Regional Cancer Center in Teaneck, New Jersey. Dr. Vialotti is a pioneer in respiratory gating therapy—a unique Varian technology that tracks the position of tumors as patients breathe, enabling doctors to choose exactly the right moment to target the tumor. This unique technology opens the door to a new level of precision, allowing doctors to increase the dose of radiation to destroy the tumor while minimizing harm to surrounding tissues. In addition to respiratory gating therapy for her lung tumor, Dopico was treated with external-beam radiation as well as noninvasive stereotactic neurosurgery for the brain lesion.
"The results have been tremendously encouraging in almost every case we've treated," says Dr. Vialotti, who has used respiratory gating therapy on about 40 patients in the past year. "We're treating many kinds of tumors throughout the body—liver, stomach, heart, and esophagus. And we're seeing dramatic advantages, not the least of which are excellent local control and minimal toxicity."
At the Klinikum Dortmund, the clinical arm of Munich University in Dortmund, Germany, doctors are using respiratory gating technology on lung and breast cancer patients. Many of these patients have delayed seeing their doctors, which often means tumors are well advanced with metastases by the time they are diagnosed. Nevertheless, Ralf Rohn, MD, head of the radiology department, is encouraged by the results so far. "There is no doubt that respiratory gating can be beneficial to patients," Dr. Rohn says. "It enables us to reduce treatment margins, spare normal tissue, and increase patient comfort." Dr. Rohn and his colleagues are planning to expand the gating program to treat abdominal tumors.
