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Cancer treatment's future the present in Casa Grande

Surgery, radiation done simultaneously on patient with pacemaker - procedure, unique in Arizona, speeds recovery

By Melissa St. Aude
Staff Writer

Published: Monday, November 14, 2011 4:12 PM MST

When Barbara Poindexter learned she had breast cancer earlier this year, she prepared emotionally for the traditional unpleasantness of cancer treatment.

Living in Casa Grande as a retired nurse, Poindexter had seen family members and friends struggle through cancer treatment and expected that freeing her body of the disease would require a mastectomy followed by several long weeks of radiation therapy.

“I trusted the doctors and left everything up to them, but I knew cancer treatment could be tough,” she said.

But when her surgeon, Dr. Ramon Mourelo, referred her to radiation oncologist Dr. Ajay Bhatnagar, Poindexter’s dread over the impending cancer treatment began to fade away.

On Sept. 30, Poindexter made history when she was wheeled into the operating room at Casa Grande Regional Medical Center and became the first patient in Arizona to have a new intra-operative radiation treatment while still in the operating room.

“I get goose bumps when I think about it,” she said.

By the time she awoke from the procedure, Poindexter, 79, was cancer-free. A few hours later, she was discharged from the hospital and required no follow-up treatment.

“By the end of the day, she was up and about, and by the next day, she was cooking,” her husband, Clarence, said.

Poindexter’s treatment was part of a national clinical trial aimed at assessing cancer recurrence, serious adverse events and cosmetic results following intra-operative radiation therapy.

CGRMC and Cancer Treatment Services Arizona are among 10 centers across the country to take part in the trials, and they are the first in Arizona to use the machine as an intra-operative treatment.

To treat Poindexter’s cancer, Mourelo surgically removed her breast tumor — a procedure also known as a lumpectomy, and then, while she was still under anesthesia and on the operating table, Bhatnagar inserted a thin needle into the tumor site and with the press of a button, delivered a therapeutic dose of radiation.

The radiation was delivered with CTSA’s Xoft Axxent Electronic Brachytherapy System, a treatment machine, which unlike its traditional counterparts, is lightweight and easy to transport from the doctor’s office to the hospital operating room. It also has minimal shielding requirements so it is safe for the patient as well as the doctors and staff in the operating room.

With traditional radiation therapy, the patient is typically alone in a room while doses are delivered remotely by personnel, who must be shielded from the radiation.

“Radiation therapy usually has intensive shielding requirements that most hospital operating rooms can’t accommodate,” Bhatnagar said. “This machine eliminates that intensive shielding requirement, so any operating room can accommodate it — even a regional hospital.”

Another patient underwent the same procedure later that day at CGRMC with Dr. Joyce Bonenberger performing the lumpectomy and Bhatnagar again delivering the intra-operative radiation treatment.

Bhatnagar said the procedure is the future of cancer treatment.

“This is a cancer treatment that takes 10 minutes and eliminates the need to have weeks of radiation therapy,” Bhatnagar said. “By delivering the radiation at the time of surgery, these patients will only receive this single dose of radiation to treat their breast cancer, greatly reducing treatment and recovery time.”

Although Cancer Treatment Services Arizona commonly uses the machine to treat skin, uterine and breast cancers in office — a regimen that requires several visits and anywhere from one to six weeks — delivering the treatment in the operating room is new.

Bhatnagar said that Cancer Treatment Services Arizona has treated about 150 cases of skin cancer using the machine in the office.

But Poindexter was an ideal candidate for trying the machine in the operating room because she has a pacemaker on her left side, close to the tumor site, and had other medical issues that made traditional radiation therapy and weeks of treatment difficult.

“Barbara’s case was complicated,” Bhatnagar said. “People who have a pacemaker near their tumor cannot undergo conventional beam radiation unless the pacemaker is moved because the radiation can interfere with the device.”

Having the pacemaker on her left side, near the breast tumor, meant that she would either have to have a mastectomy or have the pacemaker moved to the other side. Also, to be treated with a normal one- to six-week regimen of radiation therapy would require a catheter to be left in her breast for the duration of the treatment. Due to other medical issues, that option was not ideal, Bhatnagar said.

“Breast conservation was an important priority,” Bhatnagar said. “There are situations where women undergo a mastectomy rather than a lumpectomy for many different reasons. In some cases, it’s because they live too far from a radiation facility or because transportation for six weeks is difficult to arrange. Here we were in this situation where, because of the pacemaker and other medical problems, a six-week run of radiation was not suitable.”

A lumpectomy followed by inter-operational radiation therapy allowed Poindexter to be rid of the tumor, keep her pacemaker in place and wake up from the procedure cancer-free as well as eliminating the need for additional treatment.

“She exemplifies the reasons and the benefits for this treatment,” Bhatnager said.

One month after her lumpectomy and intra-operative radiation therapy, Poindexter said her life is back on track and she is thankful that cancer is behind her.

“I feel good,” she said. “I think this treatment is something that people need to know about.”

Although the inter-operative therapy is only being used to treat breast cancer, Bhatnagar expects that uses for the new technology will grow.

“I think we will eventually be treating other types of cancer with this,” Bhatnagar said.

Who can get it? Candidates for intra-operative radiation treatment must be women at least 45 years old with a breast tumor about an inch or less in diameter that has not spread beyond the breast tissue.

Think it’s for you? Those who believe they are candidates for the procedure may call Dr. Ajay Bhatnagar at 836-9800.

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