Smoke 'Em If You Got 'Em

Cleveland Clinic may have found a way to kill those pesky lung tumors. Camel Cash not accepted.

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Dr. Raymond Rodebaugh says the new Cyberknife - "hasn't been tested in the world yet." - Walter  Novak
Dr. Raymond Rodebaugh says the new Cyberknife "hasn't been tested in the world yet."
In the 1930s, when Frank Stern began smoking, he paid a dime a pack. He burned Old Golds, then Chesterfields, then Raleighs.

Around 1987, 55 years after he began smoking, he quit. The Mayfield man says he hasn't lit up since. Now 88, Stern is a robust, still-restless senior with an 88-year-old girlfriend and bowling buddies. But the cigs finally caught up with him. Last October, a chest X-ray found a small tumor lurking in his right lung.

Doctors told him he could let the cancer slowly kill him, or he could die trying to kill it with surgery and/or heavy radiation. Either way, Stern had but two years to live.

Joann Cline was encountering a similar fate. The 73-year-old Perrysburg woman didn't have long to live. She had never smoked, but a rare form of cancer sprouted on the lining of her lung eight years ago.

Cline underwent surgery. Yet every time a tumor was taken out, a new one -- or two -- grew back in its place. Over two years, her body absorbed four surgeries. When another tumor turned up in April 2000, doctors offered either to remove the entire lung or to treat her with radiation -- at a level she describes as "victim of Chernobyl."

Lung cancer kills about 160,000 people each year, according to the American Cancer Society -- as much as colon, breast, and prostate cancer combined. Of those who find malignant tumors in their lungs, 86 percent are dead inside five years. Cline and Stern were looking at much less -- which proved to be their good fortune.

At the time, the Cleveland Clinic was launching its Cyberknife experiment, a lung cancer treatment that involved no surgery, no side effects, and virtually no pain. "It's a fairly new application that hasn't been tested in the world yet," says Dr. Raymond Rodebaugh, a medical physicist. "We tend to start these studies with patients who have no other effective means of treatment."

Translation: He was looking for people whose lungs and fate left them screwed. So the clinic rounded up Cline, Stern, and eight other people who met the nothing-to-lose prerequisite. "They figure we're washed up, ready for the other side anyway," says Cline.

The $3 million Cyberknife is a 12-foot-tall robotic arm that uses the same computer-guided technology employed in the "smart" bombs that annihilated Iraqi bridges and factories during the Gulf War. It was previously used to treat brain cancer, where stationary tumors could be targeted with huge, precisely aimed doses of radiation.

Killing lung cancer would prove a greater challenge, since breathing makes tumors a moving target. Misfiring means tearing up healthy tissue. But clinicians appear to have found a way around this obstacle.

Bent like an elbow, the Cyberknife hovers over the patient, who lies still in a form-fitting mold. Doctors don't actually see the patient. They're in an adjacent room, watching computer screens, as the Cyberknife, operating by images of the patient's body, moves in perfect sync with the patient's breathing, tracking the tumor and shooting beams of radiation from every angle.

The procedure, which takes two to three hours, involves not a single incision. Only slight pain comes when gold beads are injected into the tumor, which allows the device to locate the problem area.

"I'm laying there like this," says Stern, putting his arms above his head. "I hear a little whir, a little click. There's no one in the room but me and this monster!"

Cline says she felt no ill effects and was active the next day. It was a far cry from her three previous thoracotomy operations, in which the ribs are sawed or spread by a splitter. In the first operation, doctors removed a two-and-a-half-pound tumor that was the size of a "small football," Cline says. The second found a tennis-ball-sized tumor, while the third extracted both tennis-ball- and golf-ball-sized tumors. Her fourth involved open-heart surgery, in which two more sizable tumors were discovered.

After the most recent surgery, she was bedridden for the better part of 10 weeks.

"The doctor told me flat out, 'We can't keep doing this. We can't keep putting you under, doing this to your body. You just won't make it,'" Cline says. "When I saw [the Cyberknife] -- even if it might not really work -- it didn't give me any worse chance than the previous surgeries."

By comparison, it was "a walk in the park." Stern brags that he took his girlfriend out for dinner the very day he was under the Cyberknife.

But if Stern thought it was a miracle cure, it would be a while before he convinced friends and family. A retired physician he knows said the whole procedure sounded "fishy." Stern's 90-year-old brother also thought it unwise for him to volunteer for the clinical trial.

"He said, 'You're gambling.' I said, 'What do you mean, I'm gambling? The other way, I know what's going to happen to me: I'll have to go into a nursing home and die. This way, at least I have a chance.'"

His bet appears to have paid off. Of the 10 original volunteers, 2 didn't last. One man's tumor was shrinking after Cyberknife treatment, but he died of an infection unrelated to cancer. Another man's tumor had grown too large by the time he went under the robotic arm; he also died.

Yet Stern, Cline, and the other six patients are very much alive. Rodebaugh won't say they're cured, but four months after the treatment, the patients have all seen exactly what they hoped to see: shrinking tumors.

Cleveland Clinic is one of the nation's leading medical research facilities, but the Cyberknife results are a big deal even by the clinic's standards. Dr. Roger Macklis, chairman of the Department of Radiation Oncology, made sure the clinic bought a Cyberknife -- there are only five in the world -- and he's giddy over the investment's early dividends. The first experiment shows "profound potential" for killing other forms of cancer, he believes, especially since lung cancer is so difficult to treat.

"In essence, we're doing the hardest part first," says Dr. Richard Crownover, the oncologist on the study. "If we can treat lung tumors, where the movements are very large and complicated, then it means we can easily treat other kinds of tumors using the same method."

The clinical trial is still in its first phase. The next group of 15 patients will receive increased radiation, which enhances the Cyberknife's power, but also entails more risk of damage to healthy tissue. A study on prostate cancer recently commenced, and Crownover says the clinic will be testing the robot's effect on liver and breast cancer soon.

"We can treat a whole new crop of patients radiosurgically, in the rest of the body," says Crownover. "If I were to speculate wildly, I'd say that may turn into 10 to 15 percent of cancer treatments, and that's a lot."

Macklis, however, is quick to point out that "we have not cured lung cancer." The Cyberknife can't treat the largest, most lethal tumors, because the doses of radiation needed would harm healthy tissue. And the procedure can't eradicate cancer that's spread throughout the body.

The key is catching tumors while they're small and manageable. That means no operating tables, no chemotherapy, no prolonged hospital stays.

Stern, retired since 1964, has never been a homebody, but since his cancer treatment, he's caught a second wind. He not only bowls; he sits on the Friends of the Mayfield Library committee and organizes dances and other social outings for seniors.

Cline is happy to stay at home. She's nursing her ailing husband and watching after two grandchildren. For the first time in eight years, she finally feels she has the upper hand against her tumors.

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