Henry McFall of Savannah, Tenn. was the first patient to undergo stereotactic body radiation therapy (SBRT), the most advanced radiation treatment to target tumors, at Methodist University Hospital. He had a tumor wrapped around a vertebra in his thoracic spine that was causing him excruciating pain.

“The pain was so bad during the day that it was just unbearable,” said McFall. “I couldn’t even squeeze a tube of toothpaste.”

McFall underwent surgery through the back of his neck to remove as much of the tumor as possible. That surgery was successful, and Jason Weaver, M.D., a neurosurgeon with Semmes Murphey Neurologic and Spine Institute, determined the tumor was an aggressive benign tumor. Since the tumor also reacts well to radiation, he contacted Michael Farmer, M.D., a radiation oncologist with Methodist University Hospital. The remaining tumor in front of McFall’s thoracic spine was the width of just three sheets of paper away from his spinal cord, so he required a treatment with pinpoint accuracy and SBRT was the exact procedure he needed.

“The advantage of SBRT is that we can now treat tumors that we could not treat before,” said Dr. Farmer. “With the invention of image-guided radiation therapy over the last five years and with newer stereotactic localization systems that allow us to become extremely accurate with radiation therapy treatments, SBRT allows us to have millimeter accuracy when treating tumors.”

Until the development of SBRT, only two beams of radiation were used, one from above and one from below. In cases like McFall’s, that full dose of radiation would have directly hit his spinal cord. Now, using 3-dimensional therapy, radiation oncologists can use numerous beams of radiation to shape the dose around the contours of the tumor so the tumor receives a full dose of radiation, while nearby vital organs and healthy tissue are spared high levels of radiation.

“Not every patient needs surgery and I believe it is our role in communicating with other doctors about what the best possible treatment strategy is, whether it is radiation only, radiation and surgery, or simply observation,” said Dr. Weaver. “Ultimately our goal is to provide our patients with the best quality of life.”

SBRT is used to treat both benign and cancerous tumors such as spine, lung and liver tumors. It is very important to treat benign tumors that have an aggressive nature because these particular tumors grow rapidly and interfere with other areas of the body resulting in pain and adversely affecting a patient’s health. For instance, if a benign tumor is near the spinal cord, it can cause pain, weakness or numbness.

“Stereotactic radiation is a very accurate new technology that allows us to treat epidural disease which is disease right next to the spinal cord,” said Dr. Weaver. “One way radiation oncologists can target a tumor is to use instrumentation such as screws and rods that neurosurgeons have implanted to stabilize the spine. They can effectively target and use in real time these screws and rods to direct radiation beams to the precise location of the tumor.”

Often, the best candidates for stereotactic body radiation therapy are those who are not a good surgical candidate due to illness or other factors. SBRT offers doctors another option to treat patients with tumors, in many cases in conjunction with surgery.

 “I was so scared of having a second surgery because of my heart condition,” said
Mc Fall. “When the doctor told me I wouldn’t have to have any more operations and he was going to treat me with radiation that was the best news I ever heard.”

During the procedure, the patient is comfortably secured to the table to keep the patient as still as possible helping to ensure the radiation is delivered to the exact location where it is needed.  The linear accelerator moves 360 degrees around the patient delivering radiation beams at precise angles. Depending on each patient’s individual case, three to five high dose radiation sessions may be planned. Traditionally, low doses of radiation were given over several weeks.

“I never felt anything during the procedure,” said Mc Fall. “It was wonderful.”

Doctors are already seeing just how effective SBRT can be. “In non-small cell lung cancer patients who are not able to have surgery, we believe that there is an improvement in outcomes by using hypofractionated high-dose treatments over several treatments than extending low dose radiation over several weeks,” said Dr. Farmer.

Treating tumor patients whether the tumor is cancerous or benign, requires a collaboration of physicians including radiation oncologists, oncologists, medical oncologists, physicists, neurosurgeons, pain specialists, and primary care physicians.

For more information, go to methodisthealth.org.