Medicine always evolves. Each year, new research, tools and drugs give those with serious illnesses improved chances for better lives. Oklahoma physicians, hospitals and medical groups are on the forefront of treating a variety of diseases, such as stroke, breast cancer, brain tumors and lupus.
Light Energy Destroys Brain Tumors
Visualase at St. John Medical Center offers an alternative to traditional craniotomy.
Introducing a tool to treat brain tumors, St. John Medical Center offers Visualase – an MRI-guided, minimally invasive laser ablation system – as an alternative to a traditional craniotomy.
With Visualase, a laser is used to destroy unwanted soft tissue. A small incision is made in the skull and a laser applicator is inserted to deliver light energy to the target area. The temperature in the target area begins to rise and is observed under real-time imaging, allowing surgeons precise control of the tissue ablation.
“Laser ablation can be used on individuals with metastatic brain tumors, primary brain tumors – recurrent, not first line of treatment – and radiation necrosis– abnormal tissue caused by previous radiation therapy,” says neurosurgeon Tyler Auschwitz, St. John director of neuro-oncology. “Laser ablation can also be used where there is a focus for seizure activity.”
Benefits of laser ablation include minimal invasiveness, a shorter hospital stay (often one day), little or no hair loss, and a small suture to close the incision.
“A craniotomy is much more invasive with a larger incision, longer recovery – minimum of two-to-three-day hospitalization and usually longer – and a greater chance of post-operative complications due to the invasive nature of the procedure, such as infection, hemorrhage, stroke, weakness and speech difficulties,” Auschwitz says.
He describes the technology as “one more tool in the arsenal” to treat patients with brain cancer.
“With every new and additional treatment option we can provide, we … offer patients extended overall survival with improved quality of life,” he says.
Imaging Software Helps Stroke Patients
Mercy Hospital has added Rapid to its protocol.
According to the Centers for Disease Control and Prevention, stroke kills about 140,000 Americans each year and is the leading cause of serious, long-term disability. Recently, the guidelines involving the early management of strokes changed.
It was previously thought that for stroke patients to benefit from certain treatments, they had to begin within six hours of symptoms becoming present. Now, studies have shown that stroke patients may benefit up to a day after the onset of symptoms. Supporting these changes is a new technology called Rapid, a fully automated, image-processing platform. Mercy Hospital in Oklahoma City recently added the program to its comprehensive stroke protocol.
“Rapid is a software program utilized in conjunction with a CT [scan] to help determine how many brain cells have died and how many are at risk of dying,” says Amber Elliott, Mercy’s director of neurosciences. “The software was utilized in [previous] trials. The data the software provided to these studies is now guiding stroke treatment up to 24 hours in our hospital.”
She says Rapid allows providers to screen more patients for potential treatment and treat more of them based upon the protocols used in the recent medical trials.
“Additionally, it is very fast and a standardized algorithm, which ensures that we are getting accurate information in a timely manner,” Elliott says. “Combining these aspects, Rapid and the 24-hour stroke window have the potential to drastically improve stroke survivors’ lives by decreasing the severity of disability – possibly even eliminating disability in some cases.”
She emphasizes that it’s important to know the signs and symptoms of a stroke and know what nearby hospitals are comprehensive stroke centers, which can treat all forms of stroke.
Treating Gynecologic Cancer
A scarce pool of specialists expands at Cancer Treatment Centers of America in Tulsa.
Gynecologic cancers are fairly common; more than 107,000 women in the United States and about 1,000 women in Oklahoma will be diagnosed with one of these diseases in 2018, according to the American Cancer Society and the Centers for Disease Control and Prevention.
To expand clinical offerings for patients with gynecologic cancers and add to Oklahoma’s short list of specialists in the field, Cancer Treatment Centers of America in Tulsa added David McIntosh as a gynecologic oncologist. There are only about a dozen such specialists in Oklahoma, and McIntosh is one of six in metropolitan Tulsa.
“Gynecologic cancers may be complex. That is why seeking medical advice from a physician … trained in gynecologic oncology is so important,” says Daniel Nader, chief of staff at the Tulsa hospital. “Dr. McIntosh is trained in robotic surgery and has performed close to 100 cases over the past two years. He is dedicated to using evidence-based cancer treatments to fight gynecologic malignancies on multiple fronts.”
McIntosh provides patients with continuity of care throughout their cancer journeys by performing complex surgeries and guiding treatment, which may include chemotherapy and radiation therapy.
First Lupus Prevention Trial Begins in Oklahoma
Oklahoma Medical Research Foundation is a leader in treating this autoimmune disease.
Lupus – a chronic autoimmune disease that can damage skin, joints, organs and other parts of the body – affects about 1.5 million Americans, according to the Lupus Foundation of America.
Scientists at Oklahoma Medical Research Foundation gathered data from decades of studies and identified elevated blood markers in individuals with a high risk of developing lupus. To test whether prevention of the development of full-blown clinical lupus is possible, they have begun a clinical trial at the Oklahoma City-based foundation. The initiative represents the world’s first clinical trial aimed at preventing lupus, which has no known cure.
The trial, known as SMILE (Study of Anti-Malarials in Incomplete Lupus Erythematosus), first uses biological testing to identify people at high risk for developing lupus. Foundation physicians then give these individuals an immune-modifying medication with the hope that it will prevent the disease from developing, delay its onset or lessen its symptoms if it does develop.
“For some time, our lab has been interested in understanding the first things that go wrong in the body that lead to lupus,” says Dr. Judith James, the foundation’s vice president of clinical affairs and leader of the trial. “Now we want to find ways to identify people at high risk so we can offer help before the damage starts.”
For those interested in participating or learning more about the trial, call 405.271.7221.
Detection of Recurrent Prostate Cancer
Oklahoma Cancer Specialists and Research Center is the first in the state to offer a new imaging agent.
For anyone who has survived cancer, there’s always a concern that the disease will return. To support prostate cancer survivors, the Oklahoma Cancer Specialists and Research Institute in Tulsa became the first in the state to offer Axumin, an FDA-approved diagnostic imaging agent (or tracer) that helps to determine if and where prostate cancer has returned.
According to the Axumin website, up to a third of men treated for primary prostate cancer will experience a biochemical recurrence within 10 years, and a third of those will develop metastatic disease within eight years. The Axumin exam is for men with suspected prostate cancer recurrence, based on elevated prostate-specific antigen (PSA) levels after treatment.
Once a patient receives the Axumin injection, he undergoes a combined positron emission tomography (PET) and computed tomography (CT) scan. The Axumin website states that the agent, like many tracers, includes a radioactive element (fluorine 18) used to produce images of the body and its internal organs and tissues. Over time, fluorine 18 becomes non-radioactive and much of it leaves the body through urine.
Approximately one in nine U.S. men are diagnosed with prostate cancer and an estimated 164,690 new cases of prostate cancer will be diagnosed in 2018, according to the American Cancer Society. However, despite these numbers, the society reports that most men diagnosed with prostate cancer do not die and that more than 2.9 million American men who have had prostate cancer are alive today.
Life Support Therapy Saves Lives
ECMO is now used for longer periods on adults at INTEGRIS.
Oklahoma City’s INTEGRIS has given patients on the brink of death a fighting chance. As part of a specialized life-support program, the hospital offers extra-corporeal membrane oxygenation, known as ECMO, as a last-resort, lifesaving technique.
ECMO technology isn’t new – it’s traditionally used to support underdeveloped hearts and lungs in premature babies – but medical advancements have led to increased adult usage and longer periods of use. INTEGRIS reports that a severely ill patient, Adrianne Ayers, was recently dependent on ECMO for 119 days, setting a hospital record for a person benefiting from this technology.
ECMO provides both cardiac and respiratory support to patients whose hearts and/or lungs are so severely diseased or damaged that they can no longer function – perhaps after a heart attack, cardiac surgery, pulmonary embolism, near drowning or lung-related issues from flu or pneumonia.
“The old ECMO technology didn’t allow us to run ECMO long enough to give a patient time to recover,” says Aly El Banayosy, a transplant and acute circulatory support critical care physician with the INTEGRIS Advanced Cardiac Care team. “It would be used for two days previously; now we can use it for much longer than that for the heart and lungs to recover or to prepare for any necessary surgery.”
The therapy continually pumps blood from the patient via a tube inserted into the groin vessels or neck vein. The blood is pumped through an artificial lung that imitates the gas exchange process of the lung by removing carbon dioxide and adding oxygen before returning the blood to the patient. The goal is to allow the heart or lungs to rest and recover while the machine does the work. When the heart or the lungs have healed and can work on their own, the lifesaving support of the ECMO artificial heart/lung machine is weaned, then removed.
Five-Fraction Radiation EASES Chemo’s Side Effects
Stephenson Cancer Center unveils a targeted, shortened breast cancer therapy.
Working to lead the state in breast cancer care, Stephenson Cancer Center in Oklahoma City has introduced five-fraction radiation as part of its advanced treatment options. A candidate for this therapy must have a relatively low-risk breast cancer and require a lumpectomy.
“Five-fraction radiation is a type of partial breast irradiation,” says Christina Henson, a radiation oncology specialist at Stephenson and an assistant professor with the University of Oklahoma College of Medicine. “This means that rather than doing the traditional treatment of the entire breast, we focus our treatment just on the area where the tumor was. This is done in five treatments – 5 to 10 minutes each – over the course of a week and a half. It is noninvasive and the patient feels nothing – much like getting a CT scan.”
In comparison, she says the more common, traditional type of radiation treatment after a lumpectomy for breast cancer is daily treatment for a month to the entire breast. This frequency is often inconvenient and, for some women, causes fatigue and significant irritation of the skin. With five-fraction radiation, a smaller area is treated, thus minimizing skin irritation and fatigue and lowering the risk of lymphedema (uncomfortable swelling of the arm.)
Additional parameters for eligibility include that the patient should be at least 45 years old with a tumor measuring no more than 3 centimeters.
“She cannot have cancer in her lymph nodes, and the surgeon needs to have gotten the entire tumor out,” Henson says. “We also ask that the surgeon place a marker in the lumpectomy cavity at the time of surgery so that we can better target the area.”
She also notes that the largest trial comparing this type of treatment to the more traditional treatment resulted in the same recurrence rate but side effects and cosmetic outcomes were significantly better with the shorter course of radiation.
“An overarching goal right now in the field of cancer treatment is ‘less is more,’” Henson says. “If we can provide the same or better outcomes with fewer side effects, and convenience as a bonus, we want to do so.”
Pediatric Stroke Team Makes Every Minute Count
Saint Francis Health System has created a pediatric stroke protocol that saves lives.
Stroke is often considered an elderly condition, but this life-threatening condition has no age requirement. Stroke is one of the top 10 causes of death for children between 1 and 19, according to the National Stroke Association. To provide specialized care for these patients, the Children’s Hospital at Saint Francis and Saint Francis Hospital created a pediatric stroke team last year.
The team has critical care nurses, pediatric pharmacists trained in pediatric stroke, and pediatricians specializing in emergency medicine, critical care medicine, radiology, neurology and neurovascular surgery.
“The phrase ‘Time is Brain’ applies at any age,” says Kelly Kennebeck, the clinical process improvement supervisor at the children’s hospital. “A delay in recognizing the signs and symptoms of stroke and initiating appropriate interventions when it occurs can result in greater neurologic impact for kids, just as it can in adults.”
Kennebeck says physicians and nurses assessing the possibility of stroke within pediatric patients must acknowledge developmental milestones and capabilities so that they can recognize abnormal conditions of those children.
“Sometimes, using interactive techniques, such as making a game out of a neurological assessment, can help to calm a frightened child and yield better insight into any cognitive or physical deficits that may exist,” she says.
Using the National Institutes of Health’s pediatric stroke scale, the Saint Francis team, on average, completes a pediatric stroke screening within 9 minutes of seeing the child.
“This prompt evaluation has facilitated the rapid initiation of a pediatric stroke protocol, more rapid completion of radiologic and laboratory diagnostic studies, and more timely initiation of needed medications and interventional therapies, if indicated,” Kennebeck says.