By Dr. Edward M. Soffen
Radiation oncologist, J. Seward Johnson Sr. Radiation Oncology Center, University Medical Center at Princeton
Friday, March 29, 1996
Publicity about radon, nuclear waste and fallout have caused the public to view radiation as a danger. The use of radiation in cancer therapy, however, is one instance in which its power has been harnessed to the benefit of humankind.
For many years, radioactive isotopes have been important tools in diagnosing and treating patients with cancer. Today, the therapeutic role of radiation has expanded to include two new forms of radiopharmaceutical compounds.
The first new area includes systemic radiotherapy and uses the radionuclide strontium 89, which is given intravenously to treat cancer that has spread to the bone in a process called metastasis. The second area involves new radioactive seed pellets that can be implanted in the prostate gland to control or eradicate localized prostate cancer.
Strontium 89 (under the brand name Metastron) is used to treat painful bone metastases that can accompany breast or prostate cancer. Once injected, strontium 89 is selectively taken up by the bone tissue surrounding the metastasis. The body treats the strontium as if it were calcium, putting it into the bone surrounding the cancer. The strontium then bathes the tumor with radiation while sparing all the normal tissues in the body. Strontium emits beta particles which kill the cancer. The tumor shrinks, relieving pain. The development of painful new tumor sites is also slowed or eliminated.
Previously, the palliative treatment of choice included powerful pain medications such as morphine that are derived from the opium plant. These medications mask the pain, but do not actually kill the cancer. They also have side effects that can interfere with the patient’s ability to enjoy life.
In its use at University Medical Center at Princeton and other cancer treatment centers, strontium 89 therapy has improved the quality of life for patients whose care focuses on the palliation of pain. When patients receive strontium 89 therapy, the great majority – over 75 percent – experience significant pain relief and fewer report new pain areas.
Many are able to dramatically reduce or completely eliminate their dependence on analgesics. With increased freedom from opiates, their quality of life improves dramatically. Among the lifestyle changes for these patients has been an increase in mobility that improves their ability to participate in familiar activities and return to a more normal lifestyle. After one injection, the therapy may be complete or may be repeated at three-month intervals if necessary.
Strontium 89 systemic radiotherapy is still a new tool in the fight against cancer. To date, it has been used on a selective group of patients as a valuable adjunct to the use of External Beam Radiation. EBR treats the metastatic cancer that falls within the range of the focused X-ray beam, but the strontium radioisotopes target all skeletal metastases, including those that may not yet have been diagnosed.
Like many other forms of modern cancer treatment, strontium 89 is done on an outpatient basis, further helping the patient to enjoy as normal a lifestyle as possible. Other treatments are available to control metastatic prostate cancer, including hormonal manipulation or chemotherapy. Both of these may be used before, after or in conjunction with, strontium 89.
On the other side of the treatment spectrum, the best cure for prostate cancer remains early detection. Through regular check-ups, starting at age 40, a man who develops prostate cancer may have it addressed at an earlier-therefore more curable-stage. Earlier detection and treatment may also improve the patient’s ability to retain his sexual potency.
Since prostate cancer remains one of the most common cancers among men, new treatments continue to be researched and applied. There are often excellent options available to treat early stage prostate cancer. They include radical prostatectomy, three-dimensional conformal external beam radiation and prostate seed implantation of the prostate gland.
Seed implantation within the prostate, formerly performed through open surgery, is now performed far more precisely, using ultrasound guidance. Furthermore, three-dimensional treatment planning is made possible using sophisticated new computer
software. Radioisotopes with improved properties are bringing radioactive seed implantation of the prostate gland into the mainstream of local, definitive therapy.
Unlike some other treatments for prostate cancer, the risk of impotency or incontinence with seed implantation is quite small. The ultimate decision regarding the best treatment modality for each individual patient needs to be made jointly between the patient, family members, the urologist and the radiation oncologist.
Copyright © 1996-99 The Princeton Packet, Inc.
By: Dr. Jonathan Lebowitz,
University Medical Center at Princeton
July 20, 2001
According to the American Heart Association, each year 1.5 million Americans have heart attacks, and the number is rising. For 20 to 40 percent of these people, a heart attack is the first symptom of heart disease, and one in three people does not survive a first heart attack.
To help reverse this trend, it is important to take sensible steps to ensure a healthy heart before a tragedy occurs. In addition to making smart choices regarding nutrition, exercise and lifestyle, there is an exciting testing tool that can help you and your doctor assess your heart health — the coronary artery CT scan.
Coronary arteries are blood vessels that supply oxygen to your heart. Deposits called “plaque” can build up in your coronary arteries, which may eventually cause blockage. Over time, calcium can accumulate in part or all of the plaque. The more plaque that is present, the more calcium can accumulate. High levels of calcium may indicate that at least one major heart artery has a blockage, which can cause heart attacks.
The coronary CT scan evaluates the presence of — and quantifies — calcified plaque in the coronary arteries, generating a coronary artery calcification (CAC) score. This score reflects a broad estimate of cardiac risk and can be compared to average scores of people in the same age and gender category.
Regardless of the total score, it is imperative that your doctor evaluate all your risk factors. After discussion, your doctor may recommend lifestyle changes, medications, or other tests that would be appropriate.
Please note: You should not schedule this test if you are experiencing acute chest pain or other acute cardiac symptoms. Instead, call your doctor immediately.
The calcium cardiac scoring scan has been available for about 10 years, but it is only quite recently that the equipment has become faster and more accurate. The scan is done using fast spiral CT technology, without contrast, and takes less than five minutes to perform.
Another benefit is that patients may remain fully clothed, making this a comfortable and non-invasive procedure. The radiation exposure is less than that of a routine CT scan and has not been associated with harmful biological effects.
To better understand your overall heart health, familiarize yourself with the risk factors for heart disease and identify any you may have. Some risk factors,
including age, gender, family history and personal history cannot be changed.
• Age/Gender: In the middle decades of life, the risk of heart disease is three to four times higher for men than for women. For both men over 45 and women over 55, the risk gradually increases with age.
• Family History: A family history of early heart disease increases your risk.
• Personal History: The risk of a heart attack is five to seven times higher for people who have had a heart attack or stroke than for people who have not.
Controllable risk factors include:
• Smoking: Smokers are twice as likely to have a heart attack than nonsmokers.
• High Blood Pressure: High blood pressure (140/90 or higher) weakens the heart, contributing to heart disease. Reducing your blood pressure in turn reduces your risk of heart disease, stroke, kidney failure and blindness.
• High Cholesterol: Too much cholesterol in the blood can lead to clogged arteries and eventually to coronary heart disease. Opt for foods low in saturated fat and cholesterol.
• Weight: Being overweight increases your risk of high blood pressure, diabetes and heart disease. You can significantly reduce your risk by losing even 10 or 15 lbs.
• Diabetes: A person with diabetes has a two to three times higher risk of heart disease than a person who does not have diabetes. Maintain proper weight, keep active and eat a healthy diet, high in fiber and low in refined foods.
• Sedentary Life Style: Regular physical activity can cut your risk of heart disease in half and help prevent obesity, high blood pressure, high cholesterol levels and high blood sugar. It will also improve your energy level and your ability to cope with stress.
Although you may have some or all of these risk factors, modifying them will reduce your overall risk of developing heart disease. If your risk factors warrant a closer look, you can either call your hospital directly or ask your doctor to set up a cardiac calcium scan appointment for you.
The test, currently available from University Medical Center at Princeton, costs $450 and is not yet covered by insurance. Test results are mailed to both you and your doctor, at which point you can discuss appropriate treatment options, if necessary.
To be heart smart, assess your risk factors, control those you can, keep an open dialogue with your doctor, and put medical advances to work for you.
Copyright © 1996-99 The Princeton Packet, Inc.