In Fall 2004, Paul Nauman started feeling like he had heartburn after eating. Gradually, Paul felt more and more uncomfortable eating and swallowing. A visit to his family doctor in March 2005 resulted in a number of tests to see what could be causing the problem.
At the age of 55, the Burlington resident received news that nobody wants to hear. Tests determined that Paul had a cancerous tumour in his esophagus, the muscular tube that leads from the back of the mouth to the stomach.
Paul was referred to the Juravinski Cancer Centre (JCC) in Hamilton for treatment. There, a team of doctors met with him to discuss the best course of action. They recommended that Paul be treated using a type of radiation therapy called high-dose brachytherapy followed by nine weeks of chemotherapy.
High-dose brachytherapy is a leading-edge treatment that patients have traveled from as far away as Manitoba and Newfoundland to receive at the Juravinski Cancer Centre. That’s because the JCC is the only centre in Canada offering high-dose brachytherapy for lung and bile duct cancer and one of few centres offering the treatment for esophagus cancer. High-dose brachytherapy has been available at the JCC just since January of this year and already 80 patients like Paul have received a total of 200 treatments.
The recent expansion of the JCC made it possible to design a state-of-the-art, high-dose brachytherapy suite. However, providing a new treatment is about more than space and equipment – it also takes talent. And, in Dr. Ranjan Sur, the Juravinski Cancer Centre has that talent. Dr. Sur is a world-leader in high-dose brachytherapy and was recruited from South Africa to lead the JCC team.
“High-dose brachytherapy is a modern, high-tech treatment that can make an impact on reducing the size of a tumour and improving the quality of life of people living with cancer,” said Dr. Sur. “Our team is highly skilled and we’re pleased to be able to offer a new treatment option for patients when surgery is not possible.”
The therapy involves implanting tiny, radioactive seeds adjacent to, or directly into, cancer cells in order to destroy them without damaging delicate tissues nearby.
Brachytherapy for the prostate has been available at the JCC for several years, however high-dose brachytherapy is different because the radiation source is removed from the patient several minutes after implantation (compared to the several hours or several days of exposure for patients receiving low-dose brachytherapy.) Every procedure requires a team of professionals including a radiation oncologist, radiation therapists, a dosimetrist, a medical physicist, nurses, brachytherapy nursing assistants and a respirologist when lung cancer is being treated.
A lot of work goes on to prepare a precise treatment for the patient. The radiation oncologist prescribes the amount of radiation based on the size of the tumour. Then, accurate treatment plans are created using treatment planning software.
The patient receives mild sedation just before the procedure. While looking at a monitor, the doctor inserts one or more fine tubes into or adjacent to the tumour, then everyone except for the patient leaves the room while the radiation seeds travel from a machine, through the tube to the tumour.
A computer programmed with the patient’s treatment plan controls the seed while the brachytherapy team watches the procedure on monitors in another room. After just a few minutes, the seeds make the trip back into the machine and the patient is no longer radioactive. Then, the health care team returns to complete the procedure and within an hour, the patient is ready to go home.
Paul only required three high-dose brachytherapy treatments and found the procedure to be quick and convenient.
“It’s a really intense treatment. There is a swarm of people all around you getting set up. Then they leave and you’re alone for a few minutes,” said Paul. “I really didn’t experience any side-effects and the next week, I was able to eat normally including fruit juices which used to cause a lot of irritation,” he added.
The treatment significantly reduced the size of the tumour in Paul’s esophagus. However, his battle is not over. Paul still has to complete nine weeks of chemotherapy. “The whole experience has been overwhelming. It has all happened so fast, it’s been stressful, but everyone has been very supportive,” said Paul.
In addition to cancer of the esophagus, high-dose brachytherapy at the JCC is offered in bile duct cancer, lung, nasopharyngeal cancer, tracheal cancer, cervical cancer and endometrial cancer. Clinical trials for prostate cancer, lung cancer and esophageal cancer are currently underway.
Because of Dr. Sur’s expertise and leadership in the field, the Juravinski Cancer Centre is a show site for Varian, the high-dose brachytherapy equipment manufacturer. Clinicians from across Canada come to the JCC to be trained by Dr. Sur using the latest technology.