CyberKnife Treats Pancreatic Cancer When Tumor is Inoperable
On the morning of October 23, 2012, Jack Jackson, a communications professional who lives in Needham, saw yellow eyes staring back at him from the bathroom mirror. By the time he was examined by his primary care physician in the afternoon, his skin color matched his eyes. His doctor found high levels of liver enzymes in his blood stream, and sent him straight to the emergency room at BIDMC.
A series of tests and an endoscopic procedure revealed a cancerous mass in the head of Jackson’s pancreas. As a new patient, Jackson (right), now 59, met with several specialists from BIDMC’s multidisciplinary Pancreatic Cancer Center. These seasoned pancreatic cancer specialists would work closely together in the months following to oversee his care. The initial recommendation called for surgery to remove the tumor—the only real cure for pancreatic cancer.
Change in Course
But the team was obliged to change course in mid-operation when Jackson’s surgeon, Dr. Mark Callery, discovered a metastatic spot on Jackson’s liver—indicating that his cancer had already spread. Rather than remove the tumor from Jackson’s pancreas, Dr. Rebecca Miksad (right) would begin treating Jackson with chemotherapy to attack his cancer, body-wide.
Dr. Callery’s discovery of the metastatic liver spot placed Jackson squarely among the 40 to 50 percent of pancreatic cancer patients whose cancer at diagnosis is advanced and inoperable. The life expectancy of most patients in his condition is an average of 11 months—even with treatments that typically include chemotherapy, radiation therapy or both—and the five-year survival rate for cases like his is only about 2 percent.
Beating the Odds
Fifteen months after being diagnosed, however, Jackson is currently beating the odds: Two successive PET (positron emission tomography) scans showed no visible cancer activity. His weight is back to normal. For the past six months, he hasn’t experienced symptoms needing anything stronger than a Tylenol to relieve. Most importantly, the original tumor appears to be under control and radiology tests show no sign of metastatic disease.
Jackson’s good fortune is always top of mind. “I’m fighting some very long odds,” he says, “and I think about that every day. I’m trying to be a better person; I’m more aware of what’s happening around me, and I make an effort to get the most out of every day.”
Jackson began chemo the day before Thanksgiving 2012, returning to BIDMC for every other Wednesday to start three days of infusions. In May 2013, his tumor had responded well enough on imaging and his CA 19-9 level -- a tumor marker or substance in blood that helps doctors track the course of the cancer -- dropped low enough to make him a candidate for treatment with the CyberKnife (above right).
Doctors recommend this innovative approach to extend survival for patients whose tumors cannot be surgically removed. CyberKnife is especially effective at targeting hard-to-reach tumors like those that grow in the pancreas, an organ that produces insulin and lies deep in the abdomen behind the stomach.
Originally developed to treat brain tumors, CyberKnife is painless and (despite the name) requires no cutting. It allows radiation oncologists to deliver high doses of radiation focused directly on a tumor with minimal exposure to surrounding healthy tissue. Image-guided robotics track even miniscule patient movements in real time, allowing the machine to lock precisely into the location of a tumor or cancerous cells before delivering a narrow radiation beam.
Unlike conventional radiation therapy that requires weeks of daily sessions, CyberKnife treatments are usually completed in one to five sessions of about 90 minutes each. Additional benefits include patient comfort during treatment and reduced side effects. BIDMC’s Keith C. Field CyberKnife Center, the first in New England, opened in 2005 and was upgraded to the most advanced technology in 2010.
“Aggressive chemotherapy successfully shrank Jack’s tumor. However, it was CyberKnife that gave him the extra tumor control needed to return his CA19-9 tumor marker to the normal range and to allow Jack to enjoy time free of chemotherapy,” says oncologist Dr. Rebecca Miksad.
First Jackson underwent a minor procedure to insert tiny gold marker seeds in his tumor. These would serve as signposts and help guide the CyberKnife. In mid-June, Jackson underwent CyberKnife therapy with Dr. Anand Mahadevan on three successive days.
“It was the easiest treatment I’ve ever had,” says Jackson. “I was perfectly comfortable, lying on a procedure table listening to my iPod, while the arm of the robot moved around to deliver the radiation. I breathed normally and actually fell asleep during one session."
“We are all so happy for Jack,” says Mahadevan (right). “His case is a perfect example of why it is so important to have the CyberKnife in our mix of treatment options.”
Almost Back to Normal
Says Jackson, “In my mind, CyberKnife played an immense role in the positive track my disease has taken. CyberKnife made all the difference.”
Today, he remains on a chemo vacation and savors every moment. His everyday life is almost back to normal, too. He’s teaching communications twice a week at Stonehill College and making it a point to spend quality time with his wife.
In the fall, they bought an Audi A5 convertible (right), which has given Jackson and his wife a carefree way to enjoy the world—and each other.
“On beautiful days last fall, we’d just point the car out of our driveway, put the top down and drive. We’d just talk and take in the scenery. Before October 2012, we wouldn’t have thought we had the time.”
Were you to listen in on Jackson and his wife during one of their drives, you might just hear them talking about their son’s upcoming wedding, which they will attend together in the fall.