Amidst this discouraging news, Badagliacca discovered she did have options. She found a different doctor and began a series of treatments with the most advanced chemotherapy drugs available. “I made a decision that fear was not going to be part of my program and that I would do all I could,” she said. “I joked with one of my doctors that if they kept inventing things for me to take,” she said, “I would stay alive to take them.”
Treating cancer has long been a carefully negotiated balance between good and bad. Badagliacca’s tumors were re-evaluated at Stanford, not as Stage IV, but as an early stage of an unusual, slow-growing lung cancer that often appears in non-smokers, especially women. Surgery was not possible because it would have left Badagliacca with too little breathing capacity. Radiation was her next best hope.
While radiation is good to destroy cancer cells, it kills healthy cells, too. Adler’s quest, then, was to build a delivery system that could get a lethal dose of radiation to the cancer without spillover and to get the radiation to wherever the tumor was at any given moment, regardless of body movement.
The CyberKnife, Badagliacca said, “gave me a whole new option for fighting the cancer and surviving it.”
More than 400,000 Americans live with lung cancer, with another 200,000 newly diagnosed each year. More than 160,000 people die each year from the disease. Ninety percent of new lung cancer cases are attributable to smoking. Non-smokers like Badagliacca, who grew up in homes where people smoked, are at 20 to 30 percent increased risk to develop the disease. Unfortunately, the survival rate for lung cancer is lower than most other cancers, driven in large part by its lack of symptoms until the disease reaches its later stages. Only 16 percent of lung cancer tumors are found while still localized. About one in six people with the disease die within one year of diagnosis.
“I joked with one of my doctors that if they kept inventing things, I would stay alive to take them.”
– Marsha Badagliacca, lung cancer patient
Those numbers drive the work of physicians such as Billy Loo, MD, PhD, Badagliacca’s physician at Stanford and leader of the Hospital’s Thoracic Radiation Oncology Program. Stanford has been at the forefront of developments in radiosurgery―radiation focused with surgical precision, combined with advances in imaging systems to see cancer and track the radiation delivery.
Mapping A Moving Target
The CyberKnife, Loo said, is a leading edge radiosurgery player to treat difficult cancers such as Badagliacca’s. Its methodology, which Adler first prototyped in 1994, delivers radiation in highly focused beams that keep the radiation away from healthy tissue. Keeping the radiation under tight control allows physicians to deliver a higher dose of radiation with each treatment. That translates into fewer treatments, which translates into a patient being able to tolerate almost double the total amount of radiation in conventional treatments. The increased intensity of individual doses in the CyberKnife increases the DNA damage done to the cancer cells, which increases the odds they will not be able to reproduce and grow.The CyberKnife’s movements achieve their precision through sophisticated robotic engineering, but knowing where to go is the first step. “The key to radiosurgery is seeing the tumor, focusing the radiation on the target and verifying that we are hitting that target,” Loo said. Stanford physicians can build a four dimensional image of a patient by integrating information from a CT scan’s view of the body’s anatomy with the PET scan’s view of that anatomy’s biochemical behavior. The final image is a map of a tumor in time and space, a crucial guide for treatment.
