Finding new ways to beat an old enemy
By Julian Kesner, DailyNews, September 24, 2006
The glittering new Mortimer B. Zuckerman Research Center building at Memorial-Sloan Kettering Cancer Center doubles the size of the city's premier cancer battleground to 650 attending physicians and 445 clinical trials on nearly 60 cancer types.
But that's not the only front in the cancer wars. Across New York, top-flight doctors are working tirelessly to help their patients, bringing the city to the cutting edge of cancer care and science. Here are some of the best:
Patients who develop a rare stomach cancer called peritoneal mesothelioma usually succumb within a year. But 30% of Dr. Robert Taub's patients at New York Presbyterian Hospital Columbia are disease-free after four years.
Kendra Ferreira, 46, an artist from Portsmouth, R.I., learned she had the cancer in 2002.
"The doctors in Rhode Island didn't know what to do for me," said Ferreira, who had eight months of chemotherapy and radiation under Taub. "Now, the cancer is gone.
"So far, nothing has returned. I'm absolutely thrilled, since the first doctors I saw made it seem I wasn't going to be around much longer."
Taub, director of the hospital's mesothelioma-sarcoma program, injects chemotherapy into the stomach's peritoneal cavity in addition to performing surgery.
"We've operated on more such patients here than anywhere else in the country," about 75 total, he said. Some patients are alive nine years later.
The well-tolerated chemotherapy is also now used in the chest and lungs - which, Taub pointed out, is "very important for the 9/11 survivors."
Dr. Theodore Schwartz, director of brain tumor and minimally invasive skull-base surgery at New York Presbyterian Hospital Weill Cornell, is testing ways to eradicate malignant cancer cells that infiltrate normal brain tissue.
One method involves placing catheters around a tumor margin and infusing chemotherapy or immunotherapy. Another is brachytherapy, which delivers high doses of radiation "via an implanted balloon filled with liquid radioactive iodine," Schwartz said.
The neurosurgeon also pioneered the endoscopic removal of tumors to avoid open cranial surgery. The brain "is such a sensitive part of the body, and it makes us who we are," Schwartz said. "It's very humbling."
Queens resident Anthony Cicalese had a benign tumor (it could only be biopsied after the fact) removed endoscopically by Schwartz last year, even though other doctors recommended invasive surgery.
"After a week of headaches, it was a piece of cake," said Cicalese, 41, who works in construction. "People didn't believe I had brain surgery. It was amazing."
St. Vincent's Comprehensive Cancer Center pulmonologist Dr. Joseph Cicenia now uses a machine called a bronchoscope to perform biopsies and treat lung cancer. It's one of just a few nationwide.
The device re-creates a 3-D model of a patient's lungs on a CAT scan, allowing a scope to do pinpoint biopsies on suspect nodules, and even lymph nodes behind airways.
"We have a pathologist looking at slides then and there," Cicenia said. "By the time they leave, we have a diagnosis."
For the cancer treatment, the bronchoscope delivers concentrated radiation, in gold seeds, exactly upon the nodules - leaving surrounding areas unharmed.
Dr. Ivan Grunberger, urology vice chairman at Brooklyn's Long Island College Hospital, is testing a high-intensity focused ultrasound (HIFU) machine to treat recurrent prostate cancer.
"In the old days, all we had was hormones" after initial radiation, Grunberger said. "They have a lot of side effects and resistance. HIFU is the least invasive treatment and improves chances of keeping the nerves."
The machine beams ultrasonic waves directly onto the prostate gland, frying the tissue. Grunberger said the accuracy of the device appears to leave most nerves intact, thus preserving normal sexual function in patients.
Beamed 74-year-old HIFU patient Kalman Ginsburg: "The last PSA reading I had was about a 0.66 - I was a little over 1 after radiation. (Anything under 2.5 is considered low.)
"A little praying, a little luck and things might work out!"
More than 14,000 U.S. women develop cervical cancer each year. In 99.7% of cases, the patients carry a strain of human papillomavirus (HPV).
But thanks to Mount Sinai Medical Center's Dr. Rhoda Sperling and other clinical researchers, a new HPV vaccine was approved in June and is now in use.
"It's a major breakthrough," said Sperling, vice chairman of the hospital's department of obstetrics, gynecology and reproductive science. "It's a vaccine that really will prevent a cancer."
Sperling hopes the future holds more of the same: She's already at work on the next generation of HPV vaccines for other HPV strains.
LIVER & KIDNEY CANCER
Dr. Tim Clark, chief of interventional radiology at NYU Medical Center, uses a technique called cryoablation to treat liver and kidney tumors, freezing them in their tracks with supercool argon gas.
A tiny probe is inserted through the skin - under light sedation, via a tiny hole "no bigger than a shaving nick," Clark said - and guided to the tumor with a CAT scan machine. It then blasts tumors with a ball of ice.
"We're able to destroy 95% of tumors that are 3 centimeters or less in size," Clark said, adding, "and if there's some remaining live tumor, we can go back in and treat it again."
Shirley Barkan, 79, of Great Neck, L.I., had two tumors on her left kidney removed via cryoablation in January. Two MRIs later, she's still cancer-free.
"Dr. Clark was wonderful, and everything seems fine," Barkan said. "All I can say is, I still have my kidney - and it's a miracle."
Dr. Gina Villani, associate director of the Queens Cancer Center of Queens Hospital, sees 250 patients per week, mostly minorities.
"Everybody who has a patient that's uninsured, or has a Medicaid-managed care that doesn't pay much, sends them here," she said.
That hasn't stopped Villani from getting five breast cancer patients enrolled in a trial combining chemotherapy with the drug Avastin, already approved for use in colorectal cancer. Such combinations have proven effective and have grown increasingly popular in recent years.
Julie, a 47-year-old woman from Queens, received six courses of this treatment. Her breast cancer is "now just a really tiny lump," she beamed. "We're going to see if it will completely go away - I think it will!"
Lymphoma patients may soon be able to ward off recurrence using a vaccine, now in final testing phase.
"I'm really excited about the vaccines," said Dr. Michael Grossbard, chief of hematology/oncology at Beth Israel Medical Center and St. Luke's-Roosevelt Hospital.
"You can harvest proteins from the lymph node, manipulate them, and reinject them to trigger an immune response."
Grossbard sees close to 1,000 active patients a year. "The trend is to move away from chemotherapy, and toward biological therapy," he said, "and a majority of patients are taking advantage of this and changing their outcomes."