Cancer treatment new to area

Gilbert Zylka, 79, goes every October to have, among other things, that annual prostate exam. Last time, it came up with a lump. After a trip to the urologist and a biopsy, he was diagnosed with cancer, a fairly aggressive one.

Gilbert Zylka, 79, goes every October to have, among other things, that annual prostate exam. Last time, it came up with a lump. After a trip to the urologist and a biopsy, he was diagnosed with cancer, a fairly aggressive one.

"That means, 'We better do something right away,'" Zylka put it.

His doctors had a new tool to recommend to him -- Intensity Modulated Radiation Therapy, or IMRT.

For Zylka, it was an easy decision. He has made a point of putting his health first for about 27 years with diet and exercise, especially since a bad car accident he was involved in, and he says he's not afraid of new technology.

"I agreed to be the first to do this," he said. "... I believe in everything that is new is better."


In this case, he may well be right about the technology. Dr. Rodolfo E. Urias, one of the physicians working with the new form of treatment at Miller-Dwan, said it's been developed over the last several years and began making inroads in communities over the last two years.

Miller-Dwan is the only place in Duluth that offers the technology, but perhaps that's unsurprising considering it's not even available at the Mayo Clinic yet.

"It's been spotty where it started, but it's taking off," Urias said.

As Urias described it, the new form of radiation therapy is an improvement for some patients over an older method called 3D conformal treatment. In 3D comformal, which is still the preferred option in some cases, physicians can direct four to seven different beams of radiation from different angles and with different intensities of radiation. The goal, generally speaking, is to get the right dose of radiation to the tumor, which can take odd shapes, and minimize the amount of radiation to surrounding tissue, and particularly any nearby vital organs.

Under the 3D conformable system, the physician would model up different approaches and, by trial and error and long experience, would work out the best approach.

Under the IMRT system, rather than four to seven beams, there are "hundreds and hundreds of tiny beamlets," Urias said, with the ability to control the intensity of each. This allows doctors to define the treated area with much greater precision and also allows physicians to load that area up with a stronger dose of radiation, even while more successfully sparing adjacent tissues.

Miller-Dwan officials cite a study of prostate cancer patients at the Memorial Sloan-Kettering Cancer Center in New York which showed that the higher radiation doses delivered with IMRT showed a nearly 71 percent improvement in tumor control compared with conventional treatment.

The big holdup for this kind of approach has been complexity -- if modeling up a half dozen streams of radiation is complex, figuring out the right approach of hundreds of them is much more so. And so the big breakthrough has been computing power.


With IMRT, physicians enter in the right details about the desired dose, the tumor and the limitations posed by surrounding tissues.

"Then the computer looks at hundreds of thousands of different possibilities," he said. It comes up with the best plan, which is then always reviewed by human beings.

Currently, the computing for cases in Duluth is being done at a University in Pittsburgh, but within a year, Miller-Dwan expects to be doing it on site.

Because of the characteristics of prostate cancer, it's one of the cancers for which IMRT is best suited, Urias said. Its tumors typically have a well-defined volume and unique shapes, and it often occurs near vital organs.

"And also, prostate cancer is a common cancer, and it's a curable cancer," he said.

The first several patients at Miller-Dwan to take advantage of the new technology all have prostate cancer.

But it's also useful for some kind of head and neck cancer, he said, as well as selected breast cancers for those with an unusually shaped anatomy, particularly if other forms of radiation treatment might damage the lungs or the heart.

Urias says the technology is evolving rapidly and may overcome certain limitations, but he said, "I think we're getting into it at the right time."


There are also some limitations with Medicare coverage.

He says the treatments are no problem at all.

"Well, I don't feel a thing," he said. "I don't even know that the treatment is going on."

He has a session five days a week, with each appointment lasting about 20 minutes. He will have 39 total treatments, and his doctor speaks to him every Monday.

It's too early for he and his doctor to know how the treatment is working. "But we're both confident that we're doing the right thing," Zylka said.

He reports no side effects at all so far.

His positive attitude and personality have no doubt contributed to his rapport with the staff, but there may be another reason things go so well:

"Another reason to be first is you know you're going to get the best treatment in the world."

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