If God wanted to send me a message, he or she can send me a letter.
──Pam Girsh, 非何杰金氏淋巴瘤、婦科腫瘤和乳癌患者
剪這篇新聞就只是因為對上面這句話很有感覺而已。XD
不過，裡頭提到的MammoSite還是提一下。（我不知道台灣有沒有引進）
傳統的乳癌放射線治療是病人接受外科手術完，傷口癒合後由腫瘤科醫師連續七個星期，每天從乳房外部照放射線。MammoSite則是反過來，在手術切除病灶的同時，在患部置入裝有生理食鹽水的小水球跟導管。要接受放射線治療時，從導管置入高劑量的放射線物質十分鐘，一天兩次，間隔六個小時，療程只要五天。治療結束後，將水球中的食鹽水排空取出即可。（看不懂的人，請直接看新聞原始網頁的流程圖。）
因為不是從乳房外部大範圍照射放射線，所以周圍器官接受的放射線劑量比傳統療法低。不過用途也受到限制，只有腫瘤小於三公分、沒有淋巴轉移和切除的組織周圍沒有受到侵犯的四十五歲以上女性適用。
FDA在2002年核准這種療法，目前臨床成效的追蹤和研究並不多，所以不清楚是不是有不明的毒性。（嗯，這幾年FDA也出包不少次……）
不過，醫療事業不就是為了改善人類生活品質而存在的嗎？所以，療法多點人性，也挺好的。
Seattle Post-Intelligencer
http://seattlepi.nwsource.com/local/370048_triplethreat09.html
Radiation treatment with a new twist
Higher doses in shorter time used on woman who's had three cancers
Wednesday, July 9, 2008
Last updated 12:27 a.m. PT
By CHERIE BLACK
P-I REPORTER
As she sat outside on her back porch, sipping tea, Pam Girsh found her misfortune almost laughable. Or maybe it's fortune, she wondered. After all, she's still alive despite being diagnosed with three types of cancer -- all unrelated to the others -- in the past five years.
The first was non-Hodgkin's lymphoma, diagnosed in 2003 and treated by chemotherapy and eight weeks of daily radiation.
The second, a gynecological cancer diagnosed last year, was treated the same way.
But when she was diagnosed with breast cancer in February, the idea of enduring even more radiation didn't sit well.
"If God wanted to send me a message, he or she can send me a letter," Girsh said, laughing at the memory of her third cancer diagnosis while enjoying a breathtaking view of the Cascades from her Redmond home. "The fatigue and the mouth sores were the worst of it."
Then her oncologist suggested what some doctors are calling a new twist to radiation treatment called MammoSite. It localizes the radiation to where the tumor is removed and delivers the dose from the inside instead of whole breast radiation, which is given from the outside.
The treatment uses a higher daily dose of radiation for a shorter period of time -- five days instead of seven weeks -- and surrounding organs aren't exposed to high doses of radiation, said Dr. James Pelton, medical director of radiation/oncology at Overlake Medical Center and Girsh's doctor.
After the breast cancer tumor is removed, a small balloon attached to a catheter is placed inside the hole through a small incision in the breast. The balloon is inflated with saline solution and during the five days, radiation is given through the catheter for 10 minutes twice a day, with about six hours between doses. When the treatment is finished, the catheter is removed.
Girsh, 61, finished her treatment last month and has had no side effects or other problems.
"There's certainly no downside," said Pelton, who began treating patients with MammoSite at Overlake in 2004, and has a suite dedicated to the treatment. "While the results are comparable to external radiation, the benefit to the patient is quite intensive in reducing the radiation dose to the lungs, heart and other organs."
But the treatment isn't for every woman diagnosed with breast cancer, and the comparable results make some physicians reluctant to try the treatment without more long-term data.
According to guidelines from the American Brachytherapy Society and the American Society of Breast Surgeons, which differ slightly, the tumor must be 3 centimeters or less (some hospitals such as Virginia Mason Medical Center opt for 2 centimeters or less) and the woman must be 45 or older. The cancer can't have spread to the lymph nodes, and the edges around the removed tumor must be cancer-free.
Though the treatment was approved by the Food and Drug Administration in 2002, it has just recently gained momentum as small clinical studies are showing positive preliminary success rates. But many doctors, including Girsh's gynecologist, hadn't heard of MammoSite and many oncologists are reluctant to use it.
Dr. Huong Pham, radiation oncologist at Virginia Mason, has been using MammoSite since 2004 and said the results have been good. "But do we know five years from now what the effects could be?" she said. "Is there going to be some late toxicity we don't yet know about?"
A 2006 American Society of Breast Surgeons study showed the treatment worked well in 169 patients followed from 2002 to 2004, but noted long-term follow-up data were necessary to determine how effective the treatment really is.
A large national study looking at MammoSite's long-term results is currently under way on the treatment's effectiveness, and to see whether it is effective in a broader group of women.
Pelton and Pham are optimistic.
"The treatment isn't for everyone, but for those who do qualify it's effective," Pelton said. "Most patients who have done it would do it again."
One hundred women have been treated with MammoSite so far at Overlake and the recurrence rate is zero, he said.
There's no question how Girsh feels about the treatment.
"I'm all about percentages -- I'm a mortgage banker," she said. "I grasp on to the numbers."
She credits a circle of close friends and her husband for her positive attitude. Girsh met Russian conductor Alexei Girsh 17 years ago when his symphony orchestra performed at the Folklife Festival. Months later, he returned to Seattle for good.
"He has been by my side nonstop through it all -- except for when the doctors would kick him out of the room," she said as her husband listened to what he called the hundredth rendition of how the two met.
"Sometimes in my dark moments, I wonder if there's a fourth" cancer, she said, "but it's not a death sentence -- I should know, I've had it three times."
P-I reporter Cherie Black can be reached at 206-448-8180 or cherieblack@seattlepi.com. Read her To Your Health blog at blog.seattlepi.com/toyourhealth.
?1998-2008 Seattle Post-Intelligencer
