A New Specialty: Orthopedic Oncology
Until
recently, area patients with the rare diagnosis of bone cancer
were forced to go to great lengths for treatment. Advanced
care in California was available only in university settings,
including those in far-flung parts of the state. Now that
expertise is close to home. Alta Bates Summit has established
a new program in spine and orthopedic oncology — one
of only a handful in the state and one of three in the San
Francisco Bay Area; all the others are in university settings. “There’s
a definite need,” says the program’s founder,
Rakesh Donthineni, M.D., a spine and orthopedic surgeon. “There
aren’t many orthopedic surgeons who do orthopedic oncology.”
According to the National
Cancer Institute, about 2,300 new cases of primary bone cancer
and about 7,000 soft tissue cancers — in which malignant
tumors originate in bone tissue — are diagnosed in
the United States each year. Such cases can also result from
metastatic cancer that has spread to bone or tissue from
the breast, lung, prostate, or other parts of the body.
All of these cancers, affecting adults and children, can
now be diagnosed and treated at Alta Bates Summit. The
approach to care is comprehensive and multidisciplinary,
says Dr. Donthineni, who came to the Medical Center in
February with stellar experience in orthopedic oncology.
His most recent posts were at the University of California
at Davis, where he was chief of the orthopedic section,
and the University of Pennsylvania. “I work very closely with medical
oncologists, radiation oncologists, pathologists, and radiologists
to pinpoint a diagnosis and the best way to manage the disease.”
The good news, says Dr.
Donthineni, is that treatments have improved tremendously. “As
recently as 25 years ago, surgery, including amputation,
was the mainstay of treatment, and more than 80 percent of
patients died. With the advent of effective chemotherapy,
improved radiation techniques, better surgical techniques,
and the recent imaging options of CT scans and MRIs, the
prognosis for bone cancer patients is better than ever — about
a 70 percent rate for five-year survival. Patients feel rightfully
that they have better choices.”
Breakthroughs in Radiation Therapy
Alta Bates Summit has introduced an important innovation
in radiation therapy, a key weapon in the battle against
cancer. In January, the Medical Center became the first facility
in Northern California, to use TomoTherapy, an advanced technology
that blasts tumors with targeted radiation and minimizes
exposure to surrounding healthy tissue. As a result, patients
can complete treatment more quickly and with fewer side effects.
How does it work? In TomoTherapy, hundreds of thousands
of “beamlets” rotate
around the patient and precisely conform to the size and
shape of the tumor before delivering radiation. “TomoTherapy
literally runs circles around cancer with a 360-degree arc
of radiation as you go through a CT scanner,” says
Valery Uhl, M.D. “I’ve been in this field for
more than 20 years, and it just amazes me every time I do
a plan and see how much more effectively someone can be treated.”
Prior to treatment, 3-D images of the tumor are taken and
special software is used to develop a plan for therapy.
But if need be, TomoTherapy can make modifications on
the fly. “If
the tumor has shifted, the technology can adjust to its new
position,” says Cliff Lew, director of business development
at Alta Bates Summit. “It integrates the images taken
before treatment and then validates the tumor location. Other
systems can also do that, but TomoTherapy is more precise
because it combines use of a linear accelerator with a CT
scanner, a very advanced imaging machine that creates a 3-D
image. This image can also be evaluated by the physician
to quickly adapt treatments to any new conditions.”
TomoTherapy can be used to treat cancers of the breast,
brain, head, neck, lung, abdomen, pelvis, and prostate.
The radiation therapy typically involves daily treatments,
Monday through Friday, with the number of treatments
varying by patient. Each TomoTherapy treatment takes
about 20 minutes.
For more information about TomoTherapy, call Radiation
Oncology at the Summit Campus (Peralta Pavilion), in
Oakland at (510) 869-8888 or e-mail radoncsum@sutterhealth.org.
RAPID HIV Screening in the ED
June 27 is National HIV Testing Day, and Alta Bates Summit
Medical Center’s East Bay AIDS Center is leading the
way with new testing procedures at the Summit Campus Emergency
Department.
Since February, the Medical Center has offered patients
in the Summit ED the option of taking a free, noninvasive
test to screen for HIV. The test uses a cotton swab similar
to a Q-tip to obtain a saliva sample and provides a preliminary
result in approximately 15 minutes. If the initial result
is positive, further blood testing is required for confirmation.
In the program’s first eight weeks, about 2,500 patients
were tested. From this group, 25 patients had a preliminary
positive result. “We are able to refer these patients
to the proper channels, which is extremely important,” says
Steve O’Brien, M.D., medical director of the East Bay
AIDS Center. “Testing in the Summit ED is available
17 hours a day, seven days a week.”
This rapid-testing program
was made possible by a grant to the East Bay AIDS Center
from the Centers for Disease Control and Prevention. HIV
testing is also supported by the California State Office
of AIDS and the Alameda County Department of Health and works
in concert with Oakland Mayor Ron Dellums’ Get
Screened Oakland campaign. The screening program at Alta
Bates Summit aims to improve access and treatment for
patients in need of HIV/AID services and to help educate
the public, emphasizing that our community is at risk
and residents deserve to know their HIV status.
If treatment starts early, Dr. O’Brien stresses, many
patients can lead normal lives—a cause for hope that
inspires the East Bay AIDS Center’s continued efforts
to promote prevention and testing and underscores Alta Bates
Summit’s vital role as the area’s leading HIV
care provider.
