The newly renovated Penn State Health St. Joseph Cancer Center in Bern Township delivers innovative oncology services and state-of-the-art technology to area patients so they can receive virtually the entire spectrum of cancer care without the burden of long commutes.
Navesh K. Sharma, DO, PhD, FACRO, discusses the TrueBeam Radiotherapy System’s capabilities with a patient.
Advances at the Cancer Center include incorporation of leading-edge technologies, such as the TrueBeam Radiotherapy System, the Calypso localization system, stereotactic body radiotherapy (SBRT), stereotactic radiation surgery (SRS) for brain tumors and yttrium-90 (Y-90) radioembolization of liver tumors, as well as expanded treatment and infusion areas and an academic-level genetic risk assessment program. Oncologists on faculty at Penn State College of Medicine oversee the individualized courses of treatment.
“We offer care that is designed to give each patient the best opportunity to fight their cancer,” says Navesh K. Sharma, DO, PhD, FACRO, associate professor in the Department of Radiation Oncology at Penn State College of Medicine and section chief of Radiation Oncology at Penn State Health St. Joseph Cancer Center. “We give patients the compassion and support they need, paired with the benefits of the most advanced technology available, but also, as part of a major academic institution, we can appropriately connect them with additional specialists if needed.”
"There are many areas where the TrueBeam Radiotherapy System, in conjunction with the Calypso localization system’s high precision in detecting and compensating for patient movement, allows us to give enough radiation to kill tumors completely — not just shrink them.”
— Navesh K. Sharma, DO, PhD, FACRO, associate professor in the Department of Radiation Oncology at Penn State College of Medicine and section chief of Radiation Oncology at Penn State Health St. Joseph Cancer Center
The TrueBeam Radiotherapy System represents a $5.5 million investment by Penn State Health St. Joseph Medical Center. The second linear accelerator at the facility, the TrueBeam required the construction of a new vault, including radiation shielding. New radiation therapists and a new physicist and dosimetrist joined Penn State Health St. Joseph Cancer Center’s staff.
The TrueBeam linear accelerator solves a conundrum facing radiation oncology patients: Higher radiation doses are often more effective against tumors but can damage surrounding tissue, while lower-dose radiation does less damage to healthy tissue but is also less lethal to tumors. The image-guided TrueBeam delivers an extremely precise dose of powerful radiation directly to the tumor, sparing healthy tissue.
“We perform standard radiation therapy as well, but among our most important offerings is radiotherapy delivered very specifically to target areas,” says Marc Rovito, MD, medical oncologist, medical director at Penn State Health St. Joseph Cancer Center and assistant professor at Penn State College of Medicine. “With the TrueBeam, we can home in to track the tumor in motion, so the radiation field fits narrowly around the tumor.”
This precision reduces procedural time — shortening prostate cancer radiology sessions from 20 minutes to five, for example — and the side effects associated with radiation. Additionally, local patients are spared the minimum hour of travel one way to obtain TrueBeam treatment elsewhere.
Marc Rovito, MD, talks with a patient in the recently expanded infusion area.
To address tumor movement and enhance TrueBeam’s accuracy, Penn State Health St. Joseph Cancer Center has also acquired the Calypso localization system. Even when patients are still, tumors move — between treatment sessions, perhaps due to the pressure of food in the bowel, or during sessions, as a response to breathing. Cancer pain itself, Dr. Sharma adds, can affect a patient’s posture and breathing patterns. To compensate for movement of all kinds, the Calypso system — nicknamed the “GPS for the prostate” but effective for cancers at many sites — tracks a beacon that is placed in the patient’s body to mark the tumor’s location.
“It can track the prostate as it moves during real time, cutting the margin for error,” says Dr. Sharma, who was on staff at the University of Maryland Medical Center — a National Cancer Institute-designated Comprehensive Cancer Center — during the benchmarking of the TrueBeam and during initial implementation of the Calypso system at the Fox Chase Cancer Center. “This makes the treatment more precise and limits side effects.”
In addition to prostate cancer, the Calypso can pinpoint the location of tumors in the lungs and liver. For lung cancer patients in particular, Dr. Rovito notes, use of the TrueBeam can mean the difference between life and death. Many people with lung nodules also suffer from COPD, chronic bronchitis or emphysema, potentially making them ineligible for surgery.
“The TrueBeam fills that void,” Dr. Rovito says. “Treatment via radiotherapy alone cures a significant number of people with pulmonary nodules who cannot undergo surgery.”
“In addition to being referred by their physicians, patients may come to us for evaluation for cancer risk because they’ve seen an ad, read an article or met our risk evaluation coordinator at a health fair. It is great that people have the courage to take a step out of their comfort zone to obtain a cancer risk evaluation.”
— Marc Rovito, MD, medical oncologist, medical director at Penn State Health St. Joseph Cancer Center and assistant professor at Penn State College of Medicine
A minimally invasive option for the treatment of primary or metastatic liver disease, Y-90 radioembolization involves seeding the tumor with minute, radioactive beads. Placed via a catheter threaded through the groin or wrist, the beads deliver radiation directly to the tumor, sparing surrounding liver tissue. Y-90 radioembolization can significantly decrease the amount of tumor in the liver and delay the time tumors grow back in the liver, giving certain patients a better chance of living to transplant, according to the Radiological Society of North America.
Dr. Sharma is a national expert in the use of Y-90 radioembolization to treat liver cancer, and he is glad to bring this treatment to patients in the Berks County region.
“I have been the principal investigator for the largest international 14-country trial of Y-90 therapy,” he says. “I’ve had experience using that technique and integrating it with stereotactic body radiation therapy for liver tumors. I founded and led the liver SBRT program at the University of Maryland Medical Center, and I have applied my knowledge about that sensitive organ to other programs.”
Stereotactic Radiosurgery for Brain Nodules
Another advanced offering now available locally at Penn State Health St. Joseph Cancer Center is stereotactic radiosurgery for the brain.
Dr. Sharma notes that candidates for this procedure often have metastases that result in a solitary nodule or a small number of brain nodules. The SRS procedure is a more effective and streamlined approach to this condition than conventional technologies to treat these tumors with a single, very high, precise dose of radiation that may serve as an alternative to surgery or be used instead of whole brain radiation, he adds.
Genetic Risk Assessment
Along with new technologies and treatments, Penn State Health St. Joseph Cancer Center has expanded its ancillary services. Of particular interest for patients and families is the Cancer Risk Evaluation Program, directed by Dr. Rovito. Genetic counseling for cancer patients has grown in scope in the past decades and now encompasses up to 80 genes, rather than the two genes for which cancer geneticists originally screened. Further, scientists are tracing more connections between potential diseases stemming from common genetic causes, with some genetic combinations being responsible for multiple cancers in hereditary cancer syndromes.
Gone are the days when a patient was simply handed a result based on blood work. Now, Dr. Rovito says, “It’s a coordinated effort between a doctorate-level genetic counselor and the physician. They work as a team to determine the best course of risk reduction for the patient.”
Interpretation of test results involving multiple genes is a complex process. At Penn State Health St. Joseph Cancer Center, a genetic counselor is on hand to do that work. Together, the counselor and Dr. Rovito discuss the results with each patient, suggesting steps to take to reduce the likelihood of cancer developing and to protect family members.
“Risk evaluation extends like a star,” Dr. Rovito says. “It can radiate to children and siblings; it can backtrack to parents. It is critical for patients to come to a center where there is a program in place to study and manage risk, which includes a thorough evaluation of family history.”
At Penn State Health St. Joseph Cancer Center, patients find the answers they need, as well as the support not only of caring physicians but also of a dedicated social worker, a cancer navigator and a team prepared to treat the whole person.
For more information, visit thefutureofhealthcare.org.