Upstate Cancer Center: Advanced Cancer Therapies and Technologies

By Jennifer Webster
Tuesday, August 28, 2018

With every carefully selected piece of technology and each nuanced therapy, Upstate Cancer Center is building an oncology program comparable to those found at the nation’s leading institutions.

Lisa Lai, MD, Associate Professor of Surgery at SUNY Upstate Medical University and Medical Director of the Breast Cancer Program at Upstate Cancer Center

In addition to attracting expert physicians with specialized training in their fields, Upstate Cancer Center gives its providers the tools they need to offer patients precise, tailored medicine. From radiation oncology equipment to molecular medicine and access to clinical trials, Upstate Cancer Center consistently invests in equipment that offers Central New York cancer patients every advantage science and technology can provide — making state-of-the-art care readily available close to home.

Jeffrey Bogart, MD, Chair of the Department of Radiation Oncology and Interim Director of Upstate Cancer Center, states the rate of advancements in the last decade for cancer treatments and therapies has been phenomenal.

“We have new diagnostic technologies both in imaging and in precision medicine and genomics, and that has advanced the way we approach different testing and personalized therapy by looking at pathology and biopsies,” Dr. Bogart says. “The way we personalize treatment has changed markedly. It’s led to improvements that we’ve never seen before in the history of managing and treating cancer.”

“Advances in understanding the human genome sequence have also revolutionized cancer care,” adds Jeffrey Pu, MD, PhD, Director of Hematopoietic Stem Cell Transplant and Cell Therapy Program and Director of the Hematological Malignancy Program at Upstate Cancer Center.

Jeffrey Pu, MD, PhD, Director of Hematopoietic Stem Cell Transplant and Stem Cell Therapy Program and Director of the Hematological Malignancy Program at Upstate Cancer Center

“We have the technology to look into more detailed information about particular patient populations, genomic stability, mutation or deletions,” Dr. Pu says. “Our advanced DNA technology and testing, combined with our understanding of the human genome, allow us to address cancer at the genomic level.”

Advances in Radiation Oncology

Upstate Cancer Center adapts technological advances, Dr. Bogart says, with the goal of offering patients the widest range of possible treatment options. That is particularly true in his department, radiation oncology.

“What we strive to do at Upstate is offer our patients the greatest breadth of options in terms of technology,” he says. “We want to be able to make sure we address each patient’s situation and can individualize his or her treatment.”

This leads to the acquisition of multiple technologies with similar capabilities, which allows for nuanced treatment different patients and different cancers. Dr. Bogart illustrates this with the choice between Varian TrueBeam or Vero Stereotactic Body Radiotherapy for treating lung cancer.

“We perform a CT scan called a 4-dimensional CT, with the fourth dimension identified as time,” Dr. Bogart says. “We can see how much the tumor moves. And based on the motion, we can use technology that’s part of our Varian TrueBeam to trigger when the beam comes on, based on the breathing pattern, to help avoid unnecessarily treating areas of lung that are not associated with the tumor. With Vero, on the other hand, we can track tumors, meaning the radiation beam moves with the tumor. That’s a fairly new, unique technology. In fact, we’ll soon be one of just a handful of centers in the U.S. with the latest Vero upgrade.”

Gamma Knife

Dr. Bogart lists the Gamma Knife, a radiotherapy tool designed to treat certain cancers of the head and neck, as one of the advanced radiology technologies maintained by five doctorate-level physicists at Upstate Cancer Center. Grahame Gould, MD, FAANS, Assistant Professor of Neurosurgery at SUNY Upstate Medical University, concurs.

Grahame Gould, MD, FAANS, Assistant Professor of Neurological Surgery at SUNY Upstate Medical University

“The Gamma Knife has proven to be a very effective way to treat certain types of tumors in the brain without having to do open surgery,” Dr. Gould says. “It’s minimally invasive, very well-tolerated, and works with tremendous accuracy and very few complications. It’s changed the practice of neurological oncology. We still perform surgery for brain tumors, but we do that a lot less than we used to.”

Like Vero radiotherapy, Gamma Knife has gone through multiple iterations.

“The therapy itself is not particularly new, but the equipment continues to evolve and develop, allowing us to offer shorter treatment times and more accurate treatments,” Dr. Gould says. “We’re continually making treatment easier on the patient.”

Breast IORT

Upstate Cancer Center is an accredited breast cancer program through the National Accreditation Program for Breast Centers. The program has an already impressive armamentarium of the latest advanced technology, and joining that list of offerings is intraoperative radiation therapy (IORT) for breast cancer. Lisa Lai, MD, fellowship-trained breast surgeon, Associate Professor of Surgery at SUNY Upstate Medical University and Medical Director of the Breast Cancer Program at Upstate Cancer Center, describes IORT as a game-changer for patients in Central New York.

Breast surgeon Kristine Keeney is one of the team members affiliated with the Upstate Cancer Center to offer breast IORT for the first time in the region.

“Breast cancer patients who need radiotherapy ordinarily require three to six weeks of outpatient radiation treatments, but now patients can come in once and have a lumpectomy and radiation therapy at the same time,” she says. “Following the lumpectomy, we place a delivery catheter in the lumpectomy space and deliver a targeted, focused dose of radiation to the location.”

As this is the area at the highest risk of recurrence, Dr. Lai explains, the treatments are highly effective because they target at-risk cells while sparing healthy tissue.

“The treatment takes eight to 20 minutes,” she says. “Patients wake up with their surgery and radiation for breast cancer both completed. In the past, patients might have spent four weeks recovering from surgery, then three to six weeks having radiation therapy.”

Advances in Robotic Surgery

Though not used exclusively for cancer resection, robotic surgery has been a key player in making oncology surgery less onerous and recovery less painful and prolonged. Upstate Cancer Center has invested heavily in robotic technology, starting off with thoracic surgery, says Mark Crye, MD, Assistant Professor of Surgery in the Division of Thoracic Surgery at Upstate Medical University.

“Robotic surgery took off when Jason Wallen, MD, arrived,” Dr. Crye says. “When I was recruited here almost a year ago, a main focus of my appointment was to expand on robotic technology, in which I have extensive training. It’s blossomed immensely over the past year.”

The number of robotic procedures has probably tripled in the past year, especially in the areas of esophageal cancer and chest cancer, including lung cancer, Dr. Crye says. Robotic surgery provides benefits to both patients and physicians alike. For patients, the advantages are well reported: shorter hospital stays, less blood loss and need for transfusion, and quicker recovery — all with similar therapeutic effectiveness to open surgery. Indeed, some robotic surgeries have proven more effective than open procedures.

“Data shows we obtain a better lymph node dissection in esophageal cancer when using a robotic platform,” Dr. Crye says. “It’s yet to be determined how this translates into long-term survival, but it does help us assess how far a cancer has advanced. With a minimally invasive approach, there is less pulmonary compromise, meaning we can offer a variety of techniques to patients who might not have been candidates for an open approach.”

For the surgeon, robotic surgery offers three-dimensional visualization and highly nuanced maneuverability, Dr. Crye adds.

“The da Vinci Xi is our most up-to-date system,” he says. “Its advantages span not just what the instruments can do, but some of the add-ons benefit us from a teaching perspective. It permits visualization techniques, such as injecting dye or medicine into the patient and using a special filter that lets us observe tissue and blood flow. With esophagectomies, for instance, the conduit for blood flow you are making is critical to avoid some common but detrimental complications such as leaks. The Xi provides a level of technology that allows us observe blood flow and avoid complications. We are trying to be as precise as we can.”

Immunotherapy: A Fast-Growing Hope

Within less than a decade, scientists have made strides in recruiting the body’s immune response to fight cancer, and Upstate Cancer Center has embraced the new immune therapies available, many based on the specifics of a patient’s tumor.

Stephen Graziano, MD, Professor of Medicine at SUNY Upstate Medical University and Chief of the Division of Hematology and Oncology at Upstate Cancer Center, observes that in his own area of specialization, immunotherapy has advanced rapidly.

“In early trials, immunotherapy proved superior to chemotherapy in second-line treatment of non-small cell lung cancer,” Dr. Graziano says. “Soon after that, immune therapy resulted in greater overall survival, compared to chemotherapy, in lung cancer patients with greater than 50 percent expression of the PD-L1 protein. Then we found that a combination of chemotherapy and immune therapy was superior to chemotherapy alone for advanced non small-cell lung cancer. So immune therapy has moved from a second-line to a first-line treatment for patients with non-small cell lung cancer.”

The FDA will likely soon approve immune therapies for small-cell lung cancer, too, Dr. Graziano adds. In addition, Upstate Cancer Center offers immunotherapy for numerous other cancers, including advanced melanoma, kidney and bladder cancers, Hodgkin’s lymphoma, colorectal cancer and cancers of the head and neck.

“Indications for immune therapy are growing almost monthly,” he says. “The nice thing about the drugs is they tend to be well-tolerated; you must observe patients closely for side effects, but only a minority of patients must discontinue therapy.”

The Upstate Cancer Center has a multidisciplinary team dedicated to lung cancer, known as the Thoracic Oncology Program (TOP). For surgery,TOP has the region’s highest volume of robotic lung and esophageal surgeries.

Bone Marrow Transplant Techniques

Upstate Cancer Center provides hematopoietic stem cell transplant and advanced care for patients with leukemia and lymphoma. Hematopoietic stem cell transplant, like other cancer therapies, has also seen development, Dr. Pu says. The key changes are that we have more hematopoietic stem cell sources, such as bone marrow, peripheral blood, umbilical cord blood, available now; and technology advance makes HLA-haploidentical hematopoietic cell transplantation a reality and almost every transplant candidate can find a proper stem cell donor, Dr. Pu says.

“The characters of hematopoietic stem cells from different sources are slightly different” Dr. Pu says, “wisely and properly use them benefit our patients.”

Because umbilical cord stem cell requires less HLA match stringent for graft, umbilical cord stem cell transplant becomes an alternative transplant technology with a donor pool, Dr. Pu says.

Convenience Is Therapeutic

While care close to home is often touted due to its convenience for patients, locally available, high-quality care can also make a distinct difference to treatment outcomes. A 2016 meta-analysis published in The BMJ Open found that, in about three-quarters of studies surveyed, distance to cancer treatment was associated with worse patient outcomes in areas including survival rates, length of hospital stays and adherence to treatment. That’s why it’s so vital that Upstate Cancer Center offers treatment to patients near where they live and work.

Local care in Central New York can spare patients long drives to major cities, increasing appointment adherence and lessening the expense and effort of treatment. Just as important, Upstate Cancer Center physicians open their arms to patients as to family.

“There is a personal approach to the way we see patients,” Dr. Bogart says. “We have navigators who help with questions, and we try to provide a welcoming environment and as much information as we can. We want to reduce our patients’ stress and optimize their experience. We know it can be fairly daunting to go through the decision and treatment process for cancer, so we try to make each patient feel part of our family as much as possible.”

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