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Moffitt: Targeted Radiation Zaps Cancer, Speeds Recovery




Three months into her third pregnancy, Tarpon Springs resident Tiffany Keller-Fritz understood that something was wrong. A difficult first pregnancy, during which doctors discovered disease in her gall bladder, had taught her to pay close attention to her body's signals.
   
Her concerns weren't alleviated when an obstetrician recommended attending to her symptoms -- severe rectal pressure and diarrhea -- after the delivery of her baby. Six months felt like too long to ignore the unusual pains.  
   
"It got to the point where I almost couldn't even sit,'' Keller-Fritz says.     
   
When she found a new obstetrician and finally visited a gastroenterologist seven months into her pregnancy, Keller-Fritz received a shocking diagnosis: Stage 3 anal cancer. A tumor the size of a soda can had been causing her discomfort. 
   
The months that followed were among the most difficult of her life and, ultimately, the most fortunate, Keller-Fritz says. Within a week of her diagnosis, she became a patient at Moffitt Cancer Center in Tampa, where oncologists worked with her new obstetrician to develop a plan integrating treatment of her cancer with the delivery of her baby. Thirty-five weeks into her pregnancy, Keller-Fritz gave birth by cesarean section to a healthy baby girl. The same week, she began the first of three rounds of chemotherapy, followed by five weeks of high-dose radiation therapy. By June 2010 -- almost a year after her mysterious pains began -- she was cancer free at age 37.     
   
While singing the praises of her Moffitt physicians, Keller-Fritz likes to give her daughter credit for the tumor's discovery.
   
"By being pregnant with her earlier than I planned, she was putting pressure on that area,'' Keller-Fritz says. "In that sense, I think she probably saved me in so many ways.''

The Goal: Return To Normal Life
   
Advances in radiation therapy at Moffitt are turning diagnoses like Keller-Fritz's -- ones that once spelled a death sentence or necessitated life-altering treatments -- into experiences that patients walk away from to return to normal lives, says radiation oncologist Sarah Hoffe.
   
Hoffe leads a team of radiation specialists working out of Moffitt's SABR Center, a radiosurgery facility housed at the cancer center's University of South Florida campus and its International Plaza outpatient location. Working together and with colleagues who specialize in medical oncology (e.g., chemotherapy) and conventional surgery, Hoffe and her staff develop plans to treat patients with the latest in radiation technology: high doses of carefully pinpointed radiation, delivered over far fewer sessions than was once standard.
   
Much of that progress is the result of imaging technology that allows Hoffe's team to generate complex maps of cancer tumors in multiple dimensions. Patients at the SABR Center undergo four-dimensional PET-CT scans that show where their tumors are located and how they change position inside the body during movement, such as breathing, that occurs while lying still. Using those high-tech pictures, a technician creates a complex blueprint -- more like an animation than an architectural plan because it changes over time -- of each patient's tumor. Coupled with the ability to deliver radiation in high doses through Varian and Novalis machines, such detailed information permits the Moffitt team to treat tumors with unprecedented precision.
   
Traditionally, radiation oncologists have treated patients with much less accuracy, exposing tumors as well as surrounding tissue and organs to broad fields of damaging radiation over dozens of sessions. By comparison, a patient of Hoffe's might lay in a contoured cradle underneath a Varian machine for five sessions of 30 minutes as radiation targets their tumor down to the millimeter and avoids critical areas nearby. (To ensure maximum accuracy, a technician nicknamed "Velvet Mike'' for his soothing voice periodically reminds patients to breathe normally during radiation.)
   
"Gone are the days of the gross field,'' Hoffe says. "Everything I treat moves.''
   
The payoff for Keller-Fritz was a tumor eliminated entirely by a combination of chemotherapy and radiation therapy. She avoided surgery and a colostomy.

Cancer Free: Only Place-Markers Remain
   
For Sarasota resident Paul K., radiation therapy in Hoffe's lab transformed a tricky tumor into one readily removable by surgery. Seven months after his 83-year-old mother died from pancreatic cancer in 2011, an endoscopy delivered bad news: Paul K. had the same disease. Worse still, his tumor was in contact with blood vessels, making its removal a difficult proposition for a surgeon. Enter Hoffe and her team, whose radiation treatments shrank the tumor until another Moffitt physician, Pamela Hodul, was able to operate. Within about six months, Paul K. was cancer free.
   
His cancer treatment went by so quickly that Paul K. is sometimes surprised to look down in the shower and see visible evidence of his cancer: a trio of tiny tattoos on his abdomen that were used as place-markers to ensure he would receive radiation in the same place each time. He is now enrolled in a trial of an experimental pancreatic cancer vaccine at Moffitt and has urged his three siblings to enroll, too.
   
"There's nothing easy about cancer, but there is something easier when you have a doctor that you have faith and confidence in,'' he says of Hoffe.
   
As a thank you to Moffitt, Keller-Fritz asked her employer, the major Japanese corporation Itochu, to undertake a special project. She oversees sales for LeSportsac, a maker of fashionable handbags and luggage, and an Itochu brand. With the company’s support, Keller-Fritz created a line of LeSportsac bags in a lavender floral pattern called "Hope Garden'' that she designed. A portion of proceeds from sales in the U.S. benefit Moffitt, while Asia sales benefit a Japanese cancer center.
   
Launched in April, the line has proven to be one of the season's most popular for LeSportsac -- nearly 70 percent of 30,000 bags produced have been sold. In the future, Keller-Fritz hopes to produce more bags for the cause, perhaps raising money to combat a different kind of cancer each year.

Megan Voeller of Tampa is a contributing writer to 83 Degrees Media and the visual art critic for Creative Loafing. Comments? Contact 83 Degrees.
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