Double Advancement in Cancer Care at FHN

Cancer treatment is advancing rapidly, and FHN is keeping pace, by expanding the footprint of its cancer treatment center and introducing the latest in treatment technology equipment.

Cancer continues to affect a significant portion of the population, impacting not only patients, but also their families, colleagues and friends. The good news is that treatments are advancing tremendously. The newest chemotherapy and radiation methods are more effective and refined, and are delivered in a shorter time span. The atmosphere in which they are administered is evolving as well, to help patients better tolerate treatments.
Such is the case at FHN in Freeport, Ill., where the FHN Foundation recently committed $2 million to help to expand the footprint of the Leonard C. Ferguson Cancer Center and to upgrade its oncology radiation technology.
The FHN Foundation has helped to fund the Leonard C. Ferguson Cancer Center in Freeport since it opened 15 years ago. “We decided to go ahead and put in the new equipment now,” says Terry Egan, executive director of the foundation. “And we’re launching a capital campaign this fall to coincide with the expansion’s groundbreaking.”

Space has been an issue at the center, because of a steadily growing patient load.
“In 2009, our patients received 1,485 chemotherapy treatments, while 170 patients were given 3,866 radiation treatments,” Egan says. “Since the center opened, it has provided more than 14,500 chemo treatments, and 2,700 patients have received radiation treatments. We believe the numbers will only increase.”
The center often has more patients than room to treat them. Even with four dedicated, totally private mini-suites for chemotherapy treatment, it’s sometimes necessary to place some patients in less private areas.
“Some patients like to share and talk about their treatments with other patients, but others prefer privacy,” Egan says. “Face it: Chemo doesn’t make people feel good.”
The expansion plan includes semi-private spaces with movable dividers, so that patients can choose to be sociable or secluded.
FHN Foundation’s capital campaign co-chairs Brian W. Stewart, president and CEO of Brian W. Stewart & Associates, and Martha Furst, President and CEO of Furst-McNess Co., will lead the fundraising effort, which will correlate with the groundbreaking. A date hasn’t yet been set for this event.
Egan describes the patient-care goals of this newly-expanded center in three words: closer, faster and better. The center regularly treats regional residents from Stephenson and Winnebago counties as well as those from Ogle, Carroll, Jo Daviess and Monroe counties, and has attracted patients from as far away as New York.
“Instead of going to Madison, Chicago or the Mayo Clinic, patients can come to FHN in Freeport,” says Egan. “We have a relationship with the University of Wisconsin (UW) Carbone Cancer Center, in which we use video capabilities to host meetings with UW doctors who review patient cases. This brings costs and time requirements down considerably, while maintaining the highest possible quality of care.”

Meanwhile, the latest oncology radiation technology has been installed in the cancer center and is already being used to fight specific cancers.
“First, it’s important to understand that radiation is simply a very powerful form of x-rays,” says Dr. Patrick Fernandes, a radiation oncologist who practices at FHN’s cancer center. “Of the one in three people diagnosed with cancer, more than half receive radiation therapy to kill cancer cells. The goal is to do this without damaging surrounding normal cells, as much as possible.”
About a century ago, when radiation therapy was first introduced, the radiation delivery was based on a crude technique that treated the cancerous tumor but also caused serious side effects. In the 1950s, linear accelerators were developed that allowed radiation oncologists to refine the therapy. The field of radiotherapy advanced greatly in the 1980s, with the advent of three-dimensional conformal treatment planning. This newer technology made it possible to focus the radiation beam more tightly on tumors, thereby reducing collateral damage.
“We still had challenges, because the beam could be conformed in round, square and rectangular shapes, but it couldn’t truly match tumor configurations, which can be convex, concave and irregular,” Fernandes explains.
Thus, intensity-modulated radiation therapy was developed, a computer-aided technology that delivers radiation comprised of thousands of fine beams instead of one. The therapy is literally sculpted to match the tumor’s shape and size. This not only prevents damage to surrounding healthy tissue, but also allows higher doses of radiation to be used, potentially improving tumor control.
“Intensity modulated radiation therapy has been introduced within the past 10 years,” Fernandes says. “One remaining problem with radiation therapy has been the lack of means to exactly localize the target area every day with this conformal radiation beam. Even with immobilization methods and aligning patients to external marks on their skin, we still could not accurately rule out day-to-day variation of the patient during a five-to seven-week radiation schedule. A tumor in the lung could also move during treatment, primarily due to breathing.”

This challenge has been answered by the most recent innovation, image-guided radiation therapy (IGRT), the frequent use of imaging in an attempt to ensure precise delivery of radiotherapy. FHN, in collaboration with UW, soon will be treating patients with ELEKTA INFINITY, a state-of-the-art linear accelerator capable of delivering radiation with IGRT. The physician will be able to image the patient immediately prior to each fraction of treatment, while the patient is on the treatment table.
Three-dimensional CT scans obtained in this manner are then compared with the original treatment plan. Should there be any misalignment, the necessary adjustments are made to the patient’s position and then the treatment continues, Fernandes says. This ensures the maximum degree of accuracy and precision in delivering the maximum amount of radiation to the tumor and decreasing exposure of healthy tissues.
Another vital step in the progress of cancer treatment, says Fernandes, is volumetric modulated arc therapy (VMAT), which is integrated into the ELEKTA INFINITY machine.
“Cancer treatments with IGRT can take as long as 30 to 40 minutes for each delivery, while the patient lies totally still, because of the complexity of the treatment design,” says Fernandes. “This would be hard for some patients to handle. The VMAT is sophisticated software capable of controlling the position, angle, speed and dose rate of the ELEKTA INFINITY machine. This leads to a significant drop in treatment time, by 50 percent or more, without compromising tumor control. This is highly sophisticated technology, the first to be installed in the northwestern Illinois region, I believe. Patients no longer need to travel to Chicago, Madison or other large metropolitan centers to take advantage of this leading-edge therapy.”
Yet another innovation to be added to FHN’s cancer center is the Philips four-dimensional CT scan (4-D CT) simulator. Fernandes emphasizes that every patient needs to undergo “simulation” before receiving radiation treatment. Conventional simulation uses an x-ray machine capable of the same mechanical movements as the treatment machine.

Because images obtained from these machines are only two-dimensional, they have limited benefit. The introduction of CT scans helps the radiation oncology community with providing superior three-dimensional data for treatment planning. In addition to the three dimensions of space, the Philips 4-D CT Simulator compensates for the problem of tumor motion by measuring its movement in the fourth dimension of time. It factors into the treatment equation such elements as patient breathing, heartbeat and natural abdominal motion. Fernandes says this is particularly important when treating lung cancer, one of the most common cancers treated with radiation therapy.
All of this highly advanced technology gives Fernandes and his colleagues the ability to track and treat tumors in the lungs, abdomen and pelvis while delivering an extremely focused radiation beam.
“We’re now able to treat complex tumors as never before,” says Fernandes. “But what it’s really all about is saving patients’ lives, in ways that don’t diminish their quality of life. We want to cure the cancer, and at the same time, protect patients from suffering the horrific side effects that once were part of radiation therapy treatment.”
According to FHN president and CEO Michael Perry, FHN’s Leonard C. Ferguson Cancer Center is a great example of the organization’s commitment to provide regional health care services driven by need.
“The increase in volume of patients we’ve seen in recent years at the Cancer Center is the most basic reason behind the enhancements we are making to our cancer treatment facility and services,” says Perry. “We try very hard to match local needs to what we make available, partnering where it makes sense to do so. That way, we’re building on success, which helps to ensure continued success.”

Perry describes the relationship with the UW Carbone Cancer Center as a wonderful asset to the people of northwest Illinois, one that allows FHN to bring true state-of-the-art care to the area very efficiently.
“We have partnerships with other health care organizations too, which range from information technology initiatives to other clinical support efforts, all arranged with the care – and pocketbooks – of our patients in mind,” Perry says.
“Combined with the excellent care and services available at FHN Memorial Hospital and our 25 regional offices, we’re able to provide high-quality health care very close to home. This is especially great for cancer treatment, which can be challenging, both physically and emotionally, for patients and their families.” ❚