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Just one radiation session treats teen's serious brain condition

Posted on Tuesday, June 30, 2009 · Volume: XLII · Issue: 13


Dr. Aidnag Diaz talks with Michaela Caballero a few minutes before the teen’s radiosurgery. The CTRC’s new Novalis Tx system “zapped” a tangle of blood vessels in her brain to keep them from bleeding.
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Dr. Aidnag Diaz talks with Michaela Caballero a few minutes before the teen’s radiosurgery. The CTRC’s new Novalis Tx system “zapped” a tangle of blood vessels in her brain to keep them from bleeding.clear graphic

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A new radiosurgery system in the hands of an experienced team of cancer specialists has defused the time bomb ticking in the brain of 18-year-old Michaela Caballero. Caballero received a procedure using the advanced technology, known as Novalis Tx™, June 23, at the Cancer Therapy & Research Center (CTRC) at The University of Texas Health Science Center at San Antonio.

The technology can safely treat patients with surgical precision, but without an incision. It replaces actual cutting with the delivery of high-energy X-ray beams into the tumor or lesion. The goal is to destroy the target, which in Caballero’s case was an abnormal tangle of blood vessels called an arteriovenous malformation (AVM), without harming surrounding sensitive brain structures.

“The 40-minute Novalis Tx procedure enabled us to close off the abnormal blood vessels to keep them from bleeding,” says Caballero’s CTRC physician, Aidnag Z. Diaz, M.D., associate professor of radiation oncology at the UT Health Science Center. “We believe Michaela has a 90 percent chance of a complete recovery,” he said, following the one outpatient treatment.

Less invasive procedure, easier convalescence
Caballero headed home shortly after the 6:45 p.m. procedure and was able to resume her normal activities after a day of rest. She avoided the hospital stay and several days’ convalescence that comes with conventional surgery. Perhaps most importantly, her long, beautiful brown hair did not have to be shaved.

During radiosurgery, the patient is closely monitored from the adjacent control room by her treatment team, including (left to right) Dr. Alonso Gutierrez, Sian Buxton, June Duran and Dr. Aidnag Diaz.
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During radiosurgery, the patient is closely monitored from the adjacent control room by her treatment team, including (left to right) Dr. Alonso Gutierrez, Sian Buxton, June Duran and Dr. Aidnag Diaz.clear graphic

 

Caballero now considering becoming a nurse
“I’m happy I could keep my hair,” Caballero said two days after the procedure. “I feel as if nothing happened. I woke up with band aids on my forehead and I just have to take it easy for a couple of days.” The 2008 MacArthur High School graduate said the positive experience confirmed her interest in becoming a nurse.

Advantages of the technology
A partnership between the Health Science Center departments of radiation oncology and neurosurgery paved the way for Christopher Koebbe, M.D., clinical assistant professor of neurosurgery, to refer his otherwise healthy young patient to Dr. Diaz. Conventional brain surgery was ruled out due to the location of the lesion and because a previous procedure known as an embolization had caused Caballero’s face to droop temporarily.

“With conventional surgery to remove the AVM in a functional area of the brain, patients are often left with facial paralysis, numbness and partial blindness on the side of the malformation,” Dr. Diaz said.“With radiosurgery, Michaela’s chances of temporary or long-term neurologic side effects are very low and she has the peace of mind of knowing that she took action. Without treatment, she would have a 5 percent chance of having a stroke every year for the rest of her life. At her age, this is unacceptable.”

Procedure backed by team of experts
While the radiosurgery procedure was quick, it took 12 hours to prepare, starting at 6:30 a.m. with an angiogram at St. Luke’s Baptist Hospital to show the exact location, size and shape of her AVM. A team composed of a half dozen radiation oncologists, medical physicists and a neurosurgeon created the plan that guided narrow beams of radiation directly to the tangled blood vessels. Novalis Tx’s ability to shape the beams to match the lesion’s jagged contours enabled the maximum dose to cover the deep-seated lesion while avoiding delicate brain tissue nearby.

Only Novalis Tx surgery site in Central and South Texas
Dr. Diaz notes that a large majority of pediatric (age 21 or younger) tumor patients in San Antonio come to the CTRC for treatment. Although some still go to Houston or Dallas, Dr. Diaz hopes that public awareness about the arrival of Novalis Tx will help parents realize they do not need to leave San Antonio to treat their children’s cancer. CTRC is the only cancer center in Central and South Texas to have Novalis Tx, which represents the latest technology in noninvasive, image-guided radiosurgery.

 
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