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Precision-Guided Cancer Weapons


In early 2005, Phil Ogden noticed he was having trouble swallowing food and went to a doctor, thinking he might have acid reflux. The news was far worse. The 66-year-old retired cop from Modesto, Calif., had esophageal cancer, and it had already spread to nearby lymph nodes. Dr. Albert Koong, a radiation oncologist with Stanford University's Comprehensive Cancer Center, asked if Ogden would mind being the first person to undergo a new type of radiation treatment. "The doctor said: 'For the first time in history, we can bomb the equivalent of an outhouse from 30,000 feet with no collateral damage,'" Ogden recalls.

Koong was referring to treatment with a $3 million device from Varian Medical Systems Inc. (VAR) It combines a linear accelerator, which emits high-energy X-ray beams, with advanced imaging gear. The machine enabled the doctor and his team to home in on cancerous cells and deliver precise doses of radiation over a six-week period without harming surrounding tissue. For the patient, that meant fewer side effects of radiation, such as a dry mouth and weight loss. Within days, Ogden was putting on pounds as it became easier to swallow. Ogden has since had to receive chemotherapy to treat small spots of cancer elsewhere in his body, but his esophagus remains cancer free.

A CHEAPER ALTERNATIVE

Thanks to a stream of innovations, the century-old medical technology known as radiation therapy is starting to play a more prominent role in treating many kinds of cancers, including cases in which the tumors have begun to metastasize to other parts of the body. "We used to consider metastatic cancer incurable, so what was the point of taking aggressive treatment that would lower the quality of the remainder of the person's life?" says Dr. Yoshiya Yamada, a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York. But improved radiation therapies are dramatically changing that equation, he says. "We're giving options to people that had no options."

Radiation, often in combination with other types of treatment, is now used to treat 70% of diagnosed cancers, according to the American Society for Therapeutic Radiology & Oncology. And with a typical 40-session regimen costing under $20,000, it can be a relatively cheap alternative to the latest drug therapies, which cost $40,000 a year or more for a single medication. In the future, some patients may be able to go into the hospital for a yearly radiation treatment to kill off any newly appearing cancer cells, thus turning a once-fatal disease into a chronic condition. Varian Chairman Richard M. Levy believes improvements in radiation therapy are largely responsible for raising the five-year survival rate for cancer patients from 40% to 65% over the past 30 years. He says that could go as high as 80% in the not-too-distant future as technology keeps improving.

With 70% market share for medical radiation gear in the U.S., Varian has come up with many of the key advances in this field—along with software and training programs that make it easier for hospitals to embrace the technology. Most of the breakthroughs involve reducing collateral damage to healthy tissue. A high-intensity beam of energy can zap almost any cancer cell it encounters. But until recently, radiation was a fairly blunt instrument, killing everything around the diseased cell and making it difficult to treat tumors deep in the body. Doctors would use X-ray imaging to get a bead on tumors, then aim thick, uniform columns of radiation where they thought the cancers might lie. Varian and other radiation-device makers changed all of this in the late 1990s with a technology called intensity-modulated radiation therapy, which allowed physicians to beam lower-intensity rays from almost any angle, with each ray sculpted to conform to the shape of the tumor.

PINPOINT ACCURACY

Varian's next breakthrough, called image-guided radiation therapy, lets doctors monitor any shift in the position of the tumor from day to day by means of combined CT scans and PET scans, further reducing the damage to surrounding tissue. This is the treatment Phil Ogden received at Stanford. The CT scan helps doctors pinpoint the location of the cancer, and the PET scan provides details on the tumor's size and activity. With the help of infrared imaging during the procedure, the beams can be adjusted to compensate for movement as the patient breathes. "This was all a pipe dream just four years ago," says Sloan-Kettering's Yamada.

One powerful application of all this technology is stereotactic radiosurgery, which allows massive doses of radiation to be given in a few sittings, or just one. This has been used initially for inoperable brain tumors, but the technique could be employed more broadly as doctors gather clinical evidence that it is effective and safe. "It's extraordinary to look at where we started and where we are now," says Dr. Marnee Spierer, a radiation oncologist at Montefiore Medical Center in the Bronx, N.Y.

Innovation has resulted in a profitable business for Varian. In the fiscal year that ended last September, the company earned $245 million on sales of nearly $1.6 billion, and it reported net income of $49.5 million for the latest quarter, up from $41.2 million the year before. Varian sold 500 linear accelerators in 2006 alone, many of them high-end models with full imaging capabilities.

Cancer centers that spring for the expensive equipment have no trouble finding patients. Memorial Sloan-Kettering says its 10 linear accelerators are fully utilized. At cancer center operator Radiation Therapy Services Inc.'s (RTSX) 76 locations, about 1,600 patients are treated every day. And some 120 patients receive daily care at Stanford University Hospital's cancer center.

It's true that some forms of cancer remain inaccessible to radiation treatment. And there are limits to how much radiation the body will tolerate—especially organs such as the pancreas, the eyes, and the spinal chord. Phil Ogden hit his limits for radiation, and now relies on chemotherapy to attack spots of cancer in his neck and upper back. And skeptics would like to see more long-term data that the latest developments in radiation therapy can actually keep patients alive longer.

Recently, critics also have raised questions about the economics of radiation therapy. Insurance reimbursements to hospitals performing such treatments tend to be higher than for some other therapies. So once a hospital splurges on a radiation center, critics say there could be a risk that doctors or administrators will steer patients in that direction.

But physicians deny that treatment decisions are driven by financial concerns. For one thing, they note, Medicare and most private insurers have their own physician committees, which review diagnoses and prescribed treatments on a case-by-case basis. Dr. Charles Vialotti, radiation oncologist at Holy Name Hospital in Teaneck, N.J., points out that using the latest combined radiation and imaging techniques is "very labor-intensive. I can't imagine prescribing it when it wasn't necessary." Not that doctors lack enthusiasm for the technology. Says Todd Scarbrough, a radiation oncologist at the MIMA Cancer Center in Melbourne, Fla.: "We have this hammer, and we see many appealing nails."

By Peter Burrows and Nichola Saminather


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