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Then and now: The CAT scan on the left shows the tumor in Waldron’s liver soon after it was discovered; in the image on the right, several months after advanced treatment, all signs of cancer were gone.
The treatment that Salem proposed was an innovative therapy with yttrium 90 microspheres. A leader in this therapy, Northwestern has performed about 1,500 treatments. Salem has worked with yttrium 90 microspheres for ten years, treating patients referred to him from as far away as Hong Kong, and Northwestern Memorial has published about 50 percent of the medical literature on this treatment. The therapy, indicated for patients with inoperable liver tumors and other tumors that have spread to the liver, uses tiny radioactive spheres to attack cancerous tumors in the liver; yet the impact on the patient’s healthy tissues in general is minimal.
“It is a very sophisticated, very potent form of radiation,” says Salem. “We place a catheter through the groin up into the liver, and we inject these microspheres. When you think about normal radiation therapy, the patient lies there, and the machine tries to focus on the tumor for radiation. But it’s treatment from the outside in. For this microspheric treatment, you go on the inside to the tumor, and you inject the radiation directly into it.” The micro-spheres are directed through radiologic imaging, and patients receive usually only one treatment, sometimes two.
Salem delivered six million micro-spheres of radiation to Doug’s liver. Then the wait began. “It takes several months to see what the results are,” Salem says.
The aftermath: Waldron at home with his wife, Diane. “It’s a funny thing to say,” he explains, “but it was a very good experience.”
The road to recovery wasn’t smooth. Shortly after his radioembolization treatment, Doug became very ill and ran a fever up to 103 degrees. Northwestern didn’t have any beds avail-able, so Doug was transported from his home by ambulance to the Con-dell Medical Center. On the way, he suffered a mild heart attack. In this situation, doctors would normally have prescribed heart medication and exercise. Due to his poor circulation as a consequence of diabetes, however, Doug was unable to exercise. After he recovered from the heart attack, his team of doctors at Northwestern inserted stents into one of his legs to increase circulation. That dramatically increased his mobility. “At first, Doug would walk a few extra yards,” says Diane. “Then he could walk to the end of the driveway. Then he could make it around the park in back of our house.”
Still, a month after Doug’s micro-sphere treatment, Salem saw no change in the tumor in his liver. “It looked like there had been no improvement whatsoever,” says Salem. “I was a little disappointed.
In fact, I even gave him the ‘This therapy didn’t work for you’ speech. Then he came back in two months for a recheck, and there was an inescapable, incredible improvement. It just got better and better after that, with the tumor disappearing.”
“You could see it on the CAT scans,” says Doug. “There were no hot spots of cancer. And then, slowly but surely, you could see that the liver had started to grow back.” By February 2007, Doug was strong enough to overcome his final health obstacle: Surgeons at Northwestern removed the top part of his right lung, successfully ridding him of that tumor. Tests showed that the lung cancer had not spread to any other organs or lymph nodes.
“These kinds of stories are almost unheard of,” says Salem. “But in medicine, this is what we chase. We use statistics and clinical trials to help us try to make decisions, but what we are truly chasing with individualized patient care are these dramatic responses. It doesn’t mean that everyone is going to have this result, but it does show the proof of the concept. If we can fine-tune this therapy, then we can use it in so many ways.”
As for the Waldrons, they are understandably thrilled. “It’s a funny thing to say, given the circumstances,” Doug explains, “but it was a very good experience.” Diane adds, “They gave me my husband back.” Their future plans possibly include a move back to Arizona in the spring. “Why not?” Doug says. “I feel great.”
Photography: Tom Maday