Joella Bush waits with her husband, John, before he gets a CT scan. He had gamma radiation treatment for a tumor on his acoustic nerve. JENNIFER BRUNO/STAFF

Radiation treatment will not cut patients

Web posted June 8, 2000

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By Tom Corwin
Staff Writer

John Bush had just been wheeled out of brain surgery Wednesday, but he still managed to quote James Brown.

``Yeah, I feel good,'' Mr. Bush, 68, told his wife, Joella.

He is the 11th patient at Medical College of Georgia Hospital to undergo a noninvasive procedure using a device called the Gamma Knife. It allows doctors to focus beams of cobalt 60 radiation to a spot in the brain to destroy tumors and malformations without opening the skull. And like Mr. Bush, patients can leave the same day with little more than a couple of bandages.

The device uses a special helmet with 201 portals to guide gamma radiation to a single focus. The patient must undergo an MRI scan wearing a special helmet with copper sulfate spots around it that show up on the scan to aid three-dimensional positioning and allow doctors to measure and check for distortion on the scans, said MCG medical physicist Rebecca Cantrell. Doctors need the scans to be precise to a millimeter or part of the target may be missed, said neurosurgeon Joseph Smith, director of stereotactic and functional neurosurgery at MCG.

John and Joella Bush watch as another patient receives radiation treatment with the Gamma Knife at Medical College of Georgia Hospital. JENNIFER BRUNO/STAFF

Doctors aim the doses with precise three-dimensional positioning of the patient's head within a framework that fits into the helmet. Lying prone on a platform, the patient is then moved headfirst into the machine until the helmet holes line up with the radioactive sources inside. The radiation then courses along the convergent pathways to intersect at the target. The patients don't feel the radiation during the treatment, so there's no need to put them under, said Dr. W. Chris Sheils, chief of radiation oncology at MCG.

The new device will allow Augusta doctors to treat patients who would be at risk from conventional surgery and will also be an option for those, like Mr. Bush, who do not want to undergo an open procedure.

``I would say that probably about 80 percent could have either conventional neurosurgery or Gamma Knife,'' said Dr. Mark Lee, chief of neurosurgery at MCG. ``And about 80 percent of them would choose Gamma Knife because it's less invasive and (carries) less risk.''

Mr. Bush has suffered since 1995 with a benign brain tumor called an acoustic neuroma, which forms in the lining of the acoustic nerve that carries sound impulses from the ear to the brain. As with most cases, his started off with a constant ringing in his right ear.

``It's more like a hiss, constant noise,'' Mr. Bush said. An MRI scan found the small benign tumor, but after referrals to specialists, he rejected the conventional surgery to remove it.

``I wasn't real excited about them drilling a hole in my skull,'' he said. Over the years, he lost hearing in the ear, but the Bushes were still against the surgery. But when they heard about the Gamma Knife, they decided to give it a try. A new MRI scan found the tumor had grown from 1.5 centimeters to 2 centimeters in a year, putting Mr. Bush at risk for facial nerve damage, Dr. Smith said. While the Gamma Knife procedure carries about a 5 percent risk of causing facial nerve damage, the risk of conventional surgery is probably double that, Dr. Smith said. And recovery from conventional surgery is longer, he said.

Therapy physicist Rebecca Cantrell (left) checks the alignment of the Leksell Gamma Knife with Patrick Jenkins as John Bush (center) waits to be placed in the machine for treatment. Mr. Bush was the 11th patient to be treated with the new device. JENNIFER BRUNO/STAFF

``They would probably be in the hospital for a minimum of four to five days,'' Dr. Smith said. They would likely return to work a week or two after that. With a good Gamma Knife outcome, ``They can go back to work in a day or two.'' The radiation kills cells over weeks and months, spreading out the damage and the need for recovery; that also can be a drawback in that conventional surgery is much quicker and may be more effective for some conditions, Dr. Lee said.

And the Gamma Knife has its trials. Mr. Bush, who is not crazy about needles, had to get shots of local anesthetic to his face so a metal frame could be attached to his head to allow for precise positioning. He ended up wearing it for about seven hours, because of problems with MRI scans that are fed into positioning software and used to create the coordinates. But after the procedure, he was able to smile at his wife and head home.

``And get a good meal,'' he said later. And fall asleep in his own recliner.

Reach Tom Corwin at (706) 823-3213.