Beaming in on The Cure

A new type of radiation therapy, developed by a Bay Area company, shows astonishing promise in fighting cancer

The Stanford Cancer Center, an $85 million, 165,000-square-foot facility that opened its doors March 1, feels more like a hotel than a hospital. The high-ceilinged lobby, suffused with natural light and calming earth tones, features a piano ringed by overstuffed chairs and leads to a reception area where employees direct patients toward the facility's highlight attractions, including a boutique, a Zen garden, and a cybercafe. Gone are the dimly lit corridors linking drab clinics with cramped chemotherapy treatment rooms; the Stanford Cancer Center offers comfortable waiting areas that could pass as airport lounges, with wall-mounted plasma-screen televisions broadcasting soothing images of running water. Ten years in the brainstorming and construction, the state-of-the-art center is more than just an architectural marvel or a technological mecca -- it's an embodiment of the new trends in fighting cancer, and an overt acknowledgement that the battle lines are shifting away from death and toward life.

But some things never change, and that's why the still-unpacked office of Dr. Richard Hoppe, chairman of the radiation oncology department, is located down a long flight of stairs. It's a running joke in the medical community that a hospital's radiation oncology unit is invariably shoved in the basement. There's good reason for this: Radiation therapy usually involves shooting patients with high-energy beams of X-rays, which kill cancer cells but are quite harmful to healthy human tissue. It's imperative, then, that the surrounding walls are thick enough -- usually made of concrete laced with lead -- to contain the radiation being emitted by the hulking microwave machines. "It's better if you can take advantage of the earth or the ground in a couple of directions," says the amiable Hoppe, who played a major role in the design of the center. With a wry grin, he points to a narrow window near the ceiling of his office, which overlooks the base of an exterior wall: "Quite a view, huh?"

The underground location of radiation oncology departments has become something of a convenient metaphor, helping to foster a perception that they are looked down upon, ever so slightly, by the physicians, surgeons, and medical students who toil aboveground. Radiation oncologists are quick to emphasize that their treatments, unlike most chemotherapy, are curative, eradicating cancerous cells and, often, giving patients long, happy lives. But though half of cancer patients undergo radiation treatment at some stage, surgery remains the quintessential mode of cure in the minds of most patients and physicians, with chemotherapy in second place.

As this IMRT treatment plan shows, doctors 
can aim 
X-ray beams from several different 
directions and 
angles to target previously untreatable 
tumors, in this 
case a throat cancer.
As this IMRT treatment plan shows, doctors can aim X-ray beams from several different directions and angles to target previously untreatable tumors, in this case a throat cancer.
Dr. Patrick Swift is a pioneer in IMRT treatments, 
which require head-and-neck patients to wear a 
protective mask like the one shown here.
Paolo Vescia
Dr. Patrick Swift is a pioneer in IMRT treatments, which require head-and-neck patients to wear a protective mask like the one shown here.

But in the bowels of Stanford's new building, inside one of seven underground vaults in the radiation oncology department, the future of cancer care -- and, perhaps, a step toward a cure -- is on display. A medical linear accelerator, standing about 9 feet tall, extending 15 feet in length, and weighing almost 19,000 pounds, commands the vault, its overhanging arm stretching from the far wall to the center of the room. The arm rotates 360 degrees around a movable gurney and emits radiation beams from several different directions, which are aimed to intersect in a shape that closely mimics the 3-D, rounded contours of a tumor; where the beams intersect, the radiation dose is increased. Because the technology is so precise, doctors can spare the healthy tissue around the tumor from all but minimal radiation, while giving high doses to the cancer itself, enabling them to target tumors long considered untreatable because of their proximity to vital organs. "As you increase the dose to the tumor, you can increase the cure rate," Dr. Hoppe says. "As you decrease the dose to healthy tissue, you decrease the risk of side effects. Our aim is always to apply as high a dose as possible to the tumor and as low as possible to the healthy tissue."

The implications of this technique -- called intensity-modulated radiation therapy, or IMRT -- are staggering, and it has been shown to increase cure rates in cancers of the prostate, head, and neck. "It's really revolutionized how we think about radiation oncology," says Dr. Steven Leibel, who is the foremost authority on the technique and will become the head of the Stanford Cancer Center this summer. "It's been a quantum leap in our profession and in our ability to treat tumors."

Although Medicare and most major insurance carriers now cover the treatment, the public, media, and investor attention that's been paid to the tiny company delivering the technology -- Varian Medical Systems -- is utterly underwhelming.

A Palo Alto firm that has been in the X-ray business for 55 years, Varian has eschewed the kind of high-profile clinical trials and broad-based marketing campaigns favored by many in the medical device industry, instead refining its technology through near-continuous dialogues with the physicians and physicists who use it. This approach hasn't earned the company many headlines, but it did garner more than $1 billion in sales in 2003, and word of IMRT is spreading: Following FDA approval of the technology in 2001, nearly 500 facilities nationwide, including several pioneering centers in the Bay Area, bought Varian's $1.7 million IMRT package. Now, the Palo Alto company that started with six employees and $22,000 in 1948 finds itself in a unique position at the forefront of oncology care.

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