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Dr. Forcade on a Promising Treatment to Help Patients Battling Metastatic Liver Cancer

Posted on: August 25, 2014

When There is No Cancer Cure, There Can be ‘Cancer Control’

Carlos Forcade, MD

Chief, Interventional Radiology, Northern Westchester Hospital

Some radical cancer therapies are being replaced in favor of treatments that honor a person’s wish for quality of life over prolongation of poor life.

One example is an interventional radiology treatment at Northern Westchester Hospital using trans arterial radioembolization, or TARE.  TARE shows promise in prolonging quality of life for many patients battling liver cancer and metastatic colorectal cancer in the liver.

This unique interventional treatment delivers Yttrium-90, a radioactive isotope, directly to a tumor through the vascular system. It is a scientifically sophisticated technique for giving NWH patients a cancer treatment that doesn’t harm the healthy cells.

First, What is Interventional Radiology?

A subspecialty of Diagnostic Radiology, Interventional Radiology uses image guidance to perform minimally invasive procedures to treat a wide range of diseases.

Better Outcome for Our Patients

More than three-fourths of liver cancer patients can’t have surgery; TARE with Yttrium-90 gives patients more time.  And as an interventional radiology procedure, it offers the benefits of a minimally invasive treatment:

  •    Reduced infection rates, risk, pain and recovery time
  •    Shorter hospital stays
  •    Uses under local anesthesia instead of general anesthesia

TARE with Yttrium-90 is an advanced treatment that is invaluable for patients with primary and secondary malignancies of the liver who have previously exhausted or who do not have other options in combating their liver cancer.

How TARE with Yttrium-90 Works

Tumors need a blood supply, which they actively generate, to feed themselves and grow. Interventional radiologists are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body. In treating cancer patients, Interventional Radiologists can attack the tumor from inside the body without medicating or affecting other parts of the body.

Combining the radioactive isotope Yttrium-90 (also known as Y-90) into microspheres to deliver radiation directly to a tumor allows for a higher, local dose of radiation to be used-without subjecting healthy tissue in the body to the radiation.

 trans arterial radioembolization Northern Westchester HospitalEach microsphere is about the size of five red blood cells in width. These beads are injected through a catheter from the groin into the liver artery supplying the tumor. The beads become lodged within the tumor vessels where they exert their local radiation that kills the cancer cells. Y-90 radiates from within and is administered via the hepatic artery. Y-90 treatment is approved by the Food and Drug Administration for the treatment of inoperable liver cancer and metastatic colorectal cancer in the liver.

While this advanced treatment doesn’t cure liver cancer, the lives of patients at NWH are being extended and their quality of life is improved with Yttrium-90 microsphere treatment.

The Team Approach at NWH

Paramount to the application of this leading-edge treatment is the multidisciplinary collaboration at Northern Westchester Hospital between the Interventional Radiology Department and the Radiation Oncology Department, led by Dr. Alfred Tinger, Chief of Radiation Oncology in The Cancer Treatment and Wellness Center.

There are other interventional radiology treatments available at Northern Westchester Hospital that are used to treat primary liver cancer, as well as other cancers that have metastasized in the liver, such as colorectal cancer, breast cancer, gynecologic cancers, melanoma, and others. These nonsurgical interventional radiology treatments are:

  • Trans arterial embolization (TAE)
  • Trans arterial chemoembolization (TACE), which delivers chemotherapy directly to the liver
  • Radiofrequency ablation (RFA), which kills the tumor with heat to treat the cancer locally.

Editor’s Note:  Carlos Forcade, MD, is Director of Interventional Radiology at Northern Westchester Hospital in Mt. Kisco, NY.  For more information or for a referral please call the Interventional Radiology Department at 914.242.8154

NWH is one of only 5 Hospitals in New York State to offer Yttrium-90 therapy for the treatment of liver cancer. (The other hospitals are: Memorial Sloane-Kettering, NYU, Mt. Sinai and NY Presbyterian.)

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Northern Westchester Hospital Chief of Dermatology Talks Skin Cancer and Melanoma

Posted on: July 31, 2014

Melanoma: The black sheep of the family

By Dr. Ross Levy

Of the three common types of skin cancer, melanoma is the most worrisome. This aggressive cancer is deadly when caught late. Skin cancer in general is on the rise: Fifty years ago, one in 2000 people developed a melanoma. Now it’s one in 35. By gaining a better understanding of melanoma and its causes, you remove some of the scare and can protect yourself. Continue reading

Northern Westchester Hospital Chief of Pediatrics Discusses New Vaccination Requirements in New York

Posted on: July 22, 2014

Back-to-School Preparations May Need to Include Vaccinations
By Dr. Pete Richel

Your child may need a new vaccination before classes start this fall. For the first time in more than a decade, New York State has updated its school immunization requirements, and now children must be vaccinated twice against varicella—chicken pox.

Image courtesy of Sura Nualpradid / FreeDigitalPhotos.net

Image courtesy of Sura Nualpradid / FreeDigitalPhotos.net

Prior to July of this year, parents could opt out of the second chicken pox vaccine. Why the shift? After all, many adults may remember chicken pox parties from their youth: Mothers would take children to visit a sick kid so that their children would be exposed, get ill, and gain immunity. Although chicken pox can be relatively mild, it can also cause permanent scarring and in some cases turn deadly. As recently as 10 years ago—before use of the vaccine was widespread—the US had as many as 100 deaths a year from chicken pox. From a public health perspective and from mine as a doctor, one death is too many. If we can eliminate this risk, we should seize that opportunity.

There have been some other minor changes to the immunization requirements, such as stipulating a schedule of three to five polio vaccinations before starting school. This has to do with timing. If your child has received the required three polio vaccines in infancy, they must still receive one at the time of school entrance. Three are required, and four are recommended for complete immunization. In either case, one must be received between the ages of 4 and 6. The new requirements—which will be phased in over the next seven years—apply to students starting daycare, Head Start, nursery, pre-kindergarten, and grades kindergarten through 12. If you’ve already taken your children for their wellness visit and vaccinations—or you’re not sure if your child is vaccinated against chicken pox—contact your pediatrician.

Editor’s Note: Dr. Peter Richel, MD, FAAP is Chief of Pediatrics at Northern Westchester Hospital.

Northern Westchester Hospital Dietitian Shares the Benefits of Berries

Posted on: July 22, 2014

Benefits of Berries
By Stephanie Perruzza

 

Berries are delicious and nutritious, packing a tasty and powerful punch in every bite.  They contain large amounts of antioxidants important in protecting against chronic disease; they are also low in calories!  Enjoy them fresh or frozen in your favorite dishes. Continue reading

New York Neonatologist Talks Pulse Oximetry and Newborn Screenings

Posted on: July 16, 2014

The Fourth Vital Sign

By Dr. Rick Stafford

SONY DSCCongrats. You’re having a baby! Whether this is your first, or your fifth, you’ve most likely read everything you need to know about what to expect, and you’ve no doubt gotten advice from well-meaning friends and relatives. But before you take your infant home, doctors will be looking for a few key signs that your child is healthy and ready to leave the hospital. All states require specific tests for newborns to assess for potentially fatal disorders that aren’t otherwise apparent at birth, among them the recently required pulse oximetry assessment. The information below explains its significance.

New to the newborn screening docket, as of 2013, is pulse oximetry screening for cyanotic congenital heart disease (CCHD). Pulse oximetry, which indirectly measures the oxygen level in the bloodstream, has become almost a fourth vital sign (temperature, pulse rate and respiratory rate are the traditional 3 vital signs). New York State health code now mandates pulse oximetry screening for CCHD in all newborns born in New York. Northern Westchester Hospital was proactive in this regard and has been administering the screening since April of 2013.

The right side of the heart pumps blood through the lungs, where it picks up oxygen. Blood returns to the left side of the heart, where it is then pumped to the rest of the body. There are some congenital cardiac defects that impair oxygen delivery to the blood.  This results in the delivery of de-oxygenated blood to the body, a condition (cyanosis) that is not compatible with life. Pulse oximetry screening can pick this up in a newborn before he or she becomes critically ill. In a fetus, the circulation is very different. Oxygenated blood comes from the placenta and two shunts; it then circulates around the lungs into the left side of the heart where it flows to the rest of the fetus.  Because of this, a fetus with a cyanotic congenital heart defect will not be sick while in the womb.

These shunts are supposed to close within a few hours after birth, and when they do, the babies may begin to get sick. The shunts don’t always close right away and a baby may get sick after being discharged home. This is why applying pulse oximetry screening to a newborn is so valuable. Doctors and nurses normally wait at least 24 hours before administering the screening. Do the test too early and it’s possible those shunts are still working, thus masking the condition. Too late and the baby could become very sick very rapidly.

The test is administered with a sensor that measures and compares the differences in the wavelengths of oxygenated and deoxygenated blood. The sensor is first placed on the baby’s hand and then on the foot, with the expectation that the numbers will be the almost the same. A cardiologist would be called in for a consult if there is a percentage difference of three points or higher, or if the baseline saturation is low. If a diagnosis of CCHD is made, the neonatology team would then work to stabilize the baby and prepare him or her for transport to a large regional center where corrective heart surgery could be performed.

It’s all about early detection, intervention and treatment.

Editor’s Note: Rick Stafford, MD, FAAP is the Director of Neonatology at Northern Westchester Hospital. Parents looking for more information on this subject should check out the web-site of the American Academy of Pediatrics: www.aap.org