From the October 2012 issue of HealthCare Business News magazine

For any public radio devotees out there, you probably know the dark, witty writing of David Rakoff. He was a regular contributor to NPR’s This American Life. Rakoff, a prizewinning writer and humorist, died this summer from cancer at the age of 47.

In his essays, Rakoff often discussed what it was like having Hodgkin’s Lymphoma at the age of 22, and then two decades later, battling a malignant tumor that appeared in the same spot where radiation treated him during his first bout with cancer. Rakoff died in August from what is known as a post-radiation sarcoma (PRS) — a tumor — most likely the result of his original treatment. PRS is rare, affecting less than 1 percent of patients. It’s categorized by its appearance more than four years post-therapy within the radiated site, and has a different histology from the original tumor.



In a recent interview with NPR Fresh Air host Terry Gross, Rakoff talked about his second cancer diagnosis, acknowledging “access to great medical care,” and the fact that cancer therapies are advancing.

It’s impossible to know if Rakoff could have been spared from a second cancer and a life cut short if he had been treated for his first cancer in more recent years, or in the years to come, as treatment becomes more precise.

During the past several years, radiation therapy has been revolutionized by highly targeted and customizable radiation delivery and planning. According to experts, these new techniques allow clinicians to deliver high doses of radiation more quickly, effectively and with fewer side effects.

The rise of SBRT
The American Society for Radiation Oncology (ASTRO) defines stereotactic radiosurgery as “a distinct discipline that utilizes externally generated ionizing radiation in certain cases to inactivate or eradicate (a) defined target(s) in the head and spine without the need to make an incision.” What’s key is that radiation can be delivered in five treatment sessions, or “fractions,” versus 40 with conventional radiation therapy, according to Dr. Omar Dawood, senior vice president of global medical affairs at the Sunnyvale, Calif.-based Accuray Inc.

“The high dose beams are divided up over many beams, so each beam can’t do much damage as it goes through normal tissue to get to the tumor,” says Dawood. “This allows clinicians to do really high doses, and in only one to five fractions, minimizing damage to normal tissue.”

Stereotactic body radiotherapy (SBRT), also known as stereotactic ablative radiation therapy (some radiation oncologists are trying to coin the term “SABR” to convey the latter term that they feel is more accurate), has proliferated over the past five years. This advanced technique treats not only the head and spine, but also cancers elsewhere in the body, because SBRT addresses the problems of motion from breathing, blood flow and heartbeat.

October 2012 Magazine

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