Even among the most challenging cancer diagnoses, the case of Jorge Gamez Estrada, 61, (pictured above with his daughters Elizabeth and Cassandra) was a complex one that required a multidisciplinary team and the most advanced treatments for brain metastasis.
About four years ago, he was diagnosed with a rare, duo-type of lung cancer — one with the more common type of malignancy, called adenocarcinoma, which combined with a small component of “squamous cell,” the type that is generally slow-growing but can eventually spread to other areas of the body.
Almost from the start, he presented with brain metastasis, which means the cancer spread to the brain. He would undergo multiple treatments, including surgeries (or “craniotomies” in which surgeons cut a bony opening in the skull) and stereotactic radiosurgery, which delivers precisely-targeted radiation therapy in fewer high-dose treatments than traditional radiation therapy.
Nonetheless, Mr. Gamez’s condition would worsen, affecting his ability to walk.
“He had a total of three craniotomies and he had had a total of four stereotactic radiosurgeries to all the different sites,” said Yazmin Odia, M.D., Chief of Neuro-Oncology at Baptist Health’s Miami Cancer Institute. “When he presented the last time, the lesion was causing a lot of swelling in the brain. And as a result, it was causing his leg to be quite weak and he became increasingly immobilized.”
That’s when the patient and his family were told by his team from Baptist Health’s Miami Neuroscience Institute and Miami Cancer Institute, that Mr. Gamez should undergo brachytherapy, which is increasingly becoming the go-to therapy for patients with recurrent brain metastases after surgeries and more common external radiation treatments have been exhausted.
“The brachytherapy is constantly emitting radiation therapy, so there’s some potential biological advantages against tumor cells that are cycling through the cell cycle to try and replicate and make new tumor cells,” explains Michael McDermott, M.D., neurosurgeon and the Chief Medical Executive of Miami Neuroscience Institute.
The patient’s daughter, Elizabeth Gamez, recalls the family’s quick acceptance of the brachytherapy strategy, especially the treatment’s ability to spare healthy issue. Baptist Health performed one of the first brachytherapy procedures last year in Florida and is the first center in South Florida to offer this novel therapy.
“What I liked the most about it was that it was going to target the tumor itself,” said Ms. Gamez. “It wasn’t going to touch any other areas of the brain, which is kind of concerning because you don’t want radiation where it doesn’t need to be.”
Mr. Gamez’s brachytherapy involved implants of specially encased, radiation-emitting capsules, also referred to as “seeds,” that target residual tumor cells. Most of the radiation is emitted over the first 30 days after the surgery.
“This was his site of progressive and recurrent disease, and this is why his case was reviewed in our multi-disciplinary setting to consider what innovative treatment options that we could offer him,” said Rupesh Kotecha, M.D., a radiation oncologist and Director of the Central Nervous System (CNS) Metastasis Program at Miami Cancer Institute. “For this patient, surgically targeted radiation therapy was the way that we could offer him additional treatment to be able to control that area of cancer.”
Vitaly Siomin, M.D., neurosurgeon at Miami Neuroscience Institute and Miami Cancer Institute, adds: “When we implant the seeds the radiation therapy is delivered into the vicinity of the previously resected tumor and, theoretically, it gives an advantage of not penetrating the healthy tissues.”
Mr. Gamez’s progress has been significant and he is very grateful for the team from both Institutes that enables him now to walk and resume normal daily activities.
“With the (brachytherapy), I have nothing to worry about it,” says Mr. Gamez. “I didn’t have any hair loss at all — nothing. I feel fantastic. I party. I do whatever I want to do. I highly recommend it. I think it’s a fantastic reward for me.”
Not only was the surgery a success, “but based on the most recent scan there’s really not much evidence of any residual or active tumor,” said Dr. Odia. “He has made truly a great recovery.”