Froedtert becomes the second hospital in the U.S. to use a new device in the war against cancer

At 9:29 on a recent morning, Paula Wendt, a 47-year-old school nurse and mother of three, lay on her back in a small white room dominated by the massive white tunnel her head was poised to enter. Soon she would glide into the tunnel, where two powerful magnetic fields would help define and destroy the tumor on her liver.

“Would you like a blanket?” a member of the medical staff asked.

“I’ll take one,” Wendt said, her face a picture of calm.

The scene, which played out under the watchful eye of a split-screen monitor in a control room at Froedtert Hospital, resembled something from “2001: A Space Odyssey.”

It is instead a new frontier in cancer treatment.

Wendt, who’d driven in with her husband from their home in Fond du Lac, was just the second person in the U.S. to be treated with a new device that combines the precision of magnetic resonance imaging (MRI) with the tumor-killing power of radiation.

The device with the fancy name, Elekta Unity MR-linac, addresses a decades-old problem in cancer care: the fact that treatments are not targeted precisely enough to avoid destroying many healthy cells along with the tumor cells. For Wendt, who has been fighting cancer since the day after her 43rd birthday in 2014, the new weapon had an added benefit.

“I think it’s a very significant advance,” said Mike Bassetti, an associate professor in the department of human oncology at the University of Wisconsin School of Medicine and Public Health. “Up until this point, there has been no way to directly visualize the tumor and the surrounding tissue as we are treating the tumor.”

One of the reasons doctors have been at a disadvantage fighting cancer is that tumors move anywhere from 1 to 2 centimeters when patients breathe. They shift, too, when a patient’s bladder fills. As a result, previous treatments — which involved static images of the tumor taken a week or more before radiation — ran the risk of missing parts of the tumor and hitting healthy cells.

By using magnetic resonance imaging, radiation oncologists can now use a precise image of the tumor to direct the radiation beams.

The three main tools medicine uses to combat cancer are surgery, radiation and chemotherapy. Often patients undergo a combination of two or all three. Recent innovations have combined radiation treatments and computerized tomography (CT) scans, allowing doctors to use CT scans as they deliver radiation to the patient’s body.

However, CT scans don’t offer clear enough images of the exact location of tumors found in soft tissue.  For example, the scans have difficulty displaying the precise borders of a tumor from muscles in the mouth used in speech or swallowing — muscles that can be damaged during radiation treatment for a head or neck cancer.

“The beauty of this device is that it goes a step further,” said Michael Milosevic, a radiation oncologist at Princess Margaret Cancer Centre in Toronto. “It allows us to track motion in real time.”

In North America, the device is in use at Froedtert and MD Anderson Cancer Center in Houston. In Europe, it is being used by the Royal Marsden NHS Foundation Trust in London, the Netherlands Cancer Institute and the University Medical Center Utrecht in the Netherlands.

One of the complications engineers had to overcome in developing the device was that the imaging and the radiation beam each use separate magnetic fields. Developers had to devise a way to keep the two magnetic fields from interfering with one another.

The device should improve treatment of many different cancers including those of the head and neck, the esophagus, pancreas, prostate, cervix and breast, according to Christopher Schultz, chairman of the department of radiation oncology at Froedtert and the Medical College of Wisconsin. He said the device should also help researchers by providing a clearer picture of how tumors shrink, grow or move during treatment, and which therapies are most effective.

For Wendt, the path to that January morning began more than four years earlier. She went to see an optometrist thinking she was overdue for a new pair of glasses. She’d had her current pair for a couple of years.

The optometrist said there was an elevation in the retina of her left eye. Wendt knew something was wrong because the optometrist had her see a retina specialist the same day.

Without realizing it, Wendt had lost some of her peripheral vision. That same day, Sept. 4, 2014, the day after her birthday, she received the diagnosis: ocular melanoma. Although it is the most common primary cancer of the adult eye, just 2,500 Americans a year receive the diagnosis.

When she Googled ocular melanoma, Wendt recalled, “the stats are awful.”

The disease is considered an aggressive form of cancer. In roughly half of all patients, the cancer spreads beyond the eye within 10 to 15 years. The diagnosis made Wendt a firm believer in yearly dilation eye exams, which allow doctors a better view of the back of the eye.

She received radiation treatment to her eye in October 2014, and again in July 2015. The following year the cancer spread to her liver.

Wendt began to worry that she might not live to see the high school graduation of Tyler, the oldest of her three children. He graduated in June 2016 and Wendt was there to celebrate.

In January 2017, she received more radiation treatments for cancer on her liver; by August that year the disease was in remission.

In addition, for almost two years ending in August 2017, Wendt received immunotherapy every three weeks.

Still, in October 2018, the cancer returned to her left eye; she had the eye surgically removed. Two months later, on the day she received her prosthetic eye, doctors discovered the cancer had returned to her liver.

“I’m not one to sit around and sulk. Stay busy and be optimistic is my response,” Wendt said. As she prepared for her treatment with the new device, she said, “My thought is that it’s got to work.”

Wendt lay with arms crossed above her head so that the scanner would not have to peer through them to see her liver.

The medical team took a scan to form their treatment plan, then took additional images to use for research.

“We’re ready to start the treatment,” said Brooke McMichael, a radiation therapist.

McMichael then pushed a green button sending an invisible beam of radiation into the tumor. Wendt felt nothing.

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As she lay perfectly still, Wendt prayed and allowed her mind to go where it always goes during treatment. She imagines a beach in Pensacola, Florida, a favorite vacation spot.

“You feeling OK,” said Becca Kocher, another radiation therapist. “We’re going to take one more scan.”

The final scan was a check to make sure that the tumor had not moved.

Aside from stiffness in her shoulders from crossing her arms above her head, Wendt felt fine.

“Holy cow!” she said afterward. “I feel very lucky to be able to go on this machine.”

Her doctor said it is too early to tell whether her treatment destroyed the tumor.