DETROIT – Cancer survival rates have improved dramatically in recent decades, giving patients more years, but also raising new challenges for doctors who must manage complications that emerge long after treatment ends.
One of the most serious is when cancer returns or spreads to the spine, where treatment options are limited, and the stakes are high.
Now, a team at Henry Ford Health in Detroit has performed what is believed to be a world-first procedure, adapting a brain cancer technology to treat a spinal tumor.
When cancer comes back
Michael Baumstark thought he had beaten colon cancer.
Then, six months after being declared cancer-free, a routine follow-up scan changed everything.
“It was a routine test they do every six months, I guess, after you get diagnosed,” Baumstark said. “It showed that it started creeping back in. So they did some more testing and found out that the tumor was growing back in my back.”
The returning tumor was treated with chemotherapy and radiation, but Baumstark’s pain only worsened. Daily life became nearly impossible.
“I couldn’t focus on things. I mean, it was even hard to drive. It was hard to focus on anything. And just daily life was very hard. It was nonfunctional, basically. I mean, I really need help with almost everything,” he said.
A problem without a clear solution
When Baumstark was referred to Henry Ford Health neurosurgeon Dr. Adam Robin, the case was already complex.
“He had already had sort of the kitchen sink thrown at this tumor,” Robin said.
Additional external radiation was not a safe option given the tumor’s location near vital organs.
“There’s only so much external beam radiation you could give to the lower back and sort of pelvic area, because of all the other organs there, right? So, you know, the rectum and the colon and the bladder and everything else are all at risk when you’re sort of shooting radiation into that part of the body,” Robin said.
The surgical team needed a solution that was both precise and durable.
“We had a problem. The problem was that we needed to take out the tumor, but we needed to make it durable. It needs to be a durable solution. We wanted to use radiation again, but we couldn’t use a radiation that was going to irradiate all of the area around it. So we needed a focal radiation,” Robin said.
Adapting brain cancer technology
Robin drew on his experience treating brain tumors using a treatment called a GammaTile, a small implant containing radioactive cesium-131 seeds housed in a titanium capsule.
The tiles are designed to deliver targeted radiation directly to a surgical site after a tumor is removed.
The challenge: gamma tiles had never been used in the spine.
“We approached the company and said, ‘Have you ever done this before?’ The answer is no,” Robin said.
A team-based approach
Rather than abandon the idea, Robin turned to Henry Ford Health’s innovation institute to build a collaborative solution.
“Thankfully, we have an innovation institute here at Henry Ford, and we could go to them, and we could talk, because we use a team-based approach for some of these problems at Henry Ford. We could talk with our radiation oncologists, we could talk with our medical physicists, and we could talk with the company, and everybody sort of worked together, on Mike’s behalf,” Robin said.
The team created a 3D-printed model of Baumstark’s spine and tumor, then performed a full simulated surgery in a lab before ever operating on the patient. Baumstark, who works with 3D printing himself, immediately understood the approach.
“He talked about 3D printing the spine, and I thought, well, gosh, that’s what I, you know, I 3D print all the time. That’s great,” Baumstark said.
The simulation proved critical in fine-tuning the procedure.
“We took that model to the surgical lab, and we did the surgery that we were planning on doing on Mike; we did it in the simulation center, the surgical lab first,” Robin said.
‘Let’s do it’
With the simulation complete and the team confident, Baumstark was ready.
“I was like, Let’s do it. I wanted to try to get rid of this pain,” he said.
The actual surgery closely matched the team’s projections.
“We went, and as a team, thought through every step, and that’s why we created the phantom (3D model), and that’s why we did the surgery, and that’s why we tested the radiation in advance. We were within 10% of our predicted radiation dose,” Robin said.
“Our goals for Mike were achieved,” he added.
Robin acknowledged the weight of performing a procedure with no prior precedent.
“It is a little bit of a leap of faith, when no one’s ever done this before. But we felt like we did all of the testing that you could do beforehand to try to ensure it was going to be effective and safe,” he said.
18 months later
The outcome exceeded expectations.
“It turned out great,” Baumstark said. “Everything worked out wonderful. And since then, I haven’t had any pain. So it’s 18 months later, and I’m doing great.”
Based on Baumstark’s results, Robin and his team, along with the other specialists involved, are now designing a clinical trial to evaluate gamma tile therapy in other patients with similarly difficult-to-treat cases of cancer that have spread to the spine.