Another Winthrop Success Story
Child treated by pediatric cancer specialists with most advanced radiation technology and chemotherapy
At 15 months, Elmer Garciaromero has endured more than most adults.
A bright-eyed, active child with a captivating smile and passion for chocolate, he has been battling a rare form of cancer for nearly half of his life.
Shortly before his first birthday, he developed rhabdomyosarcoma -- a rare, fast-growing, highly malignant tumor that made his right cheek bulge out from temple to jaw.
Elmer was referred to Mark Weinblatt, MD, Chief of Winthrop's Division of Pediatric Hematology/Oncology, who diagnosed the boy's condition and immediately began a course of chemotherapy. "Because we can provide chemotherapy in unusual ways, we were able to treat Elmer as an outpatient," explained Dr. Weinblatt. "That made life a lot easier for him and his mother."
Dr. Jonathan Haas and Elmer have a heart-to-heart.
The chemotherapy shrank the tumor, allowing surgeons to remove it and perform reconstructive craniofacial surgery.
Following surgery, Elmer received another course of outpatient chemotherapy, as well as Intensity Modulated Radiation Therapy (IMRT) -- a new cancer treatment that uses advanced three-dimensional, high-precision radiotherapy. Also administered on an outpatient basis at Winthrop's Radiation Oncology Center, this treatment was planned and managed by Jonathan Haas, MD, a radiation oncologist with special training in pediatric radiation oncology.
Pediatric radiation oncologists are skilled in treating childhood cancers with radiation doses very different from those used for adults. Additionally, they must always consider their patient's future. They not only design treatment for who their young patients are at the time of diagnosis, but also must be concerned about who they will be 20 years following recovery.
"We always think about the long-term effects of our treatment," explained Dr. Haas. "You're not only curing the child, you're tailoring your plan to reduce the burden of long-term serious side effects.
"In Elmer's case, we focused on customizing the treatment in order to limit the potential for future facial abnormalities. That's why we used IMRT."
IMRT uses very sophisticated computer hardware and software that enables radiation oncologists to "sculpt" the contours of the tumor with the radiation beams. "We actually told the computer we wanted to treat the tumor bed and avoid the majority of Elmer's face," explained Dr. Haas.
IMRT can not only match the beams to the three-dimensional shape of the tumor, it also can vary the dose of radiation within a single beam. This enables higher, more effective radiation doses to be delivered to the tumor while minimizing radiation exposure of surrounding normal tissue.
"We can also send the beams to the tumor from the most favorable angles and locations with greater precision and accuracy so that the potential for side effects is greatly reduced," added Dr. Haas.
How does IMRT work?
Before beginning treatment, Dr. Haas used three-dimensional computerized CT scans of Elmer's head to visually chart the location of the tumor bed and surrounding normal tissue. Once charted, the information was transferred electronically to the Center's physicist, who used virtual reality simulation to plot a radiation treatment plan. He employed the CT images in conjunction with computerized dose calculations to determine the dose intensity pattern that would best conform to the shape of the tumor.
Dr. Haas with Elmer and his mom, Rosa.
After plotting the target and establishing the dose intensity, the treatment plan was electronically transferred to a linear accelerator -- the highly advanced technology that actually delivered the carefully calibrated radiation beams to the target.
Over the course of four weeks, Elmer received 20-minute treatments five days a week in the outpatient Radiation Oncology Center so he wouldn't require hospitalization. Cared for during each visit by the same team of gentle and thoughtful nurses, as well as anesthesiologists skilled in meeting the special needs of children and other sensitive professionals, Elmer grew increasingly accepting of his ordeal and his new found friends.
"Everyday an anesthesiologist administered the sedation on site, and didn't leave the Center until the child was fully awake," said Joseph Greco, MD, Chairman of Winthrop's Department of Anesthesiology. "We used the latest drugs so he would not require hospitalization. He was sedated rapidly and awoke each time cradled in his mother's arms."
Throughout the treatment process, Winthrop provided Elmer's mother with an interpreter, who explained that Mrs. Garciaromero felt overwhelmed when first told that her son had a potentially fatal disease.
However, once Winthrop's team of pediatric oncology specialists became involved in Elmer's care, she knew her son was being treated by people who genuinely cared about him. "I feel very good today," she said, through an interpreter, during Elmer's final visit to the Radiation Oncology Center. "I'm grateful for all the help these people gave us."
That help involved more than the medical care. Charmed by the delightful little boy and his strong, soft- spoken mother, the staff -- led by Maureen Oliveri, RN, MSN, Nurse Manager, Radiation Oncology -- has mounted a campaign to collect clothes and other items for the baby, whose prognosis is excellent, according to Drs. Haas and Weinblatt.
"Elmer's cancer was confined to the head and neck," explained Dr. Haas, "and his response to treatment has been excellent. I've told his mother I hope to be invited to his wedding."
For more information, call 516-663-2234.