Early this year, Elizabeth Russo's doctors in Germany told her that the cancer diagnosed in 1977 had spread throughout her lower abdomen and that she only had six months to live. But Russo, 84, an American citizen who has lived in Germany since the 1940s, refused to give up.
She came to Washington in October to undergo a relatively new cancer treatment at Howard University Hospital called "interoperative radiation." The new treatment, which Howard helped pioneer, has attracted the attention of specialists from several medical research facilities, including Harvard Medical School and Johns Hopkins University Hospital.
In the past few years, Massachusetts General Hospital, the National Cancer Institute in Bethesda and the Mayo Clinic in Rochester, Minn., have joined Howard Hospital in using interoperative radiotherapy.
Most radiation therapy is applied from outside the body, which usually results in healthy tissue being bombarded with radiation along with the cancer. Because of this danger, only limited amounts of radiation can be administered safely.
Interoperative radiotherapy, however, allows physicians to jolt cancerous tissue with an extra dose of radiation without damaging healthy tissues.
The technique involves irradiating the cancerous tissue directly during surgery. After as much of the tumor as possible is removed surgically, doctors say, it is easier to see the area needing radiation treatment and move healthy organs safely out of the way, preventing unnecessary, and possibly dangerous, radiation exposure.
This new technique is giving Howard a valuable boost. "There is no question that interoperative radiotherapy has further enhanced Howard's reputation in cancer" research, said Dr. LaSalle Leffall, chairman of the surgery department of Howard's College of Medicine.
Howard's designation as a comprehensive cancer center by the National Cancer Institute (NCI) has enabled the institution to receive numerous grants to study the disease and its treatment.
Russo is among about 90 Howard patients who have been treated by the interoperative technique since Howard began the program in 1976.
It is nothing "high falutin" but rather a "different application of a known modality," says Dr. Alfred Goldson, the 35-year-old chairman of Howard University's radiotherapy department. He said the idea of treating tumors with radiation during surgery intrigued German-born radiologist Ulrich K. Henschke, chairman of Howard's radiotherapy department from 1969 until 1979 when he turned the reins over to his young protege, Goldson. Henschke was killed in an airplane accident last year while he and Goldson were visiting Tanzania.
According to Goldson, Henschke first experimented with the interoperative technique using hand-held irradiating equipment in the 1940s.
Goldson said he believes that most cancers can't be treated with surgery, radiation or chemotherapy alone, but that a combination of the three often is necessary. "Short of a magic remedy," he said, "I think it's the most logical approach to the problem."
During the past five years some Howard patients with cancers of the cervix, bladder, breast, brain and pancreas have been treated with the interoperative procedure to shrink tumors. Goldson believes this aggressive approach is most useful with localized cancers that have not spread, and are deep within the body in places that are hard to reach with a scalpel. Goldson says the long-term effectiveness of interoperative radiation therapy has yet to be determined.
Radiation during surgery has been used at the National Cancer Institute in Bethesda for 18 months with 27 patients treated. Senior NCI investigator Timothy Kinsella says he hopes the institutions using this procedure will pool their results to determine how well it is working.
Stanley Order, chief of radiotherapy at Johns Hopkins University's medical school, said he has followed Goldson's work and hopes Johns Hopkins soon will have its own interoperative radiotherapy facility.
While other hospitals have begun to implement programs similar to the at by Howard in 1976, there are still few hospitals experienced in the technique. Russo said a friend advised her about Howard after her own doctors told her there was nothing they could do to treat her advancing cancer.
Tests suggested that Russo was strong enough to undergo surgery, Leffall said, so he pulled together a treatment team that included Goldson. After the surgeons had cut away as much of the tumor as possible, Goldson directed the brass-and-plastic cone of the high-powered X-ray machine into Russo's open belly, pressed a button and zapped the remaining cancer with electron beams.
So far, her physicians are pleased with Russo's progress. "None of us can predict what will happen to her next. Only time will tell that story," said Leffall, who believes Russo has a good chance of living to 90.
"I feel marvelous," Russo said following the surgery. "As soon as my legs get strong enough, I want to travel.
"You have to fight to survive," said Russo, who was given protein, vitamins and minerals intravenously after the operation. As soon as her stomach could handle it, Russo said, she asked for a glass of beer.