Lee’s Attack

Once Gayla Farrar’s physicians gauged surgical removal of her melanoma too risky, they turned to radiation oncologist D.J. Lee, M.D., Ph.D. (shown on facing page with radiological therapist Paul Scott), for a recommendation on how best to attack the tumor. Lee opted for the relatively new strategy of delivering a one-two radiation punch via implanted “seeds” followed by standard treatments.

“There is some subtlety involved in this approach,” Lee says. “You really have to know the patient and the tumor—size, location and everything else.”

A decade ago, when Lee first began implanting radiation seeds to treat head-and-neck cancers, he’d get into the nasopharynx through standard surgical routes, such as through the roof of the mouth. Today, he and head-and-neck surgeons sometimes use the much-less-invasive endosinus surgery, in which a rigid scope equipped with a camera is inserted through the nose and positioned to deliver images of the tumor to a nearby monitor. A second rod is then inserted, this one holding a radiation seed; it’s equipped with a plungerlike device that helps drop seeds into the right spots.

Using this combination method actually helps lessen uncomfortable side effects endured by patients, because the standard radiation employed after the seeding surgery involves doses that are smaller and more carefully targeted.

“The combination approach is done infrequently, because it is relatively new and because many tumors are resected before patients come to radiation,” Lee says. “But I think in the future it will be used more and more.”