By The Numbers: Local Mathematician Finds Comfort in the Science of TomoTherapy
Written by Mikalee Byerman and featured in Renown Journey, Volume 2 Issue 3 RENO MATHEMATICIAN BILL NEWHALL HAS A SPREADSHEET FOR EVERYTHING. He charts the progress of his math students at Truckee Meadows Community College, where he has taught for 31 years; he charts performance; he charts attendance. And he charts his personal PSA score. The PSA, or Prostate Specific Antigen, is a simple blood test that helps predict a person’s chance of developing prostate cancer. Since Newhall was diagnosed with prostate cancer and treated with a radical prostatectomy in 2003, his chart was examining PSA numbers to determine the likelihood of recurrence. “Yeah, I may be the only patient they’ve ever had that came in with an Excel spreadsheet in-hand, tracking my PSA,” Newhall laughed. “But as a mathematician, that’s how I think.” His ideal PSA chart: numbers appearing on the graph around the “0” — and well below the “1.” And between 2003 and 2008, that’s exactly how his graph looked. But in late 2008 he watched with concern as the line edge upward at a 0.8. “I did a lot of research and had a lot of conversations with my doctor,” he said. “I knew that if it was back, and it was less than 1, it was probably still localized. If I waited any longer, it wouldn’t be localized and would therefore be harder to get.” He consulted with Daphne Palmer, MD, FACRO, a radiation oncologist. “We needed to treat this very precisely,” Dr. Palmer said. “We were treating where the prostate used to be, and the prostate is only the size of a walnut. But the goal, of course, is to only treat the tumor bed — where the cancer used to be — and avoid everything around it, including the rectum and the bladder.” Treating surrounding structures with radiation would not only be unnecessary, but could also result in detrimental effects. “This was the perfect case for TomoTherapy,” she said. TomoTherapy is precise, painless TomoTherapy is a type of radiation therapy that delivers tens of thousands of highly targeted “beamlets” of radiation in a 360-degree spiral pattern around the patient. Prior to each treatment, a computed tomography (CT) scan is taken to ensure pinpoint accuracy with every treatment and spare surrounding healthy tissue. And Renown is the first and only healthcare provider in the region to offer this advanced technology. While Newhall could have chosen other methods of radiation therapy — such as CyberKnife — he and Dr. Palmer recognized the benefits of treatment with TomoTherapy. “With CyberKnife, fiduciary markers are necessary,” Dr. Palmer said. Fiducials are tiny “seeds” injected into the treatment area to help guide the radiation to the correct target. The problem is, even with fiducials, the structure and target itself can move daily depending on such small things as bladder volume and positioning. “But with TomoTherapy, we see the anatomy directly, so there is no need to surgically implant fiduciary markers. We can make daily adjustments to precisely target where the prostate used to be.” Benefits of TomoTherapy include no pain, no recovery from invasive procedures such as surgery, no listlessness and minimal side effects. And the technology differs greatly from others, such as CyberKnife, which does not provide three-dimensional verification of tumors, takes significantly longer per session and is not able to treat large cancers or multiple tumors. Newhall’s first treatment with TomoTherapy was Jan. 22, 2009. He was scheduled for 38 15-minute treatments on consecutive days — with time off for weekends. “I thought the whole process was very, very easy,” Newhall said. “Having the procedure scheduled every day at the same time was just like having to teach a class at the same time every day — it was no big deal. The entire staff that treated me was amazingly friendly.” In fact, he noted that the process was so easy, it almost felt like nothing was happening at all. “I’d walk out feeling so good, I wondered if it was doing any good,” he said. “I had no side effects from treatment.” But the outcome was evident when Newhall returned to his graph. Post-TomoTherapy, he returned to tracking the PSA level. And the result: 0. “It’s been more than a year now, and his PSA is undetectable,” Dr. Palmer said. Newhall acknowledges that his fixation on the spreadsheet may seem odd, but it has helped him gain an appreciation for the science behind the disease. “That Excel chart really helped me see the process clearly,” he said. “I teach predictions, data analysis, regression curves. In a way, I was actually predicting my own life. But there’s an emotional side no matter how rational and logical I was, and I was surprise how significant that was for me. And now I definitely feel I have a new lease on life.” With his new lease, he spends more time with wife Lynn — traveling, kayaking in the Truckee, skiing at Lake Tahoe and gardening. “I take advantage of every moment now,” he said. “And I’m so grateful to have the opportunity to do so.” Read other patients stories from Renown Journey.
More patient stories