Celilo Cancer Center in The Dalles makes milestone for the Northwest

Radiation therapists Steve Dugick and Craig McPheeters work in the near darkness adjusting equipment and tightening the net-like mask that forces Sanders' head against the table: the position of his head in these 39 treatments, administered over seven and a half weeks, must be unchanging to ensure radiation bathes the identical cancer-laced area each time.

Sanders, 66, now retired, was an ironworker for 35 years. The worst trauma he had faced during those years was two broken ankles, the result of a fall.

Now, in his battles with cancer, he is the first to be treated at Celilo Cancer Center in The Dalles with a leading-edge device that, and in a continuous motion, precisely targets diseased tissues.

This is a new development that reduces or eliminates the radiation's effect on adjacent glands, bone and organs, which were often the victims of older, less precise radiation therapies.

In the past, physicians asked patients, "Do you want to live or do you want to be blind?" says Mark Scott, CEO of the Mid-Columbia Medical Center since 1984, and driving force behind development of Celilo Cancer Center.

According to Dr. Keith Stelzer, oncologist and medical director, Celilo's "linear accelerator" (a device which produces therapeutic radiation) is outfitted with an innovation called a "multi-leaf collimator."

The collimator is a series of 120 narrow metal leaves, positioned in the lens of the accelerator to control the radiation's output pattern. What sets this technology at the forefront of radiation therapy is the fact that the adjustment of the individual leaves is dynamic -- they move continuously once the process is initiated, allowing the field of treatment to move across complicated shapes, altering its intensity as it does so. Combined with the re-aiming of the radiation along five separate pathways, this allows for intricate treatment patterns.

"A tumor may be bending around a critical structure such as the lower intestine," Stelzer says. "By better shaping the dose we can spare normal tissues."

The direction of exposure changes five times. Each individual beam is of relatively low strength to minimize damage to healthy tissues through which it passes; therapeutic doses occur only where the beams intersect, creating a cumulative dosage at the cancer site.

The process -- "intensity modulated radio therapy" -- is currently being performed by only 50 or 60 centers nationally, according to Meryl Ginsberg, public relations manager for Varian, the device manufacturer.

Currently, Celilo Cancer Center is the only facility in the Northwest using the dynamic, or "sliding window," aspect of the technology.

"With the new technology we could see the future," Scott says. "With traditional treatment, they put lead blocks in the accelerator to shape the beam. We've gone from buggies to engines."

Back in the treatment room, Dugick tightens black plastic knobs, pulling the mask taut against Sander's face.

"I was kind of claustrophobic when I first started," Sanders says. "The first time they put the mask on, it kind of gave me the heebie-jeebies."

Once Sanders' position on the table is secure, Dugick ushers everyone from the treatment room and presses a button, closing a six-inch-thick concrete-filled door. In an adjacent room, the therapists take up stations in front of a bank of monitors, including a closed circuit television, which pans down on Sanders strapped amidst the accelerator, a machine the size of a large elevator car.

"He won't feel anything," Dugick says, as he activates the giant L-shaped gantry, which begins rotating around Sanders' body, taking position to administer the first dose of radiation along one of the five computer-controlled pathways.

"He can hear it, though; it sounds like a bag of bees."

"Sanders' treatment is a result of over a hundred hours of [preparatory] work because he is the first patient treated with the sliding window procedure," says Klaus Buzzi, medical physicist. "Subsequent patients will take much less time."

However, even with the precision of the new technology, Sanders will experience lasting side effects.

"My saliva glands are gone," Sanders says. "My taste buds will take four to six weeks to come back but won't be the same."

"The kind of cancer I got, they claim is from tobacco use. If you would have told me 20 years ago what I'd have to go through, they couldn't have paid me to smoke."

The cancer first became noticeable as a lump the size of an elongated golf ball in Sanders' neck. Once a biopsy confirmed the cancer, his left tonsil and the tumor were removed at OHSU in Portland.

"They recommended radiation because it was likely to come back," says Don's wife, Diana. The doctor who performed the surgery referred them to Celilo, which began treating patients in February. (Sanders was the first to receive the dynamic aspect of the technology.)

Scott terms Celilo Cancer Center a gift to the community, funded through reserves and borrowing. The private non-profit of which Scott is president is the parent company to 26 different corporations.

The Mid-Columbia location for extended treatment also reduces stress on Sanders and other patients.

"We were lucky this center was here or we would have had to drive to Portland everyday," Sanders said.

As it is, the Sanderses make a 100-mile round trip from Trout Lake, which means that by treatments' end, they will have traveled 3,900 miles.

With the day's treatment finished, the Sanders relax in a sunny conference room. (In keeping with MCMC's embrace of complementary therapies to encourage healing, Celilo features sauna and massage areas for relaxation.)

"I get tired after the treatments," Don says. "I was walking three miles a day, but not now."

The Sanderses are extremely appreciative of the care they have received at the center.

"It is the best I ever went to," Don says. "Everyone is friendly and wants to help. You're part of the family."