Jack’s Story: MRI-Guided Radiation for Pancreatic Cancer
On May 3, 2017, Jack Liang was diagnosed with pancreatic cancer.
On May 3, 2018, he celebrated his cancer being in remission with a three-mile hike at Arches National Park in Utah with his family.
“That was a triumphant day. A year ago, my wife Debbie and I never knew our lives would again be this good. I can’t tell you how blessed I am,” says Jack.
Jack credits his good health to support from his wife of 36-years, family, church, neighbors, friends, a terrific medical team – and one long-time friend who connected him with a team at the Henry Ford Cancer Institute that had just begun treating patients with world-first MRI-guided radiation technology.
Jack and his wife were retired from their respective metro Detroit careers – Jack in management, Debbie a senior care specialist. The couple was very much looking forward to spending more time together with family and friends, volunteering, and traveling in retirement.
Jack, 70, was a fit and healthy man. He only took medication for high blood pressure.
Then he began to lose a lot of weight due to changes in his bowels; almost 20 lbs. in one month.
Jack was in touch with his internist, who ordered a series of tests. After morning testing, the doctor called Jack later that evening to tell him to go to the ER for a CT scan and an ultrasound. The imaging tests discovered a mass on his pancreas. Subsequent endoscopies confirmed the diagnosis: pancreatic cancer.
He met with an oncologist the next day, and consulted with former colleagues at hospitals locally and out of state. All agreed the best course was to begin treatment with 12 rounds of Folfirinox chemotherapy, followed by radiation therapy and possibly surgery.
Because the tumor on his pancreas was near a major blood vessel (the superior mesenteric artery) it was hoped that chemotherapy and radiation might shrink the tumor so surgery could safely be performed.
“That was the start of a pretty intensive time,” recalls Jack. Side-effects from his first round of chemotherapy sent him to the ER with an ICU admission; the rapid response team was called twice. His oncologist revised his chemotherapy treatment, which enabled Jack to receive his subsequent 11 treatments.
Old friend, new treatment
Jack had been friends with recently retired Henry Ford Health System CEO Nancy Schlichting since they worked together in the 1970s at a health system in New York. Nancy stopped by Jack and Debbie’s Grosse Pointe home after learning of Jack’s diagnosis.
Although Jack was already under the care of an oncologist, Nancy encouraged him to meet with David Kwon, M.D., Director of Surgical Oncology at the Henry Ford Cancer Institute, and Director of the Multidisciplinary Pancreas Clinic at Henry Ford Hospital, to explore radiation and surgical options.
Nancy told Jack about a new, advanced radiation therapy that uses real-time magnetic resonance imaging (MRI) to deliver more precise and accurate radiation treatment with a linear accelerator.
Under the leadership of Benjamin Movsas, M.D., Chair, Department of Radiation Oncology, the Henry Ford Cancer Institute was the first in the world with this new MRI-guided radiation therapy technology, called ViewRay MRIdian Linac, and had just treated its first patients in July 2017. “This novel technology allows the radiation oncologist to actually see and track the tumor in real time,” says Dr. Movsas.
What’s more: This game-changing technology is available at Henry Ford Medical Center-Cottage in Grosse Pointe Farms, minutes from Jack’s home.
Jack met with Dr. Kwon and the pancreatic cancer tumor board at Henry Ford, and was introduced to Henry Ford Cancer Institute radiation oncologist Jadranka Dragovic, M.D.
“By then, Mr. Liang had a number of courses of chemotherapy. There was some response but tumor still looked the same on the scans. At that point the question is: ‘What can we do to decrease the size of the tumor?’ And that’s where the radiation came in,” says Dr. Dragovic, Medical Director, Edith McNaughton Ford Radiation Oncology, Henry Ford Medical Center - Cottage.
Dr. Dragovic recommended radiation therapy using ViewRay. Jack would have 15 radiation therapy sessions over the course of three weeks. It would be given in conjunction with oral chemotherapy.
With an MRI, ViewRay made it possible for Dr. Dragovic and team to track Jack’s pancreatic tumor in real-time during treatment, delivering high-dose radiation with smaller margins to help avoid other neighboring organs.
“Jack’s tumor is located in the midst of other critical organs, such as the duodenum, small bowel, kidneys, organs that can get damaged by radiation in higher doses,” explains Dr. Dragovic. “With ViewRay we are able to not only reduce the amount of normal tissue in the radiation field, we can actually see and track the tumor in real-time, as it’s being irradiated and control for tumor motion (due to breathing) by coaching the patient when to hold the breath, so the tumor stays in the targeted area.”
And if the tumor moves out of target, the ViewRay system automatically pauses the radiation delivery until the target (tumor) is back within the designated boundary.
“We were very blessed with meeting the team at Henry Ford,” says Jack. “Dr. Dragovic and the staff there were first rate. We really consider them family.”
Debbie adds: “We felt so confident that (Dr. Dragovic) was taking good care of Jack. As soon as you walk in the door, everyone treats you so well, from the receptionist being on top of scheduling appointments, to the care of the nurses and techs, who told us, ‘don’t worry we’ll take care of it.’”
After radiation therapy, there were continuing, positive changes in Jack’s tumor. The CA 19-9 tumor marker that indicates the presence of pancreatic tumor cells in the body continued to decrease into a “normal range,” meaning cancer cells were dying.
The tumor was now one-third its original size. The radiation therapy had destroyed, or ablated, the tumor cells.
Jack returned to meet with Dr. Kwon in January 2018 to discuss the possibility of surgery. While the tumor was much smaller, it was still too close to the superior mesenteric artery. Surgery was still too risky, and would greatly alter Jack’s quality of life.
Jack sought second opinions and ultimately decided against surgery. It proved to be the right course of action. Testing a few months later showed no signs of active cancer cells in his body. He was in remission.
“I think about how the planets aligned with chemotherapy and how Henry Ford Medical Center-Cottage got this new radiation therapy in July of 2017, so close to our home. It’s hard to grasp how all of this happened,” says Jack.
“The confirmation from Dr. Kwon and other surgeons about the fortuitous changes to my tumor, I just shake my head. It’s very humbling.”
Hit the ball out of the park
While Jack experienced side-effects from chemotherapy, including loss of appetite, low energy, weight loss, neuropathy, and mouth sores, his wife Debbie said he never once complained or asked, “why me?”
“It was a great day when Jack could walk to the end of the driveway. I drove him everywhere. One of our biggest joys was to drive along Lake St. Clair,” she recalls.
Debbie was by Jack’s side every step of the way. She took meticulous notes at each appointment, recorded Jack’s side-effects, and, most importantly, kept a journal of the blessings during their cancer journey. “Throughout this difficult time there was still beauty around us,” says Debbie.
During Jack’s treatment, the couple would often visualize “hitting the ball out of the park.” “We had a vision of a baseball stadium. Every seat was filled with friends, family, neighbors, cheering us on. We had people praying for us near and far, to lift Jack up. We are of strong faith and we asked God for this mass to be gone,” she says.
A friend even created “Team Jack: Outta the Park” wristbands to show support. The couple handed the bands out to Jack’s cancer teams, their family, and friends.
In May, Jack and Debbie, along with one of their two daughters, traveled to visit their son in Los Angeles. From there, the family went to five national parks in Utah, logging a memorable hike at Arches National Park – one year from the date of his cancer diagnosis.
“It makes me feel wonderful that Jack was able to complete this strenuous hike,” says Dr. Dragovic.
Jack is back to a healthy weight, and enjoying life. And, he and Debbie rarely miss a monthly meeting of the pancreatic cancer support group at Gilda’s Club in Royal Oak.
Learn more about ViewRay: henryford.com/PreciseRadiation