An innovative treatment technique brought hope to a local cancer patient

When Cynthia Mathison’s ovarian cancer returned in 2020 after more than 20 years in remission - this time to her liver - she was first told by doctors in Boston that she would likely need chemotherapy to treat the disease. In her 70s and sole caregiver for her husband, who has a variety of health issues, she was hesitant about the various side effects that she believed would weaken her and prevent her from living the life she wanted.

And then, her oncologist at Cape Cod Hospital suggested another option.

Image-guided thermal ablation is used to treat complicated tumors located in spots that are hard to remove surgically, medical oncologist Jaclyn Flanigan, MD explained to Mathison. Dr. Flanigan told her that her colleague at the hospital, Damian Dupuy, MD, FACR, an interventional radiologist with a special focus of interventional oncology, could treat the tumors using a microwave ablation technique that uses a small needle-like CAT scan guided probe to burn away the tumor while sparing most of the surrounding tissue.

After talking with Dr. Dupuy, in consultation with Dr. Flanigan, Mathison agreed it would be the best option for her. “This ablation technique is so much less invasive, and that appealed to me,” she said.

Now, three years later and after five ablation treatments, there is no trace of the cancer in Mathison’s body.

“I’m proof positive that it works,” she said recently.

Tumor Board Approval

When Mathison’s case was originally discussed at a Cape Cod Hospital Tumor Board, the multi-disciplinary group of medical experts reviewing the case agreed that thermal-guided ablation made sense if the patient did not want to undergo chemotherapy or liver surgery for metastatic tumors, Dr. Dupuy said. On the staff at Cape Cod Hospital since 2017, Dr. Dupuy had treated scores of cancer cases – mostly liver, kidney, bone and lung cancers - with the technique while he was at Rhode Island Hospital and Women and Infants Hospital in Providence, RI. Since arriving at CCH, he has treated several hundred, including 164 last year, alone.

“This is a repeatable, minimally-invasive outpatient procedure that works well with other cancer treatments and can help patients who ordinarily have to go through surgery,” he said.

“The toxicity is very low and it’s an outpatient procedure. It’s not like cutting a patient open and, unlike radiation where there’s a plateau effect, with thermal ablation, you can do it til the cows come home because it’s using heat-based energy.”

The technique is particularly important for Cape Cod, because of the region’s senior population, he said.

“The older you get, the more likely you are to get cancer, so sometimes the treatment can be worse than the disease in an older, frailer patient, if you go with conventional treatment. But if you look at thermal ablation, you can say that’s a little more forgiving as far as actual treatment and return to normal activity,” he said. “I tell people, there is no losing proposition here. If what I do doesn’t help you, you still have the option to go to surgery if you want to.”

Society of Interventional Oncology

While the practice of interventional oncology isn’t as well-known as the other types of cancer treatment, there is a medical society devoted to it and it’s a name that is well-suited to what they do, Dr. Dupuy said.

“We’re the fourth pillar of cancer care: Surgery, radiation, medical oncology and interventional oncology,” he said.

At CCH, the department also includes interventional radiologist Michael A. Bevilacqua, MD, who treats liver tumors in patients who for some reason can’t have an ablation procedure. He uses an embolization technique that kills the tumor by cutting off the blood supply.

“I’ve become part of the cancer care community here, albeit a lot of people still don’t know what I do,” said Dr. Dupuy.

Thermal ablation is also used as palliative treatment for patients whose cancer is not curable, but who are seeking a better quality of life, he said. He recently was able to use the technique to help a patient whose tumor was pressing on his ribs, causing him to have chronic pain. “I was able to kill the nerves on the rib so the area became numb and he got some relief,” he said.

Mathison’s Case

Prior to starting treatment, Mathison underwent PET CT scans and biopsies to identify the type of cancer she had, which confirmed it was the same ovarian cancer she had in 1999. Dr. Dupuy began the ablation procedures, each time removing more of the tumor.

“The problem with a large tumor like that is you can’t kill it all at once; you can’t see the margins,” he said. “You can see the imaging margins, but the microscopic margins are invisible. So, you have to create margins with your imaging to try to knock it off.”

The treatment wasn’t without its side effects, Mathison said, including a compressed lung and fluid buildup from inflammation next to the right lung that needed to be drained. Patients can also feel sore and tired for a few days, but most can return to normal activities in a week, according to Dr. Dupuy.

Mathison’s lung issues arose because of the location and size of the tumors, he explained. The diaphragm sits on top of the liver and the lung comes over the diaphragm behind the liver, “and that’s exactly where the tumor was, so the tumor was touching the lung and the liver.”

To treat the margins of the tumor, he had to heat into the lining of the lung. “I was aggressive with my microwave treatment,” he said. “Her lungs were healthy overall and I felt the benefit to risk ratio was very high.”

Mathison had to return four more times after her initial treatment, since PET CT showed that the tumor wasn’t completely gone.

“We were being very close with our surveillance and we knew we could combat it locally successfully. Eventually we were able to get clean margins,” he said.

Mathison was also fortunate in that she had what Dr. Dupuy described as “a really good tumor marker,” which was CA-125. “Every time her CA-125 would go up, we knew there was residual tumor somewhere,” he said. “We used PET CT and that would show small areas of regrowth. I’d bring her back and I’d touch them up.”

Not a Well-Known Option

Not all hospitals have an interventional oncology program, which allows physicians to think outside the box when treating cancer patients, Dr. Dupuy said.

The doctors Mathison saw initially in Boston wanted her to go on chemotherapy, which is “kind of the knee-jerk reaction because most places don’t know what image-guided thermal ablation can do with solid tumors when they appear,” he said.

The good news was that Mathison’s ovarian cancer never went anywhere else in her body, he said. Her last PET scan this summer showed no evidence of new disease. “Every time I treated her, her CA-125 went down,” said Dr. Dupuy. “Now it’s like 7, which is completely normal, and her PET scan is completely clear. She didn’t lose her hair; she didn’t destroy her immune system. If she had not had the ablation, she might not be alive today.

“She’s lucky it was only one place and she’s lucky she came to Cape Cod Hospital because not a lot of places would have done what I did.”

Mathison will continue to be monitored closely, with PET scans every 90 days.

In the middle of the ablation treatment for the ovarian cancer tumor, Mathison was diagnosed with invasive ductal breast cancer - a different type of cancer from the ovarian cancer - last February after a routine mammogram. She opted for a partial mastectomy and the results of her last mammogram showed no remaining cancer. She will be followed closely for this disease, as well, she said.

Mathison said she is indebted to Drs. Flanigan and Dupuy for offering her the option for a less invasive solution for the treatment of her cancer.

“I understood it was new and not for everybody, but the amount of time they spent with me explaining it helped me decide,” she said. “I was a grateful and enthusiastic participant.”

She is hopeful others will learn about this option for cancer care, and question their doctor about whether it is appropriate for their care.

“It’s good news and let’s share it,” she said.