Reducing the Burden of Radiation
Shorter courses of more intense radiation therapy mean fewer visits and less cost for patients. Studies show abbreviated treatments are just as effective as longer courses.
ONE MORNING AS SHE DRESSED FOR WORK in July 2017, Tiffany Fagnani’s eye began to twitch. Then her arm began to twitch too. Fagnani, then 36, was working as a nurse in Hershey, Pennsylvania, and suspected she was about to have a stroke. “I thought, ‘I’m going to lose consciousness,’” she recalls. She knew what to do. While she still could, she called 911, unlocked her front door and grabbed her migraine medicine so the emergency responders would find it when they arrived. When they did, she was unconscious and unresponsive.
Fagnani had occasional migraines starting when she was 19 and, more recently, had lost weight and experienced vision problems. But she was busy: She managed care for her brother, who has cerebral palsy, and her parents had been living with her. In retrospect, she chides herself for not paying more attention to her symptoms. “Like a good nurse that I am,” she jokes, “I didn’t tell my doctor about the vision changes when I had a migraine check-in.”
A CT scan at the hospital revealed the latest episode wasn’t a stroke, but she did have a mass in her brain. Further imaging revealed another mass in one lung. She underwent a diagnostic bronchoscopy—a procedure that uses a narrow, glowing tube to examine the inside of a person’s lung. Biomarker testing on a sample of the lung mass revealed it was a tumor with a mutation in the EGFR gene. The diagnosis was both unwelcome and discouraging—stage IV non-small cell lung cancer that had spread to the brain. Stage IV disease is not curable, the oncologist told her, and he estimated she had six to 18 months to live. Fagnani was shocked and devastated. While she had smoked a little when she was younger, she had kicked the habit years before and was still young and in good health.
Tiffany Fagnani
Her first oncologist recommended that she consult with specialists, so Fagnani transferred her care to Fox Chase Cancer Center, about two hours away in Philadelphia. There she met with an oncologist who offered a different way forward. He treated Fagnani’s lung tumor with Tarceva (erlotinib), an oral drug that targets tumors containing certain EGFR genetic mutations, and with surgery to remove the brain tumor. She also met with a radiation oncologist to discuss radiation treatment that would target the lingering cancer cells and keep the cancer at bay.