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Case Study: UVA-Riverside Partnership Gives Tidewater Cancer Patients Access to the Most Advanced Radiosurgical Technology Available

At a Glance

  • Riverside Health System has one of the only dedicated radiosurgery spaces in the world.
  • Through a collaborative partnership with UVA, Riverside provides advanced treatment utilizing the full spectrum of radiosurgical technology, including the Varian Edge linear accelerator.
  • Case study highlights the advantages of having access to advanced radiosurgical technology.

The radiation oncology program at UVA Health System has long been ahead of the curve in the adoption of new technology. It was one of the first in the world to employ the Gamma Knife® in the late 1980s. Radiation oncologist Ronald Kersh, MD, was a young attending at UVA at the time, and worked Gamma Knife cases well into the night.

Fast-forward to today. Now Kersh oversees an entire dedicated radiosurgery center at Riverside Regional Medical Center in Newport News, and he’s had UVA’s support at every point during its evolution. “We started doing our first treatments in 2006 and have done over 5,000 cases since,” says Kersh. “There are only two to three places in the world that have a dedicated radiosurgery space with everything under one roof, including the new Varian Edge™ linear accelerator. There’s no way we could do it without UVA support. This partnership is so much more than a name on the door. UVA set up protocols on how to treat these patients. We still call the UVA radiation oncology team four to five times per month. It’s a very active partnership.”

The benefits of this collaboration are mutual. “Riverside has been an excellent partner for UVA,” says UVA neurosurgeon Jason Sheehan, MD. “Their program has had more than a decade of experience with stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). The clinical providers at Riverside have worked collaboratively with UVA colleagues to perform clinical trials. Together, we are advancing the radiosurgical field and elevating the standard of care for patients in the Tidewater area.”

The case study below demonstrates the impact of this partnership as the two centers continue to provide patients in the Tidewater area and beyond access to the latest in radiosurgical technology.

Case Study: Metastatic Hepatocellular Cancer

Patient: 77-year-old male

An active, fit Navy veteran who served three tours of duty in Vietnam, William Frigge kayaks 20-30 miles per week near his home in Hallieford. In 2013, he received treatment for a pulmonary embolism and doctors discovered a lesion on his liver.

Evaluated by: Riverside radiation oncologist Ronald Kersh, MD

Presented with: metastatic hepatocellular cancer

Frigge had multiple treatments after his initial diagnosis to control the spread of disease, including liver resection surgery at Riverside Regional Medical Center, immunotherapy at Johns Hopkins as part of a clinical trial, radiofrequency ablation and TheraSphere® transarterial radioembolization at Georgetown University Medical Center.

“The doctor at Georgetown told me I didn’t have any other options. Then I read about Dr. Kersh and the Edge [linear accelerator] in my local paper,” says Frigge. “I did my research and I knew Riverside was connected with UVA, so I felt good about pursuing it.”

“When I first met with Mr. Frigge in 2016, he had tried everything, but one small tumor remained on his liver,” says Kersh. “The remaining tumor was not in a place that we could easily biopsy because it was right beside areas that had previously been treated. If we tried to treat this with a standard radiation approach, we’d have to treat way too much liver. There was a risk of actually inducing radiation hepatitis, so that was not an option.”

Treatment: Radiosurgery utilizing the Varian Edge linear accelerator

According to Kersh, radiosurgery is meant for treating limited, small tumors with very focused, high-dose radiation, so this was the best option for Frigge. The first step in the treatment process was to make a mold of the patient’s body. This step ensures the patient remains in the same position throughout the treatment regimen. The radiation oncology team also did a CAT scan and an MRI, which were then merged together to provide a clear depiction of the tumor’s location. “I outlined the area that needed to be treated and, just as important, the area not to be treated,” says Kersh. “I was assisted by the medical physicists who planned the treatment.”

Instead of the two to three beams of radiation standard with traditional radiation therapy, the Edge uses dozens. For Frigge, 25 different beams were used to target his tumor during four separate treatment sessions.

“Mr. Frigge came in once a week for treatment; each session lasted between 30-45 minutes,” says Kersh. “During the treatment, the patient doesn’t feel a thing. It’s noninvasive, so for them it’s no different than getting an Xray. With the Edge, the fields are much smaller and more accurate than standard radiation therapy. Also important is that these machines are designed to treat the tumor we see, but also account for the patient’s movement. A tumor can move as much as two to three centimeters when the patient breathes, so we can measure for that.”

Outcome: a complete response to treatment

Frigge completed all four radiosurgery sessions with no side effects beyond some mild fatigue. On the initial scan after treatment and on a follow-up scan, there was no sign of the liver tumor.

“I’m feeling good,” says Frigge. “I’m back into exercising normally three to four times a week.”

Follow-up: quarterly MRIs

“Primary liver tumors typically are very aggressive, with an average survival of two years, so Mr. Frigge has already way outlived that,” says Kersh. “We’ll continue follow-up imaging every quarter for the first year and then do scans every six months in the second year.”

Should another tumor arise, further radiosurgery treatments with the Edge may be considered. “We used to tell patients that once you’ve been radiated, you can’t get radiated again, but that’s not the case here,” says Kersh. “That’s another advantage of this highly targeted, high-tech technology.”

To refer a patient to UVA Cancer Center, call UVA Physician Direct at 800.552.3723.

To refer a patient to the Radiosurgery Center at Riverside Regional Medical Center, call 757.534.5220.


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