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Medical Marvel

Ronald Jackson Medical Marvel

Ronald Jackson is a medical marvel. Not only did he beat lung cancer and liver cancer, but he also was one of the first patients in the world to undergo a powerful form of radiation treatment as a bridge to a liver transplant. His historical case paved the way for a growing number of other patients to also have this lifesaving procedure done. Yet despite all the attention he has received, Ronald remains humble and deeply appreciative that he has a second chance at life.

“It’s an honor to get all this attention, but I’m just happy that I’m alive,” says Ronald, 62, a resident of Verona. “It’s great to feel healthy again."
 
For someone who was extremely ill only a short time ago, Ronald looks remarkably well. He maintains his lean, athletic build by taking his dogs for walks and by doing yard work at home. He has an easy, gentle laugh and projects a sense of serenity. Ronald says his faith kept him going through one stressful period after another.
 
“I felt that God had a plan for me. I didn’t worry about being sick because I believed I would overcome cancer,” he says.
 
Ronald still finds it hard to believe he was so sick—and so close to death—just a few years ago. He rarely missed work because of illness and kept in shape by playing pickup basketball well into his forties. “I don’t think I caught a cold until I was 42,” he recalls. “I thought I was just one of those persons lucky to have good health.”
 
But Ronald’s luck changed abruptly in his early fifties. During a routine physical, he learned that he had a malignancy in his left lung. Fortunately, Ronald’s cancer had been detected early. With prompt surgery, Ronald’s cancer could be cured. In 2002, Robert Keenan, MD, a thoracic surgeon at Allegheny General Hospital, removed Ronald’s diseased lung. The cancer hadn’t spread and Ronald’s prognosis was excellent.
 
By then, Ronald, who owned a house painting business, decided to retire. He looked forward to spending his retirement years playing with his grandchildren and doing some more traveling. His health was good except for a nagging pain in his back. In 2005, when Ronald’s discomfort became intolerable, his wife Joanne took him to the emergency department. Ronald was expecting the doctor to tell him he had a pulled muscle or another minor problem. Instead, Ronald learned he had something much worse. He was diagnosed with hepatocellular carcinoma, a malignant tumor in his liver.
 
“It was a shock,” says Ronald, shaking his head. “I couldn’t believe that I had another form of cancer. But my wife, who is a nurse, reassured me that I would be all right. She said a lot of progress was being made in the fight against cancer. I resolved to beat cancer and do whatever it took to live a long life.”
 
During a resection procedure at Allegheny General Hospital, Mark Roh, MD, a former AGH surgeon, removed the diseased part of Ronald’s liver. Again, Ronald made a smooth recovery and resumed an active life. Then during a checkup four years later, Ronald learned his cancer had returned. He now had several tumors in his liver. This time the prognosis was much more ominous.
 
“Ronald had recurrent liver cancer,” says Ngoc Thai, MD, director of the Center for Abdominal Transplantation at Allegheny General Hospital. “We were encouraged that Ronald’s tumor appeared to be confined to his liver. Ronald was very lucky that his cancer hadn’t yet metastasized to another part of his body. That improved his prognosis tremendously. However, Ronald needed a liver transplant soon; otherwise, the tumor would eventually spread beyond the liver. By then, it would be very difficult to help him.”
 
Like other patients who need a liver transplant, Ronald was put on a waiting list that, on average, includes more than 17,500 patients. Depending on the availability of a donor organ, Ronald could expect to wait six months to one year for a new liver. Ronald’s son volunteered to donate a portion of his liver. But Ronald declined his son’s offer.
 
“I was very touched that my son would want to do this, but I told him no,” says Ronald. “He had his own children and he needed to be there for them. I would just wait for a suitable organ to come in.”
 
However, there was a question whether Ronald would survive long enough for the transplant. Ronald’s doctors were concerned that his liver tumors could soon metastasize. To keep the cancer at bay, they proposed a treatment plan known as “bridge-to-transplantation.”
 
“Our goal was to shrink the tumors and keep them confined to the liver. That would buy Ronald some time while he waited for a donor liver,” says Alexander Kirichenko, MD, a radiation oncologist at West Penn Allegheny Health System. 
 
Dr. Kirichenko’s first option was transarterial chemoembolization. During this procedure, chemotherapy would be directed through a catheter to the site of the tumor. But Ronald was soon ruled out for this procedure. The hepatic artery going into Ronald’s liver was too constricted to accept a catheter, due to the aftereffects of previous surgery. Dr. Kirichenko then proposed a novel alternative. He told Ronald he could use stereotactic body radiotherapy (SBRT)—a powerful, new form of radiation therapy—to shrink the tumor.
 
“Because SBRT has pinpoint accuracy in killing cancerous cells, it spares the patient from damage to the surrounding organs and tissues,” explained Dr. Kirichenko, who is one of the pioneers of this procedure. “Also, the patient only has to undergo SBRT for five days, compared to two months of conventional radiation treatment. Plus there are fewer side effects for the patient. This would be one of the first times that SBRT would be used as a bridge-to-transplant procedure for a liver cancer patient. We were very encouraged that SBRT would work for Ronald.”
 
Dr. Kirichenko added that there were some risks associated with this procedure. Ronald’s liver had cirrhosis, which diminished critical volumes of liver function that were required for the patient to survive. If doctors were not careful, radiation could destroy the remaining healthy parts of Ronald’s liver. To eliminate such a catastrophe, Dr. Kirichenko and his team at the AGH Radiation Oncology Department developed a method of detection and avoidance of the remaining functionally active liver volumes during this power, precision-guided radiation treatment.
 
Fortunately, this groundbreaking approach worked perfectly. SBRT shrank 90 percent of the tumors without harming the rest of Ronald’s liver. During the next three months, he patiently waited for a liver. Twice, Ronald was summoned to Allegheny General Hospital, but each time the transplant had to be called off. One of the donor livers was too small and the other was too large.
 
“You really don’t know how useable the liver is until you can thoroughly examine it,” says Dr. Thai, who performed 21 liver transplants last year. “Liver transplantation is an emotional roller coaster ride for the patient. You want the patient to be waiting for the organ but you don’t want the organ to be waiting for the patient.”
 
For Ronald, Allegheny General Hospital offered a world-class liver transplantation program close to home. Launched in 2007, AGH’s liver transplantation program features cutting-edge treatment modalities delivered by a dedicated multidisciplinary team. Physicians from medical oncology, surgery, radiation oncology, interventional radiology and hepatology convene each week to discuss the most appropriate treatment regimen for each patient. This process eliminates the need for multiple consultations and ensures that all available options are considered. Thanks to this team-oriented approach, AGH’s liver transplantation outcomes are among the best in the country. Its one-year survival rate is more than 90 percent, compared to the national average of 85 percent. What’s more, AGH’s three-year survival rate is over 90 percent. 
 
Finally, Ronald’s time had arrived. One June 6, 2010, Ronald’s transplant nurse called him with good news. Another donor liver was on its way to AGH and this one appeared to be a perfect match. During a six-hour procedure, Dr. Thai and his transplant team replaced Ronald’s diseased liver with a donor liver. Ronald did remarkably well during the operation and was discharged from AGH within four weeks. 
 
“Before long, I regained much of my strength and I was able to resume many of my everyday activities,” says Ronald, who will need to continue taking immunosuppression medications the rest of his life to prevent rejection in his liver. “I’m back to walking my dogs and doing yard work. I also am taking trips across the country. I hope to do some home renovations this coming summer.”
 
Both of Ronald’s doctors agree that his prognosis is excellent. “Ronald’s case is an amazing story,” says Dr. Kirichenko. “He should have a very active, healthy and fulfilling life.” Adds Dr. Thai: “Ronald takes very good care of himself and he should do very well in the years to come.”
 
Since Ronald was treated three years ago, 15 other liver cancer patients have also successfully undergone SBRT as a bridge-to-liver transplant procedure at West Penn Allegheny Health System. Several of those patients are currently waiting for a liver transplant. 
 
“Liver cancer was once considered one of the most lethal and difficult forms of cancer to treat,” said Dr. Thai. “But the future for liver cancer is very exciting. With new technologies and a multidisciplinary approach, we are making dramatic improvements in survival rates and we are helping to improve the quality of life for many people.”
 
Ronald says he is deeply appreciative for all the help he received from many people. “My doctors and nurses are incredible. They treated me like I was a member of their family. My wife and my family also helped me to get through what was the most difficult period of my life. But I’m most grateful to the family of the organ donor for giving me the gift of life. I love them for enabling me to live.”

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