Tuesday, August 14, 2018
Health

A limb is saved, a life is changed as Moffitt Cancer Center works to perfect a targeted blast of chemo

TAMPA

The amputation was scheduled for July 29, 2014.

Earlier that summer, a doctor in Denver had found a malignant tumor tangled in the tendons of Mike Hladky's right wrist. The doctor said an above-the-elbow amputation was the only way to prevent the cancer from spreading. So did a specialist at MD Anderson Cancer Center in Houston.

Hladky, a Wyoming man who had made a living in construction before retiring in 2013, tried adjusting to the news. He bought himself a pair of shoes that didn't need to be tied.

"I was driving one-handed, trying to shower one-handed," he recalled. "My wife and I were both devastated for about three weeks."

But four days before the amputation, the doctor in Houston called with a last-ditch proposal: Would Hladky consider an obscure procedure at the Moffitt Cancer Center in Tampa that might shrink his tumor and save his arm?

He booked a flight to Florida the next day.

• • •

Hladky had long relied on his right arm. It helped him sink free throws for the basketball team at Montana State University Billings, and launch a successful career building coal mines and power plants.

Now, in his retirement, the arm was key to his golf game. He used it to demonstrate shooting techniques to the kids he coached in basketball, and to dig out when snow blanketed the small city of Gillette, Wyo.

He had never really given his arm much thought. But one day in early 2014, he noticed a bump the size of a silver dollar on his right wrist. It stuck up about half an inch, and throbbed when he swung a golf club.

He tried wearing a brace. The bump didn't go away.

That spring, Hladky scheduled an appointment with his family physician. The doctor directed him to a hand and wrist specialist in Gillette, who directed him to a specialist six hours away in Denver.

The diagnosis was the one he feared most.

Cancer ran in Hladky's family. His mother had died of colon cancer, his father of lung cancer. Hladky was diagnosed with soft-tissue sarcoma in his wrist, a type that is found in only about 12,000 people a year, according to the American Cancer Society.

He returned to Denver in early July to discuss his options for treatment. Traditional chemotherapy wouldn't work, his doctor said. A sarcoma like his was unlikely to respond. Surgery wasn't an option, either. The tumor was wrapped too tightly around nerves and tendons.

"They said they had to amputate," Hladky recalled.

He traveled to the prestigious MD Anderson Cancer Center in Houston for a second opinion, but doctors there reached the same conclusion. He scheduled the amputation for late July.

When the doctor from MD Anderson called back a few weeks later, Hladky was having supper with his two daughters and four of his seven grandchildren. He took the call outside.

Hladky was nervous. Doctors usually don't call patients so late in the evening, he thought to himself. But as the doctor explained the alternate plan, he looked down at his right arm and smiled.

• • •

The procedure is called an isolated limb infusion.

It is relatively new as far as cancer treatments go. The technique was developed by an Australian surgeon in the 1990s and is offered only at a handful of cancer centers in the United States.

Moffitt is one of them. Dr. Jonathan Zager, a melanoma and sarcoma specialist there, has completed more than 200 limb infusions — likely more than any other physician in the country, he said.

The thinking behind the procedure is this: A sarcoma in the arm or leg may not respond to a normal dose of chemotherapy circulated throughout the body. But it may respond to a stronger, targeted dose.

To do that, doctors place catheters in the artery and vein of the groin and snake them through the body until they reach the affected arm or leg. Then, they pump the chemotherapy drugs directly to the cancer.

To keep the highly toxic drugs confined to the limb, doctors place a tourniquet around the patient's arm or leg, stopping the normal blood flow for about an hour. That's risky because the limb could swell, causing permanent damage to the hand or foot.

"It is an emergency (if that happens)," Zager said. "The only way to fix it is to make incisions and literally release the pressure."

Zager has only seen that happen once at Moffitt. By and large, he said, the results have been "encouraging." Some patients have had a complete response and no evidence of recurrence.

"About half of them are going to recur," he said, and could wind up requiring an amputation. "But if I can give (my patients) another six, nine, 12 months with their limb, it is worth it."

Hladky had the procedure done in Tampa on Aug. 7, 2014.

He woke from the anesthesia with a thick purple bruise wrapped around his upper arm where the tourniquet had been. He spent the next day in the intensive care unit, a precaution in case his arm started to swell.

It didn't.

Instead, Hladky recovered as expected. He returned to his family in Wyoming several days later with the first sign of progress: The tumor in his right wrist had gotten smaller.

• • •

Hladky was back in Tampa this week for a routine checkup.

As he waited to see Zager at Moffitt's new McKinley Outpatient Center, he imagined all the things the doctor might say. In the best-case scenario, he would say the tumor was gone. In the worst, he would say it had spread.

Hladky had already returned to Moffitt for a second infusion in August 2015. A third treatment was also a possibility.

Just before 11 a.m., a medical assistant called Hladky's name and ushered him into a small room to take his blood pressure. She then brought him to another room to see the doctor.

The news was mixed. While a report from the radiology department showed "marked" improvement in some areas, the tumor had become slightly more pronounced in other areas.

Still, Zager was pleased. Overall, he said, the cancer appeared to be shrinking. He suggested Hladky continue monitoring his wrist and return every three months for new MRIs.

"So the plan is every three months, I thank you for how hard you studied?" Hladky asked.

Zager laughed.

As he gathered his belongings, Hladky looked ahead to his week in Wyoming. The plan was for 100 family members, friends and former basketball players to gather at his house for a barbecue.

He would spend the night celebrating life, a cold beer in his right hand.

Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

     
   
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