New tool being used in cancer fight

The Varian TrueBeam is the latest in radiation treatment technology.The Varian TrueBeam is the latest in radiation treatment technology.

BY Molly Congdon
Gazette Reporter
CLIFTON PARK — The black table is flat, hard, cold and unfeeling. Yet, glancing up at the ceiling — right above your eyes — there is a bright blue sky with the green leaves of palm trees on the panels. It serves as a distraction from the harsh truth: If you’re laying there looking up at it, you’re fighting for your life against cancer.

In the other direction, behind the patient’s head, rests the Varian TrueBeam — the latest in radiation therapy technology. The machine is made of carbon fiber and has the ability to rotate 360 degrees around the table. The table itself has 6 degrees’ freedom of movement, which enables radiation to be customized for each patient.

The setting is not a major hospital; it’s happening right here in Clifton Park, at New York Oncology Hematology.

Since May 4, NYOH’s doors have been open at 3 Crossing Blvd. for local cancer patients who require certain forms of treatment.

The treatment process begins with a patient consultation, then a simulation — a planning session where the patient gets into a position that’s reproducible on all subsequent visits, so that they can be treated in exactly the same way each time, and the radiation hits the right spot each time.

After that, a treatment plan is put in place that will meet the objective target dose with constraints to protect healthy tissues. Finally, the radiation therapy commences.
Patients typically visit daily in 15-minute time blocks for six to eight weeks. It is an outpatient procedure.

$4 million investment
NYOH, which also offers chemotherapy and therapy with drugs at its Clifton Park office, said it has the only TrueBeam treatment in the area.

“NYOH made an investment of nearly $4 million to bring the very first Varian TrueBeam Radiotherapy System to the region as part of our Clifton Park Cancer Center,” Executive Director Edwin Graham said. “We began using it on May 4. . . . This technology represents the next generation in radiation therapy. The Varian TrueBeam is fully integrated [meaning hardware and software are connected], allowing for pinpoint precision and improved efficiencies in both treatment planning and delivery.”

*The Varian TrueBeam machine is designed to deliver tightly focused radiation treatment with the aim of minimizing side effects.

Radiation creates a slew of side effects, which can be difficult to endure and range from unpleasant to devastating. The hope with tightly focused radiation treatment is to minimize the side effects.

“Think of the [computer’s] mouse as being like a knife,” said Dr. Justin Juliano, one of the NYOH radiation oncologists. “All of the side effects from radiation are related to where we are directing the radiation, except for fatigue. We can shape the prescription dose with this technology; higher dose rates equal lower treatment times.”

He continued: “Onboard imaging allows us to take snapshots — plain X-rays and advanced three-dimensional imaging — to ensure that how the patient is aligned is exactly how we want it. We can make millimeter shifts in the patient’s setup to ensure high accuracy.”
Returning home

Juliano’s route to NYOH’s Clifton Park office was long and winding, but it forms a circle of sorts.

He graduated from Shenendehowa High School in 1992 and always enjoyed helping people, so it seemed natural that he should go into the health care field. After high school he began training to become a radiation therapist — the technician who delivers the radiation under the direction of a radiation oncologist — at the SUNY Health Science Center at Syracuse. At the time, it was a two-year program resulting in an associate’s degree, although now it is a bachelor’s degree program.

During that training, he found himself on rotation at Albany Medical Center and met Dr. Henry Keys, a radiation oncologist who made a significant impact in Juliano’s career and life. “I remember him saying to me, ‘You should go to medical school; you’ll be a great physician,’ ” he remembered with a smile. “And that kind of seeded the thought at that time.”

The next step toward being a doctor was to obtain his bachelor’s degree, so he enrolled at the University at Albany. The first week, he spotted a sign that said: “NEW UNDERGRADUATE PROGRAM: Human Biology — combined major in biology and anthropology.” He was instantly intrigued by ithe nterdisciplinary major and he decided to do it, even though it increased the length of his undergraduate studies. “Because of that I had extra time to work as a radiation therapist, so I was able to continue that work prior to medical school,” Juliano said. “I was way better for it; a better physician all the way around.”

Then, after receiving his diploma in 1997, he headed to SUNY Upstate Medical University until 2002. He completed his internship year at Bassett Hospital in Cooperstown and his residency at Cleveland Clinic in 2007. He was on staff there until March 2010 when he went to Penn State to work at Hershey Medical Center, and has been with NYOH since this past January — back in his hometown, Clifton Park.

The move was for both professional and personal reasons. “The combination of being closer to family and coming back and being able to give back to our community is something that fits very well with my overall career objectives,” Juliano said. “It’s a huge draw.”
He and his wife, Erin — a family physician — met in medical school and were married in 2003. They have three children: Marietta, 5; Marilyn, 3; and Jonathan, 5 months.

Bittersweet job

He said he’d like to be able to move on to a different specialty someday.

The reality is that it’s a bittersweet occupation.

“Cancer is a horrible disease, I’ve seen lots of battles won but there’s a big fight left,” Juliano said. “The job is not always hunky dory, but at the same time, it’s those positive experiences that offset the catastrophes. If we one day we find a cure, I would be very happy to hang it up and go into some other field of medicine.”

Until then, he said, he and the NYOH team will try to make the patients’ journey easier.
“We focus on each individual, making sure they know they are number one,” he said. “I can’t tell you how many patients come in and you can tell that they are just worried about scheduling this and that, but we’re going to take care of you. Let us worry about that for you and we’ll get you through this.”