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    SMART Cancer Center: Safer, Better, Cheaper.

    • Arc techniques minimize second cancers
    • 6 MV LINAC provides maximum sparing of critical organs
    • 3D Treatment significantly reduces costs
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SMART approach to cancer


DEVICE EXPLAINED Dr. Robert McLaurin explains the value of a Stereotactic frame that he invented. Shown here with Dr. McLaurin is Jamie Staton who is chief therapist at the local cancer center. (Times photo by Gary Cunard)

“Technology is a necessary ingredient, but it’s not sufficient,” says cancer fighter Dr. Robert McLaurin — and that may seem like an unusual statement coming from a man who has dedicated his life to beaming
radioactivity into patients to kill malignant cells.

To paraphrase cyclist Lance Armstrong, he adds, “it’s not about the accelerator.”

Dr. McLaurin, owner of Franklin County Cancer Center and a radiation oncologist, explains that dealing with cancer is not merely about the size and power of the radiation-producing equipment, it’s also the careful, exacting control of the dose that can spell the difference between successful treatment and dangerous side effects.

And though precise control is a primary goal, personalized care is equally important — and that’s why it’s not uncommon for Dr. McLaurin to cast a curious eye on the waiting room or even the parking lot of his Louisburg clinic to determine which patients are visiting for treatment and to make sure they are getting their treatments promptly and without unnecessary waiting.

Dr. McLaurin, who opened the Franklin County Cancer Center in the former Perry-Medders Clinic adjacent to Franklin Regional Medical Center in 2006, has drawn on a robust educational background to develop the skills necessary to create a concept he calls the SMART Clinic. (The clinic is not associated with FRMC.)

As an undergraduate at Emory University, Dr. McLaurin studied physics — and developed a working knowledge of radiation and its effects. Then it was off to medical school where he earned a medical doctor’s degree, followed by a residency in Texas.

But that’s only part of the story, because a few years later, he tackled his master of business administration (MBA) degree at UNC, and it was there that he pulled together his previous studies to develop the clinic concept into a workable business plan.

The SMART Clinic’s name comes from Strategic selection of the Megavoltage of the Accelerator in Radiation Therapy.

To a layman, it means using superior targeting technology to very precisely focus the radiation beam on its malignant target, and that precision allows the use of smaller, far less costly linear accelerators (those complex machines that deliver the dosage) in order to deliver measured doses of radiation precisely.

What happens today in cancer treatment, Dr. McLaurin explains, is that once a diagnosis of cancer is made, the patient usually gets a CT or MRI scan which provides digital image “slices” that are re-assembled electronically in a computer to create a three-dimensional “virtual patient” which can be viewed from a variety of angles.

Doctors can then plot how the tumor should be treated, testing and analyzing various angles for the radiation beam to target the malignant tumor, and find ways to radiate the tumor while reducing the dosage received by nearby tissue and organs.

That means, Dr. McLaurin points out, that the treatment is more effective and the side effects are minimized as much as possible.
“When cells mutate into malignant cells and begin to grow into tumors, they lose the ability to repair radiation damage the way normal cells do,” he said.

“Thus, when hit by doses of radiation, the malignant cells can’t repair the damage although nearby healthy cells, while initially hurt by the radiation, can repair themselves as long as the damage is not too severe.”

For that reason, careful targeting is critical — and the ability to create an electronic “virtual patient” allows doctors to study the tumor and plot the best way to attack it so as to minimize collateral damage.

Today’s treatment technique is the result of years of technological evolution, Dr. McLaurin explains, beginning with something called Fast Fit, an immobilization system that is one of two patents Dr. McLaurin has for related innovations used in precision treatment.

The first patent, which he received in late 1994, is for a Stereotactic frame that holds a thermoplastic mask made to precisely conform to the patient’s face. Then, when the mask is re-fitted to the patient, it is held in place by a plastic arch that provides accuracy to within 1 to 2 millimeters. It’s also compatible with Magnetic Resonance Imaging (MRI), allowing a superior visual image.

The second patent, which he received in 1998, allows for automatic image registration of the MRI scan so that the original position during scanning can be accurately reproduced as part of the virtual patient image. In other words, it helps ensure the electronic image on the computer is in an identical position as the real

Those two patents, coupled with 3-D treatment planning software, greatly increased computer power and better imaging systems were the ingredients that Dr. McLaurin pulled together to create his SMART clinic concept.

The prototype clinic was first established at Raleigh Community Hospital beginning in 1995 — with Dr. McLaurin as its chief — and proved very successful. Plus it costs a fraction of what centers relying on highest energy accelerators pay and, he says, offer no better treatment than carefully targeted, lower energy machines.

McLaurin stayed at Raleigh Community for a couple of years until it was bought out by Duke and then went to work creating a cancer center for the Federal Bureau of Prisons in Butner. After three years as director of oncology for the entire federal prison system, it was time to look around and somehow his gaze fell upon Louisburg.

Here, he emphasizes, the focus is on personalized treatment plans that not only involve a team of medical specialities but also put an emphasis on prompt, friendly service.

“State-of-the-art treatment is a compliment to good medical care, but not a substitute for it,” he says.

Currently the local center is treating about 12 to 15 patients a day with 20 “about our maximum,” says Dr. McLaurin. Most of the patients are referrals from other doctors who previously confirmed the cancer diagnosis. Currently, the radiation clinic uses about half the building and a related, medical oncology practice from Rocky Mount provides chemotherapy one day a week, and may go to twice a week soon. (Many patients use a combination of therapies including radiation, chemotherapy and surgery.)

The patient mix at the local center pretty much mirrors the national population in that about 20 percent are fighting prostate cancer and the same percentage battling breast, lung and gastrointestinal cancer.

The remaining 20 percent are dealing with one of the more than 200 variations of the dreaded disease which can strike at virtually any spot in the body.

But, Dr. McLaurin emphasizes, the “overall cure rate is above 60 percent” on average although it varies widely by the type of tumor involved.

For example, according to the National Cancer Institute, there is a 100 percent chance of five-year relative survival from prostate cancer if caught at the stage 2 level or below.

However, when you’re dealing with stage 2 lung cancer, the rate drops to 32 percent, to 9 percent for stage 3 and to just 2 percent for stage 4 cancer.

“There is nothing more important than early detection,” McLaurin emphasizes, adding that’s one of thereasons for the much poorer prognoses for lung and pancreatic cancer. “There are simply no reliable early detection methods” for those cancers, he says.

“But the vast majority of early stage disease is no longer a death sentence,” he said, “the cure rate is going up.”

And that’s where psychology kicks in and the cancer fighter gets animated.

“In the past when a person suspected they had cancer — and sometimes even when they had been diagnosed with cancer — they delayed treatment because they believed treatment would create terrible side effects and offer little hope. That delay could allow the tumor to progress to a higher stage resulting in a lower chance for cure.

“That’s simply not the case anymore,” he emphasized.

“While the cure rate goes up, the side effects and complications are going down,” he said, aided in no small part by the precise treatment methods he has just described. The majority of the treatment side effects are gone in two weeks, at most four weeks, he said. “Anything we can do to catch these concerns earlier, including patient and physician education, is a step toward a higher cure rate,” he said.

Even so, he acknowledged, the cancer radiation treatment regimen is tough, often a treatment every day, five days a week for as long as nine weeks.

“Sometimes we have to slow the radiation dose delivery schedule to avoid or lessen complications and that can extend the treatment timetable,” he explains.

That’s the main reason he says he focuses so carefully on how long a patient must wait — and on how they are treated during their frequent visits to the center.

“A treatment usually lasts five to 15 minutes,” he said, “and we do our best to keep waits for treatment to a minimum so that patients don’t waste their time in the waiting room.”

To help maintain the schedule, he admits a little sheepishly, he has been known to keep an eye on the parking lot to see who is arriving and to make certain their wait times are minimal. “I can now tell who is here by what kind of car or pickup truck is in the parking lot,” he grins, a far cry from the hectic pace he once endured when, at a mere 31, he was director of a radiation oncology program in a hospital as large as Raleigh’s WakeMed.

But if the pace has slowed a little, it’s because of a conscious choice. He and his wife, Paige, are the parents of four, ranging in age from 1 to 17, and he makes no secret of the pride he has in his family, and in his intention to devote quality time to them, even if he did convince his wife to pursue a masters in business (MBA) degree while working full-time and dealing with a toddler.

But that’s a trait that apparently runs in the McLaurin family.

His father was a physician who graduated from high school at 16, college at 19 and Harvard Medical School at 22, and went on to get a law degree.

His mother, now 89 and a Raleigh resident, is a physician who earned her medical degree at Cornell as one of only two women in a class of 200.

That commitment to higher education was evident in his generation as well. “My parents expected a lot from us,” he says with a grin. Apparently, it worked. In a family of five siblings there are three medical doctors, an architect and a special education teacher with two master’s degrees.

The local cancer center director earned his undergraduate degree in physics from Emory University, his medical doctorate from Cincinnati Medical School and did his residency at Baylor University in Houston.

Then, as he looked for ways to use his medical training to better serve patients, he earned his MBA at the University of North Carolina Kenan Flagler Business School. He completed that degree in two years — a task which he said took about 30 hours a week between classroom and other assignments — while working 40 hours a week at Raleigh Community. “It was gruelling,” he admits with an obvious sense of pride.

But it was during those studies that he developed a business plan for the SMART Clinic concept that he brought to Louisburg and which allows him to knit together the academic disciplines that have shaped his career.

“I think I could do this another 20 years, at least,” he said, explaining that providing carefully personalized treatment to patients, while reserving enough family time for his wife and children, created a balance where he is quite comfortable. — by Gary Cunard, Times Publisher