Next-Generation Radiation Therapy Cures Patient With Metastatic Bladder Cancer

It was a search for alternatives — and hope — that brought Giovanni Erazo to Baptist Health Miami Cancer Institute after his bladder cancer spread through his body.

Unwilling to give up, Mr. Erazo and his wife, Tanya, hoped to extend the life of the father of three from Homestead. They got what they prayed for — more time — as well as something unexpected: the complete eradication of three tumors near critical organs that were threatening his life.

Using highly sophisticated MRI-guided radiation technology, Michael Chuong, M.D., Miami Cancer Institute’s medical director of radiation oncology, skillfully treated Mr. Erazo’s tumors with millimeter-precise ablative radiation therapy. The advanced imaging and radiation dose sculpting abilities of this technology, called MRI Linac, enabled him to deliver a radiation dose dramatically higher than what otherwise could have been safely used with other types of radiation machines, increasing the probability of success.

“Just slowing down tumor growth would have been a win — let alone having all three of his growing tumors completely go away and not come back in the more than five and a half years since I treated him. It is just beyond anyone’s wildest imagination,” Dr. Chuong says. “Mr. Erazo had no other good treatment options, including surgery or other local therapies. This really points to how new, novel types of treatments like MRI-guided radiation are changing the paradigm of how we think about treating cancer patients in general.”

(Watch now: After his bladder cancer had spread through his body, Giovanni Erazo was searching for options and hope. Michael Chuong, M.D., at Baptist Health Miami Cancer Institute gave him something even more – a cure. Video by Alcyene de Almeida Rodrigues.)

A Frightening Prognosis

The cancer journey of Mr. Erazo, 56, began 10 years ago when he awoke one morning and saw blood in his urine. Although he had no pain or other symptoms, it alarmed him enough that he sought care at a hospital emergency room. He was shocked to be diagnosed with bladder cancer; his bladder was surgically removed a few months later.

Chemotherapy kept the disease under control for several years, until it metastasized and new tumors appeared in locations that were considered beyond treatment. “They told us that I wasn’t going to make it because the cancer had spread to my abdomen,” Mr. Erazo recalls. The location of the tumors prevented aggressive local treatment due to a high risk of severe complications. But Tanya Erazo refused to accept that. “My wife, she decided to look for a second opinion, and that’s when we ended up at Miami Cancer Institute.”

Aggressive treatment continued for two years with additional chemotherapy and immunotherapy, which leverages the body’s immune system to recognize and attack cancer cells. “They kept changing treatments because it wasn’t working as well as they wanted it to,” Mrs. Erazo says. “I’m grateful that they didn’t give up. They were willing to try different treatments in order to get rid of the cancer.”

Dr. Chuong became involved when it appeared they had run out of options. “You take a patient like Mr. Erazo who was essentially told, ‘Get your affairs in order, go to hospice’ and ‘I’m sorry, we don’t have anything to offer you.’ And now, to essentially be cured of his advanced, stage 4 cancer more than five years after his last treatment — it’s really an incredible story.”

Exploring New Options for Treatment

All three of Mr. Erazo’s new tumors were not treatable by surgery or standard radiation because they were too close to other vital parts of his anatomy, Dr. Chuong says.

“He had some nodules in the middle of his abdomen surrounded by the intestines, he had a tumor in one of the adrenal glands near the intestine, and he had a third tumor in a lymph node in his neck near some of the major nerves that control function and sensation in the arm,” Dr. Chuong explains. “It’s not surprising that he was told that he had no effective options where he was treated before coming to Miami Cancer Institute.”

Dr. Chuong’s solution was to treat Mr. Erazo with radiation doses so high they normally would be dangerous without the paradigm-changing capabilities of the MRIdian Linac system. Miami Cancer Institute was just the second center in the world to begin treating patients with this advanced technology. Mr. Erazo underwent five outpatient treatments lasting about 45 minutes each without needing anesthesia or even an IV.

His wife says they were almost afraid to hope it would work. But then the tumors not only shrank, they eventually disappeared.

"Mr. Erazo’s case defies what we as oncologists in the field ever thought would be possible,” says Dr. Chuong, an international expert on this treatment. He published a case report outlining his patient’s early treatment response and continues with research and clinical trials to guide future advancements.

The key to Mr. Erazo’s survival was his willingness to explore a new treatment approach, Dr. Chuong says.

“He would not have had the outcome that he had if he had not been treated with the technology that we used with him, which is offered at very, very few centers in the world,” Dr. Chuong says.

“At the time, this technology was new and its optimal use was not well understood — although it seemed to me he would be a perfect fit,” Dr. Chuong continues. “To the best of my knowledge, he was the first patient in the world to be treated with such a high ablative dose using MRIdian Linac to a tumor in the mesentery, a region in the middle of the abdomen.”

Without this technology at Miami Cancer Institute, Dr. Chuong says he would have only been able to treat Mr. Erazo with low, palliative radiation that would have “at best slowed the tumor growth but certainly would not have been able to eradicate them.”

How MRI-Guided Treatment Works

Since 2018, Miami Cancer Institute has been at the international forefront of treating cancer tumors using the MRIdian Linac, the first FDA-approved MRI-guided radiation therapy system. By “marrying” the technology used for radiation treatments with an MRI, it allows real-time monitoring as therapy is administered.

Michel Chuong, M.D., medical director of radiation oncology at Baptist Health Miami Cancer Institute

When surgery is not an option, this system enables extremely high radiation doses to be delivered noninvasively in as few as one to five outpatient sessions. Research has demonstrated that it can be especially effective in treating abdominal tumors — such as those of the pancreas, liver, bile duct and adrenal gland — while rarely causing significant side effects.

Combining radiation therapy with real-time MRI visualization allows oncologists to define very tight treatment margins, avoiding radiation exposure to nearby organs. The system is so advanced that it even accounts for movement when a patient breathes, or whether their stomach and intestines are empty or full. It allows radiation oncologists to customize their approach for even the smallest anatomic changes each day, reducing toxicity as they sculpt the radiation in a very personalized way.

“Such precision in delivering pinpoint radiation to tumors in the abdomen has never been possible before,” Dr. Chuong says. “With this accuracy, we are able to deliver such high doses of radiation that we can completely eradicate even very large tumors.”

A Brighter Future

Although Mr. Erazo now has no signs of cancer, he is closely monitored and has not needed chemotherapy since he completed radiation therapy.

Considering the grueling chemotherapy he underwent for four years, Mr. Erazo is grateful for every day he can enjoy with his wife and family. A former landscaper and IT worker, he enjoys his hobbies of sculpting bonsai and when he can, working on cars.

“I can’t believe that I’m here,” he says, crediting his wife for her dogged insistence on additional treatment. “I lost hope at one point.”

Mrs. Erazo was not sure what she was pursuing when she sought a second opinion at Miami Cancer Institute, only that she couldn’t let go. In her heart, she wanted days, weeks, months. But more than five years cancer-free after a stage 4 diagnosis? It was inconceivable.

“I kept my faith and I believed,” she says, “but I really didn’t imagine a picture like this one.”

A New Treatment Frontier For Metastatic Cancer

Dr. Chuong believes that MRI-guided radiation treatment is an important new tool in the fight against cancer, especially inoperable tumors, and has been active in developing more effective and efficient ways to use this technology.

In March, Dr. Chuong published the outcomes of a clinical trial he led at Miami Cancer Institute and the University of Wisconsin that was the first in the world to evaluate ablative radiation therapy given in just a single treatment with the MRIdian Linac. Most patients were treated for stage 4 cancer and the tumor control rate was almost 100 percent. Treatment was usually completed in less than one hour. It’s a far cry from traditional radiation that is nearly always delivered over several days and sometimes multiple weeks, and commonly to a lower total dose.

“I think Mr. Erazo’s case really has a lot of implications for patients, not just with bladder cancer but with stage 4 metastatic cancer,” Dr. Chuong says. “Radiation typically is not offered or may not be offered routinely for patients with stage 4 cancer because it’s a systemic problem and we need to treat it with systemic treatments, like chemotherapy and sometimes immunotherapy.”

Michael Chuong, M.D., at Baptist Health Miami Cancer Institute with Giovanni Erazo, whose stage 4 bladder cancer was cured using highly sophisticated MRI-guided radiation technology

Mr. Erazo’s care with chemotherapy and immunotherapy was routine and it helped him for a period of time, Dr. Chuong notes, but it was ultimately radiation therapy that provided such a successful outcome.

“We need to start thinking differently about select patients with one or a few metastases who get systemic treatments and may further be helped with local ablative treatments like radiation therapy,” Dr. Chuong says. “This can potentially eradicate tumors — maybe even with a curative effect like what we were able to do for Mr. Erazo.”

Dr. Chuong is glad he had the opportunity to make a difference, thanks to Mrs. Erazo.

“I think this is an example of the value of looking for a second opinion when you are told there are no other good options,” Dr. Chuong says. Miami Cancer Institute “offers the gamut of advanced types of treatment as well as advanced clinical trials. There may not always be a good second option, but sometimes there might be. You just don’t know unless you ask.”