Collaboration, chemo, surgery and CyberKnife used to attack aggressive thyroid cancer

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High school agriculture teacher Mindy Calisso is back in the classroom, coaching kids competing in floral design, farm management and goat raising for show at county fairs. She credits the collaboration of three doctors and cyber technology at the Community Cancer Institute for helping her overcome a rare and aggressive thyroid cancer and get back to her passion — being with students.
Calisso usually toughs out discomfort and puts off going to the doctor, but persistent back and chest pain propelled her to make an appointment in 2018. An X-ray showed she had masses in her sternum and on her thyroid. After having her thyroid removed, she was referred to hematologist-oncologist Michael Moffett at the Cancer Institute, who diagnosed her with metastatic medullary thyroid cancer and ordered more scans.
“It had spread to my sternum and my spine, and my liver, my lung and my hip,” she describes. “So that just brought a whole new wave of emotions … Dr. Moffett told me, ‘Don’t look (the cancer) up.’ That was his advice. He did a good job of making me feel comfortable.”


an X-ray of Mindy Calisso's sternum

Grateful to have a cancer team close to home

Calisso considered travelling for treatment when she heard that her cancer had spread so far. But now she’s happy she trusted the experts close to home. “I’m really grateful,” she says. Calisso recommends the Cancer Institute to others: “I say, ‘Don’t go out of the area. You can get what you need right here and be close to home.’”
At the Cancer Institute on the Clovis Community Medical Center campus, Calisso was also introduced to radiation oncologist Nhat-Long Pham to help address the increasing pain she was feeling in her back, where an orange-sized tumor was growing near her spinal column.
Dr. Pham recommended conventional radiation therapy and she received 10 treatments over two weeks in February 2019. But six months later, Dr. Pham explains, “Her pain actually worsened … And we got a repeat MRI of the spine, and actually the lesion that we treated around the T4 vertebrae showed that it was progressing, or growing.”
And Calisso’s pain was growing along with her tumor. “That pain was pretty unbearable … I stopped having feeling in my lower body, and so I knew that wasn’t normal. And then Dr. Pham referred me to Dr. Levine for surgery,” she says.

Surgical help for her pain

When neurosurgeon Nicholas Levine met Calisso, she was stooped over, unable to stand up straight, and she had numbness in her legs and torso. “Because she couldn’t feel her legs well, she was having difficulty using them,” Dr. Levine describes. “She couldn’t tell where she was placing them.”
He explains that the orange-sized tumor “had grown into the epidural space, which is the area surrounding the spinal cord. It had diminished the size of the spinal canal, so the spinal cord was compressed.”
Dr. Levine performed surgery to remove the tumor from Calisso’s spine and surrounding areas.
Traditional radiation alone could not have removed such a large tumor without causing significant damage to the spinal cord, which might have led to paralysis, explains Dr. Pham. It would take both doctors teaming up.
“After the surgery, Dr. Levine discussed with me that, you know, even though he tried to get as much out, there might be microscopic disease that has been left behind, so we needed to do additional radiation,” says Dr. Pham. The two doctors worked together to take advantage of CyberKnife technology to attack the remaining cancer cells.

CyberKnife removes need for more invasive surgery 

CyberKnife, or stereotactic radiosurgery, uses precise, focused radiation beams to treat tumors. A robotic arm moves around the patient and uses 3D imaging to deliver high-energy radiation beams from thousands of different angles. Radiation is concentrated precisely on a tumor, while minimizing damage to surrounding healthy tissue.
The Community Cancer Institute is the only place in the Valley to provide such advanced technology to attack tumors.
“We used to try and remove every possible element of the metastasis because we didn’t have other options,” explains Dr. Levine. “Radiosurgery has really changed the playing field. Now we provide just enough resection to safely proceed with radiation.”
Before CyberKnife, surgical removal of every bit of cancer carried higher risks and required much longer surgeries. “You have a patient who is usually quite debilitated already, so the less invasive, the better, and the better the potential that patients have to get up and go about their lives,” says Dr. Levine.

Dr. Nicholas Levine operates

During surgery, Dr. Levine put in titanium rods and screws to help stabilize Calisso’s spine where the tumor had started to erode bone. “Because titanium does interfere with the imaging,” he explains, “Dr. Pham and I had to work very closely in pre- and post-surgical imaging to develop a treatment plan to diminish the radiation to the spinal cord and other critical structures, and give a very high dose of radiation to the resection cavity to prevent any reoccurring disease.”

Cancer team is great advantage for patients

Having a team of colleagues to collaborate with makes a big difference for patients. “That’s one of the great advantages of being able to work directly with the neurosurgeon to develop a treatment plan for Mindy,” says Dr. Pham. “She was also put back on a different chemotherapy with Dr. Moffett. And she’s doing really well … Our recent scans show no reoccurrence of the disease.”
Calisso agrees the collaboration and team effort by her doctors was key for her survival. “That’s one thing about this institute that was known — everyone works together,” she says. “Dr. Moffett talked to Dr. Pham and Dr. Pham talked to Dr. Levine. Pham and Levine were always working together. And I could come here for one appointment and see the both of them.”
Dr. Levine appreciates the passion his colleagues bring to the care team. “We’ve all come from an academic background where we were trained to really embrace and use new technology and to work together in a team.”
But he also credits Calisso and her approach to getting well. “She’s a very outgoing, positive individual … She really embraced everything. She was able to work through the pain of the operation. She was able to work through the concern that I was operating in an area where she had previous radiation. She faced it all without a pause.”

Setting life goals helps in the cancer journey

Reminding herself of all the things she wanted to accomplish, Calisso says, is what helped her work through her pain, the surgery, radiation treatments and chemotherapy.
“When I got sick and had to quit working as a teacher, I didn’t know what to do,” she says. Just before her cancer diagnosis, she had told the California Agricultural Teachers’ Association: “I wonder how many other careers have the opportunity to make such an impact on the lives of other individuals that will last their entire lifetime? I would rather take the worst day in the classroom over the best day I ever had in the office.”

Mindy Calisso poses with light-colored cow

While she was out of her classroom, she set goals to finish her master’s degree. “I had things I wanted to do still. And I got better. And I know if it wasn’t for the technology and my doctors I wouldn’t have been able to follow through with those goals, to get back to school to my students.”
Looking back on her cancer journey, Calisso says, “Life is precious and I think until you’re in a situation like this you don’t really see that. I don’t think (cancer doctors) get thanked enough … I want them to know that I’m here and I’m alive and I’m doing well, and I’m back to normal because of them.”
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