Coordinated, Expert Cancer Care Helps Patient Beat the Odds

Karl Karen of Chester, Pa. could never have imagined the journey he’d take after experiencing frequent cough and shortness of breath September of 2018. Five years later, at age 64, he’s fortunate and grateful to be alive and doing well – thanks to coordinated care, innovative technology, new targeted therapies and expert physicians from Crozer Health and Philadelphia CyberKnife. 

Karl – a para transit driver – was referred by Dr. Ashish Rana, his primary care physician, to Taylor Hospital in Ridley Park for a chest x-ray due to his frequent cough. He never smoked, but shockingly, the results were worrisome for lung cancer. He was immediately referred to Dr. Peter Ennis, a medical oncologist at Crozer Health Regional Cancer Center at Broomall, for work up and treatment. A CAT scan showed cancerous fluid around the lungs – Stage 4 lung cancer. Dr. Ennis ordered an MRI as a precaution that also showed spread of the cancer to his brain. 

Dr. Ennis immediately referred Karl to Dr. Rachelle Lanciano of Philadelphia CyberKnife, an affiliate of Crozer Health, for treatment of his brain metastases and started Karl on an intensive course of chemotherapy and immunotherapy. He and Dr. Lanciano began collaborating to co-manage Karl’s care, from development of an initial treatment plan through close follow-up with imaging and treatment as needed. 

“When I first met Karl, he had two sizable brain metastases, as well as a large pleural effusion from lung cancer spread,” recalled Dr. Lanciano. “After Dr. Ennis started treatment quickly with chemotherapy and immunotherapy for his systemic disease, I treated his brain metastases with stereotactic radiosurgery (a specialized form of radiation) utilizing the CyberKnife system, targeting only the affected areas of his brain.” Karl was treated effectively with a single fraction of SRS to each lesion.

Conventional chemotherapy and immunotherapy can’t penetrate into the brain well due to the blood brain barrier. Therefore directed radiation to each metastasis was prescribed by Dr. Lanciano using hundreds of beamlets all coalescing on the tumors while sparing the rest of the brain.  As a result, Karl has had no neurocognitive decline or other side effects that would have been more likely with traditional radiation or surgery.   

CyberKnife Robotic Radiosurgery System is a painless and nonsurgical outpatient radiation treatment with minimal side effects, providing targeted radiation for cancer anywhere in the body.  In 2022, Philadelphia CyberKnife became the first radiation oncology site to be awarded the Distinction in Stereotactic Radiotherapy accreditation, and recognized nationally for its particular expertise and commitment to patients. 

Karl was on traditional chemotherapy for months, followed by immunotherapy, which helped keep him free of active disease for a long period of time. Once there was progression of his lung cancer, Dr. Ennis discovered a new tumor gene mutation in his blood and started targeted oral therapy directed at that gene with great tumor response. 

“Stage 4 is considered incurable; Karl will be on some kind of medication for the rest of his life,” said Dr. Ennis. “The goal is to help patients with Stage 4 cancer live as long and as well as possible.“  Karl’s lung cancer is currently in what Dr. Ennis refers to as ‘stable remission’ nearly 5 years after treatment. “I just saw Karl for follow up and he is doing great!  His most recent PET/CT and MRI of the brain reveals no active disease” adds Dr. Lanciano.

Karl has great quality of life except for a painful right knee and left shoulder unrelated to his cancer.  He lives with his son and his sister lives next door. He returns to Drs. Ennis and Lanciano regularly for check-ups every 3-4 months following PET scan and MRI of the brain.

Years ago, Karl would have had a life expectancy of less than a year with his diagnosis.  However, thanks to his multidisciplinary, coordinated care from Dr. Ennis and Dr. Lanciano, he is doing well five years after diagnosis. 

Karl recommends that anyone with his diagnoses get treated by the medical professionals at Crozer Health at Broomall. 

“It’s one of my favorite places to go,” he said. “Everyone is so nice, they really care, they push you to be positive. And they’re always looking for different options to help you.”

He continued, “Dr. Lanciano and Dr. Ennis, and their staff, are so caring and so good.” “They never give you a discouraging word, they are always positive.”