A Precise Beam of Hope: Gamma Knife Procedure Gives Patient New Lease on Life

Paul Poole never expected his life would change in the blink of an eye. At 69 years old, he was enjoying his life in Redford with his wife of 32 years, Carol, and playing rounds of golf on his local course. But in May 2022, that’s exactly what happened. It all started with a seizure.

Poole was driving home from his brother’s house when his wife noticed he was acting strange.

“I kept looking out of the sideview mirror as I was driving. I was shaking my head, jerking it, and my wife kept thinking something was wrong,” Poole explained.

But he didn’t believe anything was wrong, so he kept driving. But when he got home and sat in his chair, it was apparent he was having a seizure.

“Next thing I know, my legs were going crazy, my arms were going crazy. My arm was beating on the wall, and I couldn’t stand on my leg. It felt like paralysis,” said Poole. “She [Carol] called 911, and they took me to the hospital.”

An MRI revealed that Poole had a large mass in the right frontal lobe of his brain. This news shook his and his wife’s life.

“I have a heart condition and COPD due to smoking for many years, but I have been able to manage those. Learning of the tumor on my brain was shocking,” Poole expressed. “There are just all these things I manage, plus the seizure and brain tumor; I just think sometimes, ‘I shouldn’t even be here right now.’”

Physicians eventually confirmed the tumor was cancerous and had likely metastasized from another primary site.

When he heard his diagnosis, “I quit smoking and drinking that very same day, and I haven’t touched any of it since. I was a heavy smoker and drinker for years – I was abusing myself.”

The first step in Poole’s treatment was surgery to resect the tumor on his brain on May 16, 2022.

“The tumor was located in an area where if they had to cut a hair more either way, Paul could have had altered speech, been paralyzed, or he could have lost his motor skills,” Carol explained.

“After the resection, the tumor was looked at under a microscope. It was most consistent with metastatic poorly differentiated neuroendocrine tumor,” explained Michael Dominello, D.O., radiation oncologist at the Barbara Ann Karmanos Cancer Institute, to whom Poole’s surgeon referred him for further treatment options. “While these tumors often originate in the lung, due to Paul’s recent pneumonia, the PET scan was challenging to interpret. At that time, outside of the lungs, his PET did not show an obvious alternate primary site for the cancer.”

“Everything that has happened since my diagnosis is a miracle,” Poole added.

Dr. Dominello is the medical director of Gamma Knife Radiosurgery and the leader of the Neuro-Oncology Multidisciplinary Team at Karmanos. He recommended Gamma Knife radiosurgery to the area where the tumor was removed on Poole’s brain to prevent reoccurrence of the disease.

“Gamma Knife was the best option for delivering the radiation since this machine is specialized for targets in the brain and is more precise than linear accelerator-based techniques,” Dr. Dominello explained.

Gamma Knife radiosurgery in one dose

Gamma Knife treatment is a focused form of radiation therapy that precisely aims a high dose of radiation on a tumor or target inside the brain to eliminate cancer cells and spare healthy brain and body tissue. Preserving tissue helps maintain normal function that can impact a patient’s quality of life. Although “knife” is in the name, it is non-invasive, and there’s no cutting involved.

“Patients with cancerous or non-cancerous diagnoses related to the brain are possible candidates for this type of treatment. This can include brain metastasis, when cancer spreads to the brain, meningiomas or acoustic neuromas, which are non-cancerous tumors in the brain, or even non-tumor related problems, like trigeminal neuralgia,” explained Dr. Dominello.

There are many extra steps taken with Gamma Knife radiosurgery compared to alternative high-dose radiation treatments for the brain.

“One of the most important steps includes a same-day, high-resolution MRI of the brain to get the most accurate images of the area to be treated and to evaluate for additional areas possibly requiring treatment. Secondly, we have a team comprised of a neurosurgeon, a radiation oncologist, a neuroradiologist, and a physicist present on the day of the procedure, which is unique and often can make the difference.”

Karmanos has offered Gamma Knife radiosurgery to patients for over two decades with promising results. Since the installation of the new Leksell Gamma Knife® Icon at the Lawrence and Idell Weisberg Cancer Center in Farmington Hills in 2019, Karmanos has treated over 500 patients with this precise stereotactic radiosurgery, averaging around 100 patients a year.

Poole gets treated

Poole’s Gamma Knife radiosurgery was completed on June 9. He felt anxious as he laid on the treatment table, but he was determined to face his fears. It also helped him and his wife to know the treatment would be delivered in a single dose. Gamma Knife treatment only requires a single fraction, using stereotactic radiosurgery, and is completed in one appointment.

“I feel blessed to have been cared for by such a wonderful group of doctors and nurses who were so comforting,” explained Poole. “They treated not only myself but also my wife with such kindness because they knew how concerned we both were.”

Then… the lung and the thyroid

Poole’s brain metastasis was at first a case of unknown primary cancer, according to Dr. Dominello.

“The metastasis appeared in his brain without any evidence of the primary site where the cancer would have originated from within his body, likely because the changes in his lung from his recent pneumonia made the PET scan less sensitive.” Dr. Dominello explained. “Many months after his brain surgery and Gamma Knife, the changes from the pneumonia in his lung cleared. On his subsequent PET scan, we could see a nodule in the upper lobe of his right lung. Understanding that this may be where the cancer had originated and seeing no other disease throughout the body or in the lymph nodes of the chest, we offered a five-treatment course of SBRT (stereotactic body radiotherapy) to his right lung lesion. SBRT is a high-dose radiation for tumors in the lung or other locations within the body.

“Meanwhile, his repeat brain scans showed no signs of recurrence and suggestive of a favorable response to treatment,’” he added.

Dr. Dominello worked closely with Hirva Mamdani, M.D., a medical oncologist, lung cancer specialist, and leader of the Thoracic Oncology MDT, and George Yoo, M.D., FACS, otolaryngologist (ear, nose and throat specialist), surgical oncologist, and member of the Head and Neck Oncology MDT, who are also part of Poole’s cancer care team. With Poole’s brain tumor, the nodule in his right lung, and now another nodule found on Poole’s thyroid, all three physicians bring their expertise to these specific tumor sites. They communicate and consult with each other for Poole’s personalized treatment plan, and with all of them practicing at the same location, they minimize the number of times Poole needs to visit for appointments.

“They’re [the doctors] just outstanding people, and they’re really caring,” Poole said as he reflected on the collaboration of his Karmanos physicians and what he’s been through. “I just have a different faith now, and these doctors have given me that.”

“Prayers got us through this, and God gave the doctors the gift to care for Paul,” said Carol, holding back tears. “I am so grateful that they’ve given him more time to live his life and do all the things in life he’s always wanted to do but didn’t at the time, like being able to take trips with me to visit our kids.”

Today, no signs of brain cancer

When Poole was first diagnosed, he made a life-changing decision that same day – to quit smoking and drinking. He has turned to a healthier lifestyle and enjoying time with his family.

“Since my diagnosis, the family gets together more often. I see my sisters and talk with my brother by phone more. They pray for me daily and have been a blessing.

“During Christmas, our kids got a cabin in Tennessee and paid for the entire vacation for us to stay and be with the grandkids and just enjoy each other. I even got to walk my daughter down the aisle when she got married in January. She brought a tear to my eye.”

All three doctors are monitoring Poole’s health, and he’s doing well. When it comes to his brain metastasis, he cannot say enough about the expertise of Dr. Dominello and Karmanos. He is also so grateful to his wife for her strength and unwavering love during a difficult time. His most recent MRI from January 2024 shows no signs of cancer.

“I would recommend this treatment to anyone who is a candidate for it,” added Poole. “Cancer is scary. It doesn’t affect you until it happens to you or a loved one, and where you get care is the most important part of the journey.”

If you or a loved one is diagnosed with cancer of the brain or upper spinal cord or has a non-cancerous tumor in those areas, they may be a candidate for Gamma Knife radiosurgery. Call 1-800-KARMANOS or visit karmanos.org to request an appointment with a specialist on our Neuro-Oncology MDT.

You may be eligible for the Lung Cancer Screening Program at Karmanos if you are a current or former smoker. Receiving annual lung cancer screenings can help reduce the risk of dying from lung cancer by monitoring the lungs to find the disease early. Visit karmanos.org/lungcancerscreening to learn more about the program, or call us.