But some things never change, and that's why the still-unpacked office of Dr. Richard Hoppe, chairman of the radiation oncology department, is located down a long flight of stairs. It's a running joke in the medical community that a hospital's radiation oncology unit is invariably shoved in the basement. There's good reason for this: Radiation therapy usually involves shooting patients with high-energy beams of X-rays, which kill cancer cells but are quite harmful to healthy human tissue. It's imperative, then, that the surrounding walls are thick enough -- usually made of concrete laced with lead -- to contain the radiation being emitted by the hulking microwave machines. "It's better if you can take advantage of the earth or the ground in a couple of directions," says the amiable Hoppe, who played a major role in the design of the center. With a wry grin, he points to a narrow window near the ceiling of his office, which overlooks the base of an exterior wall: "Quite a view, huh?"
The underground location of radiation oncology departments has become something of a convenient metaphor, helping to foster a perception that they are looked down upon, ever so slightly, by the physicians, surgeons, and medical students who toil aboveground. Radiation oncologists are quick to emphasize that their treatments, unlike most chemotherapy, are curative, eradicating cancerous cells and, often, giving patients long, happy lives. But though half of cancer patients undergo radiation treatment at some stage, surgery remains the quintessential mode of cure in the minds of most patients and physicians, with chemotherapy in second place.
But in the bowels of Stanford's new building, inside one of seven underground vaults in the radiation oncology department, the future of cancer care -- and, perhaps, a step toward a cure -- is on display. A medical linear accelerator, standing about 9 feet tall, extending 15 feet in length, and weighing almost 19,000 pounds, commands the vault, its overhanging arm stretching from the far wall to the center of the room. The arm rotates 360 degrees around a movable gurney and emits radiation beams from several different directions, which are aimed to intersect in a shape that closely mimics the 3-D, rounded contours of a tumor; where the beams intersect, the radiation dose is increased. Because the technology is so precise, doctors can spare the healthy tissue around the tumor from all but minimal radiation, while giving high doses to the cancer itself, enabling them to target tumors long considered untreatable because of their proximity to vital organs. "As you increase the dose to the tumor, you can increase the cure rate," Dr. Hoppe says. "As you decrease the dose to healthy tissue, you decrease the risk of side effects. Our aim is always to apply as high a dose as possible to the tumor and as low as possible to the healthy tissue."
The implications of this technique -- called intensity-modulated radiation therapy, or IMRT -- are staggering, and it has been shown to increase cure rates in cancers of the prostate, head, and neck. "It's really revolutionized how we think about radiation oncology," says Dr. Steven Leibel, who is the foremost authority on the technique and will become the head of the Stanford Cancer Center this summer. "It's been a quantum leap in our profession and in our ability to treat tumors."
Although Medicare and most major insurance carriers now cover the treatment, the public, media, and investor attention that's been paid to the tiny company delivering the technology -- Varian Medical Systems -- is utterly underwhelming.
A Palo Alto firm that has been in the X-ray business for 55 years, Varian has eschewed the kind of high-profile clinical trials and broad-based marketing campaigns favored by many in the medical device industry, instead refining its technology through near-continuous dialogues with the physicians and physicists who use it. This approach hasn't earned the company many headlines, but it did garner more than $1 billion in sales in 2003, and word of IMRT is spreading: Following FDA approval of the technology in 2001, nearly 500 facilities nationwide, including several pioneering centers in the Bay Area, bought Varian's $1.7 million IMRT package. Now, the Palo Alto company that started with six employees and $22,000 in 1948 finds itself in a unique position at the forefront of oncology care.
"Our goal is a pretty simple one," says Varian CEO Dick Levy, with as much understatement as he can muster. "We want to cure cancer. And to make it cost-effective, easy, and mainstream."
X-rays were discovered by a German physicist shortly before the turn of the last century, and a few days later, doctors in Chicago became the first to apply the new form of electromagnetic radiation to tumors in the human body, treating a woman with breast cancer. The fundamental ideas behind the science remain unchanged to this day: Microwave energy is used to accelerate electrons that collide with a tungsten target as they approach maximum speed; the tungsten emits photons of electromagnetic radiation of a certain wavelength that has come to be known as the X-ray. When this radiation hits flesh, reactions with water inside the body destroy cells, both normal and malignant. Healthy cells can eventually repair themselves, if the radiation dose is not too high, but cancerous cells lack this ability and die off over repeated treatments.