Janice Combs, brain meningioma, Stereotactic Radiosurgery

The blistering desert sun strikes the sweltering pavement below. It is high noon, but there still are miles left to go. You pedal for hours with just a few stops for water and a short reprieve. Imagine nothing but you, a bicycle and 100 miles of desert road stretched before you. Now, imagine doing that less than five months after brain surgery.

Janice Combs imagined. Janice Combs did it.

In 2005, 45-year-old Janice Combs was training for a Leukemia and Lymphoma Society bike ride in Tucson, Ariz. Her training consisted of long rides—sometimes 15 to 25 miles per day.

Janice, a resident of Oak Ridge, Tenn., and a substitute teacher at Linden Elementary, set out one day for an 18-mile training ride. Taking a route she had rode so many times before, Janice was enjoying her sunny afternoon ride and did not worry when she saw a cat on the side of the road. She watched it, not thinking he would jump out in front of her. However, as she approached, the cat darted under her bicycle between the tires, knocking her off the bike and plunging her to the pavement.

Although she cannot recall the events that followed, Janice later saw the damage that was done. “My helmet had a huge dent in it, “she recalls. “Those are made to not do that, and there it was—a huge dent. I cannot imagine how much force you would need to put such a dent in a helmet.”

Due to her terrible trauma, emergency medical services took Janice to the University of Tennessee Medical Center, the area’s only Level I trauma center. There, Janice underwent many tests and treatments for her various injuries. “I love UT Medical Center’s nursing,” she says. “I couldn’t have made it through this without their support.”

The accident left Janice with a punctured lung, broken ribs, a damaged shoulder, broken thumb and many stitches. However, these were not the worst of her story. A CT Scan to determine if she had any head injuries revealed a brain meningioma.

A brain meningioma is a tumor in the brain that occurs most commonly in women ages 40 to 70. Meningioma usually is a benign tumor of the meninges, a membrane that covers the brain that can grow to invade the skull and compress the underlying brain tissue. While 90 percent are benign, they still may cause devastating complications and even death due to their size or location.

Janice’s neurosurgeon, Dr. William Snyder, Jr., scheduled a magnetic resonance imaging (MRI) for a better look at the tumor. The tumor was still small, and Janice had never shown any symptoms. She was anxious about having any surgery and even more fearful when hearing about the details of other surgeries.

Janice was worried about her treatment options. “You are not looking for alternative treatments when you find out you have something like that,” she explains. “You trust that your doctor will know all of the alternatives.” Luckily, her doctor knew of a non-surgical treatment.

Janice’s doctors believed her tumor could be treated by stereotactic radiosurgery, a non-invasive, image guided, high-energy radiation treatment. Stereotactic radiosurgery offered a frameless alternative to other treatment methods, painless treatment and no recovery time was predicted. For an active person such as Janice, there was no question.

Once Janice met with her doctor, the process began. “I met with Dr. Robert Bertoli, a radiation oncologist at UT Medical Center, who was absolutely wonderful,” she said. “He took the time to explain everything to me. He spent lots of time with me and took me from the beginning to the end of my Stereotactic Radiosurgery treatment and really made sure I was informed.”

Stereotactic Radiosurgery is used to treat tumors and other conditions throughout the entire body.  This technology is able to treat conditions such as trigeminal neuralgia, lung tumors, liver tumors, prostate tumors, brain tumors, spine tumors, pancreas tumors and other soft tissue tumors. 

The Stereotactic Radiosurgery staff created a personalized, fitted face mask for immobilization during treatment and mapped out a treatment plan. Janice would undergo five daily treatments for an hour and 15 minutes each day. “I would rehab my shoulder, workout or bike ride and then go in for treatment,” she says. “It did not slow me down.”

Janice would simply have to lie down on the table wearing her face mask and let the machine do the work, all while listening to her choice of music. First, the image-guidance system would track and verify Janice’s tumor location. This system also automatically compensates for any patient movement during treatment delivery.

“It is really neat technology,” Janice says. “Although they still want you to hold still, if you should have to move, the Stereotactic Radiosurgery stops itself, aligns with your new position and continues your treatment. It made the procedure so much easier to have some flexibility like that.”

After Janice’s five treatments, she felt great. Janice attributes her successful Stereotactic Radiosurgery treatment with the kind and caring staff of the medical center. “The Stereotactic Radiosurgery staff was wonderful,” she says. “They were very friendly and kept me informed. They made it able for me to relax and recover. Less than five months after the treatment, I rode 100 miles.”

Janice continues regular checkups, which initially were every three months, then six months and then a year. Her results: no growth of the brain meningioma and a healthy, active lifestyle that almost was lost. She continues to ride and regularly participates in biking marathons.

Janice is an inspiration to her friends, her family, other patients and her students. “My accident has been an excellent teaching tool for my students on why they should wear helmets, but it also is a great example of an alternative to surgery,” she says. “I can walk. I can run. I can talk. I can think. I am so happy Stereotactic Radiosurgery was here!”