CyberKnife

CyberKnife

When “Going Under the Knife” is Knifeless: CyberKnife Treatment Provides Patients Choice, Comfort, Customization The CyberKnife Radiosurgery treatment system is a noninvasive, precisely-targeted radiation delivery method approved by the FDA in 2001, and implemented at Mission Health in 2005. Otherwise known as stereotactic radiosurgery, this treatment method takes advantage of an accurately aimed radiation beam directed in three planes, and uses coordinates provided by medical imaging to reach a specific locus in the body. Thanks to the flexibility of the robotic tool, CyberKnife’s unprecedented accuracy means radiation can be delivered to over 1,000 specific points on the patient’s body.

CyberKnife treatment requires no incisions, so treatments are safer, shorter, and more comfortable for patients than traditional, frequently-used radiation treatment protocols.

Additionally, CyberKnife side effects are rare, and the minimal effects are generally well-tolerated by patients. Being an outpatient procedure, CyberKnife treatment allows patients to forgo general anesthesia and hospitalization; moreover, without incisions, the risk for post-surgery infections and complications is reduced to zero.

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Surpassing Traditional Radiation Treatment Currently Mission Health’s CyberKnife patient population is comprised of 50% brain cancer patients and 50% lung cancer patients. However, an increase in treating other cancers is expected, specifically treatment for prostate cancer. Furthermore, the number of patients treated annually has risen since the introduction of CyberKnife, as more applications have discovered. In 2015, 500 CyberKnife treatment fractions were administered for approximately 170 patients; in 2016, close to 180 patients were treated.

CyberKnife therapy is especially effective on brain tumors and prostate cancer. In 2013, the results of the largest study done on CyberKnife Radiosurgery were published. The study analyzed 1,100 prostate cancer patients in eight medical centers across the country and found “an overall Biochemical Relapse-Free Survival (BRFS) of 93% at five years.” This data is not only reassuring to patients, but corroborates the effectiveness of CyberKnife treatment.

Dr. John Coletti, lead medical physicist at Mission Health’s Radiation Oncology Department, shares the benefits of CyberKnife over traditional radiation treatment, saying, “A great way to illustrate both the efficiency and safety of CyberKnife is to compare traditional radiation to CyberKnife: In the case of a typical prostate cancer patient, traditional radiation would require up to 43 fractions, whereas CyberKnife requires only five fractions.”

“CyberKnife has been used to alleviate symptoms resulting from later stage disease complications, helping those of whom have already received the maximum allowable amount of traditional radiation.”

- Dr. John Coletti

Lead Medical Physicist Mission Health’s Radiation Oncology Department

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CyberKnife Provides Numerous and Diverse Treatment Applications Dr. Coletti explains that the best candidates for CyberKnife are those whose disease is contained at an early stage. “However, it has been used to alleviate symptoms resulting from later stage disease complications,” he says, “helping those of whom have already received the maximum allowable amount of traditional radiation.”

“CyberKnife isn’t just to eliminate cancer in patients undergoing successful cancer treatment; CyberKnife also plays an important role in supporting quality-of-life for patients with advanced stages of the disease.”

– Angela Cathcart, RN

CyberKnife Coordinator

Angela Cathcart, RN and Mission Health’s CyberKnife coordinator, notes that the ways in which CyberKnife treatment can be used are expanding rapidly. “CyberKnife isn’t just to eliminate cancer in patients undergoing successful cancer treatment; CyberKnife also plays an important role in supporting quality-of-life for patients with advanced stages of the disease. For example, many patients with metastatic breast cancer are diagnosed with brain lesions that can be successfully treated with CyberKnife without compromising their quality of life, as CyberKnife results in fewer negative side effects.”

Many of these late-stage cancer patients are battling pancreatic, liver, abdominal, and pelvic lymph node challenges, as well as spine and brain lesions. With CyberKnife, these cancer patients can find immense relief.

Non-cancer patients can also be treated successfully with CyberKnife. As Dr. Coletti shares, CyberKnife can also be used for benign tumors, including schwannoma, and a rare tumor known as hemangiopericytoma. Additionally, trigeminal neuralgia (a chronic and often severe facial pain disorder) and arteriovenous malformations (a congenital disorder of the brain, brainstem, or spinal cord) can be successfully treated

by CyberKnife.

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CyberKnife Advantages • Completely non-invasive • Painless • Can isolate extremely small tumors • Fewer treatment sessions compared to traditional radiation Though each treatment typically lasts 1-3 hours, patients are never required to receive more than five treatments – or fractions – on any one tumor.

• Isolated radiation makes higher dosages possible and safer • Minimal effect on healthy tissue surrounding the tumor • Negligible to zero skin irritation, a frequent occurrence with traditional radiation therapy • Increased comfort during treatment for patients In the past, other forms of stereotactic radiosurgery required brain patients to wear circular metal frames screwed tightly to their heads, or body frames for other areas of the body, in order to remain still during treatment. With CyberKnife, frames and securing patients aren't necessary, as the robotic tool directs radiation from many angles.

• Superior alternative for brain cancer patients, as CyberKnife can bypass invasive neurosurgery; similarly, effective for solitary lung nodules • Can successfully treat complex and irregularly shaped tumors • Sites previously deemed inoperable can be treated with CyberKnife • Superior alternative for those who may otherwise receive invasive surgery • CyberKnife treatment can be delivered even if the maximum allowed dosage of traditional radiation has been exceeded.

• Patients can return to normal activities immediately after treatment.

• Cost of CyberKnife treatment is comparable to traditional radiation therapy

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The CyberKnife Experience Patients are generally referred for CyberKnife treatment by neurosurgical groups, and pulmonary and thoracic surgeons from the Asheville area and outlying western counties of North Carolina, since Mission Health’s unit is the only one in the region.

The CyberKnife treatment room is designed to reassure and comfort patients. Patients can listen to music of their choice during treatment. And even while constantly monitored, patients may communicate throughout treatment with their caregivers. Great efforts are made to ensure patient comfort, as each treatment session is lengthy (unlike traditional radiation sessions, which last 10-15 minutes on average).

Providing a comfortable treatment area not only enhances patient satisfaction, but relaxed patients make treatments more easy and efficient.

The Importance of Keeping Current The first use of CyberKnife at Mission Health was in 2005 to treat brain lesions. By early 2006, it was being used to treat lung cancer, as well. When the Radiation Therapy department was relocated to the newly built Mission SECU Cancer Center in 2012, Mission had already been using CyberKnife for seven years. Modest system upgrades were made in 2012, but the treatment platform is now 11 years old, ripe for improvements and a major upgrade. Furthermore, Accuray, the manufacturer of CyberKnife, cannot guarantee support for the platform regarding maintenance and repair in the future. Mission Health’s Radiation Oncology Department hopes to acquire an updated CyberKnife system, one superior to the current system in numerous ways.

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Investment Needs for Future Goals The new CyberKnife system is impressive and more finely designed than the current platform; patients and care providers will benefit immediately from its considerable advantages. “System enhancements will give clinicians the ability to deliver new and further-refined treatment to brain and lung cancer patients, which will allow us to expand our services to prostate cancer patients and others,” Dr. Coletti explains.

Benefits of the new CyberKnife system include: • Patients will spend less time on the radiation table, with a time savings of 25-33% per treatment, as the updated robot can be more selective in treatment sites (unlike the current system). The current system requires the robot to stop and assess multiple sites on the body for radiation delivery, whereas the new system will eliminate the need for the robot to stop unnecessarily, and provide increased radiation output.

• Robotic technology capabilities will feature a wider robotic range of motion, using beams the width of a mere pencil point.

• Better imaging quality will result in shorter treatment sessions and more accurate imaging.

• Soon, the CyberKnife treatment area will be expanded and improved at Mission Health’s SECU Cancer Center.

The project broke ground in December 2016, with plans for completion by spring of 2017, and an expectation that the department will be up and running in June 2017. The current CyberKnife system will remain in clinical operation until the new system is ready for clinical use.

• Patients will enjoy a new treatment space that is more efficiently designed and comfortable.

• CyberKnife manufacturer, Accuray, will soon be unable to guarantee maintenance services for the current system. Thus, a new system would ensure ongoing repair and maintenance from the manufacturer.

• Updated hardware and software systems will increase CyberKnife’s reliability.

• By updating our CyberKnife system and adhering to best practices, Mission Health will continue to provide the best care possible for the residents of western North Carolina.

Benefits of the new CyberKnife system Without a doubt, CyberKnife treatment has revolutionized the world of cancer treatment. Now, there is a great opportunity for community members to help in the purchase of this much-needed, updated CyberKnife system. With your help, Mission Health’s SECU Cancer Center facility can remain the choice for patients in western North Carolina.

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