I just had a great CT scan which told us that the Taxotere that I am taking has stopped my lung tumors from growing. As a good planner, I always need a backup plan. So, I met with my Radiation Oncologist. He recommended that I go over to the new Cyberknife clinic at Beth Isreal Hospital here in Boston. He knows the person who is working with lung tumors - Dr. Stewart Berman. So I'm setting up that appointment as we speak.
This Cyberknife technology was built on technology designed to track enemy fighter jets by the U.S. Airforce. I will put more detailed information on this in my next blog. My husband. Len has written an article on this for Advanced Imaging Magazine (that's what he does) and I've asked him if I can make it a little less tekky oriented so us "users" can understand it better. I'll also report on my meeting with their oncologists.
Has anyone on this sight done cyberknife for lung tumors? I'd love to hear more about it from someone who has done it.
Sharon
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Cyberknife for lung tumor shrinkage
- By shindus
- Posted January 5, 2007 at 3:07 pm · 10 replies
- In Non-small cell lung cancer - General
- Shared with the public
Explore topics in this discussion:
Kidney transplant Cancer Surgery Radiation therapy Taxotere Chemotherapy Lung cancer Pneumothorax Radio frequency ablation (RFA)
10 replies
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- Newest first
- By BrianH
- Posted January 5, 2007 at 5:30 pm
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Hi Sharon,
Congratulations on you great CT scan. Stable is great! Thanks for sharing the wonderful news with us. I'm sorry that I don't have any new news regarding the use of cyberknife for lung tumors. I just wanted to encourage you to continue sharing your cyberknife for lung tumors findings with us. I'm sure that there are quite a few of us who are interested. Like you, I'm also a Stage IV, lung cancer survivor. After three years of chemotherapy and radiation, some type of surgery appears to be more viable for my condition than before. Have you also considered Radio Frequency Ablation? I would have gone that route, but the tumor is too close to my bronchus for such a procedure. Looking forward to your future reports.
Brian
- By TomC
- Posted January 5, 2007 at 6:28 pm
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Sharon -
I'm barking up the same tree. Great minds DO think alke. I have an app't to visit a Cyberknife center in Naples, FL. Maybe the new Proton one in Jacksonville as well. I'll be interested to see what you find out.
Be sure to ask the radiation Dr about their proton rad device there in Boston.
The problem of the lung tumor moving as you breath has been addressed by a few diferent radiation modalities and manufacturers. Cyberknife, in particular, has a "synchrony" component that measures the rhythm of your particular breathing. This, from what I understand, is prgrammed ino the cyberknife device and thus when the bean locks on to the tumor it follows it (within .2mm of accuracy; that's considerably thinner than a human fingernail!). This allows a more powerful and accurate treatment to take place, sparing healthy tissue. Thus, treatment regimes typically can be done in 1 - 5 sessions.
http://216.128.12.167/Products/Cyberknife/FAQs/Answers.aspx
http://www.accuray.com/
http://www.cyberknifesupport.org/forum/default.aspx?f=6&m=7020
http://www.cyberknifemiami.com/aboutus.asp
Another modality is proton radiation. Very, very powerful and precise it is possible to radiate a lung tumor, although I'm fuzzy about hiw or if there is a way to be in synch with breathing. Only a few of these babies around. loma Linda, CA has had one since the 80's. Harvard/MIT has one, MD Anderson and a new one in Jacksonville, FL as well.
http://neurosurgery.mgh.harvard.edu/ProtonBeam/Default.htm
Yet another "on the horizon" approach involves "shaped beam" radiation. Mostly for small tumors though.
http://www.sciencedaily.com/releases/2006/11/061108154429.htm
http://www.ivanhoe.com/channels/p_printStory.cfm?storyid=12465
http://www.cksociety.org/PatientInfo/radiosurgery_stereotactic_technol ogy_comparisons.asp
Not really recommended for metastatic disease (although I personally think there is some merit to sinking the "mother ship" if possible.) various radiation techniques are now addressing lung tumors efectively. Cyberknife seems to be the front-runner.
Hope this helps.
TomC
- By Don_M
- Posted January 5, 2007 at 8:19 pm
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Hi Sharon, congratulations on your good results.
Tom C gave you some good links and info. What I have learned about cyberknife I got from going to the on line patient support group and from an interview with Dr. Vermeulen at Seattle Cyberknife. I was looking into doing it last February, but did image guided radiation therapy (IGRT) instead. I finished my radiation therapy over 6 months ago. I finished 4 rounds of alimta over 3 months ago. I had a scan a month ago, that still showed a lot of uptake. The local radiologist interprets it as marked growth of the tumor from 1 cm to 3.4 cm. That would mean the tumor was right around 1 cm for a year and then suddenly took off and grew in the last 3 months, more than tripling, right after some hard core treatment.
I went back to where I got the IGRT and had them review the data. While it is highly unlikely that the tumor would suddenly grow like it apparently has, it is also highly unlikely that there would still be inflammation after 6 months. They describe it as a “head scratcher”. I just had a bronchoscopy to investigate the area of apparent growth, but the pulmonolgist could not get the scope down to where the glowing area is and had to settle for washings. I don’t think he got any actual tissue cut from there, but I don’t know for sure yet. The report should be ready by next Monday. At this point it looks like the bronchoscopy is inconclusive.
I think they will have to meet at the board again to discuss the next step. They are reluctant to recommend more treatment unless they actually have physical data that shows there is tumor growth. They are also reluctant to pat me on the back and tell me not to worry. If there is going to be more treatment, the next step would be cyberknife. I think they are reluctant to insert the fiducials through my chest because of the risk of pneumothorax for a one lunged person such as myself. That is why I did not do cyberknife the first time. I think that if they cannot get the scope down to the tumor, there is no way that they could get the fiducials inserted by going through my bronchus.
There is a technique called blood patching that Dr. Medbury of the OK center told me about. I think a small amount of blood is drawn and injected into the area near the breach. The blood is supposed to rise to the surface and clot at the hole. I asked an interventional pulmonologist , who had just moved to Seattle Cyberknife from Boston Cyberknife, if he had heard of the technique. He had not heard of it. He said that anyway, if it could not be done by going through the bronchial tree, then an interventional radiologist would be the one to insert the fiducials through the chest.
So, if it comes to more treatment, I want to interview an interventional radiologist about the fiducial placement. The last time, I talked to a surgeon who was going to do the procedure. He was very insistent that there would be too much risk. At this point, I am more concerned about the risk of the cancer. I will ask the interventional radiologist if he has heard of the blood patch technique and if he can prep me ahead of time by having a tube inserted between my lung and chest wall and attached to a suction pump. If Seattle Cyberknife is still reluctant to insert the fiducials through my chest, I may travel to Dr. Medbury’s center and have them insert the fiducials.
It is very encouraging that your radiation oncologist is recommending cyberknife. I think you may have a shot at attaining NED if you just have the lung tumors. It won’t be a “cure” they say, but being NED sounds good, eh?
Good luck Sharon.
Don M
- By shindus
- Posted January 5, 2007 at 11:26 pm
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I was NED once at the end of 2002 and that lasted tor almost two years (except for some fiesty brain mets that were delt with by Stereotactic Radio Surgery (SRS). I'll take NED any day.
I want to thank everyone for taking the considerable time to answer my not so easy questions. I will definately report back on what I find out at the new center at Beth Isreal. I'll put the detail in my blog and then also set up a discussion so that everryone knows whats happening.
This looks like it might be a silver bullet if they can get it right.
Sharon
- By RNinMyBrothersMemory
- Posted January 7, 2007 at 5:21 pm
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Sharon, Cyberknife is not meant to shrink a tumor. What it does is focus a radiation beam much stronger than conventional radiation to the tumor and nowhere else. The goal of cyberknife is to kill the tumor with the radiation. As a result, the tumor can shrink, but again the goal is to kill the tumor. It's like leaving a bad kidney in patient who has a kidney transplant. You might want to look into RFA (Radio Frequency Ablation). RFA is a nice alternative to CyberKnife, or you can do both. In either case, the tumor is the only treated area, leaving healthy surrounding tissue intact. In my brothers case, the CyberKnife didn't kill his tumor, it still showed on his PET scan months after he had this done. He was set to have RFA prior to his passing. Keep in mind, tumor size is a factor in receiving either of these treatments.
Regards,
Gary Engelman, BSN, RN
- By TomC
- Posted January 8, 2007 at 11:56 am
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I just wanted to pass along this press release from the Cyberknife manufacturer. It sounds as if the fuducilal issue may be getting addressed. Of course it may be a while until one of the Cyberknife Centers actully get this and have it up and running.
TomC
Accuray Introduces First and Only Radiosurgery Products Designed for the Non-Invasive Treatment of Lung Tumors
Tools Designed to Eliminate Invasive Procedure and Automatically Adjust for Tumor and Patient Movement with Radiosurgery Accuracy
Sunnyvale, Calif., November 6, 2006 – Accuray Incorporated, a global leader in the field of robotic radiosurgery, today introduced three new products designed to improve the way lung cancer is treated. These products – Xsight™ Lung Tracking System, Xchange™ Robotic Collimator Changer and 4D Treatment Optimization and Planning System – combine with the Accuray CyberKnife® Robotic Radiosurgery System to offer a non-invasive, fiducial-free lung cancer treatment option that eliminates the risk of complications common with the implantation of markers or fiducials. Moreover, the products can shorten treatment times through treatment planning optimization and reduced treatment delivery interruptions.
These products will be on display in Booth 219 at the American Society for Therapeutic Radiology and Oncology (ASTRO) Annual Meeting at the Pennsylvania Convention Center in Philadelphia, November 5-9.
”Lung cancer radiosurgery using the CyberKnife System is growing, with more than a 130 percent increase in the number of patients treated in the last year alone. The Xsight Lung Tracking System offers a significant technological breakthrough which further enhances the CyberKnife System’s position to become the standard of care for lung radiosurgery,” said Euan S. Thomson, Ph.D., president and chief executive officer of Accuray. “With the first and only non-invasive radiosurgical means to precisely target and treat tumors, Accuray is breaking down barriers for patients who may not otherwise be able to receive treatment.”
The Xsight Lung Tracking System uses sophisticated image processing and registration techniques to directly lock onto and track the tumor throughout the treatment. It works seamlessly with Accuray’s Synchrony® Respiratory Tracking System to track, detect and correct for tumor and patient movement, allowing patients to breathe normally without the need for gating or breath holding techniques. Xsight Lung’s radiosurgery accuracy may eliminate the need for the invasive placement or tracking of radiographic markers or fiducials reducing the risk inherent to traditional treatment methods.
Designed to offer a non-invasive, more comfortable alternative for patients, the Xsight Lung Tracking System maintains the precision and accuracy required for radiosurgery treatments. Published data(1) states that there is a risk of pneumothorax when fiducials are used to mark lung tumors. By using non-invasive means to precisely target lung tumors, oncologists will be able to more quickly and effectively treat patients, including ones who are now considered to be medically inoperable.
“Radiosurgery with the CyberKnife System has proven to be quite successful in treating our lung cancer patients,” said John J. Kresl MD, PhD of Arizona Oncology Services at St. Joseph's Hospital and Barrow Neurological Institute. “Because these new tools from Accuray are non-invasive, we believe they will enhance our ability to treat lung tumors, including those in patients who may not be able to withstand the complications that could result from the implantation of fiducials.”
“A study in the most recent issue of the New England Journal of Medicine showed that regular screenings detected lung cancer in its earliest stages, and was curable when treatment quickly followed,” said Eric P. Lindquist, senior vice president and chief marketing officer. “We believe the Accuray CyberKnife System offers these stage I lung cancer patients an ideal alternative. With over 1000 lung tumor patients treated on the CyberKnife System to date, we believe that radiosurgery will continue to be a viable treatment option for lung cancer patients.”
Also debuting at ASTRO today are the:
*
Xchange Robotic Collimator Changer, which has the automated ability to change secondary collimators during the treatment, eliminating the need to re-enter the treatment room, while also minimizing related treatment delays.
*
4D Treatment Optimization and Planning System, which takes into account not only the movement of the tumor, but also the movement and deformation of tissue. Using this system, clinicians can better deliver the prescribed radiation dose to the targeted area while minimizing the damage to surrounding healthy tissue.
About the CyberKnife® Robotic Radiosurgery System
The CyberKnife System is the world’s first and only radiosurgery system that utilizes intelligent robotics to treat tumors anywhere in the body with sub-millimeter accuracy. The CyberKnife System treats patients in single or staged (typically 2-5) sessions by delivering multiple beams of precisely directed radiation that converge upon the tumor while minimizing injury to surrounding healthy tissue. Image guidance and computer controlled robotics combine to continuously track, detect and correct for tumor and patient movement throughout the treatment. Because of this precision and accuracy, no head or body frame is required.
About Accuray
Accuray Incorporated is a global leader in the field of robotic radiosurgery. Its CyberKnife System is the world’s first and only intelligent robotic radiosurgery system designed to treat tumors anywhere in the body with sub-millimeter accuracy. More than 100 CyberKnife Systems have been purchased by leading medical centers throughout the world and a large body of peer-reviewed papers supports its clinical practice. To date, the CyberKnife System has treated more than 25,000 patients worldwide. For more information, please visit http://www.accuray.com.
(1)Reichner, Cristina A., et al. The Placement of Gold Fiducials for CyberKnife Stereotactic Radiosurgery Using a Modified Transbronchial Needle Aspiration Technique. J Bronchol. 2005;12:193-195.
©2006 Accuray Incorporated. All rights reserved. Accuray, the Accuray logo, CyberKnife, Synchrony, Xsight, RoboCouch and Xchange are among trademarks or registered trademarks of Accuray Incorporated.
- By no1dad
- Posted December 22, 2007 at 1:22 am
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Hi Gary .
I'm so sorry to hear of your brother ..it sounds like you two were very close. It is really appreciated all your input as it seems you have certainly been involved/educated with these different treatments...
I am fighting this battle with my dad who is NSCLC stage IIIb.Also my best friend.
Primary tumour upper rt lung 2.7cm and secondary supraclavicular 4cm. He has had 2 rounds of chemo so far. not in bones and not anywhere else ...
Looking at alternative options...we are in the norhtwest. (Vancouver, B.C.)
What else can ou tell us about this cyberknife relating to size of tumour? and what is RFA?
how does it compare?
Where would be the closest treatment center for us any idea?any other sugestions of possibilities??
My thoughts are with you.
Shannon
- By Don_M
- Posted December 22, 2007 at 4:04 am
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Shannon: I think the closest ck center is in Seattle.
Seattle CyberKnife at Swedish Medical Center
550 17th Avenue, Suite A10
James Tower Life Sciences Building
Seattle WA, 98122 USA
Phone: (206) 320-7130
Visit Our Website
http://www.seattlecyberknife.com/
I had ck there last June.
Don M
- By no1dad
- Posted January 23, 2008 at 12:32 am
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Hi Tom !
I'm curious how you have made out with the cyberknife route ??
My dad is presently looking into this in Canada, Vancouver ...have you heard of any clinics up here by chance?
My best,
Shannon
- By TomC
- Posted January 23, 2008 at 11:09 am
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Shannon -
I have not had to do cyberknife yet. Locations can be found at http://www.accuray.com/.
Best of luck.
Tom C
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