Attacking Cancer From All Angles

NJBIZ, Aug 23, 2004 by Quinn, William T

A machine that zaps unreachable tumors is part of the cutting edge at Overlook Hospital

The machine looks so smart that, if it had wheels, one might imagine it leaving its post on the first floor of the Medical Arts Building at Overlook Hospital in Summit to have a look around. But the Cyberknife is firmly rooted in place and lives only to serve its robotic mission of burning out tumors from the brain, spine and other parts of the body with high energy beams of radiation delivered so precisely that their targets are measured in sub-millimeter lengths.

The Cyberknife came on line at Overlook last month as part of a $35 million expansion of the hospital's Neuroscience Institute and Cancer Center; it has so treated eight patients. Doctors who work with the device call it a marked technical advance over previous machines designed to deliver targeted radiation to cancerous growths, and say it offers new options to cancer patients.

About 40,000 people in the U.S. are diagnosed with brain tumors each year. Another 10,000 people are found to have spinal tumors, and more than 180,000 are diagnosed with tumors in the lungs.

Neurosurgeon Brian Beyerl, who with radiation oncologist Louis Schwartz co-directs the unit that delivers the Cyberknife treatments, says the machine is particularly valuable for targeting tumors previously thought to be unreachable because of their location in sensitive parts of the brain, such as proximity to the optic nerve. "That's a huge advance," Beyerl says.

Previous machines were used mainly to deliver a single high dose of radiation to the brain, says Beyerl, since doctors weren't sure they could hit exactly the same spot in later sessions. But the single treatment could expose healthy tissue around the tumor to heavy radiation.

By contrast, the Cyberknife can be precisely targeted time and again, allowing for the delivery of lower doses. That way, says Beyerl, "the critical structure [around the tumor] can recover" between treatments.

The machine combines a linear accelerator with a robotic arm originally designed for delivering spot welds to cars moving down auto lines. It can fire slender beams of radiation at a tumor from up to 1,200 positions around the patient's head or body, while adjusting for movements caused by breathing or fidgeting.

Using a combination of X-rays, MRIs and CT-scan images, the Cyberknife precisely locates the tumors it is targeting. Unlike earlier designs like the Gamma Knife, which was developed in Sweden in the 1960s, Cyberknife treatment does not require a patient's head to be kept in a fixed in position by a metal frame, or "halo".

Sharon Holmes of Roseland was the second patient to be treated with the machine last month. Holmes, a 56-year-old violinist who plays with several local orchestras, had two tumors deep inside her brain, one in the cerebellum and another near the brain stem; a third tumor located higher in her brain had been surgically removed in April.

Holmes says she first noticed a problem when she had trouble reading music and driving, and felt something like an electric current running through her head. She says she felt lucky to have the option of having the two deeper tumors treated with radiation delivered by the Cyberknife. "It's really wonderful," she says, "because it's non-invasive."

Holmes went through two treatment sessions with the machine, the first lasted one hour and the second, two hours, with her head held in place by a plastic mesh mask screwed down to a platform. "I was, of course, nervous," she says. But she says, "you don't feel anything, you just have to lie perfectly still," while the machine moves around you. Patients can listen to music on CDs of their choice while the treatment is underway. Holmes says she opted for "some heavy duty stuff because I'm a classical musician."

She says the music "worked very well; I was able to relax after the first day, the second day was much easier." Holmes had trouble sleeping after the treatments, which she blames on steroids she was taking to combat swelling and inflammation in the brain. Even so, she said she did have the feeling that her head and brain were swollen at first. "It was hard to even get dental floss between my teeth," she says. But after about two weeks, she says, she began to feel better. Now, she says, "I'm completely back to normal."

Overlook spent $3.5 million to buy the Cyber"knife from its manufacturer, Accuray, of Sunnyvale, California, and another $1.5 million to build and outfit the radiological suite where it resides.

This represents the single biggest capital expenditure the hospital, which is part of Atlantic Health Systems in Florham Park, has made in the past two years. It follows Overlook's strategy of trying to differentiate itself from other hospitals that offer radiation therapy for brain tumors by having the latest technology on hand. Lydia Tarta, who manages the business side of Atlantic's oncology services, says Overlook expects to recover the cost of Cyberknife over the next two-to-three years.