CYBERKNIFE TREATMENT IN OVARIAN CARCINOMA

CYBERKNIFE TREATMENT IN OVARIAN CARCINOMA

A 60-year-old female with a history of Stage IV ovarian carcinoma presented with rising CA-125 levels (21.1 U/ml to 34.4 U/ml), signifying a probable ovarian carcinoma recurrence. Subsequent MRI showed a 2.8 x 2.5 cm nodule in the region of the left upper vaginal cuff which was confirmed by bimanual examination. Initial diagnosis of Stage IV ovarian carcinoma was made six years earlier when the patient presented with right-sided pleural effusion and CA-125 of 1482 U/ml. An exploratory laparotomy was done and an omental cake, peritoneal studding and a nodule adjacent to the rectosigmoid were resected. Pathology showed poorly differentiated serous papillary ovarian carcinoma.

Over the next four years the patient underwent multiple rounds of chemotherapy as well as stem cell transplant and additional surgical resection in the effort to control her disease. The patient’s latest chemotherapy was prematurely discontinued when she experienced a severe anaphylactoid reaction. At that time the decision was made to follow her closely with imaging and CA-125 measurements.

CyberKnife® Treatment Rationale

 Epithelial ovarian cancer is the leading cause of death among women. More than 70% of women with epithelial ovarian cancer have Stage III or IV disease at the time of diagnosis

1 Adjuvant chemotherapy is recommended for all patients with advanced stage ovarian cancer after appropriate surgery. However, more than 70% of patients relapse, with a median time to progression of less than 2 years.

2 Secondary surgery for recurrent patients has not significantly improved survival. Radiation therapy has improved survival in a subset of patients with chemotherapy-refractory disease, particularly those patients with minimal residual or relapsed disease to the pelvis, and has provided good palliation in patients with local abdominopelvic symptoms.

3 This patient presented with a recurrent ovarian cancer in the left vaginal cuff. Due to the patient’s medical history, she was not a candidate for further chemotherapy or surgery. Nevertheless, the left vaginal cuff recurrence was and had always been the only site of recurrence in this patient, therefore aggressive definitive care was indicated.

The use of stereotactic body radiotherapy as an alternative to brachytherapy for gynecologic tumors has been reported to achieve excellent local control rates with minimal toxicities.

4 offered a minimally invasive method for delivering hypofractionated radiation to the left vaginal cuff of a patient who had failed two surgical resections and numerous cycles of chemotherapy.

Source : http://www.cyberknifetampabay.org/

To know more aboutcancer treatment at Apollo speciality hospital  kindly write to me at lakshmipriya_b@apollohospitals.com or call 9940675877

BRAIN METASTASIS

In many patients with brain metastases, the primary therapeutic aim is symptom palliation and maintenance of neurologic function, but in a subgroup, long-term survival is possible. Local control in the brain, and absent or controlled extracranial sites of disease are prerequisites for favorable survival. 

Stereotactic radiosurgery (SRS) is a focal, highly precise treatment option with a long track record. Its clinical development and implementation by several pioneering institutions eventually rendered possible cooperative group randomized trials. A systematic review of those studies and other landmark studies was undertaken. 

Most clinicians are aware of the potential benefits of SRS such as a short treatment time, a high probability of treated-lesion control and, when adhering to typical dose/volume recommendations, a low normal tissue complication probability. 

However, SRS as sole first-line treatment carries a risk of failure in non-treated brain regions, which has resulted in controversy around when to add whole-brain radiotherapy (WBRT). SRS might also be prescribed as salvage treatment in patients relapsing despite previous SRS and/or WBRT. An optimal balance between intracranial control and side effects requires continued research efforts.

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choroidal haemangioma (eye lesion)

Master ShreeVaishnav – Kerala, India 
Radiation therapy is one of the most important tools to combat cancer. However, conventional radiation therapy is long course (usually 6 to 7 weeks) treatment and may have severe acute side effects including skin and mucosal reactions, diarrhea, feeding difficulties and others. Higher dose radiation is also not possible to deliver due to limitations related to toxicities. CyberKnife is a precise radiation therapy technique by which high dose radiation therapy can be delivered only to the tumor and minimal dose to the normal structures. CyberKnife treatment is a short course treatment (usually only one to 5 days) and have no or minimal side effects. Many tumors which are ‘resistant’ to conventional radiation are ‘sensitive’ to high dose radiation delivered by CyberKnife. “CyberKnife has unique system that it can track moving tumors and treat them with immaculate accuracy”. Tumors in moving organs such as lung and liver can be treated most effectively CyberKnife. Dr Debnarayan Dutta, Consultant in Radiation Oncology at Apollo Speciality Hospital, Chennai commented “there are few tumors which were thought to be not treatable are now being treated successfully with CyberKnife”.

Master ShreeVaishnav, a 6 year old boy from Kerala suffering with choroidal haemangioma (eye lesion) had vision loss in both the eyes, he was referred from Sankar Netralaya for treatment. He was treated with CyberKnife and at 2 months follow up evaluation his vision had dramatically improved. “We are thankful to Dr Dutta for giving vision back to my son” told ShreeVaishnav’s father who was elated about CyberKnife. “CyberKnife has opened a modern and effective option for these diseases and we are happy with the result” said Dr Prativa Mishra, eye specialist involved in ShreeVaishnav’s treatment.

CyberKnife is a revolution in cancer treatment; it provides effective, short course, minimal toxic and high dose treatment in brain, lung, liver, pancreas, prostate, head and neck and many other tumors.

To know more about cyberknife kindly blog your comments or you can write to me atlakshmipriya_b@apollohospitals.com or call 9940675877

Radiosurgery in brain tumours

Radiosurgery in brain tumours Dr.DEBNARAYAN DUTTA, CONSULTANT RADIATION ONCOLOGIST< APOLLO SPECIALITY HOSPITAL CHENNAI

Short course radiation therapy is the one of the most talked about subject in recent years and also a fascinating research zone. Hypofractionated radiation therapy is an old concept, but only in recent years with tremendous improvement in radiation therapy delivery technologies there is a significant visible surge in it’s applicability in clinical practice. Modern radiation therapy technology is capable of delivering high dose to the target while sparing majority of the adjacent critical structures. Hence, it is possible to deliver short course of treatment regimen with higher dose per fraction without increasing in toxicity. In brain tumours, radiosurgery with gamma-knife is considered standard of care in many of the clinical indications such as small meningiomas, acaustic schwannomas, residual low grade gliomas, AVMs and solitary/ oligo brain metastasis. Gamma-knife radiosurgery is in clinical practice for more than five decades.  There are several prospective and randomized studies (level I evidence) with long-term follow up data supporting the use of radiosurgery in these clinical indications. Other indications of radiosurgery are pituitary tumour, craniopharyngiomas, glomus tumours, chordomas and others. Robotic radiosurgery (CyberKnife®) is precision radiosurgery delivery system and an extension of gamma-knife system. CyberKnife uses the principle of gamma-knife, but with linear accelerator source instead of multiple cobalt sources. CyberKnife is capable to treating all tumours indicated for gamma-knife with similar accuracy. This modern tool has some additional advantages from gamma-knife, such as 1) CyberKnife can use fractionated treatment, hence relatively larger tumours can be treated, 2) require only thermoplastic mask, no need for invasive frame, 3) has inverse planning system, can spare critical structure, 4) there is a ‘intra-fraction’ correction technology with imaging, 5) there is no need to change the source, hence may be more cost effective and 6) can be used to treat extra-cranial tumours also. CyberKnife has a linear accelerator attached with a robot and is capable of treatment from various coplanar and non-coplanar field arrangements. CyberKnife has sub-millimeter accuracy and unmatched dose distribution.  The advanced technology behind CyberKnife uses image guidance technology and computer-controlled robotics to deliver and extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue, and adjusting for patient and tumor movement during treatment. In conclusion, CyberKnife is an extension of gammaknife radiosurgery delivery system. This machine has immense promise to treat with short course regimens with high dose and improve local control without increasing toxicities. FOR more information you may please blog your comments or write to lakshmipriya_b@apollohospitals.com

CYBERKNIFE FOR PROSTATE TREATMENT - WHAT PATIENTS FEEL

CYBERKNIFE FOR PROSTATE CANCER _ WHAT PATIENTS FEEL

Compensating for Prostate Movement: The prostate gland can move unpredictably throughout the course of treatment that makes the ability to track, detect and correct for motion critically important. Unlike any other radiation treatment, the CyberKnife System continually tracks and automatically corrects for the movement of the prostate in real time. This enables the system to correct the beam direction so that it is focused on the prostate throughout the entire treatment. The robot constantly monitors and aligns the real time location of the prostate to ensure any adjustments in the beam delivery match the prepared treatment plan while automatically correcting for any movement during a treatment by relaying critical logistical information to the system software. Safety mechanisms are in place to ensure that the beam of radiation is ‘locked on’ to the intended target should your prostate move out of acceptable range. For example, if a gas bubble is moving through the rectum or the bladder starts to fill during treatment, a system correction compensating for movements of the prostate automatically occurs.



Reduced Treatment Time: Compared to alternative treatments that can take up to 8 - 9 weeks (including relocation in some cases) or 40 - 45 sessions of radiation therapy, an entire CyberKnife® treatment plan can be completed in 4 to 5 sessions. Each treatment session is typically completed in one hour or less. the CyberKnife System is designed to treat with a higher per-fraction dose given its superior accuracy. This substantially reduced treatment timeframe is advantageous for busy men seeking the least amount of disruption to their daily lives.



A Non-Invasive Procedure: Aside from the placement of tiny gold markers called fiducials inside of the prostate, a pre-treatment procedure that assists the imaging system to more accurately target tumors, the CyberKnife treatment process is completely non-invasive. No incisions, anesthesia or hospitalization are required. The CyberKnife robot moves quietly around a patient who lies comfortably on the treatment table. The robot will move in nearly every direction to fully deliver the prescribed treatment dose.This is in contrast to laparoscopic surgery or a traditional prostatectomy that involves incisions and associated risks. Surgical procedures usually involve general anesthesia which may last up to several hours. As with any surgical procedure, potential risks include bleeding and infection and, depending on a patient’s overall health condition, other complications including incontinence and/or erectile dysfunction. In addition, surgery requires mandatory hospitalization and catheterization.

And compared to High-Dose-Rate brachytherapy (HDR) the CyberKnife System delivers the same dose of killing radiation to the prostate, but does so without the insertion of multiple catheters. HDR typically involves a hospital stay, over a 24 hour period, and places 15-20 catheters into the prostate, through the perineum. Through these catheters a machine pushes a single highly radioactive iridium seed into the catheters one by one. Low-Dose-Rate, or LDR brachytherapy (also known as seed brachytherapy) is also an invasive procedure in which dozens of radioactive seeds are permanently implanted in the prostate with needles inserted through the perineum to deliver radiation over many weeks.



WHAT PATIENTS SAY ABOUT PROSTRATE CANCER



A CyberKnife Coalition survey conducted between February – March 2011, 304 participants were asked why they chose CyberKnife SBRT over other treatment options.

Here is what they said:

84% Most comfortable with risk/side effects

81% Seemed like the best options among my choices

66% Offers the latest technology

59% Convenience

59% Most likely to eradicate/eliminate the cancer

36% Least amount of time away from work

18% Not a surgical candidate

Additional results of this survey found that:

99% of patients described their treatment as successful

93% of patients indicated that SBRT did not interrupt their normal life routine

98% of patients indicated they would recommend SBRT treatment to others

99% of patients indicated they would choose to be treated with SBRT again

 

APollo Hospitals has treated more that 70 prostate cases and the results have been very promising. Patient have been under 2-3 year follow up.

 

Source. www.cyberknifeforprostate.com/

 

 

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Vertigo and right side hearing loss - Acoustic neuroma

Vertigo and right side hearing loss - Acoustic neuroma


A 50 years old gentleman presented with complaints of vertigo and right side hearing loss. MRI brain showed a well defined intracranial hemorrhage soft tissue lesion on the right side, possibility of an acoustic neuroma (1.1 x0.6 x0.5 cm). He was seen by ENT specialist. Audiometry revealed profound SN hearing loss on the right side and was referred to me for cyber knife radio surgery. Patient underwent Cyber Knife radio surgery from 11.10.2010 to 15.10.2010. Subsequent follow up with MRI and volume analysis has resulted not only arrest of tumour but also significant reduction in the volume of lesion, indicating success of treatment.

This patient was treated at Apollo Speciality Hospital, Chennai and has shown significant progress through cyberknife treatment


To know more about cyberknife treatment you may blog your comments or write to lakshmipriya_b@apollohospitals.com

Stereotactic body radiotherapy for low-risk prostrate cancer

Stereotactic body radiotherapy for
low-risk prostate cancer:
five-year outcomes
Debra E. Freeman1 and Christopher R. King2
1 Naples Radiation Oncology, PA, USA
2 Department of Radiation Oncology, UCLA School of Medicine, CA, USA
Radiation Oncology 2011, 6:3doi:10.1186/1748-717X-6-3
Purpose
Hypofractionated, stereotactic body radiotherapy (SBRT) is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT.
Method and Materials
Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35-36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method) and RTOG toxicity outcomes were assessed.
Results
At a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%). Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated
urologic instrumentation.
Conclusion
Five-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach.

Source: www.accuray.com

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Rectal Carcinoma with Lung Metastasis

Rectal Carcinoma with Lung Metastasis

Case History
A 77-year-old male was presented to Apollo Speciality Cancer Hospital reporting rectal carcinoma that was diagnosed in the year 2006. The patient was then undergone surgery (anterio perineal resection), radiation therapy and chemotherapy. The patient was clinically stable until the year 2009. In the year 2009, he developed repeated episodes of cough and pain on the right side of the chest. Owing to these complaints, the patient was evaluated by performing whole body PET scan. The scan revealed increased metabolic activity in lower lobe of the right lung and posterior basal segment pleural base mass. No other sight in the body showed activity (disease) in the PET scan. Biopsy from the lung mass was suggestive of metastatic adenocarcinoma.

The patient was diagnosed with solitary lung metastasis with controlled primary site disease and was planned to treat with radical intent using CyberKnife®. He was treated with 45Gy in five fractions in 1 week through CyberKnife® radiosurgery. The patient tolerated the radiosurgery well.

A follow-up CT scan was performed at 6-month post-CyberKnife®. The scan revealed a significant reduction in the lung mass.

Discussion
Generally, patients having solitary (single) or ‘oligo metastasis’ (<3 metastasis) with otherwise good general health and controlled primary disease are treated with curative intent. Surgery (metastectomy) is the preferred treatment. However, surgery may not be possible in a large
number of patients because of their medical condition or age. Therefore, these patients can be treated with radiosurgery using CyberKnife®

For more information you may please blog your comments or write to lakshmipriya_b@apollohospitals.com