Cyber Knife Radio surgery in Pediatric Patients

Cyber Knife Radio surgery in Pediatric Patients

Dr.R.Rathna Devi, Sr. Consultant Radiation Oncologist

“One little girl told me “ I want to go to school” she was one of my early pediatric patient with AVM for the new facility, Cyber Knife. That’s what was on her mind. And that’s what she did. She went to school immediately after her treatment. This made a tremendous difference to the family and to the child, and I was very happy to have offered her this”.



Cyber Knife radio surgery has a great advantage in treatment of pediatric intra and extra cranial lesions which includes non – invasive immobilization, low radiotherapy exposure to the developing normal brain other tissues and ability to fractionate the treatment.

Young patients in the past were usually required to wear a of head frame (Gamma Knife, other kind of radiosurgery equipments), and had to remain anesthetized during the entire, often day long procedure.


These procedures uses rigid metal frame attached directly to the patient’s skull to orient the radiation beams, making it difficult to treat young children with small/ fragile heads. Because the frame cannot be removed between the initial imaging and subsequent treatment, doctors also had to work fast with the other types of radio surgery. With the clock ticking, we had to place the frame, perform CT/MRI or other imaging studies; get everyone involved to meet, plan the treatment and then treat the patient, while the patient is intubated and asleep. This is not an optimal situation.

Fortunately now at Apollo Speciality Hospital we can treat young patients (who can hop off the table and go home or to school) after the initial imaging step while we plan the treatment strategy. The non invasive process uses tiny focused beams of radiation to perform radio surgery on a patients head or body. This technique allows us (Doctors) to attack trouble spots deep within the brain while minimizing the dose of radiation to surrounding healthy tissue. This is particularly important in children, whose brain is still developing.

ADVANTAGE - CYBERKNIFE

Cyberknife which was developed by John Adler, uses a mesh mask to stabilize the head. The technology tracks any unintentional movement on the part of the patient and adjusts the radiation path as necessary. Children who can understand the importance of holding still can undergo the treatment while conscious, younger kids can have short term anesthesia for approximately hour – long diagnostic and treatment session. The recovery from anesthesia is usually quicker because they don’t usually have to be intubated.

At Apollo specialty hospital, till date we had the opportunity to treat 11 children with Cyberknife radio surgery. Our first Cyberknife patient was a pediatric patient with cervico medullary haemangioblastoma 15 years male patient from Tripura . He presented with neck pain, poor cough reflex, and difficulty in swallowing and upper limb tingling sensation. Investigations revealed cervico medullary expansile lesion involving medulla to C2 C3 level.

He underwent occipito cervical craniotomy and decompression, because of high vascularity, surgery was abandoned. He underwent Cyberknife radio surgery between 24th to 26th March 2009. In the first follow up after 3 months, his symptoms completely disappeared follow up MRI showed reduction in size of lesion and contrast enhancing portion of the lesion reduced significantly.

This boy really benefited out of Cyberknife radio surgery. Treating only the affected area with out affecting adjacent brain tissue. He is due for his 10th Std board exam now.

Intracranial


We have treated 4 patients with AVM, and other treated indications include :


1 patient with Supracellular Hemartoma


1 patient with pineliocytoma


1 patient with Recurrent Meningioma


1 patient with Brainstem Glioma


1 patient with Pilocytic astrocytoma (residual)


Spine


1 patient with vertebral Haemangioma


To conclude, Cyberknife: represents an entirely new approach to radiosurgery. It is the only system that combines robotics, and advanced image guidance to deliver frameless radio surgery.

Cyberknife features robotic arm and proprietary image guided technology. The robotic arm is computer controlled and has an arm movement precision of 0.5mm.

Greatest advantage is an out patient basis treatment.


FOR MORE INFORMATION REGARDING CYBERKNIFE TREATMENT IN PEDIATRIC CASES YOU MAY BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com

DR. SURESH H.ADVANI at APOLLO SPECIALITY CANCER HOSPITAL - CYBERKNIFE CENTER.

Padma Bhushan Prof.(Dr.) Suresh H.Advani , a well known renowned specialist in Oncology visited Apollo Speciality Cancer Hospital recently.

He visited our Cyberknife facility and during a recent interview to" News Today "had the following to say :
‘I used to refer cancer patients to Malaysia where the CyberKnife procedure was available and now Apollo Hospitals, Chennai, has acquired the latest Asia Pacific’s most advanced CyberKnife robotic radiosurgery system, PET scanning, MRI, Radiography, bone marrow transplant unit which is to be set up at the earliest, with expertise in the field, all under one roof that makes Chennai city the medical destination,’ said Dr Suresh Advani


To read the interview with dr. Suresh H,Advanui please log on to www.newstodaynet.com  Monday, 23 November, 2009



 
 
It was our previlige to have him here and get his valued opinion

DR.ADVANI in the center, with the cyberknife panel of  radiation oncologits at Apollo Speciality Cancer Hospital .

 
 
 
FOR FURTHER INFORMATION ON CYBERKNIFE TREATMENT,PLEASE  BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com
 

CYBERKNIFE IN LUNG CANCER

Dr.Sanjay Chandrasekar, Senior Consultant Radiation Oncology presented on Cyberknife in Lung Cancer in the 11th Napcon 2009 (National Conference of Indian Chest Soceity ) conference in Calicut betweeb 5-8th November 2009.

The excerpts from his presentation on Cyberknife in Lung Cancer are :

FOR MORE INFORMATION ON CYBERKNIFE TREATMENT IN LUNG CANCER YOU CAN BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com

CYBERKNIFE SUCCESS STORY FEATURED IN "THE WEEK" magazine

The 1st Cyberknife Success Story , featured in " The Week " Nov 15 edition on Week-IMRB exclusive survey on Best Hospitals 2009.

The Success story of Master Sanka Subradey , aged 15 from Tripura was the 1st Patient in India to undergo Cyberknife Treatment at Apollo Speciality Cancer Hospital, Chennai.

Post treatment , the follow up in September 09 showed in MRI significant reduction in tumour size & he is back to normal life busy preparing for his Class X board examination , thanks to Robotic Radiosurgery system like Apollo Cyberknife

FOR MORE INFORMATION ON TREATMENT PLEASE WRITE TO lakshmipriya_b@apollohospitals.com

TRIGEMINAL NEURALGIA

CYBERKNIFE IN TREATMENT OF TRIGEMINAL NEURALGIA


Dr.M.Balamurugan, Senior Consultant - Neuro Surgery

"The Suicide Disease" or tic douloureux(also known as prosopalgia) is a neuropathic disorder of the facial trigeminal nerve. The trigeminal nerve the fifth cranial nerve, is responsible for sensory data (pressure, tempereature & pain) and also responsible for the motor function of the muscles involved in chewing but not facial expression.

SYMPTOMS

The disorder is characterised by episodes of intense facial pain that usually last from a few seconds to several minutes or hours. The attacks are said to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable.

Unfortunately, the symptoms of trigeminal neuralgia are often falsely attributed to a pathology of dental origin. Because of this difficulty, many patients go untreated unless a correct diagnosis is made.
There is evidence that points towards the need to quickly treat and diagnose TN. It is thought that the longer a patient suffers from TN, the harder it may be to reverse the neural pathways associated with the pain. Therefore it is essential that physicians are made aware of the seriousness of TN and the level of pain that their patient

TREATMENT OPTIONS

Medical treatment may involve usage of Anticonvulsants such as carbamazepine, oxcarbazepine, topiramate, phenytoin, or gabapentin and sometimes low doses of some antidepressants such as amytriptiline is used.

Surgically there are five options available . Of the five surgical options, the microvascular decompression is the only one aimed at fixing the presumed cause of the pain. Three other procedures use needles or catheters that enter through the face into the opening where the nerve first splits into its three divisions. Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression are available. This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression.

Other options involve using glycerol injections and radiofrequency rhizotomies. Glycerol injections involve injecting an alcohol-like substance into the cavern that bathes the nerve near its junction. This liquid is corrosive to the nerve fibers and can mildly injure the nerve enough to hinder the errant pain signals. In a radiofrequency rhizotomy, the surgeon uses an electrode to heat the selected division or divisions of the nerve. Done well, this procedure can target the exact regions of the errant pain triggers and disable them with minimal numbness.

Stereotactic Radio Surgery The nerve can also be damaged to prevent pain signal transmission using Gamma Knife or a linear accelerator-based radiation therapy (e.g. Trilogy, Novalis, CyberKnife).

Cyberknife Radiosurgery : Of these, the development of CyberKnife radiosurgery (Accuray, Inc., Sunnyvale, CA) in 1994 added a promising new treatment option for this disease. Using noninvasive head immobilization and advanced image-guidance technology, the CyberKnife dynamically tracks skull position and orientation during treatment, thereby ensuring targeting accuracy throughout the entire procedure, and patients are spared the discomfort of frame fixation onto their skulls. CyberKnife radiosurgery offers the ability to deliver nonisocentric, conformal and homogeneous radiation doses to nonspherical structures such as the trigeminal nerve. There are no risks of infection, cerebrospinal fluid leak or wound healing from Cyberknife Radiosurgery. However, some patients may develop additional numbness in the face or may experience abnormal facial sensations. This occurs in less than 10% of patients.

For more information please write to : lakshmipriya_b@apollohospitals.com;