Sunday, December 13, 2009

PROGRESS IN RADIATION ONCOLOGY

PROGRESS IN RADIATION ONCOLOGY


Dr. Janos Stumpf - ADVISOR ONCOLOGY – CYBERKNIFE SERVICES





End of the month November, was an academic feast for the Indian Radiation Oncologists at Hyderabad.

The content of the conference can be summarized in three words: It was about Research, Discipline and Development, especially that of the new machines. It is our pride to realize and say that even latest knowledge about the technical progress has found its way to India, no matter how expensive the machines are. “Precision in Delivery of Radiation” is the mantra for all these technical aspects. Tomotherapy, Cyberknife and Rapid Arc are all the ways to do radio therapy on an extremely precise way.

Cyberknife was covered by two speakers. An eminent guest from California Dr.Nissar Syed was kind enough to give an over-all review about the machine. His talk was followed by the ‘Indian experience’ with Cyberknife based on more than hundred fifty cases treated already at ASH Chennai. Characteristics of the first 150 cases were presented. Apollo has considerable success:- partial remission even in majority of the ‘lost’ cases.

Beside the advantage of saving normal tissue in the brain or extracranially, CK represents a huge leap forward in treating moving targets like cancer in the lung, liver or in the prostate. All these three organs, move during the radiotherapy.



The first patient, Master Shanka had very serious neurological complaints at the time when he came to Apollo. He was attended by Sr. Consultant Neurosurgeon Dr.Balamurugan. However his attempt to remove the haemangioblastoma from the patient’s brainstem was confined to fail due to the dangerously high vascularity which is the nature of that kind of tumors. But this surgical nightmare can be converted into an advantage with the help of High Precision Irradiation (HPI). High vascularity means high density of endothelial cells which are covering the inner surface of the vessels. These vulnerable cells can react with an overgrowth for the exposure of radiation.


Few months after the success full Stereotactic Radiosurgery with CK, part of the tumor has been obliterated its overall size started to come down.This is why the patient has improved and could resume his normal life.

Fate of a patient with inoperable lung cancer is practically known at the time of the diagnosis. Only a very minimal percentage of the inoperable lung cancer cases can be saved by the combination of conventional irradiation with chemotherapy. CK seems to bring a new hope for these patients. A 57 year old gentleman from the neighboring Srilanka successfully conquered one cancer 10 years ago with the help of Apollo Speciality Hospital. He came with hope again when an inoperable lung cancer in his chest was diagnosed. Chemotherapy has failed unfortunately. And then Cyberknife seemed to come for his rescue. High precision and short duration, biologically very intensive radiation has resulted in an impressive remission of his advanced lung cancer without any side effects. This aggressive cancer does have the capacity of invading the rest of the body. As a matter of fact the same has been observed with that particular patient too. But for him this is not the “end of the road”. A second CK treatment is planned to attend all the new sites of cancers shown on the PET CT. Highly sophisticated tools in radiation oncology do allow us to provide longer control with reasonable if not excellent quality of life even in an aggressive cancer.

There is a beautiful sentence told by Rabindranath Tagore about the disease in general. “DEATH DOES NOT HURT US, BUT DISEASE DOES, BECAUSE DISEASE CONSTANTLY REMINDS US OF HEALTH AND YET WITHOLDS IT FROM US.”

This is double true for cancer. Quality of life of a patient has to be one of the primary concerns of an oncologists. Many cancers have a tendency to migrate to the bone, to the spine. These metastatic lesions have the capacity to paralyze the patients by compressing the spinal cord. Chemotherapy frequently has only temporary control over the progress and so does conventional radiotherapy. But high precision in CK helps. We have the technical skill and opportunity to give high precision irradiation to the spine and to arrest this type of tumours even before they cause the extremely bad condition of transverse lesion of the spine. A Professor from George-Towns University in Washington DC said “by now we hardly deal with paralysis due to metastasis to the spine. It is being attended with CK at a curable and controllable stage and the patient will not be confined to bed for the rest of his/her life.


The basic question: ‘How cancer can be tamed in general’ still remains unanswered. But the tremendous progress gives hope for both temporary control with good quality of life and for cure in many cases. It is our job and duty to know about new developments and to apply them with wisdom. This conference was all about this.

Sunday, December 6, 2009

CYBERKNIFE SUCCESS STORY - TREATMENT OF PROSTATE CANCER



CYBERKNIFE SUCCESS STORY - TREATMENT OF PROSTATE CANCER
DR.MAHADEV Senior Consultant, Radiation Oncology


71 Yrs old Mr.Birendra Singh from Gopalganj, Bihar was devastated when he was diagnosed to have Prostate cancer. He had gone to his urologist for just a routine checkup because he was having difficulty in passing urine for the last couple of months. A routine PSA done was in the range of 15ng/ml. A transrectal biopsy revealed grade 2 adenocarcinoma of the prostate gland with a Gleason’s score of 3+4.

Mr.Singh went to Delhi for an opinion. He consulted various doctors which included several urologists, surgical oncologists and radiation oncologists.The options given to him included wait and watch, bilateral orchidectomy(removal of both testis), Radical prostatectomy, Brachytherapy(seed /HDR implant).The opinions were so varied that the family could not take a decision for 3 months.

Patient also consulted Apollo Hospitals at Ranchi in Jharkhand where he was advised to go to Apollo Speciality Hospital Chennai as all the treatment options were available there and he was also told that a full team of doctors decide on a treatment in the tumor board.

Mr Birendra Singh’s nephew who lives in the United States, meanwhile contacted his uncle from there and told him about a new treatment called the cyberknife which he had read on the internet. His nephew was very impressed by what he had read on the net- outpatient treatment, non-invasive, very precise radiation delivered robotically and just 5 sittings with practically no side effects. He asked his uncle to come to US for treatment as he thought it was unlikely that this treatment option would be available in India.

After going through all the treatment options Mr.Birendra Singh decided he would go in for Cyberknife as he found that to be the best treatment modality in his opinion. He visited Chennai in March 2009 to take a final decision. We had just then started using Cyberknife and we told him that the latest version of Cyberknife is now available here. He was told that the cost of cyberknife would be around 40,000 US dollars in US. We told him that the cost of treatment here would be Rs 400,000.

As we had just started Cyberknife Mr Singh was anxious about our technical capability. But when he came to know that the entire team was trained at the Stanford University, California, where actually the cyberknife was invented, he immediately decided to have the treatment here.

The first step in the treatment process was counselling him about the various treatment aspects.This included explaining to him the various stages of the treatment preparation ,planning and execution.The expected benefits and the various side effects that can be expected was explained to him in detail.The side effects that are normally seen with this treatment can be increased frequeny of micturition and bowel movemens.Very rarely, rectal bleeding can be seen as a late effect of radiotherapy.

The second step was placing 5 gold fiducials into the prostate gland transperinealy under transrectal guidance which took about half an hour. These fiducials are necessary for the machine to track the prostate gland during the entire course of treatment. Normally, we have to wait for a week after placing the fiducials for doing the planning CT scan. This is necessary because in the first couple of days, the seeds can migrate.

The third step in his planning was the making of a special type of bed called Vacloc for immobilization of the patient during treatment. Vacloc is a vacuum bed which takes the shape of the patient so that daily reproducibility of the patient in the same position can be achieved easily. This took about 10 minutes following which a CT scan was done with the patient lying in the vacloc in the treatment position.


Next, the Radiation oncologist contours the prostate gland, bladder and rectum. Then, the medical physicist puts on the treatment beams. The treatment plan was ready the next day and was reviewed by the oncologist and urologist.The treatment plan was finalized and the patient was asked to come for treatment the following day which happened to be a Tuesday. Patient was asked to have a light breakfast before 8 am and report for treatment at 10am.He was also asked to take a laxative the previous night and antacids.This preparation is a very important part of the treatment as improper bowel evacuation and gas in the bowel can interfere with the accuracy of the treatment.As cyberknife can achieve submillimeter target accuracy and continuously tracks the target while treatment ,it is absolutely essential that patients follow this preparatory regimen very carefully.Mr Singh was prescribed 5 treatment sittings on consecutive days.

Each treatment lasted for about 45-50 minutes and Mr.Birendra Singh completed his treatment on schedule on Saturday.He had initially booked his tickets for Sunday but as he did not have any side effects he preponed his journey to Saturday night.He was advised to have a PSA after 3 months which confirmed that the PSA had come down to normal values.







MR. BIRENDRA SINGH AFTER COMPLETING 5 TREATMENT SITTINGS




Mr.Singh Reported back to us in the first week of December. His PSA which was repeated was less that 1ng/ml which shows excellent response to treatment. There were practically no side effects during and after the treatment.



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

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

Monday, November 23, 2009

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

Thursday, November 19, 2009

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

Thursday, November 5, 2009

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;

Monday, October 12, 2009

CME on Robotic RadioSurgery in Brain & Spine - Recent Advances by Prof. John Adler on 5th October

During a recent visit to Chennai , on the 5th of October 2009 ,Professor Dr. John Adler  presented a  CME on Robotic RadioSurgery in Brain & Spine - Recent Advances  was conducted . Around 65 Drs attended (Neuro Physicians & Surgeons / Spine Surgeons / Radiation Oncologists from different institutions in Chennai) attended the CME and were benefitted by the insights and guidance of Dr. Adler, on the usage of Cyberknife in Neurosurgery.

Some of the photographs taken  during the CME




CYBERKNIFE® AT APOLLO – THE FIRST SUCCESS STORY

PROFILE

Master Sankha Subhra Dey, 15 year old bright young boy from Tripura and the only son of Mr. Bimalendu Dey visited Apollo Speciality Cancer Hospital, Chennai which houses the Asia Pacific’s first and latest Cyberknife® on the 31st of January 2009.

Mr. Bimalendu Dey, is a School Teacher with Govt of Tripura and belonged to the lower income group. When his son was first brought to the Apollo Hospitals, he complained of severe headache, and was registered with our Neurosurgery department.

Before coming to Apollo, the boy was treated at local hospitals in Tripura but there was no relief. Instead his symptoms worsened. That was when, Mr. Bimalendu Dey decided to bring him to Apollo Speciality Cancer Hospital. He was seen by one of our eminent Neurosurgeon Dr.M.Balamurugan.

SYMPTOMS

At the time of presentation patient had neck pain, weakness of upper limb associated with tingling numbness. Poor cough reflex and difficulty in swallowing was also seen. His motor sensation and power was 4/5 all four limbs.


DIAGNOSIS
He was hospitalized and investigated MRI brain Angio and Venogram revealed expansile lesion involving the medulla and Cervico medullary Junction extending to C2 -C3 level.



TREATMENT
After Pre – operative wok up and consent the patient was taken up for tracheostemy , and occipito-cervical craniotomy, decompression was performed.
During surgery highly vascularised tumor seen in brainstem, possibility of Hemangioblastoma was decided.Surgery was abandoned because of high vascularity,critical position and poor out come. His post-op period was uneventful.

Patient was referred to Dr.RathnaDevi, Senior Consultant Radiation Oncology for possibility of Radiation therapy treatment. This was the time that Apollo Hospital had introduced Cyberknife® system the world’s first and only robotic radiosurgery system designed to treat tumors with sub milli-meter accuracy. Cyberknife can also be used to treat tumors previously considered inoperable.The location of the lesion was in a critical area of the brain stem. It was a challenge to treat the lesion with such accuracy without affecting other adjacent critical structures which was possible only with CyberKnife radiosurgery.



A TOUGH DECISION MADE EASY!



As there was no possibility of surgery the only option of treatment was Radiosurgery.

Having a thought that Master Sankha Subhra Dey could find an answer in Cyberknife® ® treatment, Dr.Rathna Devi discussed the case in Cyberknife® ® advisory board, and the same was opined and agreed by the Cyberknife® board.

The doctor also posted the case in the CK society and opinion was sought with renowned CK specialists all over the world.Fortunately, Dr.John Adler (Father of Cyberknife® ) visited our hospital to inaugurate Cyberknife®. His valuable advise was also sought.

Patient and his father was counseled about Cyberknife treatment and that was the only option of treatment. They understood clearly and consented for Cyberknife treatment and even waited till the Cyberknife machine was commissioned and functional. HE WAS OUR 1ST CYBERKNIFE PATIENT.

CYBERKNIFE TREATMENT

After proper immobilization and imaging planning was done taking utmost care to protect the critical organs which were at risk. An additional benefit with Cyberknife is that it can be done on a Outpatient basis. After successful planning and verification, treatment delivery was done. Patient underwent 21Gy in three sittings from 24th to 26th March. Patient tolerated the treatment well.

This was also a moment when we saw the deep emotional bonding in the family. Master Sankha Subhra Dey was unable to speak during treatment because of he had tracheostomy. During treatment the patient and the father always communicated with their eyes. (Guess that was their special language and it carried so much of emotions). Of course, they had lot of hope and trust on us . They were extremely cooperative as well.



FOLLOW UP

Patient reported for his first follow up after three months. There was a dramatic improvement in his health. His cough reflex improved. Dysphagia (difficulty in swallowing)disappeared. There was no weakness of upper limbs and no neck pain.

Tracheotomy tube was removed. He had a good weight gain, his skin and eyes were literally glowing. He was handsome and beaming with confidence.

Follow up MRI revealed reduction in the size of lesion, contrast enhancing portion of the lesion has reduced significantly.

This young boy who was unfortunately suffering of brain stem SOL, and had no options of surgery was benefited by Cyberknife Robotic Radio Surgery. The patient who comes from a middle income group for whom the same treatment abroad would have been next to impossible could find a cure……………. a treatment ………………. Fortunately at Apollo!


Treatment at par with international standards at a very affordable price.. made this a fantastic first success story that every Apolloites are very proud to talk about………………..!, TOUCHING LIVES


         CT PICTURES BEFORE AND AFTER CYBERKNIFE


 LESION IN THE BRAIN STEM SIGNIFICANT REDUCTION AFTER CK
                                             

CONTRAST ENHANCING PORTION         ALMOST DISAPPEARED


FOR MORE INFORMATION PLEASE WRITE TO lakshmipriya_b@apollohospitals.com

Monday, September 14, 2009

CYBERKNIFE IN TREATMENT OF ACOUSTIC NEUROMAS

CYBERKNIFE IN TREATMENT OF ACOUSTIC NEUROMAS

Dr.Sanjay Chandrasekhar – Senior Consultant Radiation Oncology


Acoustic Neuromas have always been considered ideal targets for radiosurgery.
These tumors generally cause diminished hearing or loss of hearing, giddiness or dizziness, loss of equilibrium or balance and facial nerve paralysis.

Traditionally these tumors have been treated either surgically or with radiation. Surgical removal of these tumors has been associated occasionally with injury to the facial nerve.

Either conventional radiotherapy, Stereotactic radio therapy or single fraction Gamma knife or X-knife radio surgery have been used for patients with Acoustic Neuromas depending on size, symptoms at presentation, cost factor etc.,

Small Acoustic Neuromas are considered ideal targets for stereotactic radiosurgery. Large series of such patients treated with either Gamma Knife or X-knife have been published. The earlier experience with Gamma knife or X- Knife in treating these tumors with a single fraction radio surgery had yielded reasonably good responses and long term tumor control rates.

The incidence of facial nerve injury and diminution of hearing in a sizeable number of patients while using single high dose radio surgery prompted investigators to explore the possibility of using fractionated radio surgery of Acoustic Neuromas.

Fractionated radio surgery has evolved recently with the increased use of the CyberKnife as a potent tool in the management of these benign tumors. The frameless feature of the cyberknife has resulted in bettering patient compliance and comfort. The entire treatment is completed over 3-5 days on an outpatient basis. In addition, the entire treatment is robotically guided increasing the accuracy to a sub millimeter level.

The cyberknife experts worldwide are convinced about the efficacy and safety of the use of fractionated Cyberknife radiosurgery in the treatment of Acosutic Neuromas. The long term tumor control rates and hearing preservation rates have been extremely satisfactory according to them(University of Stanford experience).
You can also read a success story through the following link : accuray.com/uploadedFiles/Suzanne_Patient_Story.pdf

Thursday, June 25, 2009

Cyberknife Experience - Patient Profiles


Patient Profile: Mr. C.V.G

Mr. C.V.G is a senior gentleman aged 86 years with a sharp mind with shining eyes. He was diagnosed with cancer of the prostate in 1999. He underwent TURP plus Bilateral Orchidectomy and was on hormonal management. A second cancer was detected three years later. This time a much more aggressive tumour in the nasal area. Conventional radiotherapy was able to control the disease for a year. But the nasal tumour kept on coming back. Laser surgery could remove only part of the tumour so it kept on re-growing. Chemotherapy was not considered for him being above 80 at that time. By the end of 2008 patient was having a completely blocked nose with epistaxis and permanent discharge. He was unable to breath properly anymore. His eyes were not shining anymore. Another course of radiotherapy to this area with eyes in close vicinity did not come to the picture, and hence Cyberknife was the only treatment option. We completed the procedure April 2009. Few weeks later, Mr. CVG returned smiling and had an opened up nasal cavity and with no complaints. Even the radiation oncologists were surprised by the fact that this radiation has targeted the inside tumour almost exclusively. Though it was a second irradiation there was hardly any radio-reaction on the skin. He thinks of visiting his son in the US again …



Patient Profile: Mr. JT


A young man aged 17 years was diagnosed with Hypothalamic Hamartoma
This young man had a long history of Gelastic seizures. The cause for this was a large space-occupying lesion in the suprasellar region. He underwent surgery but the tumour could not be removed as it appeared very vascular and per-operatively there was a lot of bleeding.
The only option for him was stereotactic radiosurgery. The CyberKnife treatment was done for him over 5 sittings in one week. He did not experience any side effects either during
or after the treatment. In fact, he used to travel all the way from Kovalam daily for this treatment. It has been over 2 months following therapy, he is doing fine and his symptoms have reduced. Since this tumour responds slowly to radiation, a post treatment scan has been scheduled for one month from now.

Patients from Asia, Middle East & Africa benefit from the Apollo CyberKnife Treatment


  • A new ray of hope. An innovation in the treatment of cancer
  • Apollo Speciality Cancer Hospital is the first hospital in India to treat patients with the revolutionary CyberKnife.
  • Since the recent clinical inauguration, over fifty patients have undergone treatment and the results are very promising

Chennai, June 17, 2009: With the launch of Asia Pacific’s most advanced and India’s first CyberKnife®, Apollo Speciality Cancer Hospital has joined the global league of hospitals equipped to provide 360-degree cancer care. Since the recent clinical inauguration by Prof. Dr. John Adler, the father of the CyberKnife, the hospital has reviewed around 600 cases and over 50 patients have already benefited from the treatment.

Addressing the media, Dr. Janos Stumpf DMS, Director Research in Oncology, representing the Apollo Cyberknife Clinical Panel said, “Over fifty patients with Intracranial, Spine, Lung and Prostate Tumors have benefited from the Apollo CyberKnife treatment and the results are very promising. Many of the patients had tumours that would have been considered inoperable or even untreatable earlier. The CyberKnife treatment offered them a new ray of hope. In quite a few cases, the CyberKnife treatment was even preferred to avoid the risks associated with conventional surgery. Apollo Speciality Cancer Hospital has received patients from across the country, Bangladesh, Malaysia, Oman, Sri Lanka, Iraq, Iran and Pakistan.”

While introducing a few patients present at the media briefing, Dr. Sanjay Chandrasekar, Senior Consultant Radiation Oncology said, “The CyberKnife offers precise, painless and non-invasive radiosurgery treatment. Most patients who undergo the Apollo Cyberknife treatment are free to resume their daily routine almost immediately even after the procedure.”

Benefits to Patients

· A new treatment option: This extraordinary sophisticated treatment can be used as an alternative to open surgery. Occasionally CyberKnife® treatment can even convert a technically inoperable tumor to operable.

· Pain free: Treatment does not cause pain and therefore does not require anesthesia.

· Recovery Time: Vast majority of CyberKnife® treatments are out patient procedures allowing patients to continue their activities.

· Comparative comfort: Many of the available high precision radiation techniques require application of some kind of frame around patient’s body, CyberKnife® can spare that particular inconvenience for the patient. In many of the cases, it is a frameless procedure.

The CyberKnife® system has significant benefits. Many of the complications associated with other conventional cancer therapies are minimized or eliminated by the CyberKnife® system. In addition, it is possible to treat multiple tumors at different locations in the body during a single treatment session. Patient normally experiences dramatic pain relief after the CyberKnife® treatment”.

All patients are reviewed by the Apollo CyberKnife® Advisory Board prior to a decision on treatment

Wednesday, May 27, 2009

ACCURAY PRESS RELEASE ON THE FIRST CYBERKNIFE TREATMENT IN INDIA

First Patients Treated in India Using CyberKnife Radiosurgery
Newly Installed System at Apollo Hospital Treats Six and Preps Eight Patients in First Week
SUNNYVALE, Calif., April 3, 2009




Source: Accuray Inc


Wednesday, May 6, 2009

Cyberkife In India

Apollo Speciality Hospitals, Chennai has been the first Hospital in India to have started treatment with Cyberknife . We have so far treated 40 patients with Intracranial, Spine, Lung and Prostate tumors and the results are very promising.

For More Information regarding CyberKnife at Apollo please feel free to call Cyberknife Helpline, Ms.Lakshmi @ 044-24334455 or 9941056677 or SMS Apollo at 56677 . Email enquiries can also be to be sent to cyberknife@apollohospitals.com.

You may also visit us at http://www.cyberknifeindia.in/ and http://www.cyberknifeinindia.com/

Cyberknife Resource Team

Wednesday, March 4, 2009

Is the cyberknife really a knife?

Is the CyberKnife really a ‘knife’?
Though its name conjures up images of a scalpel – the CyberKnife in fact is the alternative to surgery! It is a Robotic Radiosurgery System. It is non-invasive procedure ideal for the treatment of both cancerous and non-cancerous tumors anywhere in the body. It uses image guided technology and computer controlled robotics to continuously track, detect and correct for tumor and patient movement throughout the treatment allowing for its extreme precision.
Here are more FAQs about the cyberknife:
1. Will a CyberKnife procedure be like a minor surgery?
In fact, much less strenuous! It involves no incisions, no blood, no anesthesia, and virtually no recovery time.

2. What does non-invasive procedure mean?
- It simply means that the procedure involves no invasion into the body – which means no cuts or incisions are made during the CyberKnife procedure.

3. How does a CyberKnife work?
- CyberKnife performs robotic radiosurgery during which precise radiation beams are focused on tumors while minimizing damage to surrounding healthy tissue.

4. Will patients have to get admitted to the hospital for this procedure?
- Certainly not. CyberKnife is a simple, outpatient procedure. Patients can undergo their treatment and immediately resume normal activities – as the side effects are minimal.

5. How long will the session last?
- Each treatment session may be between 30 - 90 minutes, depending on the type and location of the tumor. Sometimes the treatment is offered in stages in which case patients may have to return for additional sessions over a few days (not more than a week) – as advised by the doctor.

6. What are the pre-preparations for this treatment?
- Before starting treatment, the medical team will perform a high resolution CT scan to determine the size, shape and location of the tumor. Once this data is obtained it is transferred to the Cyberknife database and the treatment is planned in detail.

7. What can one expect during a CyberKnife treatment?
- Each case is unique depending on the health of the patient and the type as well as location of the tumor. Some patients need just one sitting while other may need to come for repeat sessions. A detailed orientation is given to patients – based on their specific case so that they know what to expect before they go in for treatment.

8. What types of conditions are considered for CyberKnife treatment?
- The CyberKnife is capable of treating tumors anywhere in the body, but its precision makes it ideal for sensitive zones like the brain, spine, lung, prostate, liver and pancreas.

9. They say CyberKnife does not require a headframe – what does that mean?
- Radiation treatment needs to be extremely precise – wrong tissues exposed to radiation could cause irreparable damage. Hence traditional radiation treatment like Lenear Accelerator use headframes or immobilization devices that are used to hold patients still. These could be extremely uncomfortable and painful. But CyberKnife eliminates all that! It has a built in sensor that only works at a particular body rhythm,. When the rhythm varies or when there is body movement (like coughing or sneezing) it automatically stops functioning.

11. Who determines if CyberKnife is the ideal treatment option for a particular case?
- The physician or a specialist can determine if CyberKnife is the ideal treatment option after evaluating the condition of the patient.

12. Can the elderly and children be treated with the CyberKnife?
- In most cases – yes. CyberKnife is less risky than traditional surgery as it involves no incisions at all. This makes it a suitable option for the elderly and the very young. The decision to perform the procedure will however be taken in consultation with the concerned physicians and anesthesiologist. The safety and comfort of the such patients are always kept in mind.

13. How is CyberKnife different from traditional Radiosurgery?
- While traditional radiosurgery methods (like the Linear Accelerator or Gamma Knife) worked on the same principle of focused radiation beams – none of the previous forms of treatment offered the precision and flexibility that CyberKnife does. Because of its robotic arm like structure the Cyberknife can reach tumors at angles that were previously inaccessible. Moreover CyberKnife uses a combination of a robotic arm, linear accelerator (high energy X-ray source), and image guidance technology – to give high precision results.

14. What are the advantages of CyberKnife?
- It has several inherent advantages. It is a pain free, non-invasive, outpatient procedure and the patients need virtually no recovery time. Moreover, there are no intrusive body or head frames and no breath-holding required during the procedure.

15.Is the CyberKnife safe?Being a non-invasive procedure, the CyberKnife is radically different from traditional surgery. It requires no anesthesia, no incision, no bleeding and no post-operative pain or unpleasant anesthesia after effects. Because of its precision, CyberKnife does not affect the surrounding healthy tissues thereby minimizing side effects – something that is not always possible with traditional radiation therapy.

16. After treatment, when will my tumor or lesion disappear?The effects of radiosurgery are not always immediately visible. Tumors also behave differently – depending on their location and the patient’s metabolism. Some tumors resolve more slowly than others and may or may not eventually disappear completely, while others simply stop growing and present no further biologic activity. After CyberKnife treatments patients will need to periodically undergo tests to assess their progress.

17. Will CyberKnife cause hair fall out or skin burn?The radiation delivered by the CyberKnife is so focused on a specific target that it is highly unlikely that hair loss or skin burn will occur. In the event that a treated lesion is very close to the scalp or skin though, the adjacent hair or skin may be affected. If so affected, this hair or skin will typically recover over time. All medical procedures, including CyberKnife treatment, have potential side effects and associated risks, and every patient will be individually evaluated and counseled in detail before a final plan of treatment is made.

18. Where in India can patients go for CyberKnife treatment?
Apollo Hospitals, Chennai, is the only hospital in India to have the CyberKnife. It is not just India’s first, but also Asia’s most advanced CyberKnife. Apollo Hospitals has trained technicians, doctors and counselors who can guide patients through the treatment process.

19. What are the facilities available for cancer care at Apollo Hospitals? Apollo Hospitals, across India have dedicated centers that offer comprehensive cancer care. The hospital's cancer centers have experienced surgical and radiation cancer specialists as well as diagnostic consultants. The center's teams of doctors examine each case jointly and decide on the best line of treatment for the patient. Since treatment of cancer involves tremendous physical and emotional strain, the hospital provides extra support to cancer patients by counseling them to stay positive and to eat right - thereby speeding up the recovery process. Specially trained medical counselors, speech therapists, dieticians and other professionals, appropriate to the individual case, provide support to the teams of doctors. The measurable success that the hospital has achieved in cancer care attracts thousands of national and international patients each year

Monday, March 2, 2009

Cyberknife

The CyberKnife® is a state-of-the-art, radiotherapy equipment for robotic radiosurgery that allows radiation oncologists to treat pathologies painlessly, without the need for an operation.
CyberKnife® uses pencil beams of radiation which can be directed at any part of the body, from any direction with the help of a robotic arm. The system tracks the tumour's position, detects any movement of the tumour or patient, and automatically corrects its positioning .It then targets the tumour with multiple beams of high-energy radiation, destroying abnormal tissue without damaging surrounding areas.The treatment is so accurate that it's now possible to treat tumours previously thought to be inoperable. Although the results of treatment do not always show immediately, in most cases, the procedure will initially stop the growth of tumours, before gradually reducing their size.As there is no open surgery, the risk complications normally associated with an operation are eliminated, as is the need for a long recovery time. This makes treatment suitable even for those who are not well enough to cope with surgery. Most patients leave the hospital the same day.