Memorial Health System building Cyberknife Center in Belpre
MARIETTA — Here’s the future of many surgeries at Memorial Health System: No scalpel, no incision, no blood, no anesthesia, no sutures, no scars.
A Cyberknife Center will be part of the new Strecker Cancer Center being built by Memorial Health System in Belpre. The Strecker Cancer Center is scheduled for completion in March 2021.
Cyberknife, a system built by Accuray Inc. in California, is not actually a knife but it is cybernetic — that is, a robotic system controlled by computers. Developed to allow more precision in radiation treatment, it is a mature and proven technology supported by continuous upgrades and new refinements.
Use of radiation on tumorous cancers is an established and effective method of controlling the diseases, but the radiation equipment has to be used conservatively to avoid damage to healthy tissue surrounding the tumor. Cyberknife, by comparison, incorporates precisely focused energy beams that can deliver higher doses in very exact locations.
The Memorial Cyberknife Center will be among scores around the world, but it is the first in its service area and will use the latest model. The nearest centers for patients in the Marietta-Parkersburg vicinity are Columbus and Huntington.
Stacey Wyer, a radiation therapist, is the interim director of oncology services for Memorial Health System and has worked there since 2002.
“It’s a noninvasive piece of equipment with a robotic arm that uses image guidance to deliver very concentrated beams of radiation, to within a millimeter,” Wyer said. “It’s able to track a tumor through the patient’s breathing process, which means only minimal doses to surrounding tissue and fewer side effects.”
The device, a six-foot pillar terminating in a rotating arm, has a small linear accelerator built into it. The accelerator generates a fine beam of energy that can be directed within less than a millimeter, enabling it to pick out targets of any shape, in any location in the body.
A millimeter is about the thickness of a credit card or driver’s license.
Dr. Srini Vasan, a radiation oncologist, is at the forefront of Memorial’s effort to adopt Cyberknife as an effective alternative for tumor treatment.
“It’s an easier way to tackle some of these surgeries, and it can work for some patients who otherwise couldn’t have surgery at all,” he said. “It goes beyond where conventional surgery stops, where traditional surgery cannot be done … It’s like surgery without cutting open the body.”
Cyberknife uses imaging technology for precision guidance. The device can follow the contours of irregular tumors with minimal disturbance of surrounding healthy tissue, using a three-dimensional map of the tumor created by a composite of conventional imaging systems.
The robotic arm can aim the energy beam from any angle around the body, and the couch on which the patient rests also adjusts itself. Sensors set in the ceiling of the room track minute movements of the patient’s body, letting the device adjust the accuracy of the energy beam to compensate for breathing and other normal processes.
Vasan said the Cyberknife has proven effective for brain, lung, liver, kidney, prostate and other cancers.
“We can treat all parts of the body,” he said.
The device is particularly important for treatment of prostate cancer, he said, one of the most prevalent cancers treated at Memorial.
Raymond Campbell, 62 and a lifelong resident of Parkersburg, is in the recovery stage of prostate cancer. A foreman for the city of Parkersburg, Campbell took medical leave from work in January after being diagnosed with rectal and prostate cancers.
“They did a bunch of tests, including a colonoscopy,” he said. “We caught it really early, that’s the best part of it.”
A four-member team of doctors determined a course of treatment that included conventional radiation supported by chemotherapy. Campbell said that in addition to leaving his job he had to give up his woodworking hobby. He’s received 40 radiation sessions and seven chemotherapy infusions during the eight-month course of treatment and was scheduled for prostate surgery in September.
“That’s a great team up there at Strecker,” he said. “It’s all done right.”
Although Campbell’s treatment seems likely to end in success – cancer-free – his course of treatment might have lasted less than two weeks rather than several months if he had been a candidate for Cyberknife treatment.
Because of the extraordinary precision of Cyberknife, doctors can confidently deliver higher doses, knowing the energy will hit its target without harming healthy tissue.
“You can miss what you want to miss, and hit what you want to hit, that is the ability of this system,” Vasan said. “There are thousands of beams, and each beam is shot with precision, knowing exactly where the tumor is at that moment. The precision is enormous.”
That precision is guided in part by Cyberknife’s ability to use imaging systems.
“That is the other beauty of this machine, you don’t have the limitation of using one imaging modality,” Vasan said. “You can use MRI, CT scan and PET scan. The computer puts the composite together.”
He explained that each imaging method has strengths: “You can see normal tissue very well in a CT (computer tomography) scan, you can see tumors very well in an MRI (magnetic resonance image), and some tumors you’ll see in a PET (positron emission tomography) scan and nowhere else.”
The composite image of the body provides a three-dimensional map for the computerized guidance system that directs the precision energy beams, and the beams are minutely adjusted to accommodate the patient’s small movements during treatment.
The treatments are brief, Vasan said, usually lasting no more than 10 or 15 minutes. With set-up time, the patient is normally in and out within an hour. Three to five sessions is usually enough to disable a cancerous growth, he said.
Like conventional radiation, the Cyberknife treatment takes some time to become fully effective – the weakening of cancer cells occurs over a period of months afterward. In addition to its effectiveness as a therapy for prostate cancer, Vasan said, it is also particularly well-suited to stage-one lung cancer. Research papers from around the world have deemed Cyberknife as effective as other treatments in a variety of cancers, including types of liver cancer.
Metastatic brain cancers, which frequently occur when lung cancer is the primary cancer, have been shown to respond well to Cyberknife treatment, with the advantage of significantly lower risk of neurotoxicity — damage to healthy brain tissue — compared to whole-brain irradiation.
In one case reported from China in 2013, a man with more than 20 scattered brain tumors was successfully treated using Cyberknife. The tumors had all disappeared within three months.
Cyberknife was designed to quell cancerous growths with greater precision than conventional radiation treatments, but its non-invasive properties and extraordinary precision make it a tool of choice for other uses, Vasan said. It has been successfully used to treat trigeminal neuralgia, a condition in which a group of nerves in the frontal lobe of the brain become ultra-sensitized, causing episodes of extreme pain in the face that can be triggered by the slightest pressure.
Vasan said it also can be used to treat cardiac arrhythmia, benign tumors, tremors and other conditions.
The system, which costs upwards of $5 million and according to Memorial CFO Scott Silvestri is the most expensive single piece of equipment ever bought by the health care nonprofit, is in the end intended to make treatment easier and less invasive for patients, Wyer said. It presents options previously available only by traveling.
“It’s going to be offered right here, without people having to go to Pittsburgh or Cleveland,” she said. “It allows cancer treatment in fewer fractions, less time at the Strecker Center, absolutely fewer side effects, less time away from what is valuable to our patients and more time for them with their families or to go back to work.”
Cyberknife could be a life-saver for patients who can’t undergo conventional surgery because their physical systems are too weakened to survive the process or those who have hit the end of their endurance and are too traumatized to consider another invasive procedure, she said.
It fits into an underlying philosophy behind the Strecker expansion.
“Because of advances in treatment, our cancer patients live longer,” Wyer said. “It has become more of a chronic condition, like a diabetic patient, it becomes a question of how they manage it for the rest of their lives.”
Strecker will maintain its current staffing levels of radiation therapists and radiation oncologists, who will work with other medical disciplines to determine best treatment options for patients.
“We use a multidisciplinary approach, surgeons, radiation oncologists, pathologists, for all our patient care,” she said.
Wyer said the center will add staff to provide the additional medical physics support the Cyberknife requires.
Cyberknife treatment is covered by Medicare, Medicaid and commercial insurance, she said.
“It’s a huge win to give patients this option,” she said.