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Intuitive Shelter From the Storm
For patients in Central Pennsylvania who are battling the storm of a cancer diagnosis, PinnacleHealth is providing a particularly well‑outfitted umbrella of care. Within the recently opened PinnacleHealth-Fox Chase Regional Cancer Center, the CyberKnife robotic radiosurgery system — a radiosurgery system so in tune with the patient it responds in near real time to movement of the body — is redefining the term “patient-centric.”
According to Brij M. Sood, M.D., Director of the Department of Radiation Oncology at the PinnacleHealth-Fox Chase Regional Cancer Center, approximately 20 patients have undergone CyberKnife treatment thus far. After full courses of treatment, two of the patients assessed at the three-month mark, showed very favorable outcomes.
Thanks to CyberKnife technology, these results were achieved without surgical resection or painful side effects. Finding the best-suited course of treatment to support a patient’s quality of life is central to PinnacleHealth-Fox Chase Regional Cancer Center’s mission.
“When a project like the new cancer center is in the planning process, the question is always, ‘If it’s built, will they come?’” says Betsy Kopp, R.N., M.S., OCN, Director of Cancer Services and Research at the PinnacleHealth-Fox Chase Regional Cancer Center. “The bricks and mortar of the project were completed in April of this year, and the community response from both physicians and patients has been very accepting.”
The Advantage of Accuracy
To the naked eye, the CyberKnife system consists of a patient table and a linear accelerator attached to a robotic arm. However, hidden within the hardware is a sophisticated computer imaging system that coordinates the near real-time delivery of radiation with the prearranged plan for an individual treatment session. Further, the linear accelerator has at its disposal 50 to 300 separate beams of radiation that can be used to create the appropriate combination of doses and angles for each patient.
Although PinnacleHealth physicists complete a blue print for the course of a patient’s radiosurgery procedure, a patient’s body and his or her tumor may shift during treatment sessions. To eliminate the need to hold patients in uncomfortable positions to achieve accurately targeted dosing, the CyberKnife system continuously images the body with near real-time tracking software to precisely locate the target before delivering radiation to the site. If the location varies from the planned treatment, the robotic arm adjusts its position or the system gently adjusts the patient table before recalculating the tumor location and then delivering the radiation.
“In other words, not only is the CyberKnife mechanically precise, it is also accurate in locating the tumor target, getting into the necessary position, matching the position with the planned treatment and then treating the area,” says Dr. Sood. “This makes CyberKnife a sophisticated and very versatile tool.”
The imaging and mechanical accuracy allow the radiosurgery system to treat within a 0.8-1.5 mm accuracy depending on what part of the body is being treated. The most appropriate candidates are those with inoperable tumors smaller than 5 cm. In contrast to a Gamma Knife system, which utilizes a single fraction of radiation and only treats brain and upper neck tumors, the CyberKnife system employs multiple, smaller fractions and can treat not only brain and spinal tumors, but can treat tumors anywhere in the body. These small fractions are better tolerated and produce less long-term toxicity.
For patients, the difference in fractions of radiation translates to a decrease in side effects, the potential for damage to normal tissue surrounding the tumor and length of treatment. Individual sessions typically last from 30 to 90 minutes. Patients do not undergo more than five treatments and experience little to no down time for recovery.
Saving the Power to Breathe
Though the CyberKnife program at the PinnacleHealth-Fox Chase Regional Cancer Center is young and does not yet have data representing long-term patient outcomes, data on the comparability of CyberKnife radiosurgery to other curative cancer therapies demonstrates the potential for success for CyberKnife. As Dr. Sood explains, treating lung cancer — specifically stage 1 and stage 2 cancer — with this system provides a noninvasive avenue that spares organ integrity.
“For our patients who had poor lung function and could not undergo surgery or patients who wanted an alternative to surgery, CyberKnife is now available,” says Dr. Sood. “CyberKnife uses only 2 mm to 3 mm of margin around the tumor, and the remaining lung remains intact. With regular surgery, most of the lung lobe would be removed.”
From Planning to Treatment
When a patient is referred to the PinnacleHealth-Fox Chase Regional Cancer Center, the Cancer Center gathers and reviews the entirety of his or her records and imaging and pathology reports and coordinates the necessary specialties for a diagnosis or a consultation. A nurse navigator aids each patient for the duration of his or her treatment, providing resources, counseling of any kind, and solutions to barriers to care such as transportation issues and childcare.
If a patient is found to be a candidate for CyberKnife radiosurgery, Dr. Sood and his colleagues meet with the patient. This visit includes a tour of the CyberKnife suite and an explanation of the radiosurgery process. A patient then undergoes a planning session, which involves performing a computed tomography scan in addition to magnetic resonance imaging or a positron emission tomography scan, depending on the location and type of tumor. This imaging is conveniently located all within the facility for not only the ease of access for patients, but for the expedited delivery of information from imaging studies, which is relayed electronically to the cancer center. Information provides radiation oncologists and physicists a picture not only of where the tumor is situated, but also of what healthy tissue or critical structures are in the tumor’s proximity and should be taken into consideration when radiation is delivered to the body.
After the patient completes the scanning process, physicists at PinnacleHealth-Fox Chase Regional Cancer Center create a unique treatment plan, or a blue print of each individual radiosurgery session. This step of the process, which involves feeding the imaging data into the CyberKnife system’s integrated software, typically requires two days to complete. The patient then returns for his or her treatments.
A Community of Care
According to Dr. Sood and Center Director Kopp, PinnacleHealth-Fox Chase Regional Cancer Center’s mission is to treat each patient with an all-inclusive approach to their care. Toward that end, both physicians and staff ask a full range of questions — beyond just cancer-related — when interacting with their patients. Through the nurse navigator program and their attending physicians, patients have access to financial counseling, genetics counseling, nutritional counseling, palliative care, social services and therapy.
Each case is also approached with the idea of providing those services, in addition to curative therapies, in the most expeditious manner according to evidence-based medicine and standards of cancer care. To ensure this is possible, communication between physicians is well coordinated so they can modify their response to the nature of a patient’s case, fast tracking workups and treatment plans when necessary.
“The focus of the whole program is to provide one place for patients and referring physicians to come for comprehensive care that is grounded in patient comfort,” says Dr. Sood. “Patients are everything that matters to us most.”
To learn more about the PinnacleHealth-Fox Chase Regional Cancer Center, visit www.pinnaclehealth.org/cancer-center.
PinnacleHealth-Fox Chase Regional Cancer Center
MD News October/November 2011, Central Pennsylvania