How CyberKnife squashes cancer - a patient's story
Cyberknife radiation therapists, Gwen Lidman (standing) and Amanda Wells (laying down) demonstrate what a fictional patient with a brain tumor would experience during treatment at the facility.
A mask is created to keep the patient’s head completely still so the tumor can be thoroughly imaged using a CT scanner. The mask is also used during treatment to ensure that only the tumor is treated with radiation to minimize damage to the surrounding healthy brain tissue that could be caused if the patient were to mode their head.
Amanda Wells lays on the table under the Cyberknife machine just as an actual patient would during treatment. The Cyberknife uses hundreds of radiation beams from all angles to treat and destroy a tumor. Normally, the mask would be used to keep the head still.
The CT scanner results are used to create a custom treatment program. Gwen Lidman prepares the Cyberknife to deliver a treatment.
Both Lidman and Wells agree that the best part of their job is getting to know their patients who often return daily for up to five days for repeated treatments. These sessions can last from 30 to 90 minutes.
Dr. Karie-Lynn Kelly
Earlier this year, my dad called and casually told me he had cancer.
“It’s not a big deal,” he said. “I’m doing radiation today and I might come by your house later.”
My dad is Steve Wilson. People might know him as the president/CEO of the Coeur d’Alene Chamber of Commerce. He’ll be retiring at the end of this year, presumably to take his four grandchildren off my hands a little more often.
Four years ago, a visit to Dr. Randil Clark at North Idaho Urology revealed a slightly elevated PSA level (prostate-specific antigen) and that Steve had the potential for prostate cancer. After some more tests, Steve and Dr. Clark opted for a “watching and waiting” approach, in which Steve would have his PSA tested every 8-10 weeks.
In the fall of 2018, Steve’s PSA score elevated to the point where a more progressive action was needed. Options included a more traditional radiation process consisting of 6-8 weeks of treatment, surgical removal of the cancer, or a third option - short-term, targeted high dose radiation treatment using CyberKnife Radiosurgery technology.
This third option, Steve was told, had been recently approved for reimbursement via Medicare coverage. So, when he entered into Medicare in January 2019, Steve was connected with Summit Cancer Centers for CyberKnife treatment.
“The deciding factor for me was that this radiation treatment consisted of five 1-hour treatments of very high intensity radiation targeted to very specific spots around the prostate as opposed to six to eight weeks of low-dose radiation,” Steve said. “It was a very easy decision. The other alternative would have been surgery, but then there are side effects to that, and I would have been out of work for a significant amount of time.”
CyberKnife Radiosurgery - ‘a giant android anteater’
Summit Cancer Centers have several locations in the Inland Northwest, including Post Falls. Summit’s Spokane Valley location also houses the Spokane CyberKnife and Radiation Oncology Center.
CyberKnife is a non-surgical, robotic radiation treatment system for tumors throughout the body designed to deliver a precise type of external radiation treatment - Stereotactic Body Radiation Therapy (SBRT). It can track tumor motion and adjust the treatment beam as patient movement is detected.
Steve was referred to Summit and Dr. Karie-Lynn Kelly. She is a part of a team at Summit that includes specialists in medical, surgical and radiation oncology and offer a wide variety of treatments beyond CyberKnife, including TrueBeam HD radiotherapy. They receive referrals from specialists and family doctors, but patients can also contact Summit directly for rapid second opinions that can be conducted within 24 hours.
“There have been a lot of advancements in medical oncology - the treatment has become more personalized,” Dr. Kelly said.
CyberKnife was approved by the FDA in 2001 but has only been available in the Spokane area since 2013, Kelly said. The system is incredibly precise, which enables clinicians sub-millimeter accuracy through the use of continual image guidance and robotic mobility. The radiation is targeting the tumor only, minimizing exposure to healthy tissue. CyberKnife is an outpatient procedure that doesn’t require anesthesia or uncomfortable head cages.
“CyberKnife treats a number of tumors throughout the body but not all,” Dr. Kelly said. “It depends on the tumor type and tumor stage. For example, those with early stage lung cancer do extremely well on CyberKnife. Low and intermediate risk prostate cancers respond well on CyberKnife….It is better for more localized disease vs. utilizing something like TrueBeam for cancer that has spread into the lymph nodes or if the disease is more advanced.”
Steve’s particular diagnosis was ideal for utilizing CyberKnife, Dr. Kelly said. His program consisted of five consecutive days of one-hour sessions on the machine.
“There’s no pain with the CyberKnife therapy, and one of the really nice things is there are very low side effects no matter what site we treat in the body,” Kelly said. “That’s because we are treating within a hair width of accuracy, so we are able to spare the normal tissue around the tumor.”
They accomplish this with advanced tracking technology and an impressive robotic arm.
‘It looked like a giant android anteater, and it would move around my extremities and make a funny whirling sound,” Steve said.
The machine can detect subtle movements within the body (more on that in a moment), allowing treatment to be consistent and precise.
“It can track the tumor in real time… the software being used is very similar to the cruise missile technology,” Kelly said.
The prostate process on CyberKnife
CyberKnife tracks tumors in a couple different ways. First, Dr. Kelly utilizes MRI and other scans of the treatment area.
“For me to be able to target the tumor I have to see it on the scan,” she said.
Second, Steve had to visit Dr. Clark a couple weeks ahead of treatment to inject four gold “seeds” that serve as fiducial markers for the tracking software.
The software is locking onto those four gold fiducials so that every little moment can be detected and will adapt,” Dr. Kelly said. “They allow the CyberKnife to track the movement while he’s on a table, because just the filling of the bladder can change it, and we have to be able to see how much it moves.”
Each morning of treatment, Steve had to follow a regimen of preparatory activities, including an enema. There were diet restrictions too - mostly avoiding foods that cause internal gas, including cauliflower, broccoli and dairy products. He said doctors told him that following the diet usually meant a slightly shorter time on the machine.
“You don’t feel anything when it’s working,” Steve said. “They created a fairly comfortable position and I tried not to move for an hour. I put on some good country music.”
The only side effects Steve experienced were minor and went away fairly quickly.
“There was never any real pain afterwards,” he said. “The biggest discomfort was the urge to urinate becomes regular. During that entire week and the week after, I was never more than a half hour away from having to urinate, and the bathroom was always in sight for those five (treatment) days.”
The week prior to treatment, Steve’s PSA score was 9.6. A month after treatment it fell to 6. Three months later, which brings the timeline to June 2019, his PSA score was less than 3.
“Then Dr. Kelly proclaimed the famous words that everyone wants to hear - ‘You are cancer-free,’” Steve said.
Technology fuels the cancer fight
While not all cancer patients can utilize CyberKnife in their treatment plans, Dr. Kelly said many advancements, studies and clinical trials have pushed the field of oncology forward in recent years. Doctors can now test genetic material to create more individualized treatment plans, and radiation therapy like Summit’s TrueBeam allows doctors to make daily adjustments to treatment in order to better target radiation therapy and reduce healthy tissue damage and side effects.
Dr. Kelly chose the field of oncology while she was working through medical school after two of her aunts were diagnosed with breast cancer.
“Just walking through that journey I got to know more about the field of oncology,” Kelly said. “I absolutely love the field because it combines the most advanced technology and patient care - being able to see my patients regularly.”
Prostate cancer is a relatively common cancer in older men. Dr. Kelly urge those with a family history of prostate cancer (like me) should begin annual screenings at age 50, even if your family doctor suggests otherwise. The PSA screening is a simple blood test.
You can congratulate my dad on his upcoming retirement (and for being cancer-free) at Steve@CdAChamber.com.
• • •
For much more information on Summit Cancer Centers and all the treatments and options they provide, including rapid second opinion service, visit www.SummitCancerCenters.com or call 855-786-6482. The Post Falls office is located at 1641 E. Polston Ave., Suite 102, phone number (208) 618-5212.