Cyberknife arrives at New Jersey's Overlook Hospital to treat inoperable brain and spine tumours

Summit 20 July 2004Overlook Hospital, part of New Jersey's Atlantic Health System, is now treating its first patients with the hospital's new $5 million CyberKnife. An incision-free "surgical" option, the CyberKnife uses the latest technology to precisely outline malignant or benign tumours and obliterate them with a super targeted beam of radiation.

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This virtual surgery transforms the way patients can be treated for cancer and other conditions. There are no incisions, no screws in the skull, no blood, no pain and no anaesthesia. In fact, patients usually resume daily activities immediately following outpatient treatment. CyberKnife provides new hope for patients with tumours previously diagnosed as inoperable, and for those who have received the maximum allowable radiation exposure through other treatments.

Overlook Hospital in Summit, New Jersey is the first in the New York metro area and, in fact, the only hospital north of Baltimore and east of Pittsburgh to offer the CyberKnife Stereotactic Radiosurgery System.

The CyberKnife treats inoperable tumours in the brain and is the only device cleared by the Food and Drug Administration (FDA) to treat lesions on the spine. The CyberKnife can be used to treat other "hard-to-reach" tumours in the body, such as in the lungs and pancreas, and can treat all areas in the head and neck. Older devices, such as the GammaKnife which require a head frame, can only reach tumours between the mid-ear and top of the skull. The average CyberKnife treatment is one to five sessions of 45 to 90 minutes each.

The most noticeable benefit to patients is the lack of a head frame during treatments to the brain. All older treatment methods require wearing a metal head frame that gets screwed into the skull. The CyberKnife sends a precise beam of high dose radiation in a single treatment without damaging surrounding tissue and organs. "A much higher dose of radiation can be sent to destroy the tiniest of tumours", stated Louis Schwartz, MD, chair of radiation oncology and co-director of the CyberKnife programme at Overlook Hospital. "This also means a tumour next to the nerves that control vision, or next to the brain stem, for example, can now be treated."

The CyberKnife uses the most sophisticated combination of robotics and computer-aided technology available today. It is the same technology used to guide missiles to precise targets, and works similarly to a car's global positioning system (GPS). If the patient moves, the CyberKnife automatically detects and compensates for the change, ensuring the radiation is accurately targeted to the tumour location throughout treatment.

CyberKnife can treat tumours and other lesions through "image-guided radiosurgery". A combination of CT scans, x-rays, highly sophisticated computer software and sensors create an image inside the body to guide the robotic arm that delivers beams of radiation, or radiosurgery to the tumour target. The CyberKnife can strike the tumour with radiation from over 1200 different angles, allowing better coverage of the target than any other radiosurgery system.

The precision of the CyberKnife and its lack of a head frame means doctors do not need to worry about patient movement and pain during treatment, making CyberKnife a promising option for paediatric patients. The CyberKnife also provides new options to neurosurgeons. "For the first time, with the pinpoint accuracy of the CyberKnife, we can try to prevent paralysis caused by tumours on the spine", stated neurosurgeon Brian Beyerl, MD, co-director of the CyberKnife programme. "We can reach abnormal tangles of blood vessels in the brain, that in the past would have been impossible to treat. In addition, the CyberKnife avoids the risks related to surgery including infection, anaesthesia, scarring, hair shaving and post-operative bleeding", added Dr. Beyerl.

Initially, Overlook's CyberKnife team will treat patients with brain and spine tumours. By fall 2004, they will treat tumors elsewhere in the body, such as the lung and pancreas, and other benign disorders in areas such as the pituitary gland and middle ear for acoustic neuromas that cause hearing loss. The FDA's clearance of the CyberKnife for treating cancer anywhere in the body, and the subsequent coverage by health insurance companies, has made it more attractive for community-based hospitals, such as Overlook, to invest in this technology.

"The CyberKnife will further enhance our state-of-the-art oncology and neuroscience services, adding still another competitive advantage to our hospitals and physicians", stated Joseph Trunfio, president and CEO, Atlantic Health System. "The quality of medicine in the suburban setting has been steadily advancing, and with our commitment to the most innovative technology, Overlook is clearly in the forefront of this trend."

The CyberKnife is part of a $35 million investment to expand existing services in Overlook's Cancer Center and Neuroscience Institute, which includes the Stereotactic Radiosurgery Programme and Brain Tumour Center of New Jersey, the Columbia Epilepsy Center, neuro-interventional radiology, and the state's first PET/CT scanner. Overlook Hospital is home to the Brain Tumour Center of New Jersey and the first stereotactic radiosurgery programme in the state, and its experience and track record treating neurological disease helped the Summit, New Jersey-based hospital obtain a CyberkKnife before other academic medical centres.

Overlook's new CyberKnife programme is led by one of the largest CyberKnife teams in the country and includes radiation oncologist, Louis Schwartz, MD, chair, department of radiation oncology; and neurosurgeons, Brian Beyerl, MD; Richard Hodosh, MD; John Knightly, MD; Michael Schulder, MD; and Edward Zampella, MD. The CyberKnife programme at Overlook is backed by the expertise of sixty medical specialists, including neurologists, neuro-surgeons, neuro-radiologists, neuro-anaesthesiologists, neuro-oncologists, surgical oncologists and interventional neuro-radiologists.

Part of Atlantic Health System, Overlook Hospital is a non-profit 548-bed teaching hospital in Summit, New Jersey. A clinical affiliate of the University of Medicine and Dentistry of New Jersey - New Jersey Medical School and a Partner of the Cancer Institute of New Jersey, Overlook has been nationally recognized for its emergency services and is home to the state's first stereotactic radiosurgery cancer treatment programme. Always in the forefront of technology, Overlook was the first in New Jersey to acquire a PET/CT and the state's first community hospital to provide neuro-interventional services.

In addition to many programmes in neuroscience and cancer care, Overlook provides speciality services in paediatrics, mother/baby care, minimally invasive surgery, cardiology, gastro-enterology, sleep disorders, wound care and joint care. Overlook is a two-time winner of the Silver Governor's Award for Performance Excellence. Atlantic Health System also includes Morristown Memorial Hospital and Mountainside Hospital in Montclair and each of its three hospitals is accredited by the Joint Commission for Accreditation of Health Care Organizations (JCAHO).

The CyberKnife System is designed, manufactured, and distributed worldwide by Accuray Incorporated, a privately-held corporation in Sunnyvale, California. More news on the company is available in this VMW issue's article Accuray launches world's first dynamic radiosurgery system for lung, liver, kidney and pancreatic tumours


Leslie Versweyveld

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