St. Louis area patients are receiving treatment with some the most advanced technological weapons to treat hard-to-reach cancers and inoperable tumors.
Targeted radiation systems in use major facilities include the CyberKnife robotic Stereostatic Radiosurgery System, the Trilogy System, and Synergy S system.
The treatments are non-surgical, outpatient and painless, with minimal side effects. The systems precisely target malignant and benign tumors and use high power radiation beams to cook and destroy the diseased cells while not affecting surrounding healthy tissue.
Cancer-fighting equipment represents significant investments for the hospitals ($3.5 million for Trilogy, $4.2 million for CyberKnife and $2.8 million for Synergy S) for better patient care. They are used for tumors in the head, neck, lungs and spine as well as other parts of the body.
These systems and others are considered life savers by doctors and their patients.
“All three techniques have worked well for patients,” said David Keys, medical physicist at St. Anthony’s.
The CyberKnife system has been is in use at Saint Louis University Hospital since 2004 and most recently at St. Joseph West in Lake St. Louis.
However, it was at Georgetown University Hospital in Washington, D.C. where 80-year-old Oscar Reynolds, of Capital Heights, Maryland received his treatment. Reynolds is a lung cancer patient with COPD who smoked for 40 years. He remains cancer-free nearly four years after receiving a week’s worth of CyberKnife treatments.
“I had no bleeding, no stitches, no nothing,” Reynolds said. “I went through the treatment and got up and drove home. Without the CyberKnife, I would not be here.”
Phyllis McDonald is another Georgetown patient who completed treatment for inoperable lung cancer two years ago.
“I had three treatments and I feel marvelous,” McDonald said.
In both of their treatments, doctors placed special markers called fiducials during biopsies for the CyberKnife to track the tumor. Patients lay still on a table in their regular clothing as a radiologist monitors and readjusts during the treatments. Patients usually receive one to five radiosurgery treatments.
CT scans and MRI images of the affected area are used to plan patient treatment. On head and neck tumors, face masks and other devices may be used to keep the affected area immobile.
“Patients we treat usually have no options often than CyberKnife,” said Brian T. Collins, a radiation oncologist at Georgetown.
Gregory Gagnon, radiation oncology chairman at Georgetown, said each CyberKnife treatment costs about $50,000.
In St. Louis, Asalee Moore wore a head mask during her single Trilogy treatment for a brain tumor at St. Anthony’s Medical Center just before Christmas. St. Anthony’s and St. Luke’s Hospital in St. Louis both use the system.
“It wasn’t a bad experience at all. I am just beginning to feel better and better,” Moore said. Treatment lasted less than an hour – didn’t feel anything – I just laid there and let my mind wander. The big thing for me was being curious if it was going to work or not.”
She did feel tired afterward, but was able to spring forth in the kitchen in time for the holidays.
“I cooked Christmas Dinner – for about 15 people.”
74-year-old Katherine Wagner thought it was her dog’s barking as she drove her car that was responsible for hearing loss in her right ear.
Tests revealed the real culprit – an acoustic neuroma, which is a slow-growing benign tumor on her auditory nerve. It had grown to the size of a peanut.
“They can’t biopsy it because it’s behind your ear. That why this is such a wonderful procedure,” she said.
The last three days of 2008, the retired psychiatric nurse went to St. Anthony’s for outpatient treatment on the Trilogy.
“The preparation on the table is the longer part. When they do the actual radiation, it is 15-20 minutes. You are absolutely still – the table moves a little bit. There is a mask that they make. It’s sort of heavy mesh cheesecloth, it’s warm and wet and they form it your face. They cut the part out where your nose and mouth goes,” Wagner described. “Your head is stationery the rest is free – laying flat on your back – you get a support for your knees. I felt very relaxed – the machine it moves around you rather than the other way around. ”
St. John’s Mercy Medical Center uses the TomoTherapy system and last August, added the Elekta Synergy S system. Dr. Robert Frazier, director of radiation oncology at St. John’s said the system was chosen because it uses a cone beam CT scan to align the patient’s internal anatomy and it has a robotic couch (similar to CyberKnife) and other features.
“It also has x-ray capability as another way to verify the position of the patient. Of course another reason we chose Synergy S is because it gives us quite a bit of flexibility as we can treat many, many types of cancer with this machine,” Frazier said.
Thus far, St. John’s has treated brain, spine, liver and lung cancers and skull-based tumors. Frazier said an Active Breathing Control (ABC) attachment to Synergy S will allow them to treat breast cancer patients.
“It allows us to move the heart out of the way while we do radiation. It eliminates breathing motion and that’s important for patients who have lung cancer and for patients with breast cancer,” Frazier said. “We have them take a deep breath and we use the machine to halt the breathing temporarily then the treatment machine turns on and then they breathe again. We have them hold their breath about 15 to 20 seconds.”
Barnes-Jewish Hospital has several advanced, targeted radiation systems in use, including Trilogy, TomoTherapy, Gamma Knife and another on the way. The Kling Center for Proton Therapy at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine are in the process of taking an expensive technology available at few centers in the United States and make it more cost effective and accessible. They are building a smaller, $20 million version of a cyclotron proton beam therapy system to treat cancers close to vital organs. Construction is expected to be completed at the end of 2009.