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August 24, 2006
By TOM VOGT, Columbian staff writer
Joan Miller didn't need new glasses.
That was bad news, as it turned out, and the news just kept getting worse and worse.
Tumor. Cancer. Surgery.
Then, more cancer and another surgery.
Then, more cancer.
"I was afraid of my choices," the Vancouver woman said. "Go blind or have a third surgery."
Miller was really ready for some good news, and it came in the form of another choice, a new scalpel-free approach to fighting cancer at Southwest Washington Medical Center. It's called the CyberKnife; the Vancouver hospital has the only system between Seattle and San Francisco, and it is one of only 140 around the world.
When Miller went in for her morning treatment session a few weeks ago, "I was in at 8 and out at 10," Miller said.
She didn't even have to take off her shoes. She stretched out on a table and relaxed.
As Miller listened to the Kenny G album she'd brought along, an 8-foot-tall robotic system pivoted around and around, aiming precise doses of radiation at the tumor in her head.
The CyberKnife system gives doctors another weapon for attacking cancer in patients who aren't physically up to the challenge of more slice-and-sew surgery.
It also allows doctors to treat patients who have already received the maximum dose of radiation, said Dr. Chris Hoffelt.
And, it allows them to target tumors that, because of location or the type of cancer, have frustrated other treatment attempts, he said.
In Miller's case, location was a big problem since the tumor was near her optic nerve. That's why she first noticed a problem.
"I thought I needed my glasses changed," Miller said. "But my ophthalmologist said, 'Something is leaning on your optic nerve. You've got a tumor.' "
Miller underwent her first surgery in February 2004, followed by a second procedure this March.
So, when she learned there was more tumor to deal with, Miller had a pretty good idea what surgery was like.
"Horrendous. Horrific," the 73-year-old retired nurse said. "After the first surgery, I lost my sense of taste and smell. With nasal packing, you can't blow your nose for six weeks; you really hope nobody gives you a cold.
"After the second surgery, I was in intensive care for two days, really sick," Miller said. "I had complications after that, and six weeks of recovery."
And after the CyberKnife session?
"I went home, took a nap, and then had dinner with a friend," Miller said.
The CyberKnife does its work by delivering small blasts of radiation from up to 200 different angles during the treatment session. All the doses of radiation are aimed at the tumor, said Dr. Ashok Modha.
"The amount that goes through any point of the skin or skull is minimal," said Modha, a neurosurgeon with Northwest Surgical Specialists, based on the campus of the Vancouver hospital. "But even though it comes from different angles, all that radiation adds up" when it strikes the tumor.
Even if the patient shifts slightly on the table, two X-ray scanners built into the ceiling of the operating room will guide the CyberKnife, and "The robot can adjust for the movement," Modha said.
So how does radiation from the CyberKnife combat tumors?
"We believe it damages its DNA," said Hoffelt, radiation oncologist and medical director of the hospital's CyberKnife Center. "The body can repair itself, but cancer cells do a lousy job of repairing DNA."
There are other methods of radiosurgery, including the gamma knife, but it isn't as quick on its feet as the $5 million CyberKnife.
"With the gamma knife, you actually have to pin the head down," Modha said.
A metal frame literally is screwed onto the skull, then bolted to the table to keep the patient's head still during treatment. CyberKnife patients do wear a custom-fitted mesh face mask, but it's not screwed to the skull.
While most traditional radiosurgery has been confined to tumors in the head, the CyberKnife can track a moving target, keeping a lung tumor in its sights as the patient breathes.
Southwest Washington Medical Center has treated six patients since its CyberKnife Center opened on June 28.
Doctors expect that from 50 to 100 patients will receive more than 100 CyberKnife treatments at Southwest Washington Medical Center this year.
Tom Vogt writes about health topics for The Columbian. Contact him at 360-759-8008 or at tom.vogt@columbian.com.
Did you know?
CyberKnife inventor Dr. John Adler said he got the idea for the blade-free device while watching "Star Trek." According to a 2003 story in the Baltimore Sun, "I'd see Dr. McCoy waving some gadget around people, and that cured whatever was bothering them," the Stanford University neurosurgery professor said.
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