79-year-old John Fratangelo of Rockville, Maryland and an employee of Georgetown University has become the first patient to be treated on the newly installed second CyberKnife at Georgetown University Hospital. Mr. Fratangelo has a three centimeter tumor on his lower spine that has been causing him great pain for the past several weeks, so on July 11 he came to Georgetown to start his radiation treatments with the CyberKnife. The tumor is a recurrence of a GI cancer that was diagnosed in 2003. The cancer spread to a different part of his spine in 2004 when he had radiation treatment with CyberKnife #1.
“The CyberKnife treatment was absolutely painless. Any pain I had, I brought in with me,” said Mr. Fratangelo. My doctor says that first CyberKnife treatment is doing its job. My tumor has shrunk. This treatment I had today should do the same thing to this second tumor. If I hadn’t been able to have this, I don’t know what I would have done. ”
Mr. Fratangelo’s treatment took about one hour and was painless and bloodless.
“Mr. Fratangelo’s only other option, if you can call it an option, was to have surgery to remove his pelvis which is a radical and traumatic surgery, and is rarely performed for these reasons,” said Gregory Gagnon, MD, radiation oncologist and medical director of the CyberKnife program.
“Mr. Fratangelo has already had prior standard radiation so another round of standard radiation was not an option either,” said Dr. Gagnon.
“The standard radiation I had was four sessions, four days a week for six weeks. With CyberKnife, it’s one hour on three different days.”
The new CyberKnife is the fourth generation of the machine since its invention at Stanford University. Georgetown University Hospital got the first commercially available CyberKnife back in 2002 and since then, physicians and physicists have been pleasantly surprised with the clinical results they’ve seen in patients with everything from lung, brain and spine tumors to cancers of the pancreas, ovaries, breast and prostate; virtually anywhere in the body.
“This allows us to treat cancer basically anywhere in the body with very little discomfort to the patient and very few side effects, “ said Gregory Gagnon, director of the CyberKnife program.
CyberKnife’s robot uses a crossfire technique to deliver as many as 1400 highly pinpointed and concentrated beams of radiation, at virtually any angle, to the patient’s tumor. Because of the way it’s delivered, unlike traditional radiation, CyberKnife radiation largely avoids normal tissue and so is unlikely to harm nearby healthy tissues or organs.
Other benefits to the patient include no pain, no blood loss, no sedation, no scalpel, no recovery time and very few side effects. Studies have shown that stereotactic radiosurgery is also less expensive and results in fewer complications than traditional brain and spine surgery and that its outcomes are comparable to surgery for malignant brain tumors.
On the day of treatment, the patient lies on a table and wears a custom-fit mesh facemask or body immobilizer. There are pedestal-like x-ray cameras, or image detectors, on each side of the patient. The image detectors receive signals from ceiling-mounted x-ray sources that tell the robotic arm where to move. The robotic arm, which can move in six degrees of freedom, then moves the linear accelerator, which delivers the radiation to the tumor with the precision of less than a millimeter. After a treatment that lasts about an hour per session, the patient can get up and go home the same day.
“The new CyberKnife is a much-needed tool here at GUH. We currently treat about 450 patients a year with the first CK. This will allow us to expand our services to more patients and to treat other forms of cancer as well as to conduct studies in the areas of prostate and breast cancer,” said Dr. Gagnon.
The first CyberKnife will be upgraded so that it is identical to the second machine.
In time, Mr. Fratangelo would like to return to his part-time job in the Facilities department at Georgetown University. “I am excited and optimistic about getting this CyberKnife treatment and I hope this buys me good, quality time with my family. I have seven grandchildren and I thank the good Lord for every extra minute I can get with them,” Mr. Fratangelo said.