- The Washington Times - Tuesday, September 3, 2002

Jennifer Resweber of Gaithersburg underwent radiation therapy for two brain lesions this past spring, but she never suffered extreme nausea, nor did she lose all of her hair in the process.
All the 32-year-old lost were the two unnatural growths.
Mrs. Resweber was among the first wave of patients at Georgetown University Hospital to experience "bloodless" surgery via the CyberKnife.
The $3.3 million system, one of six in operation across the country from California manufacturer Accuray, directs invisible beams of radiation at tumors and lesions. The growths either shrink or disappear with a series of treatments.
The beams, ranging in diameter from 2 millimeters (.08 inch) to 6 centimeters (2.4 inches), attack the tumor from an average of 150 to 300 angles via a large robotic arm that moves gracefully around the prone patient. Each beam passes through the patient in slightly different spots, sparing the healthy tissue from extensive radiation exposure. The tumor, though, endures blast after blast of radiation.
The targeted delivery system allows doctors to use higher doses of radiation on patients with less impact on their overall health. Patients typically can leave the hospital shortly after the treatments are complete.
The hospital, which began using the system in March, uses it primarily with brain and spinal-cord lesions but has expanded the program to include pancreatic tumors.
Some patients with painful spinal tumors enter the hospital crooked with pain and leave the sessions walking pain-free and upright.
For Mrs. Resweber, the CyberKnife treatments were part of an overall program designed to stave off her recurring cancer.
She was 29 when she noticed a trickle of blood coming from her right breast. She eventually underwent a mastectomy after her doctors found a malignant calcification.
Mrs. Resweber says she was deemed "99 percent cured." A year and a half later, some minor back pain tipped off her doctors to a 10-centimeter (4-inch) tumor on her 10th right rib. They also found cancerous growths along her lower spine and liver.
Her type of cancer spreads quickly, she says, but it also responds well to treatment. She underwent 10 months of chemotherapy, which proved effective.
"The liver completely cleared up, which was amazing," Mrs. Resweber says.
In March, however, her doctors discovered a small spot on her right temporal lobe.
It was then that she learned about the CyberKnife.
"You won't have the side effects. You won't lose your hair," she recalls her doctor telling her of the new procedure.
The treatments involved mild sedatives and very little movement on her part.
"You can't feel it. You can hear the machine a little bit," Mrs. Resweber says. Afterward, "The only thing I've experienced is some fatigue, not immediately, but two days afterward," she says.
Patients can stay awake during the treatments or let themselves fall asleep.
Doctors successfully treated Mrs. Resweber's lesion but later found another in the back occipital lobe of the brain near her optic nerve. A second round of targeted radiation eradicated that lesion, too.
Since then, no new abnormalities have shown up, but they still may, Mrs. Resweber says.
"It's a metastatic disease," she says. "It's not going to ever go away, they say."
Now, Mrs. Resweber undergoes Herceptin treatments, a form of chemotherapy, every Friday to keep the malignancies in her body at bay.
She is grateful her doctors have a weapon like the CyberKnife to fight future battles.
"I'm really lucky, and I'm really positive about all of this," Mrs. Resweber says. "It could be worse. I'm thankful for the technology."
Michael Lundsten, a physicist and assistant professor of radiation medicine at the hospital, says the process requires a trio of specialists to provide safe, effective treatments.
A physicist oversees the hardware and software while measuring the various data pumped in and out of the system's large computer banks. Surgeons advise on the best courses of treatment, and radiation oncologists provide an understanding about radiation treatments.
Not all patients are healed by the noninvasive surgery. The CyberKnife can, however, grant those with terminal cases a longer life, often boosting the quality of their remaining time without the side effects of other therapies.
"The definition of the word 'cure' is different when you're talking about cancer," Mr. Lundsten says.
For some, containment might be the operative word.
Some tumors are capsulated, and operating upon them or even poking them for a biopsy can release cancerous cells into the rest of the body.
A similar treatment to CyberKnife used in some hospitals, known as the Gamma Knife, also attacks tumors using highly targeted radiation, but it requires the patient to endure a head brace screwed into the skull to make sure he or she remains immobile. The CyberKnife's computer program can track a patient during treatment and adjust the beams accordingly to compensate for small movements.
The patient isn't granted much room to move, though, during a CyberKnife treatment. The body is swathed in a heavy blanket to keep it as still as possible.
The brain-tumor patient wears a plastic mesh mask molded to the contours of his or her face to help keep the head steady.
Patients suffering from tumors along the spine must have fiducials, tiny stainless-steel screws, inserted beneath their skin to help the CyberKnife computers track the tumor and its corresponding body.
That way, if the patient moves slightly one way or the other, the computer can re-calculate the position of the fiducials and adjust its movable arm accordingly.
Dr. Shalom Kalnicki, vice chairman of the department of radiation oncology for the University of Pittsburgh Medical Center, says his hospital uses the CyberKnife for "patients who have absolutely have no other alternative."
With conventional, less focused radiation treatments, just half of patients with spinal tumor can expect some pain relief, and it typically takes weeks for the relief to begin.
Dr. Kalnicki says his CyberKnife patients experience "almost immediate pain relief" and adds that the CyberKnife is used to treat basal skull tumors, head and neck cancers, lung and liver and tumors of the pancreas.
For now, the CyberKnife is available in just a handful of hospitals. That may change, but Dr. Kalnicki predicts the rollout will be a cautious one.
Only centers with physics experts on staff can tackle the treatments, and cancer experts report that radiation therapists are scarce in medical circles.
Dr. Richard M. Satava, professor of surgery at the University of Washington in Seattle, says the CyberKnife's use of directed energy is "a generation beyond X-ray treatment for cancer."
"It's the first step toward the 'Star Trek' tricorder," says Dr. Satava, referring to the handheld medical device doctors on the space show used to heal patients. "You scan the body, press a button, and it dissolves the [cancerous] tissue."
"This is clearly the direction the future is going from minimally invasive surgery, where we are now, to noninvasive surgery," he says. "It's taking advantage of information-age technology instead of industrial, mechanical-age society."
Dr. Walter Jean, director of surgical neuro-oncology at Georgetown University Hospital, cautions it will not replace traditional surgery.
"Conventional surgery is still the gold standard of treatment for many benign and malignant tumors," he says.
Dr. Fraser C. Henderson, the hospital's director of spinal surgery, sees the CyberKnife being used "in concert with an aggressive chemotherapy regime."
"If you can cut the tumor mass way back, the chemotherapy will be more efficacious," Dr. Henderson says.
He sees the CyberKnife eventually being able to tackle "every tumor in the body everywhere in the body."
Mrs. Resweber says her two rounds of CyberKnife treatments have her feeling like her old self, even if the treatments left her with a quarter-size bald patch on the back of her head an uncommon side effect.
"It's amazing that it's doing what it's doing," she says of the CyberKnife. "I have a different look on life now. Years ago, what has happened to me, I don't think I'd be here" without the technology.


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