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A Dagger In The Arsenal Against Cancer

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http://www.courant.com/news/health/hc-h ... nes-health

CyberKnife Uses Highly Targeted Radiation

June 21, 2006

By HILARY WALDMAN, Courant Staff Writer Radiation oncologist Dr. Richard C. Shumway likes his job - except when he has to tell a cancer patient that the disease has spread, and there is nothing more he can do.

He might have had one of those awful days about a month ago, when Cynthia Bossard arrived at his office with a second tumor in her brain.

In 2003, Bossard endured massive doses of radiation to zap tumors that spread from her lung to her brain. The 47-year-old woman's body could withstand no more.

But on this day, Shumway had another tool in his arsenal - the CyberKnife.

The hulking $4.6 million machine, which arrived at St. Francis Hospital and Medical Center this spring, can deliver tremendous doses of tumor-zapping radiation without damaging surrounding tissue.

It will not replace surgery or conventional radiation - at least for now. But the miniature nuclear accelerator's highly focused beams of radiation are strong enough to kill or control tumor cells in one to five treatments, each lasting about an hour.

Though the device may be good for other cancers, doctors at St. Francis now are using CyberKnife only for tumors of the brain and spine - areas that do not move much as the patient inhales and exhales.

But Shumway says he is excited that the CyberKnife someday could allow him to attack cancers of soft tissue in the pancreas, lung and prostate. Such cancers often are considered inoperable because of the location of the tumor or the frailty of the patient.

Ann Bowman, 65, was diagnosed with lung cancer that had spread into her spine, after she felt a stabbing pain in her hip while pumping gas in March. Though doctors hope chemotherapy will tame the cancer, she says she needed something fast to dull continuing the pain and spasms in her lower back and hip.

The Ellington grandmother has had three CyberKnife treatments and says the pain is now dull instead of knife-like. It has allowed her to take less pain medication, and her family says she is walking more freely.

Sometimes the CyberKnife is used to clean up residual cancer left after surgery. One patient recently treated at St. Francis had a benign tumor pushing on her optic nerve. Neurosurgeons operated to quickly remove as much of the offending mass as they could. But removing it all would have left the patient blind. So they used the CyberKnife.

"It's not so much a replacement of the surgeon but an extension of the surgeon's ability," says Dr. Stephan Lange, a neurosurgeon and co-director with Shumway of the CyberKnife program at St. Francis.

In June 2003, a few days after she started stumbling and had trouble holding a pencil at work, Bossard, a former smoker, was diagnosed with lung cancer that already had spread into her brain. Surgeons at St. Francis removed the tumor near her brain stem the next day. She then went through 37 radiation treatments of the head and lung, followed by chemotherapy.

The Windsor resident was back at her job coordinating medical lab tests for homebound patients when the symptoms returned last November.

Doctors found new tumors in her lung and brain. Awaiting delivery of his own CyberKnife, Shumway referred Bossard to Beth Israel Deaconess Medical Center in Boston, where doctors already were using the machine to treat moving parts, such as the lungs.

In Boston, doctors targeted Bossard's lung tumors by injecting tiny gold beads that highlight the tumor and allow the CyberKnife to make precise adjustments to the path of the radiation beams to compensate for movement during breathing. The radiation stops the tumor's cell growth but does not immediately remove the mass itself.

By the time Bossard was ready to tackle a new tumor that cropped up on the right side of her brain, the CyberKnife had been installed at St. Francis. The device is among about 40 such systems at hospitals across the country. Shumway says the technology is catching on, and he expects up to 100 machines to be in use by the end of this year.

While highly targeted radiation surgery has been used against brain tumors for many years, the CyberKnife makes it more comfortable. In the past, a cage-like device was screwed into the head of patients undergoing targeted brain radiation. With the CyberKnife, the patient's face is covered with a lightweight mesh mask shaped like a fencer's mask.

Bossard's treatment took about an hour. She was able to wear her street clothes and needed no anesthesia.

"You feel nothing, nothing at all. As long as you hold still, they can do what they need to do," says Bossard, who watched a slide show of nature scenes while on the CyberKnife table and said she enjoyed being covered by a heated blanket. "That was my biggest goal, to lie still, think pleasant thoughts, and [the tumor] will be gone."

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