Cary Posted May 6, 2003 Share Posted May 6, 2003 Staten Island University Hospital is performing radiosurgery on any tumor from head to toe. I knew this would be happening in the future but did not realize it would be quite so soon. This should really help alot of people who for one reason or another are unable to undergo traditional surgery or radiation. Its quite lengthy but well worth the read. Cary Staten Island University Hospital - Radiosurgery has been performed for the treatment of brain tumors for decades. Staten Island University Hospital has led the way with refined development of non-invasive techniques for Fractionated Stereotactic Radiosurgery treating benign and malignant tumors. Results are superior for many tumors - benign and malignant - with better maintenance of function, less complications and lesser need for subsequent intervention, in general. Data from Staten Island University Hospital presented at the most recent ASTRO - the national radiation oncologists’ meeting - reported development of new equipment allowing for fractionated, non-invasive treatment below the brain and skull. Staten Island University Hospital have expanded Body Radiosurgery to become an attractive, highly successful program for primary and metastatic cancers. Now the basis of this technology - Fractionated Stereotactic Radiosurgery - can be used for cancers located most anywhere in the body - from head to toe. Body Radiosurgery is not surgery. In fact, the name ‘radiosurgery’ is a misnomer. Body Radiosurgery is pinpoint precision radiation using multiple, finely-contoured beams from many different angles - all directed at the cancer minimizing radiation to normal healthy tissue while the patient’s body is maintained in a stable, reproducible position. The attractiveness of this non-invasive technique is that is can be used when surgery, standard radiation and chemotherapy are not viable options or have not produced the desired results. Body Radiosurgery can be implemented in those patients who desire a non-invasive treatment alternative that has great effectiveness in selected situations. Because Body Radiosurgery is so precise, higher than normal doses of radiation can be given over a shorter period of time. Since higher radiation doses can be given, fewer treatments are necessary compared to standard external beam radiation, yet results are superior. In fact, recent analysis shows Body Radiosurgery is superior to direct isotope infusion into organs such as the pancreas. It is easy to see the attractiveness of normal tissue protection. Since normal healthy structures are shielded, higher doses of radiation can be delivered to the cancer with anticipation of greater success. Some cancers are poorly treated by conventional radiation or chemotherapeutic means. These include metastases to sites as the lungs, abdominal cavity, mediastinum, retroperitoneal, liver and elsewhere. Primary liver cancers - like hepatomas - pancreatic cancers and lung cancers are frequently suitable for Body Radiosurgery. Other cancers, too numerous to list, have been successfully treated with Body Radiosurgery at Staten Island University Hospital. Body Radiosurgery can be contemplated even when standard radiation has already been performed. Body Radiosurgery is often used as a ‘boost’ after conventional or standard radiation to increase the dose and improve control of the primary cancer. Most all radiation oncologists (whether they are familiar with Body Radiosurgery or not) believe that higher radiation doses will provide greater cancer control. The vast majority of cancers treated at Staten Island University Hospital (primary as well as metastatic) are treated successfully in the targeted area - meaning cessation of growth, shrinkage or disappearance of the cancer. Some cancers were treated only with Body Radiosurgery while others had extensive prior surgery, chemotherapy and/or standard radiation therapy. Body Radiosurgery offers a second or third chance for many patients - especially when there are limited sites of disease. How is Body Radiosurgery Performed? Stereotactic Body Radiosurgery at Staten Island University Hospital is based upon years of experience and thousands having undergone Fractionated Stereotactic Radiosurgery. Indeed more than ten thousand stereotactic radiosurgery procedures have been performed at Staten Island University Hospital over many years. Techniques developed and refined at Staten Island University Hospital allow us to precisely and reliably stabilize the body painlessly and non-invasively with an external frame of reference. This allows cancer localization for computerized treatment planning. Fine cut CT and MRI scans are performed with the patient in the stereotactic body frame to define the tumor in relation to this external frame of reference. Each body radiosurgery frame is custom-fit to insure maximum degree of precision localization. Once localized, physicians, physicists and dosimetrists using state-of-the-art dedicated computers select beams of radiation tightly tailored to attack the cancer while minimizing effects on the normal, healthy surrounding tissues. This means that radiation will be much better tolerated with superior outcomes than standard therapy even though we give higher treatment doses. This ultimate three-dimensional radiation is part of our daily armamentarium. It is a technique with which we are most comfortable and perform repeatedly every day and every night for patients who come from around the country and throughout the world. As part of the stereotactic body frame custom fitted individually for each patient small tattoos are placed over four strategic locations to help confirm the accuracy of set-up. Multiple quality assurance steps at each point verify and re-verify the accuracy and precision of stereotactic Body Radiosurgery. High resolution CT and/or MRI scans with the patient in the fiducial-marked stereotactic body frame are performed to facilitate our skilled staff’s ability to localize the cancer and perform Body Radiosurgery. Fiducial markers located within the stereotactic frame help precisely guide us to the target. Following the CT and/or MRI scanning, there is a double-check of each step for quality assurance. Once we are confident of the precision of Stereotactic Body Radiosurgery for each individual patient, Body Radiosurgery is performed. Body Radiosurgery treatment lasts approximately 30 to 60 minutes depending on the complexity of treatment. Staten Island University Hospital uses up to ten customized radiation fields all directed from different angles and all finely collimated to attack an individual cancer minimizing dose to the normal, healthy surrounding tissue. Each beam is custom-contoured for the patient’s cancer with unique shape and direction implemented to especially exclude normal, healthy tissue beyond the tumor as much as possible. The Stereotactic Body Radiosurgery Center physicians at Staten Island University Hospital typically administer five treatments. Treatments may be administered once-a-day, alternative days or even once a week. The schedule is made with our physicians based upon experience for your individual situation. One important aspect of Body Radiosurgery is that it is much quicker overall than standard external beam radiation, chemotherapy or surgery and their associated convalescence period. Body Radiosurgery often compares very favorably to chemotherapy, surgery or even standard radiation. Body Radiosurgery is totally non-intrusive, certainly less toxic and consumes much less time than other competing modalities of treatment for those selected candidates. Compared to surgery, there is the avoidance of anesthesia, operative risks as well as hospitalization and convalescence. Body Radiosurgery patients generally are able to immediately continue their normal activities. Body Radiosurgery is performed as outpatient therapy. The Concept of Body Radiosurgery The principle of Body Radiosurgery is precise non-invasive delivery of high radiation doses to the cancer while normal healthy surrounding tissues are, in general, spared the effects of the radiation beam. This is in marked contrast to standard radiation which is much less able to protect normal tissues from radiation effects. Data collected with thousands of procedures being performed continue to show marked efficacy for primary and metastatic cancer treatment. Frequently these cancers were considered to be untreatable by other modalities or to have treatment approaches that were much less promising. Cancers treated include primary tumors and metastases to the following: a.. neck b.. lung c.. breast d.. melanoma e.. liver f.. abdomen g.. kidney h.. pancreas i.. prostate j.. mediastinum k.. spine and extremities l.. and many others Each case, of course, is unique but a vast array of types of cancers including adenocarcinomas, squamous carcinomas, lung cancers, breast cancer, germ cell tumors, primary liver tumors, pancreas tumors, colon cancers, sarcomas, melanomas, renal cell, metastatic and primary head and neck cancers and others have been successfully treated and are included in ongoing data evaluation. The Results... Patients have ranged in age from 23 to 86, with a mean age of 60 years. Volume of tumors treated range from the very small (less than a cubic centimeter) to more than 5,000 cubic centimeters (cc) with a mean volume of 284cc. A typical patient receives five treatments with up to ten pinpoint radiosurgery fields per treatment. The entire cancer site is treated at each of five sessions. Currently, 37% of patients treated had cancers in the lung with 45% of those primary lung cancers and 55% metastatic cancers to the lung. Another large category includes liver cancers with 90% being metastases and 10% primary liver cancers. Despite patients often, but not always, being heavily pre-treated with chemotherapy, surgery and radiation, 88% of patients are alive one year from the time Stereotactic Body Radiosurgery was initiated. Many patients were so-called "hopeless cases" before coming to Staten Island University Hospital. Some come to Staten Island University Hospital insisting on Body Radiosurgery only - wishing not to receive any standard therapy. Of course, each patient ultimately decides what treatment is best suited to one’s own unique concerns, needs and desires. Primary Liver Cancers Primary liver cancers are malignancies that commence within the liver itself. Body Radiosurgery has been successfully implemented over the years for hepatocellular and other primary liver cancers. Body Radiosurgery for primary liver tumors such as hepatocellular carcinomas, cholangiocarcinoma, gall bladder cancers have been successfully treated with excellent results. Most patients unfortunately cannot undergo surgical resection of their primary liver cancer. We, at this time, do not seek to replace surgery with Body Radiosurgery. Our techniques should be viewed as a viable option for those unable or unwilling to have surgery. In fact, many patients come to us after being considered for surgery elsewhere and refused or were found to be inoperable at the time of surgery. The control rate of primary liver tumors is equal - over 90% - to the success in other areas of Body Radiosurgery. Liver Metastases Liver metastases are cancers that have spread to the liver from other primary sites. Primary cancers in this category include from lung, breast, pancreas, gall bladder, melanoma, sarcoma and colon amongst others and have been treated using body radiosurgery. We have a success rate of 95%. The beauty of Body Radiosurgery is that it can be repeated, if necessary, perhaps with a higher dose for even greater expected outcome. Primary Lung Carcinomas Another attractiveness of Body Radiosurgery is that primary lung cancers can be treated with this technique minimizing harm to the healthy normal lung yet delivering higher doses of radiation. Many patients with lung cancers have chronic pulmonary obstruction disease and have limitations of respiratory function. Because stereotactic radiosurgery minimizes the adverse effects to the healthy normal lung, one anticipates a better outcome using this pinpoint precision technique. We have seen quick and dramatic shrinkage of many patients’ lung cancers. Body Radiosurgery can be used alone or in combination after external beam radiation to boost the radiation dose to enhance success of treatment. Pulmonary or Lung Metastases Lung metastases are cancer nodules that have spread to the lung from other primary sites. Pulmonary or lung metastases have been treated with Body Radiosurgery across the spectrum in size ranging from the small to the large. Most common origins include head and neck cancers, melanoma, renal cell, breast, sarcoma, gastro-intestinal, pancreas, liver, germ cell cancers, thyroid, and other primaries. The local control rate remains well in excess of 90%. An attribute of Body Radiosurgery is that tumors both large and small can be treated with this technique, in general, leaving the healthy normal lung intact. Many patients come to us with severe lung disease not felt to be candidates for standard surgery or radiation and yet, are followed after radiosurgery with good success observed, most commonly. Primary Pancreas Cancers Primary pancreas cancers have been treated with a very high rate of success. In fact, over 99% of primary pancreas cancers currently have been successfully controlled in the treated area at Staten Island University Hospital with Body Radiosurgery. We have recently analyzed Body Radiosurgery in comparison to infusion of radioactive P32 and found Body Radiosurgery superior. We had no local failures compared to a local failure rate of 29% with P32 infusion into the pancreas cancer. Furthermore, the size of the cancers treated with Body Radiosurgery were - on average - three times the size and still we had a dramatically higher success rate. This should speak to the power of Body Radiosurgery for pancreas and indeed, many primary and metastatic cancers even located in delicate parts of the body. Our technique may be performed at time of original diagnosis, with or without chemotherapy and if necessary, in the case of recurrence after standard therapy. Prostate Cancers Prostate cancers have been a very special interest of the radiosurgery group at Staten Island University Hospital. In fact, a whole information package is devoted to comparing our technique to surgery and other forms of radiosurgery. Body Radiosurgery can be implemented after prostate seed implantation for maximum effectiveness of local treatment. Prostate seeds allow high doses to be delivered to the prostate while Body Radiosurgery consolidates the radiation to the prostate and the immediate surrounding tissues. We compare exceedingly favorably to surgical or non-surgical radiation treatment with an excellent quality of life after treatment, in general. We are proud to compare our results to conformal radiation, standard radiation and radical prostatectomy. Urinary incontinence is nearly never an issue and the majority maintain sexual function. Please see our Prostate Cancer page for further information. Other Abdominal Tumors In the abdominal cavity, we treat primary and metastatic cancers. Abdominal cancers range the gamut from colon, germ cell, melanoma, ovarian, thyroid, kidney, pancreas, sarcoma and others. Size range is broad from the very small to the very large with the overwhelmingly majority of cancers showing cessation of growth, shrinkage or complete disappearance. In general, as post-treatment benefit is carried over further months and years, the likelihood of greater shrinkage increases greatly. And more.... Other tumors including sarcoma and lung and breast cancers have been treated with this modality at Staten Island University Hospital. Selected patients with recurrent Hodgkin’s lymphoma have been treated after prior unsuccessful cancer therapy. It is best to speak directly with our physicians about your individual case for the most up-to-date information. Studies Shows Effectiveness of Body Radiosurgery Studies have shown the effectiveness of Body Radiosurgery in treating both primary as well as metastases. The appeal of radiosurgery is that very high doses of radiation are precisely delivered with minimal effects to normal healthy tissues. We update our data regularly and track each case to have a complete record of Body Radiosurgery. This is important for our academic work and for patients and their families to be able to possess as much information as possible before making such a crucial decision about one’s medical care. Who Should Be Evaluated For Body Radiosurgery? Patients desiring a fresh, second opinion about whether their cancer can be successfully treated should contact our physicians directly or send in their films for review and analysis at our Body Radiosurgery Conference. Many patients with cancers who cannot be treated successfully using standard therapy or those with cancers that have recurred despite standard chemotherapy, surgery or radiation may wish to inquire about Body Radiosurgery. Also, those wishing this innovative therapy as a boost radiation dose (after standard radiation) to increase chances of local control and overall success should be motivated to investigate Body Radiosurgery by contacting our physicians at Staten Island University Hospital. With our technology, Staten Island University Hospital now has the ability to treat cancers extending from the head to the toe using sophisticated non-invasive techniques. Those interested in Body Radiosurgery are asked to send relevant information and pertinent radiographic studies - especially CT scans and/or MRI scans - to our Radiosurgery Center for review. Each week our Body Radiosurgery Conference meets to review candidates for Body Radiosurgery as well as previously treated body radiosurgery patients who send in new films for review. There, the multi-disciplinary team reviews each patient’s case and determines the best treatment method. If the patient is felt to be an appropriate candidate and wishes to proceed, the Informed Consent process is continued, fully explaining all risks, benefits and alternatives. We encourage those interested in Body Radiosurgery to inquire. We believe our staff has the greatest experience in the western hemisphere and probably worldwide. A fresh, second opinion may well benefit you. Since Body Radiosurgery is so revolutionary, our experts are best informed about the usefulness of this new technology for you or your loved one. We’re happy to speak to your physicians, if you wish. The multi-disciplinary panel of expert physicians examines pathology, CT scans and clinical history. Patients considered most suitable for this technique are invited in for consultation. During consultation a complete history, physical examination, newer films (if they exist), pathology and other records are re-reviewed. There are monthly regular seminars concerning Body Radiosurgery at Staten Island University Hospital for those wishing to meet with our physicians in an informal setting and learn about the history, success and relevance of Body Radiosurgery for themselves. For those wishing to know more about the possibility of Body Radiosurgery, the best chance is to directly inquire. Our physicians will provide advice and treatment options which we believe best serve the patient. Our radiosurgery work continues to be evaluated and updated by our research group and our current results are presented at national and international meetings as well as published in major medical journals. For physicians, we have established The Society of Body Radiosurgery to inform and educate about this important advance in the field of oncology. Staten Island University Hospital is the home of the Journal of Radiosurgery - the only peer-reviewed medical journal dedicated to the field of radiosurgery. The editor is Gil Lederman, M.D. For more information on Fractionated Stereotactic Body Radiosurgery and other innovative treatment methods, for a free videotape and information packet or to register for one of our monthly Body Radiosurgery seminars please contact The Radiosurgery Center at Staten Island University Hospital at 1-800-285-4584 or email us. 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