Six years ago, when one of our Home Health nurses, Gene Kliewer, was diagnosed with prostate cancer in its early stages, he was given four choices: surgery to remove the prostate; multiple radiation treatments; CyberKnife treatment; or do nothing and just watch to see if it got worse. He rejected choice number four, but had lots of questions about his other options. Taking to prostate cancer survivors in our monthly support group helped him decide on CyberKnife.
 

Gene Kliewer, RN, with Community's Home Health, (middle) enjoys a recent biking trip with his twin sons now that he's cancer free.

“The people with the least amount of problems were the guys who had CyberKnife,” Gene said. “I had treatment four days in a row for less than 2 hours. I went to work in the afternoons. I felt fine. I never missed a day of work...This is so minimally invasive and so gentle on a person, I don’t know why this treatment isn’t being asked for right and left.”

A decade ago when CyberKnife was installed at Community Regional Medical Center results like Gene’s were what we hoped for. When we brought this high-tech cancer treatment to the Valley it was the first of its kind in the nation and it continues as the only dedicated Robotic platform to deliver Stereotactic Radiosurgery in the Fresno area. CyberKnife delivers targeted radiation to hard-to-reach tumors.

“I've not missed a bit of life,” Gene says of his cancer fight and the years since CybeKnife treatment. “We just got back from Europe this summer. Every February or March we go to Mexico for our anniversary. I have four grandkids I keep up with and a daughter who lives in Nashville that we visit. I was so lucky we caught it early and there was CyberKnife. My PSA (prostate marker) is basically 0 ever since the treatments.”

In the 10 years since our first patient in 2005, the system itself has been continuously upgraded to remain a state-of-the-art treatment tool by offering the incredible technologies listed below. During the past 10 years 830 patients have received treatment on CyberKnife, and its utilization continues to grow as part of our commitment to improve the health status of our community.  Happy Anniversary CyberKnife!  And congratulations to all the Physicians and staff involved in the CyberKnife program!

Here are some of the little known technology upgrades we’ve made to this cancer-fighting system:

• Synchrony® Respiratory Tracking System–Continuously synchronizes beam delivery to the motion of the tumor, allowing clinicians to significantly reduce margins while eliminating the need for gating or breath-holding techniques.
• Xsight® Lung Tracking System–Tracks the movement of the lung tumors directly, without fiducials –  objects placed on the patient to help guide imaging and radiation delivery –with accuracy, reliability and self-adjusting repeatability.
• Xsight Spine Tracking System–Eliminates the need for surgical implantation of fiducials by using the bony anatomy of the spine to automatically locate and track tumors with submillimeter accuracy.
• Iris™ Variable Aperture Collimator–Using tungsten leaves to rapidly manipulate beam geometry, the Iris Collimator enables treatments of unrivaled conformality, or mapping to a patients’ body, and unparalleled preservation of healthy tissue around a cancer.
• Xchange™ Robotic Collimator Changer–Automatically exchanges collimator (the device that narrows a beam of particles or waves) sizes, allowing for highly conformal treatments to be delivered more efficiently.
• RoboCouch® Patient Positioning System–Robotically aligns patients accurately with six degrees of freedom, reducing patient setup times and enabling faster treatments.
• Linear Accelerator–Light weight 6MV X-band linear accelerator with an output of 1000 MU/min, accurately delivers highly collimated beams of radiation, which do not disperse with distance the beams travel, providing superior conformality when treating patients.
• Monte Carlo Dose Calculation–Often considered the gold standard of dose calculation, the CyberKnife System’s Monte Carlo Dose Calculation produces results in minutes compared to what typically requires hours or days with other systems. The clinical importance of Monte Carlo dose calculation is, in particular, for radiation care plans that include beams traveling through different tissues (skin/muscle/air/bone). This is mostly the case for treatment plans for lung, thoracic spine, liver, kidney, and some head and neck cancers. In those contexts, the Monte Carlo dose calculation algorithm offers improved accuracy as documented by extensive testing.

Alec Beach
Manager Radiation Oncology
Community Regional Medical Center