When Lori Brownell's first tumor appeared − on her left carotid artery − it was surgically removed, leaving an inches-long incision to heal. It was eight years before the feeling returned to that side of her neck, and for a time, she couldn't drive because she couldn't turn her head far enough.
“That first radiation just wiped me out”
On September 15, at the Stanford Cancer Center, a tumor on Brownell's right vagus nerve was the target, not of a scalpel, but of narrow, finely-focused beams of radiation. Instead of risking incisional surgery that might have affected Brownell's ability to swallow and speak, Stanford physicians decided to use a radiation machine called the CyberKnife.
And Brownell became Stanford's 5,000th CyberKnife patient − that's 5 percent of all treatments conducted since 1994, when Stanford Hospital became the first to buy and use the groundbreaking device, the brainchild of a Stanford physician.
Now, 206 health care centers worldwide have a CyberKnife, but Stanford is one of just four facilities to own two.
Once it was called Adler's Folly, a name that reflected the audacity of its inventor, Stanford neurosurgeon John Adler. Adler had imagined something that would send radiation into the body in a way that no other could do, combining computer imaging and robotic motion to treat the most difficult cancers in the brain, lung and spine, where there is no leeway for error.
A decade of development later, the folly was recognized as a treatment powerhouse, its use expanding rapidly. Brownell's tumors are benign, but genetics seem to be contributing to their occurrence. She had a second tumor, on her left jugular vein, treated with a five week course of fractionated radiotherapy two years ago. When the third appeared, her hometown neurosurgeon in Florida recommended Stanford's Griff Harsh, MD, who worked with radiation oncologist Scott Soltys, MD, to complete Brownell's treatment with the CyberKnife.
The CyberKnife, Harsh said, "not only vastly improved the safety and efficacy of irradiating many brain tumors, but also revolutionized much of radiation oncology. Our 5,000 patients, and almost 100,000 worldwide, have truly benefitted from this kind of innovative patient care."
This use of radiation has come to be known as stereotactic radiosurgery and radiotherapy.
The CyberKnife's special quality is that it tracks tumor movement whether from breathing or other patient motion. Its beam delivery arm reacts with minute precision to real-time images of the tumor. No radiation is sent out when the tumor moves out of the beam, protecting healthy tissue that can sometimes be damaged as it might be in traditional wide field beam delivery. With lung cancer, treatment is particularly challenging because tumors move with each and every 12 breaths a minute. The CyberKnife's tracking system adjusts delivery to react to that normal, active breathing pattern.
The radiation is so highly focused it is safer to deliver a higher dose of radiation, which improves the odds that the DNA of abnormal cells will be irreversibly damaged. So scrambled, as Brownell put it, that they will die and not regrow.
Brownell was relieved to know that, unlike the five-days-a-week, five weeks long radiation she endured for her second tumor, the CyberKnife treatment would last less than an hour. She's already signed up to run marathons in November and December. "That first radiation just wiped me out," she said. "After this, I can keep running."
Knowing that the CyberKnife had been developed at Stanford, she said, gave her even more confidence.
As the CyberKnife's treatment repertoire of lung, liver and pancreatic cancer broadens, Stanford physicians are creating other applications that have shown good results. "The Stanford CyberKnife Program has been at the leading edge of clinical applications since the inception of the CyberKnife," said Stanford radiation oncologist Iris C. Gibbs, MD, Co-Director of Stanford's CyberKnife Program. "Our program has expanded the uses of radiosurgery not only within the brain, but throughout the body, for a lengthening list of conditions such as vascular abnormalities; tumors, including acoustic neuroma and glomus types; and pain syndromes like trigeminal neuralgia."
Most recently, Stanford CyberKnife protocols for treatment of patients with glomus tumors, trigeminal neuralgia and skull base tumors have shown excellent results, said Richard T. Hoppe, MD, Stanford's Chair of Radiation Oncology. The CyberKnife has also been used very successfully at Stanford as a post-operative treatment that avoids the side effects of whole brain radiation, he said. "We believe the Stanford CyberKnife Program's experience is unmatched − and that that experience raises the likelihood of improved safety and outcomes for our patients."
Neurosurgeon Steven D. Chang, MD, is the CyberKnife Program's other co-director. He also leads the Stanford Neuromolecular Innovation Program. "The successful treatment of our 5,000th patient on the Stanford CyberKnife system confirms the clinical benefit for our patients and others elsewhere. We proudly celebrate this milestone with all of our patients, treatment team members and referring physicians. And we look forward to the Stanford CyberKnife Program continuing its role as a worldwide leader in the treatment and advancement of stereotactic radiosurgery and radiotherapy."
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