Cancer Treatment With Radiation Therapy

Why We Can't Cure Cancer

2009-11-04T15:51:00.000-05:00

There has been a "war on cancer" for over five decades now, and it seems little has changed, and more and more people are diagnosed with cancer and die from cancer each day. Actually we have made great advances our understanding of the disease and in diagnosis and treatment.

Unfortunately, the complexity of the problem seems to grow with our understanding. Consider this; Cancer is over one hundred diseases, which are all different but all the same. Saying a disease is a cancer is like calling a vehicle an automobile. All cars have four tires, windshield wipers and a steering wheel, etc., but a dune buggy has very different parts than a Volvo. Likewise, breast cancer is different from prostate cancer, and colon cancer is different from lung cancer. Thus their symptoms of presentation, patterns of spread, and treatment are different. It is unlikely there will be one simple solution for all these different diseases we call cancer.

Consider what we are trying to accomplish when we try to analyze all the different kinds of cancer. You are looking through a telescope at the parking garage at Yankee Stadium, 100 miles away. There are two identical looking red cars. From your vantage point, you have to tell what kind of cars they are, and what kind of engines the cars have. And you have to be able to look deeper, what color is the interior, and what type of sound system does it have?

Now look at the CD player and see there is a Billy Joel Album, maybe Piano Man. Is it playing? What track is it on? Look at the third track and the 405th note in that track, there is a scratch altering the machines ability to render the song and changing the melody to a repetitive cacophony. Now fix the scratch and change the disc back to normal, without hurting anything in the car or other cars around it. Oh, and remember that you must be able to do this from 100 miles away.

The research conducted has given us tremendous insight into the molecular function of the cell, and chemical pathways which are damaged in a cancerous cell. We have demonstrated how cancer cells can be inactivated or turned back to normal by changing these chemical pathways. Here is the "Holy Grail" - just repair the damage that causes a cell to behave wrong, and cure the cancer. Fix the scratch on the CD, from 100 yards away, so to speak. We have used this new knowledge to establish the basis for a host of new drugs and the timing of treatments. In some cases the results have been very encouraging, and in others, we have learned how rapidly nature adapts and finds ways around our chemical roadblocks.

While we continue to apply these new tools to treat cancer, we should keep in mind that the best way to approach this problem is probably not to become a cancer patient in the fist place. Don't get a scratch on your CD. Does that sound too easy? Well for some cancers like brain tumors, breast cancer and prostate cancer it is not that simple because we don't know the cause of these cancers. But for others, it is and we do. We know that 40% of all cancers are related to lifestyle choices such as smoking, exercise, diet, sun exposure and personal habits.

That means theoretically over 400,000 cases of cancer per year could be avoided with our individual effort to live differently. That is a huge number of people. All it takes is a bit of effort on our part. So, let's get started, what are you doing tomorrow? Would you to take a 30 minute walk with me?

Cyberknife of Long Island Destroys Tumors Non-Invasively using Radiosurgery

2009-09-17T08:59:00.001-04:00

Powerful new approach for the treatment of tumors without cutting or anesthesia

(Huntington, NY) – Cyberknife of Long Island has become the first cancer center in New York to treat tumors with the most advanced radiosurgery technology available to date. The newest generation of the Cyberknife by Accuray offers unprecedented capabilities and renewed hope to cancer patients. "Cyberknife of Long Island is proud to continue delivering on its promise to provide the highest quality, most advanced cancer treatment in the region with the addition of the CyberKnife System," said Jeffrey Musmacher, Chief Operating Officer at North Shore Radiation Therapy, the parent company of Cyberknife of Long Island. "With this new image-guided robotic technology, we are able to treat those whose tumors were previously thought to be inoperable and untreatable."

North Shore Radiation Therapy has installed the most-advanced version of the system in their New York office located in Smithtown.

"This technology will offer a new treatment option that revolutionizes cancer treatment in the region," said Richard Byrnes, MD, the center’s Medical Director. "The advanced technology behind CyberKnife uses real time image guidance technology and computer controlled robotics to deliver an extremely precise dose of radiation to the tumor, avoiding the surrounding healthy tissue and adjusting for patient and tumor movement during treatment."

"The procedure requires no anesthesia, as the treatment is painless and non-invasive." said Maged Ghaly, MD, a Radiation Oncologist at Cyberknife of Long Island. “The machine's robotic arm works continually with image guided technology and has the ability to move in three dimensions according to the treatment plan.”

The treatment has a higher rate of success with small tumors, and generally lasts between 30 to 90 minutes involving administration of 100-200 radiation beams delivered from different directions each lasting 10 to 15 seconds

"Other stereotactic systems, such as the Gamma Knife, treat only the brain and require that the patient be fitted with a rigid frame screwed into the skull. The Cyberknife uses a frameless system, and can treat tumors throughout the body with a accuracy of less than 0.5 millimeters” said Heather Zinkin, MD, Radiation Oncologist.

This treatment can also successfully treat lung cancers and other cancers that are in areas that move involuntarily - like in the respiratory or digestive system.

"These treatments are out-patient procedures, ranging from five to as little as one visit, allowing patients to continue their normal activities," Ghaly said.

There are about 150 CyberKnife systems around the world, the one at Cyberknife of Long Island being the most advanced.

You Have a Tumor

2009-09-11T11:15:00.004-04:00

When you hear news like this, everything changes. What are your options? Are you a candidate for treatment? Which treatment? Will it be effective? What are the risks?

How will all this affect your life?

The answers to these questions may be different from what they once were, because radiosurgery has revolutionized cancer treatment.
Radiosurgery – which isn’t surgery at all – is an excellent alternative treatment for tumors. It destroys tumors with highly precise beams of radiation... quickly, painlessly, without the use of a scalpel, cutting, or hospital stays. The revolution is that, with CyberKnife, Radiation Oncologists now treat tumors virtually anywhere in the body. This includes tumors once considered untreatable and even patients who’ve been told they are ineligible for other forms treatment.

What is radiosurgery?

The word “radiosurgery” means radiation surgery. But it isn’t surgery. It is extremely precise beams of radiation that destroy tumor cells. For many decades, radiation therapy has been used to shrink tumors prior to surgery, following surgery to eliminate residual cancer cells, in combination with chemotherapy and as a stand-alone treatment for certain cancers. In 1967, radiosurgery was introduced, and this more powerful and precise radiation treatment has been used successfully ever since.

What is CyberKnife?

While radiosurgery has been a proven, effective treatment for the past four decades, technological limitations have restricted its use to treatment of tumors in the head. CyberKnife is the first radiosurgery system to enable physicians to treat tumors anywhere in the body. It’s also the first system to track a tumor’s true position throughout treatment, providing the sub millimeter precision needed to avoid irradiating normal and critical tissues. CyberKnife can even maintain its accuracy for tumors that move with respiration, such as lung tumors.

Why should I consider CyberKnife?

Some tumors are inoperable, and certain patients aren’t eligible for surgery. But CyberKnife’s precision makes it possible to treat these people – with excellent results. It’s also a potential option for people who are ineligible for conventional radiation therapy.

CyberKnife may even be preferred for patients and tumors treatable with other methods. That’s because, with CyberKnife, we can often achieve equal or better results... without chemotherapy, surgery, incision, blood loss, anesthesia, recovery time, pain or a hospital stay. Most patients just get up and go back to their regular activities.

How does CyberKnife work?

The keys to CyberKnife’s versatility and accuracy are its imaging capabilities and its range of motion.

“Seeing” the tumor. CyberKnife takes X-ray images throughout treatment to determine the tumor’s position. If it moves, the CyberKnife moves in response, maintaining its precision. Other systems work only from pre-treatment images and are unaware of the tumor’s actual position during treatment.

Maintaining accuracy and sparing healthy tissues, the CyberKnife can bend, turn, tilt or swivel. This enables CyberKnife to move in response to the tumor’s position and treat virtually anywhere in the body. CyberKnife’s range of motion also makes it possible for doctors to treat a tumor from many different angles, minimizing exposure to healthy tissue and critical structures.

Improving your life during treatment.

Traditional forms of treatment can have a negative impact on your life. Surgery involves prep, incisions, scarring, recovery time, pain and a hospital stay. There’s also risk of blood loss, infection and complications. Chemotherapy has side effects ranging from nausea, diarrhea and hair loss to fatigue, depression, reduced immunity and more. Radiotherapy, which involves many weeks of treatments, also has side effects.

CyberKnife, however, requires only one to five treatment sessions. It’s painless and lasts only 30-90 minutes, and there’s no anesthesia, incision or downtime. Afterward, you just get up and go live your life. The CyberKnife truly gives people a new hope in cancer treatment.

Visit us at www.cancer-radiation.com for more information.

Study Shows Promise for Mesothelioma Radiation Treatment

2009-08-19T11:03:00.000-04:00

A recently published study in the Journal of Thoracic Oncology says that using treatment planning techniques such as intensity modulated radiotherapy (IMRT) could be helpful for malignant pleural mesothelioma patients.

Pleural mesothelioma is a rare type of cancer caused primarily by asbestos exposure. The bulk of cases take at least 20 years to occur after the initial exposure to asbestos and most patients are unaware of the progression of the disease. If the disease is caught early enough, several forms of treatment can be used to fight the cancer, known as multimodality therapy.

A multimodality therapy approach involving a surgical procedure known as an extrapleural pneumonectomy (EPP), chemotherapy and radiotherapy is often suggested for patients diagnosed during the early stages of pleural mesothelioma. However, setting up radiotherapy treatment after EPP can be difficult due to the large target area, the high doses necessary to prevent recurrence and the proximity of vital organs and other important structures.

V. Gupta and colleagues examined the local and nodal (lymph nodes) recurrence in patients treated with EPP and radiation therapy to establish whether IMRT could be used as a treatment method.
The study included 86 patients with malignant pleural mesothelioma who had undergone radiotherapy and an EPP. The radiotherapy technique included a combination of photons and electrons to maximize the dosage to the targeted area.

The results of the study showed that only 10 percent of patients developed late grade three pulmonary toxicity and no patients passed away. V. Gupta and colleagues concluded, “IMRT’s advantages must be balanced against the increased risk of fatal pulmonary toxicity.”

Additional information about mesothelioma may be found through the Mesothelioma Center at Asbestos.com.

Cyberknife Radiosurgery

2009-08-14T11:09:00.003-04:00

“You have a tumor.”

When you hear news like this, everything changes. What are your options? Are you a candidate for treatment? Which treatment? Will it be effective? What are the risks? How will all this affect your life?

The answers to these questions may be different from what they once were, because radiosurgery has revolutionized cancer treatment.

Radiosurgery – which isn’t surgery at all – is an excellent alternative treatment for tumors. It destroys tumors with highly precise beams of radiation... quickly, painlessly, without the use of a scalpel, cutting, or hospital stays. The revolution is that, with CyberKnife, Radiation Oncologists now treat tumors virtually anywhere in the body. This includes tumors once considered untreatable and even patients who’ve been told they are ineligible for other forms treatment.

What is Radiosurgery?

The word “radiosurgery” means radiation surgery. But it isn’t surgery. It is extremely precise beams of radiation that destroy tumor cells. For many decades, radiation therapy has been used to shrink tumors prior to surgery, following surgery to eliminate residual cancer cells, in combination with chemotherapy and as a stand-alone treatment for certain cancers. In 1967, radiosurgery was introduced, and this more powerful and precise radiation treatment has been used successfully ever since.

What is CyberKnife?

While radiosurgery has been a proven, effective treatment for the past four decades, technological limitations have restricted its use to treatment of tumors in the head. CyberKnife is the first radiosurgery system to enable physicians to treat tumors anywhere in the body. It’s also the first system to track a tumor’s true position throughout treatment, providing the sub millimeter precision needed to avoid irradiating normal and critical tissues. CyberKnife can even maintain its accuracy for tumors that move with respiration, such as lung tumors.

Why Should I Consider CyberKnife?

Some tumors are inoperable, and certain patients aren’t eligible for surgery. But CyberKnife’s precision makes it possible to treat these people – with excellent results. It’s also a potential option for people who are ineligible for conventional radiation therapy.
CyberKnife may even be preferred for patients and tumors treatable with other methods. That’s because, with CyberKnife, we can often achieve equal or better results... without chemotherapy, surgery, incision, blood loss, anesthesia, recovery time, pain or a hospital stay. Most patients just get up and go back to their regular activities.

How Does CyberKnife Work?

The keys to CyberKnife’s versatility and accuracy are its imaging capabilities and its range of motion.

“Seeing” the tumor. CyberKnife takes X-ray images throughout treatment to determine the tumor’s position. If it moves, the CyberKnife moves in response, maintaining its precision. Other systems work only from pre-treatment images and are unaware of the tumor’s actual position during treatment.

Maintaining accuracy and sparing healthy tissues, the CyberKnife can bend, turn, tilt or swivel. This enables CyberKnife to move in response to the tumor’s position and treat virtually anywhere in the body. CyberKnife’s range of motion also makes it possible for doctors to treat a tumor from many different angles, minimizing exposure to healthy tissue and critical structures.

Improving Your Life During Treatment.

Traditional forms of treatment can have a negative impact on your life. Surgery involves prep, incisions, scarring, recovery time, pain and a hospital stay. There’s also risk of blood loss, infection and complications. Chemotherapy has side effects ranging from nausea, diarrhea and hair loss to fatigue, depression, reduced immunity and more. Radiotherapy, which involves many weeks of treatments, also has side effects.

CyberKnife, however, requires only one to five treatment sessions. It’s painless and lasts only 30-90 minutes, and there’s no anesthesia, incision or downtime. Afterward, you just get up and go live your life. The CyberKnife truly gives people a new hope in cancer treatment.

www.cancer-radiation.com or www.cyberknifeofli.com

Medicare Physician Fee Schedule

2009-06-26T10:39:00.003-04:00

Major overhauls are needed in the formula that is used to calculate physician payments. Every year, congressional action is taken to patch the system to avoid significant reductions in reimbursement. In 2010, we face a 21.5% cut in reimbursement while the cost of providing the care is increasing due to technological advances, salaries and general inflation. The problem lies within the sustainable growth formula (SGR). This concept was to reduce payments as the number of services that are provided grows. The flaw in this formula is that it includes prescription drugs. One example of this is procrit. More money is spent on this one drug than all of radiation therapy treatments in the country. ASTRO has called upon Congress to prevent the 21.5% cut schedule for 2010 and replace it with a positive payment update and work towards a long-term solution to stabilize payments.

Self-referral

2009-06-19T08:38:00.001-04:00

The physician self-referral or "Stark" law was enacted to prohibit physicians from referring Medicare patients for healthcare services when the physician has a financial interest with the service provider. The intent was to assure that clinical decisions related to patient treatment were made without financial considerations, assuring patient access to high quality services and discouraging overutilization. Unfortunately, a loophole was left in the law. The "in-office ancillary services exception" (IOAE) was intended to apply to services such as x-rays ans lab tests that required a quick turnaround to facilitate medical care. Radiation Oncology was inadvertantly added to that list. Our service is ancillary to no other. As a result, arrangements have been made, whereby urologists have formed groups that invest in linear accelerators and are now able to diagnose and treat prostate cancer patients, while capturing all the technical charges associated with this type of treatment. These business arrangements have the financial incentive to "cherry-pick" cancer patients for the most profitable treatment, thus giving them an unfair competitive advantage over radiation oncology centers that offer a full range of treatment for all cancers. Patients are unaware of the financial incentives and the impact it has on thier care. The American Society for Therapuetic Radiation Oncology (ASTRO) has called upon Congress to strentghten the "Stark" law by removing radiation oncology from the "in-office ancillary exception" list. This bill is currently being reviewed by President Obama as part of the Health Care Reform package.

Health Care Policy Reform

2009-06-15T18:13:00.003-04:00

Before we can begin to talk about all the technologies available to treat cancer, we need to discuss health care policy and some current trends. I was recently invited to meet with members of Congress and Senate at the sixth annual ASTRO (American Society for Radiation Oncology) Advocacy Day. This was held in Washington D.C in March. I represented the SROA (Society of Radiation Oncology Administrators), joining over 100 physicians, physicists and administrators from 44 states. This event is coordinated to get our professional organizations more involved with the legislative process. This year is most likely the most important year as radiation oncology faces three major issues that threaten our profession. It is also our turn to make a difference. With a new president, changes in Congress and health care reform being at the forefront with our troubled economy, leaders are looking to us to help them make difficult decisions.

The goal of Advocacy Day was to reach out to our elected officials and their staffs and educate them about radiation oncology. According to the American Cancer Society, cancer is second to heart disease as the leading cause of death in the United States. Radiation therapy is given to over 65% of all cancer diagnoses. As seen in the data presented at many of our meetings, we have made great strides over the last decade with increased survival rates. Major advances in technology have also allowed us to minimize the side effects seen with treatment. These changes have brought radiation oncology to the forefront of cancer care, yet it is still misunderstood by many lay people what we do. Very often there is confusion that leads to the notion that we are “part” of radiology. As we are aware, this is simply not the case.

Attendees were briefed by the ASTRO government relation’s staff on the issues facing our profession. There were many guest speakers from legislative leaders to health care consultants. The three primary issues we face today are self-referral, proposed cuts to the Medicare physician’s fee schedule and increases in funding for cancer research.

My next post will begin to dissect these issues and better explain current challenges.

Cyberknife Radiosurgery Coming to Suffolk County - A new era in cancer treatment

2009-06-14T23:28:00.003-04:00

Cyberknife of Long Island, part of North Shore Radiation Therapy is proud to offer a ground-breaking cancer treatment - the CyberKnife® Robotic Radiosurgery System. The CyberKnife is the world’s first and only radiosurgery system designed to pinpoint and destroy tumors in the body. In many cases, the treatment offers new hope to patients who were considered untreatable or inoperable, who may be looking for an alternative to surgery, or who have recieved radiation therapy in the past, but still require further treatment.

What is the CyberKnife?

The CyberKnife System is a computer-controlled, robotic radiation delivery system that attacks tumors with high doses of radiation from virtually any direction or angle with sub-millimeter accuracy. With stereotactic radiosurgery there is no incision, cutting or anesthesia. Radiosurgery does not remove the tumor or lesions, but instead, uses the high doses of focused radiation to destroy tumor cells and stop the growth of cancer cells.At the core of the CyberKnife System is technology that continuously and automatically tracks the tumor’s and patient’s position – including his or her respiratory motion. It uses this information to guide and position the radiation beams to precisely target the tumor, while carefully sparing the surrounding healthy tissue.

Conditions Treated with the CyberKnife

The following conditions can be successfully treated with Cyberknife:

Lung cancers
Prostate cancer
Brain
Liver cancer
Spine tumors
Pancreatic cancers
Head and Neck
Other places in the body where radiation treatment is indicated

My next post will discuss the wide array of treatment options available to the community without the need to travel to New York City!