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Lenore, the CyberKnife robot. Image courtesy of Swedish Radiosurgery Center and Accuray.

Lenore, the CyberKnife robot. Image courtesy of Swedish Radiosurgery Center and Accuray.


Cutting Edge Cancer Treatment

Amanda Wilde

There is a new technology that's available for post–surgical breast cancer treatment, but chances are you haven't heard of it. Even though it's a giant step forward in treatment, it's not widely used because insurance companies haven't caught up with the technology. Amanda Wilde has the story.


Meet Lenore: she's a CyberKnife robot, and she lives in Seattle's Swedish Hospital. If you haven't heard of CyberKnife, you're in the majority. It's a revolution in treatment, but very few patients know about it.

A lot of hospital staff have never heard of it. Nurse Estelle Bolster was part of that group until she was introduced to CyberKnife at an oncological conference. It changed the focus of her career.

Bolster: "I found it just intriguing that we had this modality of treatment that's been out there like eight years, been here at Swedish, I think this in its fourth year, and none of us knew about it."

CyberKnife is a highly–focused radiation treatment. It's so precise that it spares patients scarring and other side effects of traditional radiation. Normally, machines like Lenore are used to treat brain cancer, but Estelle had an idea. This cutting edge technology could be used for her breast cancer patients.

Bolster: "I just thought, wow, you know, and my mind just swept away. Like, can we use this for breast? Can we use it for all the things, because they introduced it as — it was originally designed to treat brain."

So Estelle approached the head of the CyberKnife center, Dr. Sandra Vermeulen.

Bolster: "Dr. Vermeulen, I just love her, because when I met her to interview to come here, I said, 'So why aren't we using this for breast?' And she said, 'That's what you and I are going to work on.'"

In order to implement the new CyberKnife treatment, they would have to rethink how breast cancer has been treated in the past. Dr. Vermeulen explains.

Vermeulen: "For decades, for decades we've been using conventional whole–breast irradiation — "

That means massive doses of radiation to the entire breast, even to large areas of healthy, normal tissue. And massive radiation means massive side effects, fatigue, skin changes —

Vermeulen: " — skin burns, rib discomfort, neumonitis, radiation pneumonia, and arm swelling and breast swelling."

But those side effects are considered acceptable because the cure rates have been so great for traditional, whole–breast radiation. But that's where CyberKnife is different.

Vermeulen: "CyberKnife was unique in that it seemed to offer the coverage we wanted with the least amount of normal tissue that would be included."

The radiation beam focuses just on the area to be treated. It spares healthy tissue, and that means fewer side effects. That's what is so groundbreaking about CyberKnife for breast cancer.

To find Lenore, you have to take the elevator all the way down to the basement of Swedish Hospital, then down the corridor to the CyberKnife center.

But this place doesn't look like the rest of the hospital.

The low–lit room is painted a comforting sage green, soft music is on the stereo; you could almost imagine you're in a spa. There's a treatment table in the middle of the room and hovering above is Lenore, the CyberKnife herself; a Florence Nightingale from outer space.

Lovit Hines: "Lenore, our robot, is quite a bit bigger than people imagine it will be."

That's Lovit Hines. He's one of only two full–time CyberKnife radiation therapists in Seattle. He explains why this room looks so different from other areas of the hospital.

Hines: "Well, we tried to make it a lot less institutionalized so it's a very comfortable looking room. I think you'll agree. Dim lights and music playing, the only thing that might take them aback a little bit is the sight of the robot. They see it on the Internet or they see our model out front and they think it's a lot smaller."

Lenore is definitely a floor–to–ceiling kind of gal. Hard to believe such a big machine can treat such a specific area.

Hines: "Some think she looks prehistoric, others think it looks more like an insect, a giant praying mantis. I just think she's just sorta cute."

Much more personal, too. She's designed to follow your every movement. Lenore uses a revolutionary tracking tool called synchrony. This allows her to move with you even as you breathe. Conventional radiation requires patients to stay as still as a wax figure.

Hines: "In regular radiation therapy departments, patients usually have anywhere from 10 to 20 minutes for treatment. Typically, radiation therapy can go for six weeks. Monday through Friday for six weeks."

With CyberKnife, it's usually one to five days for about an hour a session.

Hines: " And then they're done."

So if CyberKnife is so great, why haven't more of us heard of this treatment?

Vermeulen: "It's still in a research, or a study phase — "

Dr. Vermeulen again.

Vermeulen: " — and it still will be until many, many centers are publishing on it, and there's been many, many patients treated."

That's the catch about innovation in medical technology: It has to be proven before doctors will prescribe it and insurance will pay for it. But in order to be proven it has to be used on patients first. And to be used on patients, it has to be proven.

Hines: "I think when words gets out and doctors start realizing what a great opportunity this is for their patients, that they'll refer them over here."

So far, there have been 10 breast cancer patients treated at the CyberKnife Center at Swedish. About another 10 patients have been treated in other centers in the United States.

They're hoping to treat more as CyberKnife becomes better known. Until then, Lenore is there in the basement of Swedish Hospital, waiting.

I'm Amanda Wilde for KUOW.

© Copyright 2011, KUOW

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