Cyberknife for liver mets?

[michka]

Hi Friends. I am turning to you again because I am lost.
Did anybody have Cyberknife for liver mets?
I am going crazy. My onc and a RFA Dr said should have a liver resection, but 2 surgeons refused saying it is not in the "standards" and the next appointment I have with a surgeon is in a month. This one might say no also and even if he says yes, it is another month wait. I wanted to go back to RFA before the mets are too big and it is too late but my onc is speaking about Cyberknife. This is new for me. Most of the ladies on this site went for lung or brain mets. Liver?
Any information about that?
Michka

[Lani]

seemed to remember Esther going to Stanford for cyberknife of liver met(s)

used the search function above and found:
03-07-2008, 12:45 PM #1
Esther
Senior Member

Join Date: Sep 2005
Location: Riverside, CA
Posts: 484

Woohoo Cyberknife to the liver is over!!!
I was really sick and nauseated this morning and just hated to go in for my 5th and final cyberknife treatment for my liver. But guess what? As soon as it was over I perked right up, and was feeling fine. What a powerful tool your mind is, when I knew I was done, I just felt better.

We're packing up our stuff now and heading for Lake Tahoe, and in my new perky self is looking forward to a week-end of skiing, blackjack and 25 cent slots. Just the right treat to reward myself for going through the cyberknife.

I get to come right back to Stanford though....starting on Monday the 17th of March, I will have 3 treatments for the one bone met in my vertebrae, I always called it vertebrae, now Stanford is calling it in my "spine" go figure. Stanford has 12 MD's specializing in different areas of the body, so I saw an MD that will plan out my treatment plan to the bones, and because it is in my spine, I saws a neurosurgeon also, and did all the prep work yesterday. Saved me 2 trips here being able to take care of it all this week. Apparently if a blastic bone met presses against your spinal cord that is really bad, so blasting it with cyberknife should prevent that.

Have a great week-end everyone!

03-07-2008, 12:53 PM

[kk1]

Michka;

Have you or your Onc discussed adding Xeloda to your Tykerb/Hecepetin? particularly while you try to find a surgeon. This combination is fairly easy to tolerate and I have found that it can knock back the liver met into hiding for awhile.

kk1

[michka]

Of course I remember Esther. She was such a "shining" person.
Is this the only case we know? Is there a reason why Cyberknife may be more harmful than RFA for the liver? Or is it just newer?
KK1, yes, you are right if it takes too long. I asked for appointments in several places, o/w Miami :-) . I have to have dates and a plan next week.
Michka

[StephN]

I do know that Esther had her bile ducts clog from tumors not long before she passed. Maybe the cyberknife was good for one area of her liver, but I think certain areas are not possible for this procedure. If your tumor is in the right place, go for the CK.

Xeloda seems like a good idea. I also know Esther was on an early trial for that drug and it worked well for her for a long time.

Sorry you are still in the doctors' revolving door!

[michka]

There seems to be no answer to my question about Cyberknife and that worries me. There are dozens of Cyberknife installation now in the US and no one on this site except Esther was offered that. There must be a technical reason. RFA is more like a microwave from what I understand and not radiation? Or am I wrong?
Michka

[Lauriesh]

Hi Michka,

Yes, rfa uses microwave technology. I met with my interventional radiologist yesterday, who explained the procedure to me. I will be having it done the first week of March.

I had a consult at Mayo clinic and at Univ of Minnesota (where I am having it done) and when they discussed the options, cyberknife was never mentioned, so can't help you with that.

Good Luck

Laurie

[PatE]

Hi,
Sorry but I just saw your question, yes I had CK treatment to my liver in 2008. I had three treatments over a week span. My liver is clear, I have PET scans every three months and each one showed the tumor was getting smaller,at 9 months it was totally gone.
I have been on Herceptin almost continuously, my EF dropped to 30 in August 2009 so my Onc took me off for four months. I developed a met to L2 spine which was also treated by CK. Again after 6 months it was gone or "resolved" as the PET report read. I now have weekly Herceptin and my EF has stayed in the 50s. I am NED thanks to Herceptin and CK!
Cyberknife was very easy treatment, some fatigue and stiffness with the spine but I feel absolutely great now, I highly recommend the CK.

http://www.cksociety.org/patient-resources/default.aspx

At the above link, you can ask doctors questions about CK treatment.

Wishing you all the best
Pat

[PatE]

Cyberknife is new technology and that why I believe not many people are aware of the treatment. When CK was first introduced, it was mainly for brain, prostate treatment it has only been approved for other areas for a few years. There was a prostate study released recently that showed like a 90% cure rate at 5 years so its just starting to be recognized. As we know it takes time for our doctors to embrace new treatments, sometimes too much time.

During treatment a robot moves around you and delivers very precise beams of radiation so healthy tissue is not affected, because it is so precise it allows a much larger amount radiation to be used. I wish I could explain better to you but it is amazing!
Please check out their website, I know there are videos which explain much better than I could.
PatE

[Lori R]

Michka,
While it must be frustrating to feel as if you are not making immediate progress, you actually have made a significant amount!!

Just to validate the information you are receiving from the surgeons. I too have been told that resection is not the "standard", so that response is not uncommon. I am certain that if I want to puruse the resection path, I will have to be my own advocate and look outside of my current Drs. Definately will require pushing.

Hmmmm....Cyberknife vs RFA/Cryo. The advances made with Cyberknife provide for treating an organ that moves (liver) vs one that remains stable (brain). As you can imagine, treating a moving target is much more difficult. So....you want to make sure if you choose the Cyberknife route that you go to a VERY experienced location. You need to ask the Dr. how many times he/she has treated someone with a liver met, what the short term and long term outcome was. (there is so much $ associated with medicine in the U.S. I am always trying to ensure that the recommendation is in my best interest and not the interest of the facilities wallet)

My Onc. was not supportive of Cyberknife because the center here in Denver had just opened. Also, she indicated that Cyberknife kills the portion of the liver it treats.

As you know....we ultimately chose Cryo over RFA.

I have scans next week and if I come back NED, I will be more of a proponent of cryo.

Please think of any and all questions that you possibly can and take the list with you. Force the Drs. to give you answers so you can feel that you made an informed decision.

You are almost there with a decision!!!! Wishing you all the best!!

Lori

[Darlene Denise]

I have had brain mets treated with Cyberknife and have consulted about my liver. Although Cyberknife can treat some liver lesions, I'm not a fan of using radiation on the liver. I would lean towards Cyroablation or RFA. Cyro freezes the lesion and the ice ball formation is easily seen on CT to ensure that very little healthy liver tissue is damaged. There is also emerging data that this process generates an immune response. Due to my liver lesions locations, I am unable to use focalized treatments. I am glad this may be an option for you and wish you well.

Darlene

[Sheila]

Michka, No advice but sending love and lots of prayers and healing thoughts that a decision will bereached soon and you can continue to enjoy life~~

[StephN]

Joe told me that he was getting scheduled for cyberknife for a spot on his lung. That was going to be in a hospital he had great faith in, as they were early with providing cyberknife treatments.

In my case the large areas of tumors in my liver that were killed off by the chemo cocktail all regenerated. I do not even have any scar in those areas. Just a normal looking liver. My doctors say no one would believe my scan of Jan. 2002 and now are the same person.

Sending Hugs for Healing.

[Lani]

Cyberknife was invented by a neurosurgeon at Stanford and Stanford has been at the forefront of using Cyberknife technology for tumors other than brain tumors and brain mets. Esther was only one of many who have had tumors outside the brain treated there--they are constantly seeking to treat other tumors where pinpoint accuracy is required to avoid injuring adjacent structures.

From Stanford website:

History of Stanford CyberKnife
The original CyberKnife was developed at Stanford by John Adler, MD, where the first patient was treated in 1994.

The prototype unit was used between 1994 and 2001. The CyberKnife was approved by the FDA (U.S. Food and Drug Administration) in 2001, and the first FDA approved CyberKnife was installed at Stanford in October, 2001. Stanford opened its second CyberKnife in October of 2006 (the first institution in the world to have two CyberKnife units in operation).

The 1,000th CyberKnife patient at Stanford was treated in October 2003.

The 2,000th CyberKnife patient was treated in November 2005.

The 3,500th CyberKnife patient was treated in 2007.
The 4,500th CyberKnife patient was treated in September 2009
View a video on CyberKnife Frameless Stereotactic Radiosurgery and an interview with neurosurgeon Steven Chang, MD.

^^^

CyberKnife Frameless Stereotactic Radiosurgery
VIDEO

CyberKnife - Precise Radiation Treatment


view full-size video

The CyberKnife was invented at Stanford and is considered a major advance in the radiological treatment of cancer.

This device is commonly used for treatment of tumors in the brain or the base of the skull. Physicians at the Stanford Cancer Center also have experience using the CyberKnife to treat cancers of the pancreas, prostate and lungs.

With more experience than anyone in the world using the CyberKnife to deliver stereotactic radiosurgery, the Stanford CyberKnife Treatment Center is able to provide cutting-edge radiotherapy treatment for a wider variety of cancers than any other center.

CyberKnife stereotactic radiosurgery uses computer technology that allows doctors to deliver radiation with unprecedented precision, and without uncomfortable screws or frames that were previously used to immobilize patients during treatment.
^^^^^
CyberKnife Treatment
The CyberKnife is commonly used for treatment of tumors in the brain or the base of the skull. Stanford physicians also have experience using the device to treat cancers of the pancreas, prostate and lungs.

With more experience than anyone in the world using the CyberKnife to deliver stereotactic radiosurgery, the Stanford CyberKnife Treatment Center is able to provide cutting-edge radiotherapy treatment for a wider variety of cancers than any other center.

Click here to watch a video on Brain Tumors and Cerebrovascular Diseases by Dr. Steven D. Chang.

CyberKnife is used to treat the following tumors or lesions:

Arteriovenous malformation (AVM)
View a video of arteriovenous malformation and Stanford
Acoustic Neuroma
Acoustic Neuroma Support Group at Stanford
Astrocytoma/Glioma/GBM
Chordoma
Craniopharyngioma
Hemangioblastoma
Liver
Lung
Lung Cancer Clinical Trial
Meningioma
Metastatic Tumor
Brain Metastasis Clinical Trial
Nasopharynx
Oligodendroglioma / Medulloblastoma
Other Benign Tumors
Other Primary Tumors
Pancreas
Pituitary Adenoma (Cushing's Disease)
Prostate
Schwannoma
Spine
Click here to watch a video on Spinal Disorders by Dr. Stefan A. Mindea
Trigeminal Neuralgia
Trigeminal Neuralgia Clinical Trial

^^^^
and from WWW.businesswire.com:
STANFORD, Calif. - (Business Wire) 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.

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.”

About Stanford Hospital & Clinics

Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. Consistently ranked among the top institutions in the U.S. News & World Report annual list of “America's Best Hospitals,” Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. It is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford. For more information, visit http://stanfordmedicine.org.

Photos/Multimedia Gallery Available: http://www.businesswire.com/cgi-bin/mmg.cgi?eid=6436574〈=en

[Trish]

Steph,
As I understand your signature you have been NED with regard to your liver since 2002 following taxol/navelbine/herceptin with no resection, cryo-ablation or targeted radiation. Is that correct?
Thanks for the background on CK, Lani.
Good luck with your decision making, Mischka.
Trish

[StephN]

Trish -
Yes, I was not a candidate for any of the treatments for liver mets other than chemo and more chemo. My mets were widely scattered, too numerous to count and two of them were in the 5 to 7 cm size range.

I also appreciated the info Lani posted.

[Jackie07]

http://www.ncbi.nlm.nih.gov/pubmed/20689733

[Joan M]

Michka,

I'm sorry that you have to deal with all this information and coping with the cancer at the same time. I've been there, and it can be very stressful, especially if you're looking at treatments that many doctors do not consider standard of care for advanced, or metastatic, breast cancer.

Just wanted to mention that radiofrequency ablation uses radiowaves (not radiation or microwaves) to destroy a tumor by burning it and also perhaps causing an autoimmune response. As Lori mentioned, cryoablation freezes a tumor. Interventional radiologists use microwaves to attack tumors, but that's not RFA. It's another technology.

Why is the IR doc suggesting that you do a resection instead of RFA (or cryoablation)? I'm wondering about his reasoning. Sometimes there's difficulty with the position of the tumors, other times it may be because a tumor is too close to a blood vessel that in effect "cools off" the radiowaves, among other things.

Lani, thanks for the background info on CK.

Michka, I'm sending you a lot of hugs.

Joan

[Missyw]

Hi Michka,

I sought out cyberknife for my liver met in 2009. Unfortunately, due to the location of my tumor (next to the veina cava) they could not treat it with cyberknife. The doctor explained that in order to "seed" the tumor a tube muct be inserted into the liver to the site. In most cases the tube insertion can cause too much damage if it has to go a long way through the liver. If you have a site close to the surface or edge of the liver, it is much more treatable with cyberknife. I opted for a resection. Not a great option, but I would do it again if/when I have the chance. Two more years NED; what else can I say? I had the resection done at Georgetown Univ. hospital in Washington D.C. The doctor who performed the surgery is a liver transplant specialist, but he took me on when nothing else was out there for me. Again, due the location, heating or freezing was out. If I had the option, I think I would have held off on the resection and tried something less invasive first. Let me know if you need more information.

[Lauriesh]

I just wanted to clarify that rfa, at least at the Univ of Minn, where I am having my procedure done, now does use microwave technology. They said that they still refer to it as rfa, but the technology has changed, and microwave, while still heating the tumor to destroy it, is more precise than radiowaves.

I don't know if this is true all over the country, but I assume that the Univ of Minn is not the only facility now using microwave technology, but still referring to it as rfa.



Laurie

[PatE]

Hi,
Just to clarify my CK liver treatment, I had one liver met about 2cm. My Pet scan does not even mention my liver as an issue anymore and my liver function test have been been normal for quite some time now. CK worked wonders for me so please don't rule it out until you talk to a Rad Onc that is knowledgeable about CK.
Best of luck to you,
PatE