Cyberknife and sternum

[sarah]

Hello Michka,
Came across this in a search and Lacassagne in Nice is one of the main cancer hospitals in France, good luck:
[Article in French]
Thariat J, Li G, Angellier G, Marchal S, Palamini G, Rucka G, Bénézery K, Castelli J, Trimaud R, Mammar H, Marcie S, Gérard JP, Bondiau PY.
Source

Département d'oncologie-radiothérapie/IBDC CNRS UMR 6543, centre Antoine-Lacassagne, université de Nice - Sophia-Antipolis, 06189 Nice cedex 02, France. jthariat@hotmail.com

Abstract

Image-guided frameless fractionated stereotactic radiotherapy can be performed with millimetric accuracy using the CyberKnife (Accuray Inc. Sunnyvale, USA) equipped with an integrated tracking system for intra- and extracranial lesions. Highly conformal hypofractionated irradiation has been used to treat lesions with curative or palliative intent. It is advantageous for radioresistant tumors, re-irradiating lesions, boosting small volumes and treating tumors that move with respiration. It also limits travel costs and improves the quality of life. Over 60,000 patients have been treated worldwide using CyberKnife including 600 patients in the three French cancer centres of Nice, Nancy and Lille. These expert Cyberknife centres follow quality assurance programs and work together with the "Haute Autorité de santé" and the French National Cancer Institute (INCa) to promote clinical developments. The CyberKnife has been used to treat intracranial lesions including (but not limited to) meningiomas, acoustic schwannomas, brain oligometastases, as well as skull base tumors like chordomas, or para- or intraspinal tumors, and extracranial tumors such as lung cancers. Currently, extracranial stereotactic radiotherapy is particularly attractive for tumors moving with respiration and is being evaluated in liver, prostate and re-irradiation including head and neck tumors.

[michka]

Thanks Sarah! I sent a second message on the address that is in the article.
The problem with the French centers is that they have programs (skull or liver..) and when you come in with something different; they may say no because they are not financed for that study. I hope they will answer.
Otherwise I will try either Germany or NY.Michka

[michka]

Sarah; I just got an answer from NICE: NO it is not an indication.

De : pierre-yves.bondiau@nice.unicancer.fr

Copie Ã* : direction@nice.fnclcc.fr, Brigitte.GRANIER@nice.unicaMessage du : 29/06/2011ncer.fr
Sujet : Réf. : Réf. : Cyberknife et sternum

Bonjour Madame
malheureusement, Ã* priori ce n'est pas une indication
cordialement
PY Bondiau

Centre antoine Lacassagne
Responsable Cyberknife/Cyclotron
227 av de la Lanterne
06200 Nice

[Lani]

Mischka--bone "cement" is the same plastic they use to get hip and knee replacements to adhere to bone. It was initially invented by a dentist and is similar to the plastic they now use for fillings. It is officially called methylmethacrylate.

Your met is tiny (8mm) so just think of it as using a dental filling to fill it in.

Why fill it? The bone would not be substantially weakened by leaving it unfilled as you do not bear weight on your sternum, however, if they don't plug it with something it will bleed a lot more.

I think your imagination is getting the better of you. Osteonecrosis of the jaw occurs in about 2-8% of patients on bisphosphonates if I recall, so if you don't want the dental work be willing to take those chances. Life is full of choices and few of them are perfect. Do your homework (research what is known), set up a chart of risks vs benefits and assign percentages to each possibility and then apply your own personal "weighting" on how you feel about each course of treatment. Only you can prioritize what risks you are willing to take to avoid what potential down-side(dentistry etc)

The articles I sent references to discuss treatment of larger lesions and with other techniques than cement if I recall.

If you don't know all the possibilities you can't make out your chart and be sure you make the decision which fits you and your preferences best. Better to take the time to make the right decision now, than regret it later

Good luck!

[michka]

Thanks Lani. What got me upset is that my dentist did not want to fix the tooth although I did not even start biphosphonates! That's why I went to see him. Have everything checked, fixed and then start. He said he may leave something in the root and than it will be a mess.So I want the dental work but not just pulling out the tooth at this stage and leaving a big hole! This is terrible.
As for the sternum, I don't see why cyberknife wouldnt be better than cement. Or plastic. Maybe it is not possible but I would like a cyberknife specialist to explain.
Michka