Cyberknife and sternum

[michka]

I didn't get many answers about the way to treat my sternum met so I figure it is difficult. The met is "just" in the bone. It is a zone that has already been irradiated for "prevention" 5 years ago. Does anybody think it is a zone since it is still small that can benefit from Cyberknife? Michka

[Jackie07]

Michka,

The abstract below shows Cyberknife is effective in treating bone metastasis:

Urol Oncol. 2011 Apr 8. [Epub ahead of print]
Safety and feasibility of image-guided robotic radiosurgery for patients with limited bone metastases of prostate cancer.

Muacevic A, Kufeld M, Rist C, Wowra B, Stief C, Staehler M.
Source

Cyberknife Center Munich Grosshadern, Munich, Germany.

Abstract

OBJECTIVE:

To determine the safety and feasibility after image-guided single fraction robotic stereotactic radiosurgery (SRS) in patients with bone metastases of prostate cancer.
MATERIALS:

andmethods: Forty patients with 64 bone metastases of prostate cancer were prospectively enrolled in a single center study and underwent 54 consecutive outpatient single session SRS procedures during a 4-year period. F-18 choline PET/CT in addition to standard CT imaging was done prior to SRS in all patients. Nineteen patients were under anti-androgen therapy, 8 patients had undergone chemotherapy before SRS. Overall survival and freedom from local tumor recurrence was analyzed with the Kaplan-Meier method.
RESULTS:

Mean follow-up was 14 months (3-48 months). Seventy-five percent of patients had a single bone metastasis. The median tumor volume was 13 cc. The mean prescribed tumor dose was 20.2 Gy (16.5-22 Gy). Eight patients had died at the time point of the data analysis. The actuarial 6-months, 12-months, and 24-months local tumor control rate was 95.5% (95% CI: 83.0-98.8) as measured by MRI and PET CT imaging. The median initial PSA before SRS was 5.4 ng/dl (CI: 1.4-8.2) and dropped to 2.7 ng/dl (CI: 0.14-10) after 3 months. One case of progressive neurological deficits was documented.
CONCLUSIONS:

This first report on single session, image-guided robotic SRS documents a safe, feasible, and patient-friendly treatment option in selected patients with bone metastases of prostate cancer.

[hutchibk]

The best person to ask if your Radiation Oncologist, or the rads onc at your local Cyberknife clinic. I'd make an appt asap.

[michka]

I know it sounds crazy but there is no Cyberknife in Paris or in the region. I wrote to Nice in the south of France, To Germany and to Standford, CA. I am waiting for the answers. Michka

[Lien]

I believe Cyberknife is used in Germany at this clinic:

Ernst-Moritz-Arndt-Universität Greifswald
Domstraße 11
17487 Greifswald
Tel.: +49 (0)3834 86-0
Fax: +49 (0)3834 86-1248
pressestelle@uni-greifswald.de

Hope this helps. I'm trying to find out if there's cyberknife treatment in the Netherlands, so will let you know as soon as I find out.

Hugs

Jacqueline

[hutchibk]

Intensity Modulated Radiation Therapy or IMRT is essentially the same technology as Cyberknife. It is possibly offered in Paris. Perhaps at theInstitut Gustave-Roussy with the head of the Department of Radiotherapy, Professor François Eschwège.

[Lani]

IMRT is not the same as Cyberknife technology . They both aim to minimize damage to surrounding tissues that you do not wish to get irradiated but they do so using entirely different techniques/technologies.

if you use the search function on this site, I previously posted the difference between different techniques/technologies utilized by radiation oncologists

[SoCalGal]

I had radiation to my sternum (3) times - once in 1996, general area clean sweep, then again in 2006, along scar line light sweep and in 2009, more advanced and focused on manubrium of sternum. Never with the cyberknife because my mets are sprinkled not focused. Haven't had a pet in quite some time so who knows where I stand right now but I am using Xgeva in hopes of controlling/curing and preventing more bone mets. So far, no new areas. Hope this helps!

[Jackie07]

This link from IRSA states that Cyberknife can perform IMRT:

http://www.irsa.org/imrt.html

[PatE]

Hi,
IRMT is not the same as Cyberknife ... do not let anyone try to convince you otherwise. Cyberknife is capable of a much more precise beam so and also tracks the patient's breathing. Got the following information from the Accuray site, they also have a forum where patients can ask rad oncs questions about the treatment. I believe it is called Cyberknife Society.

Best Regards,
PatE

Locations in the Country of France

Centre Alexis Vautrin
54511 Avenue de Bourgogne
Nancy, Cedex France
Phone: +33 (0)3 83 59 84 00
Fax: +33 (0)3 83 44 60 71
Visit Our Website
Centre Antoine Lacassagne
33, avenue de Valombrose
Nice, cedex 2 06189 France
Phone: +33 (0)4 92 03 10 00
Fax: +33 (0)4 92 03 10 10
Visit Our Website

Centre Leon Berard
28 rue Laennec
Lyon, 69373 France
Phone: +330478782828
Visit Our Website

Centre Oscar Lambret
3 rue F. Combemale
Lille , Cedex F 59020 France
Phone: +33 (0)3 20 29 55 95
Fax: +33 (0)3 20 29 59 72
Visit Our Website

Regional University Hospital of Tours
2 boulevard Tonnellé - 37044 Tours France
Tours, 37044 Cedex 9 France
Fax: 00 33 2 47 47 60 12

[Joan M]

Michka,

I had mentioned in your other post that the sternum may be the only bone that a nodule can be removed surgically. But that depends on the size and position of the met, as well as other factors that I'm not aware of. You may want to ask a orthopedic surgeon where you had your liver surgery.

I know of somebody here in NYC who had this procedure done a few months ago for a breast cancer met in the sternum. She has limited disease.

Sending you a lot of hugs, and perhaps we can get together in the fall in Paris if all goes well with my PET/CT in a few days.

Joan

[michka]

I already got an answer from Germany. They said they could do it.
i know the center in Lille when I was considering it for my liver. The delay was 3 months minimum and they lost my scans and never answered my onc.. I don't feel comfortable there. I didn't try Tour. I will do so today. i hope Nice will answer. If you know a good place in NY, please give me the name.
Mu onc said they could put cement in the sternum. I almost dropped dead. I have a 8mm met, I figure there is better things to do, but fast.
I rushed to the dentist before I have biphosphonates. He did a panoramic radiography and he found a very small cavity that is not even visible from the outside. He said I had to have the tooth pulled out in a hospital and that it can't be replaced. I don't want that. His justification is that if he doesn't manage to clean a root 100% and that in a year or 2 it comes back then I will be in a real mess.Did you do that before biphosphonates? All this is too much for my small tomato brain.
Michka

[Joan M]

Michka,

Cement? Never heard of that one.

8mm is pretty small, which is good.

I sent you a PM with the contact information of the medical oncologist in Manhattan who authorized my friend's procedure.

I don't know anything about Zometa and Denusumab. Why can't the dentist just drill the cavity and fill it?

I recently had a root canal and will be getting a permanent cap on Friday. But on Monday, I was eating popcorn and broke one of my premolars, so I'm looking at another root canal and cap. The first one was to fill a large space that was irritating me, but too big to just replace and ancient filling. The broken tooth hurts when I chew.

I do not want my teeth pulled because my cancer cells could be lurking in my bone marrow, which is just one of the theories about where dormant exist. I don't want to take a chance. But here's an e-mail exchange that I recently had with a scientist in Philadelphia which mentions this topic:

Dear Joan,
I'm sorry for delayed reply. I've missed your message, because guestbook messages are not re-directed to my email box.
Thanks for your attention to my blog and for sharing your personal story.
Unfortunately I have no experience in clinical oncology. I have a personal interest in cancer stem cell research and I'm teasing out this a little in my leukemia experiments.
I think local procedures for prevention metastasis could help some patients, but there will be no guarantee. It's clear now that malignant cells could undergo dormancy and stay in this condition for years. We don't know what trigger their activation. It's big unknown right now. Some researchers associate cancer dormancy with cancer stem cells, but it's just a theory.
There are many new interesting experimental approaches proposed in the last 3 years for inhibiting metastatic process. Some of them were proposed for clinical trials.
According your question about a tooth. Nobody knows right now what can instigate dormant cancer cells. There are very few research done, which show that cancer cells can undergo dormancy in bone marrow. And if they stay in bone marrow, we have no idea in what bones (maybe never in jaw). As far as I know it's very much unclear where dormant cancer cells can hide in the body.* So, I'd advice you to go ahead and pull your tooth.
*******

Joan

[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

[hutchibk]

I didn't say they "were the same", but I also didn't say what I intended as precisely as I should have. They are similar technologies and if you have access to one but not the other, you will most likely get an equally good result. http://www.irsa.org/imrt.html

[sarah]

Hello Michka,
Too bad about Lacassagne. I don't think Tzanck in Mougins does it either but I'll be there next Wednesday and will ask.
Did you check Paoli Calmettes (spelling?) in Marseille?
Health and happiness,
sarah