New York Times Article - Response on Radiation Therapy and Cyberknife Radiosurgery

A Jan. 24 article in the New York Times detailed the stories of two cancer patients who were injured during radiation therapy treatments. The treatment errors these patients suffered are tragic. It’s important to remember that they also are extremely rare. No patient should refuse to undergo radiation therapy out of concern about the safety of the procedure.

Radiation therapy is a proven treatment. Used alone or in combination with other treatments, radiation therapy can ease pain, control the spread of cancer and, in many cases, cure patients of their disease. Nearly two-thirds of all U.S. patients diagnosed with cancer receive radiation therapy – more than 1 million patients per year. With each patient receiving an average course of 29 radiation therapy treatments, that means nearly 30 million treatments are delivered annually in the United States.

An entire team of medical professionals works to develop a customized treatment plan for each cancer patient. The radiation therapist is the team member who operates the equipment that delivers the prescribed, targeted dose of radiation to the patient. Registered radiation therapists are skilled specialists who have graduated from a rigorous educational program in radiation therapy and passed a national certification examination that demonstrates their knowledge of radiation biology and safety, patient anatomy and physiology, and patient care. They also must complete continuing education coursework to maintain their registration. The radiation therapist’s goal is to deliver an effective dose of radiation to the tumor while reducing damage to normal tissue that surrounds it.

Although radiation therapists are licensed in New York, 17 other states do not require individuals to hold a license in order to deliver radiation therapy. For over the last 10 years, the American Society of Radiologic Technology (ASRT) has lobbied for the U.S. Congress to pass the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy bill (H.R. 3652). The CARE bill establishes minimum educational and certification standards for all health care workers who perform medical imaging examinations or who plan or deliver radiation therapy. The accuracy and quality of these procedures are directly related to the competency and qualifications of the personnel who provide them.

The errors such as those described in the New York Times article, while rare, must be reported and investigated so that others may learn from them. Rigid controls must be in place at every radiation therapy facility to ensure the accuracy of treatments. Radiation therapy is an important tool in the battle to control, contain and cure cancer. Thanks to the care provided by registered radiation therapists, millions of Americans are cancer survivors.

Before seeking treatment, it is important to check on accreditation. Our facility is fully accredited by the American College of Radiation Oncology (ACRO). We exceed the minimum set standards for Radiation Oncology and Quality Assurance. We are held to a much higher level and treat in a manner that reflects these standards. Be sure to ask any facility that you visit if they are accredited by ACRO. It makes a difference...

Liver Cancer Treatment Using Cyberknife

Treating liver cancer with radiation therapy is a challenge because liver tumors move with respiration. In addition the tissue surrounding the liver tumors is very sensitive and can be damaged easily. The CyberKnife Radiosurgery System at Cyberknife of Long Island is able to deliver very high doses of radiation to both primary and metastatic liver tumors with extreme accuracy. Working in conjunction with the CyberKnife System is the Synchrony® Respiratory Tracking System, which enables the radiation beam to track tumor movement in real time and allows patients to breathe normally during their treatment sessions. With the CyberKnife System, doctors can zero in on a moving target - the liver tumor - and irradiate it without harming the healthy surrounding tissue. As a result, the CyberKnife treatment is more comfortable for patients, radiation is delivered more accurately and treatments can be completed in one to five sessions.



Liver cancer treatment with the CyberKnife System involves a team approach, in which several specialists participate. A team may include:

a Radiation Oncologist
a General Surgeon
a Medical Oncologist
a Medical Physicist
a dedicated Cyberknife Nurse Coordinator
a Radiation Therapist
medical support staff

Once the team is in place, the patient will begin preparation for CyberKnife treatment.

The CyberKnife treatment generally involves four steps:

1. Fiducial placement
2. Set-up and imaging
3. Treatment planning
4. CyberKnife treatment

During the first step, the patient is scheduled for a short outpatient procedure in which three to six fiducials - tiny gold seeds each about the size of a grain of rice - are inserted into and around the liver tumor using CT guidance, ultrasound or via a camera that is passed through the mouth into the stomach and small intestine. The CyberKnife System uses those fiducial markers as reference points to identify the exact location of the tumor during treatment. Once fiducials are implanted, the patient must wait approximately one week before CyberKnife treatment planning can begin to ensure that fiducial movement has stabilized.

During set-up and imaging, the patient will be fitted for a custom body cradle, which is designed to help keep him or her more comfortable and ensures consistent positioning for both imaging and treatment. The patient also will be fitted with a special Synchrony vest, which is worn during CyberKnife treatment and enables the robot to correlate chest motion and breathing patterns with the tumor position. The data generated with the vest allows the CyberKnife robot to precisely follow the tumor's motion as it delivers each beam of radiation, ensuring safe and accurate radiation delivery.
While wearing the vest and positioned in the cradle, the patient then will undergo a series of CT imaging studies, which will enable the CyberKnife team to determine the exact size, shape and location of the tumor. An MRI or PET-CT scan also may be necessary to fully visualize the tumor, liver and nearby anatomy. Once the imaging is done, the Synchrony vest and body cradle will be stored for use during CyberKnife treatment.

Next a treatment plan will be specifically designed by a medical physicist in conjunction with the patient's doctors. The patient does not need to be present at this time. During treatment planning, the imaging data is downloaded into the CyberKnife System's software. The medical team determines the size of the area being targeted by radiation and the radiation dosage, as well as identifying critical structures where radiation should be minimized. Each patient's unique treatment plan will take full advantage of the CyberKnife System's extreme maneuverability, allowing for a safe and accurate liver cancer treatment.
After a treatment plan is developed, the patient returns to the CyberKnife center for treatment. Doctors may choose to deliver the liver cancer treatment in one session, or stage it over several days. Liver cancer treatments are typically completed within one week.

For most patients, the CyberKnife treatment is a completely pain-free experience. Patients dress comfortably in their own clothes and, depending on the treatment center, they may be allowed to bring music to listen to during the treatment. Patients also may want to bring something to read while they wait, and have a friend or family member with them to provide support before and after treatment.

When it is time for treatment, the patient will be asked to put on their Synchrony vest and lie on their custom body cradle. The radiation therapist will ensure the vest is properly adjusted and that the patient is positioned correctly on the treatment couch.
As treatment begins, the location of the liver tumor will be tracked and detected continually as the patient breathes normally. The medical team will be watching every step of the way as the CyberKnife System tracks the patient's liver tumor as it moves, and safely and precisely delivers radiation to it.

The CyberKnife System's computer-controlled robot will move around the patient's body to various locations from which it will deliver radiation. At each position, the robot will stop. Then, special software will determine precisely where the radiation should be delivered by correlating the location of the tumor using digital images of the fiducials and information from the Synchrony vest. The CyberKnife's robotic arm will adjust the radiation source automatically, to follow the liver tumor as it moves. Nothing will be required of the patient during treatment, except to relax and lie as still as possible.

Once treatment is complete, most patients quickly return to their daily routines with little interruption to their normal activities. If treatment is being delivered in stages, the patient will need to return for additional treatments over the next several days as determined by their doctors. After CyberKnife treatments, most patients experience minimal side effects, which typically go away within the first week or two after treatment. Doctors will discuss all possible side effects prior to treatment. In addition, doctors may prescribe medication to control any side effects, should they occur.

After completing CyberKnife radiosurgery treatment, it is important for the patient to schedule and attend any follow-up appointments. The patient should be aware that his or her tumor will not suddenly disappear. Response to liver cancer treatment varies from patient to patient. It could take several months or longer to determine the effectiveness of the CyberKnife treatment. Doctors will monitor the outcome in the months and years following a patient's treatment through physical exams, blood tests and imaging techniques, such as CT or PET-CT scans.

Let the expert team at CyberKnife of Long Island explain the technology and provide information on this exciting new treatment option. You can also view videos of this treatment for a better understanding of how CyberKnife works. A downloadable PDF Brochure is also available.

Liver Cancer Treatment Using Cyberknife

Treating liver cancer with radiation therapy is a challenge because liver tumors move with respiration. In addition the tissue surrounding the liver tumors is very sensitive and can be damaged easily. The CyberKnife Radiosurgery System at Cyberknife of Long Island is able to deliver very high doses of radiation to both primary and metastatic liver tumors with extreme accuracy. Working in conjunction with the CyberKnife System is the Synchrony® Respiratory Tracking System, which enables the radiation beam to track tumor movement in real time and allows patients to breathe normally during their treatment sessions. With the CyberKnife System, doctors can zero in on a moving target - the liver tumor - and irradiate it without harming the healthy surrounding tissue. As a result, the CyberKnife treatment is more comfortable for patients, radiation is delivered more accurately and treatments can be completed in one to five sessions.



Liver cancer treatment with the CyberKnife System involves a team approach, in which several specialists participate. A team may include:

a Radiation Oncologist
a General Surgeon
a Medical Oncologist
a Medical Physicist
a dedicated Cyberknife Nurse Coordinator
a Radiation Therapist
medical support staff

Once the team is in place, the patient will begin preparation for CyberKnife treatment.

The CyberKnife treatment generally involves four steps:

1. Fiducial placement
2. Set-up and imaging
3. Treatment planning
4. CyberKnife treatment

During the first step, the patient is scheduled for a short outpatient procedure in which three to six fiducials - tiny gold seeds each about the size of a grain of rice - are inserted into and around the liver tumor using CT guidance, ultrasound or via a camera that is passed through the mouth into the stomach and small intestine. The CyberKnife System uses those fiducial markers as reference points to identify the exact location of the tumor during treatment. Once fiducials are implanted, the patient must wait approximately one week before CyberKnife treatment planning can begin to ensure that fiducial movement has stabilized.

During set-up and imaging, the patient will be fitted for a custom body cradle, which is designed to help keep him or her more comfortable and ensures consistent positioning for both imaging and treatment. The patient also will be fitted with a special Synchrony vest, which is worn during CyberKnife treatment and enables the robot to correlate chest motion and breathing patterns with the tumor position. The data generated with the vest allows the CyberKnife robot to precisely follow the tumor's motion as it delivers each beam of radiation, ensuring safe and accurate radiation delivery.
While wearing the vest and positioned in the cradle, the patient then will undergo a series of CT imaging studies, which will enable the CyberKnife team to determine the exact size, shape and location of the tumor. An MRI or PET-CT scan also may be necessary to fully visualize the tumor, liver and nearby anatomy. Once the imaging is done, the Synchrony vest and body cradle will be stored for use during CyberKnife treatment.

Next a treatment plan will be specifically designed by a medical physicist in conjunction with the patient's doctors. The patient does not need to be present at this time. During treatment planning, the imaging data is downloaded into the CyberKnife System's software. The medical team determines the size of the area being targeted by radiation and the radiation dosage, as well as identifying critical structures where radiation should be minimized. Each patient's unique treatment plan will take full advantage of the CyberKnife System's extreme maneuverability, allowing for a safe and accurate liver cancer treatment.
After a treatment plan is developed, the patient returns to the CyberKnife center for treatment. Doctors may choose to deliver the liver cancer treatment in one session, or stage it over several days. Liver cancer treatments are typically completed within one week.

For most patients, the CyberKnife treatment is a completely pain-free experience. Patients dress comfortably in their own clothes and, depending on the treatment center, they may be allowed to bring music to listen to during the treatment. Patients also may want to bring something to read while they wait, and have a friend or family member with them to provide support before and after treatment.

When it is time for treatment, the patient will be asked to put on their Synchrony vest and lie on their custom body cradle. The radiation therapist will ensure the vest is properly adjusted and that the patient is positioned correctly on the treatment couch.
As treatment begins, the location of the liver tumor will be tracked and detected continually as the patient breathes normally. The medical team will be watching every step of the way as the CyberKnife System tracks the patient's liver tumor as it moves, and safely and precisely delivers radiation to it.

The CyberKnife System's computer-controlled robot will move around the patient's body to various locations from which it will deliver radiation. At each position, the robot will stop. Then, special software will determine precisely where the radiation should be delivered by correlating the location of the tumor using digital images of the fiducials and information from the Synchrony vest. The CyberKnife's robotic arm will adjust the radiation source automatically, to follow the liver tumor as it moves. Nothing will be required of the patient during treatment, except to relax and lie as still as possible.

Once treatment is complete, most patients quickly return to their daily routines with little interruption to their normal activities. If treatment is being delivered in stages, the patient will need to return for additional treatments over the next several days as determined by their doctors. After CyberKnife treatments, most patients experience minimal side effects, which typically go away within the first week or two after treatment. Doctors will discuss all possible side effects prior to treatment. In addition, doctors may prescribe medication to control any side effects, should they occur.

After completing CyberKnife radiosurgery treatment, it is important for the patient to schedule and attend any follow-up appointments. The patient should be aware that his or her tumor will not suddenly disappear. Response to liver cancer treatment varies from patient to patient. It could take several months or longer to determine the effectiveness of the CyberKnife treatment. Doctors will monitor the outcome in the months and years following a patient's treatment through physical exams, blood tests and imaging techniques, such as CT or PET-CT scans.

Let the expert team at CyberKnife of Long Island explain the technology and provide information on this exciting new treatment option. You can also view videos of this treatment for a better understanding of how CyberKnife works. A downloadable PDF Brochure is also available.

Is Cyberknife Treatment for me?

CyberKnife of Long Island is the first of its kind in Suffolk County. In fact, it is only one of three operating in New York State. This investment means that people who have been diagnosed with tumors and other medical conditions previously considered inoperable can now be treated. Cyberknife is also a treatment option for many cancers that previously required surgery, these include the following:

Brain
Cyberknife provides finite radiosurgical technology for tumors of the brain.

Spine
Many of the conditions that occur in the brain also occur in the spine and CyberKnife has marked advantages over other radiosurgical techniques in that it is capable of targeting spinal lesions.

Lung
Single or several tumours in the lung may be treated by single or only three fractions of CyberKnife radiation therapy.

Prostate
CyberKnife now offers a method to treat prostate cancers while limiting some of the side effects associated with other treatment techniques. This is done with far fewer visits to the center for standard therapy (Imagine 5 short pain-free visits instead of 44!).

Pancreas
CyberKnife allows for very high doses of radiation to the tumor while sparing surrounding organs.

Liver
A treatment that is able to spare the adjacent liver seems to be very successful.

Kidney
Renal cancer is one of the more radioresistant cancers and the need for higher radiation doses is restricted by the dose that surrounding tissues will tolerate. Radiation therapy by th CyberKnife System can be most useful in these situations. With its high degree of accuracy, CyberKnife is the optimal method of delivering an ablative radiation dose.

Other cancers
There are always cancer patients referred into the our center with sites of disease that have failed other therapies and remain as symptomatic sites of disease. The use of CyberKnife for metastases is an important advance.

Re-treatments
The ability of CyberKnife to deliver high doses of radiation to sites of cancer has led to the safer re-treatment of cancers that may have re-curred after previous radiotherapy.

Let the expert team at CyberKnife of Long Island explain the technology and provide information on this exciting new treatment option. You can also view videos of this treatment for a better understanding of how CyberKnife works. A downloadable PDF Brochure is also available.

Is Cyberknife Treatment for me?

CyberKnife of Long Island is the first of its kind in Suffolk County. In fact, it is only one of three operating in New York State. This investment means that people who have been diagnosed with tumors and other medical conditions previously considered inoperable can now be treated. Cyberknife is also a treatment option for many cancers that previously required surgery, these include the following:

Brain
Cyberknife provides finite radiosurgical technology for tumors of the brain.

Spine
Many of the conditions that occur in the brain also occur in the spine and CyberKnife has marked advantages over other radiosurgical techniques in that it is capable of targeting spinal lesions.

Lung
Single or several tumours in the lung may be treated by single or only three fractions of CyberKnife radiation therapy.

Prostate
CyberKnife now offers a method to treat prostate cancers while limiting some of the side effects associated with other treatment techniques. This is done with far fewer visits to the center for standard therapy (Imagine 5 short pain-free visits instead of 44!).

Pancreas
CyberKnife allows for very high doses of radiation to the tumor while sparing surrounding organs.

Liver
A treatment that is able to spare the adjacent liver seems to be very successful.

Kidney
Renal cancer is one of the more radioresistant cancers and the need for higher radiation doses is restricted by the dose that surrounding tissues will tolerate. Radiation therapy by th CyberKnife System can be most useful in these situations. With its high degree of accuracy, CyberKnife is the optimal method of delivering an ablative radiation dose.

Other cancers
There are always cancer patients referred into the our center with sites of disease that have failed other therapies and remain as symptomatic sites of disease. The use of CyberKnife for metastases is an important advance.

Re-treatments
The ability of CyberKnife to deliver high doses of radiation to sites of cancer has led to the safer re-treatment of cancers that may have re-curred after previous radiotherapy.

Let the expert team at CyberKnife of Long Island explain the technology and provide information on this exciting new treatment option. You can also view videos of this treatment for a better understanding of how CyberKnife works. A downloadable PDF Brochure is also available.

The Synchrony Respiratory Tracking System

This revolutionary system is designed to track tumor movement during breathing. The patient wears a vest or a simple "Under Armor" T-Shirt and during treatment. The shirt/vest tracks tumor motion, directing the linear accelerator to deliver highly accurate radiation beams to the moving tumor. The Synchrony System constantly updates its correlation model with each new X-ray image, automatically correcting for any changes in the patient’s breathing patterns. The custom-designed Vest and Tracking Markers allows for simplified patient setup and marker placement, especially for multi-fraction treatments where the Vest and Markers rarely need to be adjusted. Patients are directed to breathe normally throughout treatment delivery. Tumors that can be treated with the Vest and Markers include tumors in the Lungs, Pancreas, Kidney, or Liver.

The Synchrony Respiratory Tracking System

This revolutionary system is designed to track tumor movement during breathing. The patient wears a vest or a simple "Under Armor" T-Shirt and during treatment. The shirt/vest tracks tumor motion, directing the linear accelerator to deliver highly accurate radiation beams to the moving tumor. The Synchrony System constantly updates its correlation model with each new X-ray image, automatically correcting for any changes in the patient’s breathing patterns. The custom-designed Vest and Tracking Markers allows for simplified patient setup and marker placement, especially for multi-fraction treatments where the Vest and Markers rarely need to be adjusted. Patients are directed to breathe normally throughout treatment delivery. Tumors that can be treated with the Vest and Markers include tumors in the Lungs, Pancreas, Kidney, or Liver.