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Publish Date: 8/18/2005

Martin Post, CyberKnife lead therapist, prepares Steve Russo to undergo CyberKnife Radiosurgery to kill a tumor in his lung Aug. 11 at The Rocky Mountain CyberKnife Center in Boulder. Times-Call/Erin McCracken
Health News Headlines

Without harming the surrounding area, CyberKnife gets an exact hit on tumors with 1,200 laser angles

BOULDER — Alone, they’re harmless.

Together, doctors call them “killing beams” — the radiation a CyberKnife targets from a hundred or more different angles on a tumor to scramble DNA and kill mutant cells.

Rocky Mountain CyberKnife Center in Boulder became the eighth medical facility in the nation to acquire this high-tech, FDA-approved device in February 2003.

Though the United States now has 27 CyberKnife facilities, the Boulder center remains Colorado’s only treatment site — something Steve Russo has appreciated every day for the past year.

The 52-year-old Boulder resident and his family — his wife, Colleen, their three grown children and 3-year-old granddaughter — all wear yellow Lance Armstrong bracelets to give them hope as he fights for life.

Last summer doctors used radiation, the CyberKnife and chemotherapy to treat a tumor in Russo’s left lung, as well as a mass and seven tiny tumors in his brain.

Though given a 5 percent survival rate, he celebrated being cancer-free by January.

Then, this summer doctors discovered a pea-sized tumor on his left adrenal gland, which releases hormones that influence organs and tissue throughout the body, according to the Mayo Clinic Web site.

Because of the tumor’s size, type and location near his kidney, Russo’s radiation oncologist recommended straight CyberKnife treatment.

“(Radiation oncologist) Dr. McNeely describes it as his ‘one-two- punch,’” Russo said.

Theory and strategy

CyberKnife earned that reputation with radiation oncologists and other CyberKnife team members for the way it compares with conventional radiation.

“It’s a rifle versus a shotgun,” said Melinda McIntyre, a nurse at Boulder CyberKnife.

Because conventional radiation cannot precisely configure to a tumor’s outline and dimensions, it targets a patch over the tumor.

“If you had a golf ball-sized tumor, you would be treating a baseball-sized field,” Mark Post, Boulder CyberKnife’s lead therapist, explained.

Depending on the sensitivity of the area — the brain versus the leg, for instance — the potential collateral damage to healthy cells and nearby organs can make the tumor untouchable. In other situations, the risk of radiating healthy tissue is acceptable.

The CyberKnife — pioneered by a Stanford University researcher and developed by Accuray, a Silicon Valley-based company — makes those issues moot.

Pretreatment CT scans feed data to sophisticated software applications, which map the tumor to calculate beam angles and radiation intensity.

The CyberKnife team uses either anatomical markers, such as an indentation on bone, or implants a 4-mm-long solid gold marker — it looks like a piece of thin pencil lead — to further target the spot.

Then, as the patient lies quietly on the table, the CyberKnife’s steel robotic arm moves with a Synchrony System — developed in part at the Boulder center — to accurately zap the tumor in real time with a complex system of cameras, motion-tracking software, fiber-optic sensing technology and infrared emitters.

This system makes asking patients to hold their breath during a dosage or wear a halo bolted to their skull to steady the body obsolete.

The CyberKnife compensates movement created by normal breathing, coughs, hiccups and sighs.

These tightly directed invisible radiation beams, when converted into a computer-generated image, look like porcupine quills stabbing the tumor.

In Russo’s case, doctors prescribed 91 beams to hammer his adrenal gland tumor.

“It’s where those beams crisscross, where they overlap, that the dose magnifies to the prescribed treatment,” Post said.

That creates submillimeter accuracy, he continued, that allows such deadly high-intensity exposure on the tumor.

Russo spent two hour-long sessions last Wednesday and Thursday under the CyberKnife, which compares with three to five weeks of Monday through Friday sessions of conventional radiation therapy.

The hardware

CyberKnife treatments happen in a large, nearly empty room with a gigantic robotic arm looming over a table customized to the patient’s backside.

“Basically, this is the same robot you see on the assembly line in Detroit with the welder on the end,” Post said.

Though anchored to the floor, the CyberKnife moves very much like a human arm with its joints operating along the lines of a shoulder, elbow, wrist and hand, though the radiation-emitting hand looks more like a suitcase.

During a treatment, the CyberKnife moves around the patient as if operating in the moon’s gravity-free zone. Given its 360-degree range of motion, 100 different program positions with 12 different beam angles, it gracefully accomplishes its potentially lifesaving seek-and-destroy mission.

All told, it can shoot beams from 1,200 positions.

The technology wowed Russo, a financial analyst who retired at age 50, a year before his initial cancer diagnosis.

But during last week’s treatments, he said he quietly focused on his family and the image of a fox eating his cancer cells.

He also pulled two CDs from his 3,000 CD collection — Pink Floyd’s “Wish You Were Here” on Wednesday and Jaawobble’s “Rising Above Bedlam” on Thursday — and turned them up in the house speakers as the CyberKnife blasted his tumor.

After the treatment, he and his wife shopped for cars for their son, Kevin, 21.

Only later that day did the expected mild aftereffects from the treatment catch up with him.

“I felt a little sick to my stomach. Nothing terrible. No worse than eating too much Mexican food,” he said. “And a little tired, too. I needed a nap.”

But Russo’s not complaining about the brief, bloodless and painless CyberKnife operation.

“If this happened to me three years ago (before CyberKnife’s Boulder debut), I’d be dead,” said Russo, who calls himself Miracle Man.

Pam Mellskog can be reached at 303-684-5224, or by e-mail at pmellskog@times-call.com.


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