There is a large misconception that lung cancer is a disease that only affects smokers, but in fact, lung cancer in people who have never smoked is the sixth most common cause of cancer deaths in the U.S.

• 10-15% of lung cancers occur in non-smokers
• Two-thirds of women who are diagnosed with lung cancer are non-smokers
• Lung cancer in non-smokers is different on a genetic, cellular and molecular level
• Lung cancer in non-smokers is treated the same way as it is in smokers

 Non-tobacco-related causes of lung cancer

• radon
• secondhand smoke
• asbestos exposure
• genetic disposition/heredity
• air pollution

Right Place, Right Time

When a diagnosis of cancer strikes, timing is everything. Richard D. was diagnosed with Stage I lung cancer in the form of a malignant tumor located in the lower lobe of the right lung. Not long after his diagnosis, Richard saw an ad for CyberKnife at Rothman Specialty Hospital in The Intelligencer newspaper. Richard’s primary oncologist had recommended that Richard consider CyberKnife, a non-invasive treatment method for tumors, because of his age and lung condition.

Finding the CyberKnife advertisement became the first step in the 81-year-old’s journey toward wellness. Richard contacted Rothman Specialty, where he talked to Barbara Fischer, RN, the CyberKnife program coordinator, and provided her with his physical history. Richard later commented, “From the beginning Barbara put me at ease, and I saw that I had no worries in this process.”

After the staff at Rothman Specialty determined Richard to be a prime candidate for CyberKnife treatment, he received an orientation tour from the CyberKnife therapists at Rothman Specialty Hospital, followed by a consult with Eric Gressen, MD, a radiation oncologist and CyberKnife treatment specialist who deals specifically with prostate and lung cancers.

Richard spoke at length with Dr. Gressen about the recommended treatment for his Stage 1 lung cancer diagnosis, asking what he could expect from the CyberKnife process before, during, and after treatment. Dr. Gressen and Shari Rudoler, MD, another CyberKnife specialist at Rothman Specialty Hospital, helped prepare Richard for the CyberKnife procedure, treatment and post-treatment effects, and discharge plan. Post-surgery effects can include general fatigue and tiredness and possible changes in skin appearance.

“I left the office after talking with Drs. Gressen and Rudoler feeling completely comfortable,” Richard says. “I put my life in their hands, no problem.”

Richard’s CyberKnife treatment consisted of four radiosurgery treatments spread out over a 10-day period. The CyberKnife treatment method zeros in on a mass, targeting it with up to 200 beams of low dose irradiation, effectively “painting” the tumor with a prescribed dose of radiation.

Because of the accuracy and concentration of the radiation delivered, patients typically need only 3-5 radiation treatments versus 35-40 treatments for traditional radiation therapy, which is generally delivered 5-days a week over a 7-8 week period.

“This has been a fantastic experience for me and I have nothing but positive things to say about the team and their operative capabilities,” Richard says. “This is one of the best multi-disciplinary teams I’ve ever seen. They were marvelous.”

CyberKnife at Rothman Specialty Hospital

3300 Tillman Drive

Bensalem, PA 19020

(215) 244-7407

www.rothmancyberknife.com

Serendipitous Timing

Surgery is not an option anyone makes lightly. For more than a year, Robert M. dealt with pain, numbness, and electrical activity in his right leg. As a result, he could not stand for more than five minutes nor walk 50 yards without needing to sit down. On June 6, Robert entered the hospital for removal of a cyst located at the right branch of the sciatic nerve.

The routine surgery quickly turned into a revelation that neither Robert nor his surgeon expected. The suspected cyst was actually a schwannoma, a noncancerous tumor inside the nerve sheath. This discovery brought Robert’s surgical procedure to an abrupt end.

While Robert lay in the hospital recovery area, his surgeon called over Dr. Shari Rudoler, a CyberKnife surgeon at Rothman Specialty Hospital, who was walking through the recovery area at that moment. Robert’s surgeon asked Dr. Rudoler to speak with him about the innovative CyberKnife procedure for the treatment of his tumor.

CyberKnife is the first frameless robotic radiosurgery system that can destroy tumors or other lesions without the need for open surgery. The CyberKnife radiosurgery results in no incisions or anesthesia, no pain or bleeding, lower risk of complications, no hospital stays, and faster recovery times. On average, each treatment session lasts 30-90 minutes.

Intrigued by his recovery room conversation with Dr. Rudoler, Robert began to further research the non-invasive CyberKnife technology. He also spoke with friends who had chosen to treat tumors with conventional radiation treatments. One friend recounted to Robert that he had 45 treatments over a 12-week period to treat prostate cancer. Robert weighed the option taken by his friend against CyberKnife’s recommended one to five sessions and quick recovery time. For Robert, the option of CyberKnife over conventional radiation was the right choice for him.

Robert chose the CyberKnife program at Rothman Specialty Hospital to begin his two-step CyberKnife treatment. The first step began with Dr. Rudoler mapping the tumor, followed by a targeted radiation treatment. Because of an open schedule that day at Rothman Specialty Hospital, Robert was able to have the two-step process completed the same day in a one-time, 20-minute treatment. Robert returned to Rothman Specialty Hospital in July for a check-up with Dr. Rudoler. At the appointment, Dr. Rudoler shared the news that the CyberKnife treatment had successfully destroyed the tumor. Today Robert reports that he is 90% symptom-free and is back to working out at the gym.

“I had heard the ads on the radio and TV before I needed CyberKnife,” Robert says. “As I learned more about CyberKnife and experienced the treatment, I believe CyberKnife to be one of the greatest technological innovations in the history of medicine.”

CyberKnife at Rothman Specialty Hospital
3300 Tillman Drive
Bensalem, PA 19020
(215) 244-7407
www.rothmancyberknife.com

Q: I am currently on or have been on chemotherapy. Am I eligible for a CyberKnife treatment?

A: The CyberKnife System can treat patients that have either gone through chemotherapy or are currently undergoing chemotherapy. It is important for the patient to provide their physician with a complete medical history, so to the physician can prescribe the appropriate treatment course.

Q: I have had radiation or proton therapy. Am I still eligible for a CyberKnife treatment?

A: The CyberKnife System can treat patients that have either gone through radiation therapy or are currently undergoing radiation therapy. It is important for the patient to provide their physician with a complete medical history, so the physician can prescribe the appropriate treatment course.

Q: How much does a CyberKnife treatment cost?

A: During the consultation process, the CyberKnife staff will tell the patient how much the CyberKnife treatment costs.

Q: What side effects can I expect after a CyberKnife treatment? 

A: Most patients experience minimal to no short-term side effects and often recover quickly. Depending on the treatment site, some patient’s may experience different side effects such as mild fatigue or nausea. The CyberKnife physician will disclose all possible side effects prior to treatment.

Q: After treatment, when will my tumor or lesion disappear? 

A: The effects of radiosurgery vary and may occur gradually and over time. The timeframe can range from days, months or years depending on the medical condition targeted. Some tumors may disappear slower than others or may simply stop growing and present no further cell activity. After treatment, patients typically are asked to get periodic images (CAT scan or MRI) of their tumor(s) and additional tests may be required, so the physician can monitor the effectiveness of the treatment. 

Q: How many times can I receive a CyberKnife treatment?

A: The frequency of treatments depend on where the tumor is located and what type of tumor is being treated. Most cases can receive multi-treatments or can be re-treated with the CyberKnife System.

The treatment options available vary according to the specific cancer and its location. In general, the treatments can be divided into the following categories:

Radiosurgery:
Radiosurgery, also known as stereotactic radiosurgery, is a form of radiation and despite its name, is not surgery. It is designed to precisely destroy a tumor or lesion by delivering a very high dose of radiation to the tumor in 1 to 5 treatments over a treatment course of 1 to 5 days. Patients are not required to be hospitalized during treatment and the procedure is almost always performed on an outpatient basis.

Radiation therapy:
Radiation therapy is a form of radiation that is usually delivered 5 days a week over a treatment course of 6 to 8 weeks. Radiation therapy, (as opposed to stereotactic radiosurgery), usually treats larger areas that include not only the tumor, but large amounts of healthy tissue, increasing the risk of possible complications. Patients are not required to be hospitalized during treatment and the procedure is almost always performed on an outpatient basis.

Brachytherapy:
Brachytherapy is a specialized form of radiation therapy that requires the surgical placement of small radioactive sources in and around a tumor. The radioactive sources can be implanted either temporarily or permanently, depending on the nature of the source used. Low dose rate brachytherapy (LDR) delivers a prescribed dose over a longer period of time. Radioactive sources are usually implanted permanently. High dose rate brachytherapy (HDR) uses a different source type that delivers dose over a shorter period of time, therefore HDR sources are usually implanted temporarily. Brachytherapy has been used to treat a wide variety of cancers including prostate, breast, lung, head and neck cancers.

Cryoablation:
With Cyroablation, which is also called cryotherapy, a probe is inserted through the skin and into the tumor to freeze the tumor and kill its cells. Placement of the probe requires an incision and can be performed either on an inpatient or outpatient basis depending on the tumor being treated.

High Intensity Focused Ultrasound (HIFU):
HIFU uses a focused ultrasound beam to kill tissue containing cancer cells. It is not FDA approved in the United States, but has been used to treat prostate cancer in Europe.

Surgery:
Surgery or surgical resection is an invasive procedure that requires an incision to remove or cut the tumor out of the body.   Surgery can be performed on an inpatient or outpatient basis depending on the tumor being treated.  Because of the invasiveness of some types of surgery, some patients may be excluded from receiving this type of treatment.

Frequently Asked Questions about CyberKnife Radiosurgery

Q: What is the CyberKnife System?

A: The CyberKnife® Robotic Radiosurgery System is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the head, spine, lung, prostate, liver and pancreas.  The treatment delivers beams of high-dose radiation to tumors with extreme accuracy.

Q: Does the CyberKnife procedure require actual cutting?

A: Though its name may conjure images of scalpels and surgery, the CyberKnife treatment involves no cutting. In fact, the CyberKnife System is the world’s first and only robotic radiosurgery system designed to treat tumors throughout the body non-invasively.  It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery.

Q: How is a CyberKnife “radiosurgery” treatment different from traditional radiation therapy treatment?

A: Traditional radiation therapy typically delivers radiation to a wide field of tissue in the body resulting in the treatment of both the tumor and a large amount of surrounding healthy tissue.  This is necessary because traditional radiation therapy systems did not account for tumor motion and were therefore much less accurate.  These wide radiation fields increased the possibility of damage to normal tissue, increasing the risk of side effects following the radiation treatment.  To reduce the number of side effects, clinicians were forced to rethink the way traditional radiation therapy was delivered.  As a result, the overall radiation dose was reduced and the number of treatments was divided into 30 to 40 sessions, delivered over a period of weeks.

Radiosurgery devices, such as the CyberKnife Robotic Radiosurgery System, were designed to deliver radiation with extreme accuracy, targeting the tumor with minimal damage to the surrounding healthy tissue.  The accuracy of the CyberKnife System allows clinicians to deliver very high doses of radiation safely because the size of the radiation field is smaller and only includes the tumor and a small amount of surrounding tissue.  This allows for less damage to surrounding healthy tissue and for clinicians to complete treatment in 1 to 5 days vs. the weeks it takes traditional radiation therapy.

Q: Are there other ways that the CyberKnife System differs from other radiosurgery systems? 

A: Many tumors, even when their movement has been restricted, have been proven to move during treatment delivery. Using advanced robotic technology and the ability to track the tumors movement throughout the treatment, the CyberKnife System can deliver radiation with extreme accuracy while automatically correcting for tumor movement without interrupting the treatment or having to reposition the patient.

Q: How is CyberKnife different than traditional radiation methods?

A: Unconstrained by the clockwise/counterclockwise gantry rotations of conventional radiotherapy systems, the robotic mobility of the CyberKnife System enables it to treat from a variety of angles without clinician intervention or treatment interruption.

Q: How does CyberKnife spare healthy tissue?

A: Without the limitations of conventional respiratory gating and breath-holding techniques, the CyberKnife System delivers radiation beams that adjust in real-time with a patients breathing cycle. By dramatically reducing the planning margins to only that which are clinically relevant, the CyberKnife System’s ability to minimize damage to the surrounding healthy tissue is unmatched.