For more details about the side effects of your radiation therapy, and if treatment with an Accuray product is right for you, ask your doctor. TO Christine Tejada and her family in Brooklyn, the procedure known as Gamma Knife radiosurgery is nothing short of a miracle. When she was 8, Christine was found to have a life-threatening blood vessel malformation in her brain and was scheduled to undergo risky invasive surgery that would have hospitalized her for perhaps 10 days and been followed by weeks or months of recovery and rehabilitation.
Instead, she was treated successfully in Chicago without so much as a slit in her scalp. The treatment, which involves no knife at all but rather hundreds of powerful, highly focused radiation beams aimed at the malformation, was done on a Thursday, she left the hospital on Friday and was back at school and up to her old tricks by Monday. Gamma Knife surgery, technically known as stereotactic radiosurgery, is revolutionizing the treatment of some problems in the brain, including benign tumors in treacherous locations, like the brain stem or near the optic nerve.
The patient wears a helmet resembling a beauty salon hair dryer. The helmet has small round holes in it that aim the radiation so that narrow beams of gamma rays are all aimed at a single tiny target. The tissue being treated thus receives a very strong dose of radiation without harming anything along the way. Radiosurgery is also appealingly cost-effective, its proponents say. Although the procedure usually requires a team of specialists — neurosurgeon, radiation oncologist and radiation physicist — hospital stays are 70 percent to 90 percent shorter than with conventional surgery, there is no need for intensive postoperative care or long rehabilitation, and patients can get back to work in a few days.
About 20, patients in the United States have undergone radiosurgery so far, and tens of thousands more have been treated in Europe and Asia. It is also being used to control cancers that have spread to the brain from elsewhere in the body and, in combination with traditional surgery, it can stem the growth of malignant brain tumors that cannot be completely removed with a scalpel.
Lunsford said that in 50, to 60, patients each year, treated cancers spread to the brain, even when no trace of the disease remained elsewhere in the body. He predicted that stereotactic radiosurgery would replace other treatments, including traditional surgery, to control these brain metastases. In Dr. Obliterating arteriovenous malformations is a leading use for the Gamma Knife, even though there is a chance the blood vessels will continue to bleed for up to two years, until the defective vessels are completely blocked off.
The effects of radiosurgery occur over a period of days to years after a single treatment. With traditional surgery, the defect can usually be eliminated on the spot, but after radiosurgery the tangles of vessels close off and are gradually destroyed, and periodic CT scans or M. The Gamma Knife has also been used to treat cancers of the eye and benign tumors of the pituitary gland at the base of the brain. The Gamma Knife was developed in by a Swedish neurosurgeon, Dr. But its application had to await brain imaging techniques like the CT scan and M.
Through years of experimentation, Dr. Leksell put together an instrument that emitted gamma-ray beams from a cobalt source and focused them all, through a protective helmet, on a single point as small as three-tenths of a millimeter wide. The first treatment unit was installed in Stockholm in , where it was successful in safely and noninvasively destroying tumors and other abnormalities in the brain.
There are now 20 Gamma Knife units operating in the United States; 10 others have been bought but are awaiting various administrative or construction details. One of these is to be installed at New York University Hospital this fall. Experts estimate that it takes at least radiosurgical procedures a year for such a purchase to make economic sense.
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Patrick Kelly, chief of neurosurgery at New York University Hospital, expects that patients a year will be candidates for radiosurgery in the greater New York area. Many states, including New York, require that hospitals obtain a permit, officially known as a certificate of need, before an instrument like the Gamma Knife can be installed. Citing what he regards as the main drawback of the Gamma Knife, Dr. Kelly, who honed his enthusiasm for the instrument at the Mayo Clinic in Rochester, Minn.
There is also duplication of services. It fits very well into our overall plan for doing cost-effective, minimally invasive procedures. But if it is used inappropriately, it will jack up costs and ultimately give the machine a bad name.
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More than half the increase has occurred in people over Survival rates, too, have been inching up, thanks to improved diagnostic techniques and more precise and inventive treatments, like stereotactic radiosurgery a pinpoint form of radiation and laser surgery with a gamma knife. More progress is expected to result from some still experimental treatments, including immunotherapy, gene therapy and implanted wafers of chemotherapeutic agents…The three common cancer treatments — surgery, radiation therapy and chemotherapy — are most often used for brain tumors as well.
Gamma Knife radiosurgery uses specialized equipment to focus about tiny beams of radiation on a tumor or other target with submillimeter accuracy. Although each beam has very little effect on the brain tissue it passes through, a strong dose of radiation is delivered to the place where all the beams meet. The precision of brain stereotactic radiosurgery results in minimal damage to healthy tissues surrounding the target.
Comparing real-time images to images produced from the pre-treatment CT scans, the robotic system instantly repositions each beam, as needed, before delivery. To help the patient remain stable but not uncomfortably rigid , a soft face mask or vest is worn, depending on the area being treated. One to five treatments can be given and usually last 30 minutes to 90 minutes.
Lederman counts only one urologist who will refer his prostate cancer patients to him for the lower recurrence and lower side effects he promises. To put it kindly, Lederman seems to have a creative relationship with the facts, whether about his friendship with a former Beatle or the possibilities of a cancer treatment. From the beginning, the way that Lederman and the hospital advertised radiosurgery raised eyebrows in the medical community. Depending on your point of view, when it comes to new technologies, Lederman is either a forward-thinking early adopter or unacceptably reckless.
It was a controversial procedure because the body could not be stabilized as well as the brain: Organs move around, as much as a centimeter even in a restful state; the brain stays put.
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But the Swedes had received FDA approval for a device that they claimed stabilized the body enough to make radiosurgery both safe and effective. He called Varone from Sweden to tell him about the revolutionary new treatment.
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Within two months, before there had been any independent scientific studies, Lederman became the first doctor in the United States to offer body radiosurgery. And of course, he wasted no time in marketing the hell out of it. How about pancreatic cancer, perhaps the most quick and deadly of them all? But as Lederman scrambles to salvage his reputation, the very nature of his experimental practice has come under attack. On an evening in mid-November , Gil Lederman made a judgment call that would bring him the kind of fame that even he had never dreamed possible.
A bespectacled cancer doctor with an Alfred Kinsey fade haircut, Lederman was already something of a local celebrity; his distinctive nasal monotone had been heard for years on New York talk-radio stations, promoting his revolutionary cancer treatment, fractionated stereotactic radiosurgery, at Staten Island University Hospital. Zizmor of radiation oncology the reference is to a Manhattan dermatologist whose rainbow colored subway carriage ads were ubiquitous for a quarter century —paled in comparison with that of his patient, George Harrison, who was lying in a rented house near the hospital, dying of lung cancer that had invaded his brain.
That night has become something of an outer-borough Rashomon. Depending on whose version you believe, Lederman either had a touching visit with Harrison or bullied a dying man in a declining mental state into creating a valuable piece of rock-and-roll memorabilia. The Harrison camp claimed as follows: Lederman showed up uninvited and instructed his year-old son, Ariel, to strum a song on his Yamaha electric guitar. Lederman insisted to friends that Harrison invited the children over and happily signed the guitar. The shaky scrawl of the signature itself is inconclusive—it could have been written under duress or simply signed by a willing star on a great deal of medication.
It seemed like the ultimate disgrace for a Harvard-trained, triple board-certified physician who should have been amassing yacht money or doing Lasker Award—quality research at that point in his life.
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The doctor is now facing half a dozen multi-million-dollar civil suits, some of which accuse him of bilking terminal cancer patients by luring them with promises of a miracle cure. As Dr.
siowebhombdeck.tk Even a judge weighing a recent change-of-venue request acknowledged that Lederman had been through the ringer. Or is he a scoundrel? Lederman grew up a bookish Jew surrounded by the flinty Protestants of Waterloo, Iowa. He decided he wanted to be a doctor when he was 12 years old. It was , the year the Beatles released Revolver, and his older brother was nearly killed by a drunk driver.
The department had a single aging cobalt machine and saw only eleven patients a day. The ambitious new director set out to change that. In , Lederman became the first doctor in New York to offer brain radiosurgery. Unlike standard radiation treatment, which irradiates a large field around a cancer, exposing healthy tissue to low doses of toxic radiation, radiosurgery is designed to zero in on the tumor. Finely shaped radiation beams are sent into the head from many different directions, with the full dose concentrated where they intersect.
The upshot is that larger doses can be trained on the cancer, while healthy tissue is minimally affected. Radiosurgery can hit the plum without attacking the bread box.