Inoperable cancer goes under the CyberKnife

Noninvasive radiosurgery system sets up shop at Roper

Noninvasive radiosurgery system sets up shop at Roper

Melissa Haneline
The Post and Courier

Radiation therapists Jason Alexander, left, and Sheilah Hill, right, help Perry Mappus get situated on the memory foam table before radiation treatment with the Cyberknife.

Melissa Haneline
The Post and Courier

Perry Mappus, 75, lies on a table supported by personalized memory foam as radiation therapists Jason Alexander (right) and Sheilah Hill (CQ"D) adjust the Cyberknife, a tool that delivers radiation to less than a millimeter in accuracy at Roper Hospital.

Perry Mappus, 75, wore a black leotard with white stripes as Roper Hospital staff helped her slide into a body-hugging frame beneath the CyberKnife.

The hulking white accelerator, perched on a nimble robotic arm, hung poised to pound a small tumor in her left lung with radiation.

Music by Andrea Bocelli began to play as staff closed the 18,000-pound lead door, sealing the treatment room.

Roper Hospital began treating patients with CyberKnife, the first radiosurgery system of its kind installed in the state, this month. More than 120 sites worldwide offer the brand-name technology to treat otherwise inoperable cancers.

Some patients might not be good candidates for surgical options. That was the case with Mappus, said Dr. David Peterseim, a cardiothoracic surgeon at Roper.

"She's so frail we couldn't do the standard thing and remove the piece of the lung that contains the tumor," Peterseim said.

Conventional radiation treatments wouldn't work either, given the location of Mappus' growth, on her lung and behind her heart, radiation oncologist Dr. Mary Decker said. Tumors do not always sit still for radiation — lungs inflate and hearts beat — which can put surrounding healthy tissue at risk.

Mappus, a career nurse who worked for 16 years in the cancer clinic at Roper Hospital, is familiar with the disease and limitations of treatment. "This (CyberKnife) came just in time for me," she said.

CyberKnife tracks tumors during treatment and can deliver radiation with extreme accuracy, within less than a millimeter. The robotic system has several mechanisms to keep its radiation on target.

First, doctors inserted four gold beads in and around Mappus' tumor. These markers, the size of rice grains, showed like bright lights on X-rays, which were taken frequently during treatment through machines mounted in the floor and ceiling.

Those images were then correlated with baseline computerized tomography scans, or CT scans, taken before treatment to ensure accuracy.

Blinking red lights strapped to Mappus' chest talked to a sensor at the foot of her bed that tracked her breathing and chest wall movement. Doctors, physicists and technicians gathered in the control room, where they tracked the data.

Although using radiation to treat cancer is not new, the means of delivering radiotherapy is evolving, said Dr. Curtis Worthington, a neurosurgeon.

Another type of precision radiation technology called TomoTherapy has been used at the Medical University of South Carolina's Hollings Cancer Center since November, through a partnership with the Ralph H. Johnson VA Medical Center to purchase the equipment.

Trident Health System also has image-guided radiation therapy machines and is working to bring a linear accelerator with robotic capability to Trident Cancer Center in 2008, said Don Jackson, assistant vice president of oncology services.

Construction for the $4.2 million machine began at Roper in fall 2006. The $2.3 million chamber required 1 million pounds of lead and a 4-foot concrete floor. The hospital and California-based manufacturer Accuray will share expenses and revenues.

Treatment costs vary widely depending on the type and number of treatments required, a Roper representative said. Medicare and most private insurance companies cover the therapy with precertification.

Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.

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