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Baptist and Semmes-Murphey team up to provide a new treatment for cancer in the Mid-South.
There’s no two ways about it — the newly installed CyberKnife at Baptist Memorial Health Care Corporation’s East Memphis campus has a slightly sinister look to it, almost like a robotic version of the man-eating plant Audrey II in “The Little Shop of Horrors.”
Well over seven feet tall, the machine is fitted in smooth, sterile-looking white casings with its robotic arm extending up from the honey-brown wood-laminate floor, then over to one side at a right angle where a tapered rectangular module is held, obviously waiting to shoot blinding laser beams or something that probably won’t feel very good.
Wasn’t Halle Berry strapped down to something like this in Die Another Day before James Bond rescued her?
The chamber is sealed with a six-inch-thick door like a bank vault.
A black gantry couch — a long narrow bench, essentially — lies prone, stretching across the room beneath the arm with various other instruments suspended from the ceiling and aimed right at it.
Then there’s the name itself, CyberKnife, which is ironic because it doesn’t actually do any cutting. Actually it shoots beams of radiation so finely tuned that it doesn’t even disturb normal cells immediately around its target — a cancerous tumor.
In fact this $5 million machine is a sight for sore eyes for cancer patients whose recovery depends on the subtle nuances of technology, which make treatment as personal and as individual as possible.
Dr. Jason Weaver, a neurosurgeon at the Semmes-Murphey Clinic, talks about the CyberKnife like an old friend, though it was just installed at Baptist in late August. Just a week before its first three patients were scheduled to use it — lung and prostate cancer cases — he sounded like a race car driver with a brand-new engine.
“In this day and age, everything is highly tailored, depending on the cancer location in the body,” Weaver says. “Now we’re even getting very patient-specific, so genetic-based treatments and so forth are possible.”
CyberKnife was developed by Accuray, a medical manufacturer based in Sunnyvale, California, some 15 years ago, but many regions of the country still do not have one.Baptist’s is the first in the Mid-South.
The idea behind it is that patients lie on the couch in their own clothes, listening to music on an iPod, ostensibly as relaxed as one can be while CyberKnife moves him or her into various angles allowing the radiation beam to hit a tumor precisely from up to a hundred or so different angles.
The procedure is painless and non-invasive.
“Everything you see up to this point,” says Weaver, indicating CyberKnife’s robotic arm, “is the exact same system you’d find in a GM plant. What the developer of CyberKnife did was take that technology and mount the linear accelerator onto that arm so it shoots the electrons down this collimator and the radiation is delivered in 20-millimeter, 10-millimeter, five-millimeter beams.”
The collimators look like oversized steel thimbles with apertures of varying sizes. The robotic arm can reach down and select a collimator from a table below it.
“Each beam is actually a very low dose, nontoxic to normal tissue, but because the beams intersect at the tumor, the tumor gets a very high dose,” Weaver says.
Some upgrades to Baptist’s system include real-time tracking of the tumor via X-rays mounted near the ceiling that allows the machine to auto-correct for slight movements in the patient like the rise and fall of the chest when breathing.
This CyberKnife can also adjust the size of the beam automatically in the same way the iris of an eye expands or contracts to adjust to light.
“What will eventually happen to the tumor is it will either die or stabilize itself,” Weaver says. “It’s not like we’re going to zap it out. What we’re finding is that since we are able to deliver a much higher dose to the tumor, we’re not limited by what normal tissue can take.
“We’re effectively able to give very high doses to the tumor. When that applies to the brain and spine, for example, we’re getting much longer durable control of the disease, sometimes complete regression of tumors.”
Treatment takes about an hour. Patients can be treated in the morning and play golf in the afternoon. Some, Weaver said, may feel a slight burning sensation near the site of the tumor a day or two afterwards, but there are no real side effects.
Weaver was instrumental in getting the CyberKnife to Memphis. He made several hospital visits and participated in the training in Sunnyvale after it was purchased.
Originally from Nebraska, he went to medical school at St. Louis University, was trained at the University of Tennessee Health Science Center in Memphis, then took a fellowship at M.D. Anderson Cancer Center. He began working at Semmes-Murphey in 2007.
Semmes-Murphy is a century-old neurosurgery clinic which was the first of its kind in Memphis and carries a national reputation of leadership in the field.
Tumors in the spine are more complex than tumors in other areas of the body due to the proximity of vital structures, chiefly the spine and nervous system. If there’s not enough room between the tumor and the spine, even CyberKnife may not be a good option.
CyberKnife’s only downside is that its use doesn’t necessarily rule out surgery or chemotherapy. Often it is used in conjunction with the two, but Weaver says the tool is becoming more popular.
“We’re finding that as more and more data emerges, patients are doing better for a longer period of time, we’re keeping them relatively pain-free, and it looks like this technology does a better job than standard radiation and provides the durability of the local control,” Weaver says. “I think insurance companies’ coverage has been quick to cover that.
“Every center that we looked at has grown and exceeded their expectations in the first few years.”
Beverly Cusano, director for radiation oncology at Baptist, says she expects about 100 patients to use CyberKnife in the first year.
“We were seeing an increase in the number of patients in the community who would benefit from it,” Cusano says. “The timing was right.”
Currently there are 27 people in her department, but that may grow as use of CyberKnife increases. Because Baptist Memphis is the only hospital in its system that has one, it has in essence become a flagship for cancer treatment among the system’s 14 Shelby and DeSoto area hospitals and others elsewhere in Mississippi and Arkansas.
That’s a change from past conceptions of patient care at Baptist, says Jason Little, executive vice president and chief operating officer.
Previously, Baptist focused on keeping patients close to home by building hospitals in smaller communities surrounding Memphis. Each of those hospitals has its own oncology department for the convenience of those who live nearby. But with the addition of CyberKnife and a recently announced state-of-the-art cancer center to be built on Germantown Parkway at Wolf River Boulevard, cancer treatment will be more centralized.
“This will be a centralized focus of experts and sub-specialists that you can’t replicate in every community,” Little says. “We believe this will be a flagship approach for the rest of our system.”
Over the summer Baptist received approval of its Certificate of Need application to build the 200,000-square-foot cancer treatment center.
“It’s not just about facilities for us,” Little says. “It’s truly about integrating the program in all the ways we need to. The thing that moves me the most is to think about the cancer patients who in their first year of treatment will make over 100 different visits to physicians, statistics say. You can imagine the logistics and the stress. Our ability to bring all that under one roof helps get patients on their way to becoming survivors.”
The new center will be developed with cancer patients in mind from the lobby to the rooftop.
The cafeteria will be designed to cut down on strong aromas from food, which Little says can be bothersome to cancer patients. There will be a wig shop and boutique. The facility will offer 75 chemo chairs and serve as a center of research for 35 partnering oncologists.
“It’s a goal and dream realized,” Little says. “It will be equipped with video conferencing, so in real-time a team of physicians can gather around a specific patient wherever they might be. We’ll have a full complement of diagnostic capabilities. For chemotherapy patients, it will be one of the most healing environments based on the design of the building.”
Baptist already has one hospital, the Hospital for Women also in East Memphis, which is completely devoted to breast cancer patients. Its medical director and six breast radiologists are all women.
“At our women’s health center this is the 25th year that we’ll be providing state-of-the-art care for women with breast cancer,” Little says. “We perform over 40,000 procedures annually. This comes together in a multidisciplinary way. We have a high-risk breast management center and breast health specialists, genetic testing and counseling, and of course the surgeries. This is the only hospital dedicated to women here in the South.”
And across the river in Jonesboro, Arkansas, Baptist is building a new $350 million hospital to replace the existing one. This one will have a $30 million oncology department. It should be open in late 2012.
Again, the integration of systems is key to its design.
“The cardiologist’s office is steps away from the cath lab,” Little says. “The OB/GYN office is steps away from the labor and delivery suites — all with the same electronic medical records fully integrated.”
In other words, the technology behind treating cancer is becoming fine-tuned to the point that individuals may have as many choices for treatment as they do stereo options in their cars.
Perhaps that may be a little comforting for the patient who’s just received the worst news of his or her life.
“Particularly with the treatment of cancer, every patient is different and what that patient wants and needs as an individual is important to us,” Little says.
Still, it’s hard to hide the excitement of having a new tool.
“We’re excited and so are the patients who have been waiting,” Cusano says. “We want this to be open to everyone in the community and the surrounding areas.”
