Racing Against Cancer

New Baylor radiosurgery center offers fast access to advanced treatments

In January, Baylor University Medical Center at Dallas (Baylor Dallas) opened the Baylor Radiosurgery Center.

The center houses a Gamma Knife and CyberKnife, two advanced stereotactic (3-D) radiosurgery systems for treating tumors of the brain, spine and other organs. The staff includes neurosurgeons, radiation oncologists, physicists, diagnostic radiologists, technicians and nurses.

Neurosurgeon Cole A. Giller, M.D., Ph.D., a specialist in radiosurgery on the medical staff at Baylor Dallas and the cen-ter's medical director, answers questions about this technology.

Q: What exactly are the Gamma Knife and CyberKnife?
A: They are advanced devices that noninvasively deliver very accurate, high doses of radiation to precise locations within the brain or other organs to treat tumors. The Gamma Knife is used for brain tumors and consists of a large metal helmet with 201 holes all aimed at a single spot. Beams of radiation are cross-fired through the holes, so only the spot where all the beams intersect receives the maximum radiation. The CyberKnife, on the other hand, is an industrial robot that works by moving a linear accelerator slowly around the patient to deliver anywhere from 30 to 300 targeted bursts of high-intensity radiation precisely aimed at the tumor. What is remarkable about the CyberKnife is that the system automatically takes X-rays during the treatment, which helps the robot adjust by compensating for any patient movement.

Q: How does this compare to conventional radiation therapy?
A: In cancer, we know that chemotherapy and conventional radiation therapy eventually can fail, allowing the tumor to grow back. Whole-brain irradiation generally is not done more than once and is virtually forbidden in infants because of the high risk to the healthy brain tissue surrounding the tumor. Since the radiation delivered by the CyberKnife and Gamma Knife is precisely targeted onto the tumor, the risk to the surrounding tissue is much smaller, and so we can treat tumors when conventional radiotherapy has failed. For similar reasons, we can offer treatment to patients we could not treat before, such as infants and patients with multiple metastatic lesions. These are very exciting developments.

Q: Is radiosurgery always the best treatment option for brain tumors?
A: No. In some cases, traditional open-skull brain surgery may be the most effective way to eliminate a tumor. Finding the appropriate treatment for each patient involves a complex decision-making process; radiosurgery simply increases the options.

Q: What is the benefit of having both machines in one location?
A: Some tumors are better treated with the single-shot intensity of the Gamma Knife; others respond better to the fractionated doses given over several days available with the CyberKnife. This gives patients and physicians advanced means for targeting and destroying tumors and allows very complex treatment to be given with virtually no delays. Baylor Dallas is the fi rst medical center in North Texas, and one of only a handful in the country, to have both in a single location.

Q: Can tumors outside the brain be treated?
A: Yes, and this is one of the most exciting things about the CyberKnife. Because it doesn't require a rigid frame to be attached to the skull, beams from the CyberKnife can reach any organ in the entire body. This means that tumors of the spine, lung, liver, kidney, pancreas and other sites that were untreatable before can now be treated.

Q: Can radiosurgery treat other conditions besides cancer?
A: Yes. Radiosurgery treats benign brain tumors such as acoustic neuromas and meningiomas, as well as tumors that may be inoperable with conventional surgery. It can lessen the pain of trigeminal neuralgia, and it can destroy abnormal tangles of blood vessels in the brain and spine called arteriovenous malformations (AVMs).

Q: Why does the new center emphasize quick appointments and convenient access to treatment?
A: We are in a race against cancer. The problem is that there can be so many delays after the diagnosis-making appointments with several doctors, waiting for insurance, getting X-rays-all of which use valuable time while the cancer is silently growing. And with cancer, being treated now or in weeks can make a huge difference. So we designed and staffed the center from the ground up to streamline access to treatment and to help us win this race with cancer. With this new center we have the tools to offer aggressive and appropriate therapy to cancer patients quickly, improving their quality and length of life. It's a great gift.

By Deborah Paddison

To learn more about the Baylor Radiosurgery Center, call (214) 820-HOPE (4673).

Gamma Knife and Leskell Gamma Knife are U.S. federally registered trademarks of Elektra Instruments, S.A., Geneva, Switzerland.