People in Dayton, Ohio are fortunate to have this amazing technology right here in our small town. The CyberKnife is used at World Class Cancer Centers in almost every country to treat cancers all throughout the body, including lung cancer. The challenge that cancer specialists face with lung cancer is that those cancers move as the patient breathes. The CyberKnife Robotic Radiosurgery system offers patients breakthrough technology for the treatment of lung cancer. CyberKnife breathes with you.
The CyberKnife system treats patients with early stage lung cancer with a procedure called stereotactic body radiotherapy or SBRT. SBRT is breakthrough radiation where a few large doses or “ablative” doses are given. It is really radiosurgery not ordinary radiation therapy. So how is this done without harming surrounding, nearby tissues and organs? CyberKnife SBRT uses robotic guided, pencil thin beams of radiation focused on the lung cancer, while minimizing exposure to surrounding healthy tissues, normal lung, heart, esophagus, and spinal cord. CyberKnife treats the lung cancer with exquisite precision.
In the CyberKnife robotic radiosurgery system is the only delivery system that incorporates Synchrony respiratory technology. With synchrony, no markers need to be placed in your lung. No breath holding is required. No cutting. No pain. No invasive procedures.
The synchrony respiratory motion management system has a sophisticated software system that automatically adjusts the aim of the radiation beam to account for tumor movement due to breathing. SBRT systems at ordinary radiation centers usually results in overexposure of healthy lung tissue to radiation because a wider area needs to be treated to account for lung cancer movement during treatment. The CyberKnife system with synchrony technology adjust for movement of the tumor because of breathing, enabling the delivery of maximal doses or ablative doses of radiation to the lung cancer, while minimizing collateral damage to normal surrounding organs and tissues.
The CyberKnife system is the only fully robotic radiation delivery system. A robotic instrument is critical to enable the CyberKnife system to deliver 100s of pencil thin beams in any direction imaginable. SBRT systems at ordinary cancer centers only can go in a circle and deliver a few beams of radiation at a time. CyberKnife can go in any direction imaginable by the radiation medicine specialist. By precisely targeting the lung cancer, the CyberKnife system can deliver ablative doses of radiation with sub-millimeter precision, while minimizing radiation collateral damage to normal surrounding organs and tissues.
Radiation medicine specialist turned to the CyberKnife system when patients prefer a clinically proven, noninvasive procedure or when invasive techniques are ineffective or too risky.
The CyberKnife system was cleared by the US Food and Drug Administration in 1999 to treat cancers in the head and base of skull. The CyberKnife was system was cleared in 2001 for treatment of cancers and every other part of the body. Since then, over 100,000 patients have been treated with CyberKnife for other cancers, like lung, liver, pancreas, kidney, and prostate.
Dr. Ed Hughes and his team have the more experience using SBRT than anyone else in the southwest Ohio region. The experience really does make a difference in treating your cancer.
Plant Based Diets
With so much nutrition information at our fingertips, it can be hard to make sense of it all. For the cancer patient, it be even more of a challenge. One common question that gets a lot of attention is a plant based diet. So what does this mean, and should you be following it?
What is a plant based diet?
A plant based diet centers around consuming foods derived from plants instead of animals. Vegetables, fruits, beans, whole grains, nuts and seeds, and soy are the main food groups in a typical plant-based diet. Animal products, such as meat, dairy, eggs and fish may be consumed as well, just on a smaller scale.
The American Institute for Cancer Research (AICR) recommends 2/3 of one’s daily calorie intake should be from plants and 1/3 from animal products.1 Increasing the general intake of fruits, vegetable, beans and whole grains while reducing total meat, dairy eggs and fish in the daily diet can have many health benefits.
Benefits of a plant based diet
Following a plant-based diet is shown to be advantageous for health. Vegetables, fruits, soy, beans, nuts, seeds and whole grains can prevent cancer from occurring due to their high concentration of antioxidants, phytochemicals and fiber. For cancer survivors, including individuals with a history of lung cancer, plant based diets have been shown to help to prevent recurrence.2 Some additional benefits include:
Fiber, a nutrient found in only plant foods, can boost digestive health and strengthen the immune system.3 For individuals with cancer, a strong immune system is crucial to prevent infections, sickness, and treatment delays. The vibrant colors represent phytochemicals, which are important for protecting body cells from any damage that can cause cancer.
Plant based foods are also important to prevent heart disease.1 Avocados, nuts and seeds, and soy contain healthy fats and fiber that can reduce high cholesterol and promote beneficial heart health.
The combination of high fiber and nutrient content coupled with lower calories is effective in helping with weight loss or maintenance. Overweight and obesity can increase the risk of cancer recurrence for a number of different cancer diagnoses, which further supports the importance of maintaining a plant based diet.4
Be Mindful When Making Changes to Your Diet
For the individual with cancer, there are some things to keep in mind. Although it is possible to get all the essential proteins from plant foods, but if it is a newer way of eating for you, it can be more challenging during cancer treatment. For example, those consuming more plant foods should pay attention to consume enough calories and protein, which helps the body recover properly after treatment.5 Since weight loss can be a concern for many cancer patients following a strictly plant-based diet, it may be difficult for those undergoing treatment to get enough calories. Therefore, it is strongly recommended to consult with an oncology certified registered dietitian to make sure you are getting adequate protein, calories, and nutrients for your body during your cancer treatment if you have or plan on making any changes to your diet.
Benefitting from a mostly plant based diet does not require a radical approach, any way that you can add plant foods to your diet can be beneficial to your health. For example, adding fruit to your oatmeal, a salad with lunch, including steamed vegetables drizzled in olive oil with dinner, or using avocados, nuts, and nut butters for added calories can provide your body with extra fiber and antioxidants essential for good health during your cancer journey. After all, you are what you eat, and food is part of your medicine for good health.
1Get the Facts on Fiber. American Institute for Cancer Research. http://www.aicr.org/reduce-your-cancer-risk/diet/elements_fiber.html?_ga=2.127962825.412246095.1514302582-1784915318.1511833863. Accessed December 26, 2017.
2What you Need to Know about Preventing Lung Cancer. American Institute for Cancer Research. http://www.aicr.org/reduce-your-cancer-risk/cancer-site/cancersite_lung.html?_ga=2.47090279.1506569480.1506713576-467606187.1506460449. Accessed September 29, 2017.
3Vighi G, Marcucci F, Sensi L, Di Cara G, Frati F. Allergy and the gastrointestinal system. Clin Exp Immunol. 2008;153(Supp 1): 3-6.
4Obesity and Cancer Risk. American Institute for Cancer Research. http://www.aicr.org/reduce-your-cancer-risk/weight/reduce_weight_cancer_link.html. Accessed December 26, 2017.
5Benefits of good nutrition during cancer treatment. American Cancer Society. https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/nutrition/nutrition-during-treatment/benefits.html. Accessed December 26, 2017.
Savor Health is a provider of personalized nutrition solutions designed exclusively for cancer patients based on evidence-based science and clinical best practices and provided by a team of oncology-credentialed registered dietitians.
Today’s Curb Side Consult: Adding CyberKnife treatments after chemotherapy may help patients with stage IV non-small cell lung cancer
Marge from Kettering, sits down to talk to Dr. Ed Hughes, radiation oncologist, about her lung cancer.
Marge: “I heard a lot of good things about CyberKnife for patients with early stage lung cancers. Only 3-5 visits. No cutting. No pain. Done as an outpatient.
But I have stage IV non-small cell lung cancer. It’s in my left lower lung. I had chemo and the lung cancer shrunk up, but it’s not gone. And I still have a spot on my liver and a spot on my spine. I know that my cancer is bad. But I want to live as long as I can without symptoms. Can CyberKnife help me?”
Dr. Hughes: “That’s a great question, Marge. I now have some answers for you, some real options. And the answer is “possibly.” So what does it depend on? Stage IV non-small cell lung cancer patients who may benefit from CyberKnife include those patients who:
1). Had at least a partial response or even stable disease after chemotherapy.
2). Had only a few sites of metastatic disease, so-called ‘limited metastatic non-small cell lung cancer.’
So Marge, your situation is a quite common one. Up to 70% of stage IV non-small cell lung cancer patients have partial responses or stable disease following first-line chemotherapy. The key is to make those chemo responses last longer. I think real breakthrough progress has been made recently.”
Marge:”So what happens now after my chemo is done? Are there studies to prove that this treatment plan is going to work?”
Dr. Hughes: “A small, but crucial study done by Dr. Iyengar and Associates at the University of Texas Southwestern Medical Center showed that adding stereotactic ablative body radiotherapy (SABR), like that delivered by CyberKnife, extended survival from 3.5 months to 9.7 months. Quite remarkable results.
Importantly, major side effects from SABR, like that delivered by CyberKnife, were well tolerated. In a press release at the September 2016 ASTRO annual meeting, Dr. Iyengar said, “The addition of consolidative radiation did not increase toxicity, which allowed patients to continue onto additional systemic therapy that is important to controlling aggressive metastatic disease.” So with good collaboration between your medical oncology doctor and your radiation oncology doctor, CyberKnife can be given safely and effectively, even with chemotherapy or immunotherapy. Real hope is here.”
Marge: “So now what happens?”
Dr. Hughes: “As it turns out, the Dayton Clinical Oncology Program (DCOP), of which I am a member, does have a clinical trial called NRG-LU002-that “randomizes” the patient to maintenance chemotherapy versus maintenance chemotherapy plus SABR, like that delivered by CyberKnife. Another option is to be treated “off protocol” so that you choose CyberKnife and not leave it up to the “coin flip” of a computer as to whether or not you’ll get CyberKnife treatment. But you have to tell your pulmonologist and your medical oncologist you want it.”
For any questions about your stage IV non-small cell lung cancer, feel free to call me, Dr. Edward Hughes, at 855-Dayton 1. I guarantee that I will see you in consultation within 1-3 days of your phone call.
Stereotactic radiosurgery, like that delivered by CyberKnife, has become the “standard of care” for stage 1 lung cancer patients considered to be medically inoperable or if a patients is too sick for surgery. A new study of 62,213 patients 60 years and older with stage 1 lung cancer, showed that stereotactic radiosurgery increased the 2 year survival rate to 58% compared to 39% for seniors treated with conventional radiation.
Dr. Andrew Farach told HemOnc Today that “Our findings indicate that physicians should feel confident recommending radiation therapy to patients who are too sick to undergo surgery or choose not to undergo surgery for other reasons.”
THE CYBERKNIFE ADVANTAGE
CyberKnife is the only stereotactic radiosurgery device that continuously tracks your lung cancer as you breathe. CyberKnife treatments are painless-no incision. CyberKnife treatments are completed in only 3-5 outpatient visits. In fact, many of our patients can drive themselves to and from visits.
Many of our seniors have many medical problems that limit their surgical options. And CyberKnife is a perfect alternative. At the prestigious Massachusetts General Hospital in Boston, there has been a drop in surgery for seniors with early-stage lung cancer with many choosing stereotactic radiosurgery.
“It is a rare situation where the more convenient therapy is also the more effective therapy,” said Dr. Farach of Houston’s Methodist Hospital.
If you have any questions about your lung cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1. I guarantee that I will see you in 1-3 days of your call. Expertise. Experience. Caring. The First Dayton CyberKnife difference.
Men who undergo CyberKnife treatment become keenly aware of their bodies’ functions-and very aware of any change in their PSA levels.
For most men, the PSA level continues to get lower after CyberKnife treatment, gradually falling even after 5 years. But in some men, about 1 in 5, the PSA abruptly goes up and then back down. This rapid rise and fall in PSA is called “the PSA bounce,” and usually happens about 1 ½ to 2 years after radiation treatment.
Prostate cancer specialists speculate that “the PSA bounce” is an inflammatory response after radiotherapy, but we really don’t know for sure. “The PSA bounce” certainly causes a lot of worry both for the patient as well as their doctor.
But the good news is that those men who go through “the PSA bounce” actually do better and survive longer cancer free. This good news was recently published by Dr. Michael Zelefsky and his co-workers in the September issue of the Journal of the American Society for Radiation Oncology (ASTRO). With this extensive study, prostate cancer patients and their doctors can rest easier if they should see the “PSA bounce”
If you have any questions about your prostate cancer diagnosis and its treatment, feel free to call me, Dr. Edward Hughes, at 855-DAYTON1. I guarantee that I will see you in 1-3 days of your call.
Recently published data from a prospective study of 230 men with low-risk prostate cancer showed 98.4% had local disease control 10 years after receiving stereotactic body radiation therapy (SBRT) administered with the CyberKnife system, and toxicity was mild.
“This is a groundbreaking study—the first to report on the efficacy and toxicity of SBRT in the treatment of low-risk prostate cancer following 10 years of treatment,” says Alan Katz, MD, of Flushing Radiation Oncology. “All patients participating in the study were treated with the CyberKnife system, which delivers extremely precise radiation treatments using unique, real-time image guidance and automatic motion correction. The study outcomes were excellent both in terms of disease control and tolerability, and were superior to long-term conventional intensity-modulated radiation therapy, based on results from other studies.”
Study participants completed their entire treatment in just five daily sessions, compared to conventional radiation therapy which typically takes 30 to 40 sessions. Additional 10-year outcomes showed:
- The disease free survival rate was 93.7%, indicating there were no signs or symptoms of the cancer during the evaluation period;
- The median prostate specific antigen value was 0.1 ng/ml. A low PSA value is associated with a reduced risk of cancer recurrence or metastases; and
- Patient-reported bowel and urinary function scores showed initial declines that recovered to baseline where they remained throughout the remainder of the study period.
The prostate gland can move unpredictably throughout the course of treatment, making the ability to track, detect, and correct for motion critically important. Throughout the course of treatment, the CyberKnife system continually collects images to determine exactly where the tumor is, ensuring that clinicians deliver radiation exactly where they want it. The system detects the tumor motion and automatically adjusts the radiation beam in real time to match the motion of the tumor, giving clinicians confidence to apply smaller treatment margins and enabling higher doses and fewer treatments.
“Following early stage prostate cancer diagnosis, men have a variety of treatment options from which to choose,” says Fabienne Hirigoyenberry-Lanson, vice president of global medical and scientific affairs at Accuray. “CyberKnife prostate SBRT is increasingly being selected by men with low- or intermediate-risk disease who opt for treatment with radiation therapy. This new CyberKnife research adds to the most extensive compendium of published prostate SBRT studies available in the industry.”
Dr. Edward Hughes of First Dayton CyberKnife’s results are even more promising with disease free survival rate of 98% at the 5 year mark. Dr. Hughes expects his patients’ 10 year results to surpass those in this study. The improved outcomes are a result of radiation treatment planning done by his Medical Physicist, Matt Kolasa. Planning is individualized for each patient to spare the healthy tissue while targeting the cancer.
1. Katz A. Stereotactic body radiotherapy for low-risk prostate cancer: a 10-year analysis. Cureus. 2017; doi: 10.7759/cureus.1668.
The decision to treat breast cancer patients with chemotherapy used to be easy, didn’t it? Breast cancer patients whose tumors were small didn’t need chemotherapy. Or maybe just hormonal therapy.
But the biology of an individual woman’s breast cancer may change all that. We’re now in the age of “precision medicine.” To put it another way, your breast cancer specialist may now be able to custom tailor your treatment to your specific breast cancer’s genetic makeup.
ARE SMALL TUMORS LESS DANGEROUS?
In the study of 6,693 women in Europe, a total of 826 breast cancer patients had very small (less than 1 cm) breast cancers and no spread to the lymph nodes. By use of a special genetic test (called MammaPrint) on the breast cancer itself, the doctors were able to identify 23.7% of women who were “low risk” by the old criteria but “high risk” by the new genetic test. The key result was that the “high risk” breast cancer patients with small cancers did better on chemotherapy. In fact, the 5 year survival rate was 98.5% with chemotherapy, but only 95.8% without it in those women who were “low risk” by the old criteria but “high risk” by the MammaPrint genetic test.
The results of this clinical trial (called MINDACT) was recently reported in the September 2017 meeting of the European Society for Medical Oncology held in Madrid, Spain. Dr. Evandro de Azambuja of The Jules Bordet Cancer Institute in Brussels commented on the study and said “Small, node-negative tumors can be very aggressive, even if they are classified as low clinical risk. Tumor biology needs to be taken into account when deciding adjuvant treatments in this patient population.” And Dr. Konstantinos Tryfonidis, the senior author of the MINDACT trial, of the European Organization for Research and Treatment of Cancer in Brussels said “Our results challenge the assumption that all small tumors are less serious and do not need adjuvant chemotherapy.”
If you have any questions about the treatment of your breast cancer -with chemotherapy, hormonal therapy, or radiation therapy- please feel free to call me, Dr. Edward Hughes, at 855-Dayton1. I guarantee that I will see you in 1-3 days.
Each and every week I hear the same questions from my patients with cancer of the head and neck. “Doctor, do I really need to have all 33 treatments? This is really hard. Haven’t we done enough? Can’t I just quit?”
My answer is almost always the same. “It’s not a good idea. You’ve come this far. Quitting now puts your chances of a cure at risk. You really need to complete every one of the treatments.”
Now there is an important study that supports my answer. In the study of 8.388 Medicare patients with advanced cancer of the throat or larynx (voice box), the important result was that patients who did not complete chemotherapy and radiation therapy did worse than patients who did. Much worse, in fact.
The second important finding was the patients who completed chemotherapy and radiation therapy did just as well as those patients who had surgery. The surgery for advanced larynx cancer is called a laryngectomy that involves removing the voice box permanently. The study was published about one year ago in the prestigious journal titled Cancer.
So finishing those last few treatments of chemotherapy and radiation therapy-admittedly the hardest part of the process-really is important for your survival. It’s also the time where an experienced radiation doctor and support team, including the chemotherapist, radiation therapists, swallowing therapist and oncology nurses- are really crucial. The management of side effects is key. This is why having a dedicated team of experts who focus on you is so important to me as a physician.
If you have any questions about your head and neck cancer, please feel free to call me, Dr. Edward Hughes at 1-855-DAYTON1. I guarantee that I will see you in consultation in 1-3 days of your phone call. And when you call us, you’ll talk to directly to my team who work beside me; not a call center.
In the study of more than 1,600 veterans with early-stage lung cancer, stereotactic radiosurgery, like that delivered by the CyberKnife, more than doubled the chances of surviving compared to conventional radiation. Importantly, the study was conducted at VA Medical Centers over the past decade. The study was presented at the 2016 meeting of the American Society of Therapeutic Radiology and Oncology or ASTRO.
Dr. Brian Kavanagh, a Past President of ASTRO, told the Medscape news, “Although we are talking about treatments of an advanced technology that has only been allowed in the last 10 years or so, it is also smarter, more efficient and more cost effective way to do things. It involves fewer trips to the treatment center for the patient, fewer side effects, and is generally easier to take.” CyberKnife treatments for lung cancer are painless and can take as little as 20 minutes each. Only 3-5 treatments are needed.
CyberKnife has also been shown to be just as effective as open surgery for patients with early stage lung cancer, but without the hospitalization, the risks of open surgery, and the pain and recovery. CyberKnife is available only at First Dayton Cancer Care in the Dayton Region. And CyberKnife is the only radiation device that breathes with you as it tracks your tumor with every breath.
If you have questions about treatment of your early stage lung cancer, please feel free to call, Dr. Edward Hughes at 855-DAYTON1. I guarantee I will see you within 1-3 days of your call.