Cyberknife Consult

With all the recent drama with my own demons, I neglected giving you all an update of Satomi’s upcoming treatment.

Last Tuesday we met with a Radiation Oncologist (RO) from Newport Diagnostics Center (NDC), the local Cyberknife joint.  They wanted us to bring whatever MRI’s we had so they could make an independent determination on the application of Cyberknife to Satomi’s tumor.

On initial impression, the doctor actually reminded me of “the Beaver” from that show from the ’50’s.  Satomi thinks I’m nuts.

On secondary impression, the Doctor was a smart fellow.  I had researched Cyberknife a bit before going to the appointment and the Doctors data agreed with mine.  Not to say that agreeing with me makes him right, but its definitely in the right direction.  (:>)

The procedure would consist of (3) parts:  1) Preparation and baseline images; 2) Treatment design; and 3) the actual radiation Treatment.

The setup consists of the technicians making a mask made from plastic mesh.  It will be molded to Satomi’s face and will be used to locate it during the application of radiation.  They say that is suppose to be soft, flexible and comfortable but I don’t believe them (Nobody tell Satomi until afterward).  It looks like it’d feel like wearing panty hose on your face-Not to say I know what that feels like.

Here’s a photo I found of the mask:  

Cyberknife Face Mask

During this visit they are also going to take the initial high resolution CT and Cyberknife specific MRI’s.  The MRI’s are of the skull pointed at each temple (of course I am oversimplifying this part) that are used to verify position during the radiation procedure.  All this prep work should take a few hours.  We are scheduled for this on Monday May 11th. 

The treatment design phase is done in conjunction with the Cyberknife RO and Physicist, and our Neurosurgeon (NS).  The team reviews the CT and MRI’s and determine a detailed plan of radiation dosage, target location, application angles, and about a thousand other things that I have no idea about.  The plan is programmed into the Robotic targeting system and becomes the basis of her treatment.

Unless there is some complication during the planning process, Satomi’s treatment begins on Tuesday May 19th.

In the RO’s opinion he feels that the Treatment can be accomplished in a single outpatient visit (Remember that the NS thought 3 sessions would be preferable).  In cases of a large tumor (3 to 4 cm), it is common to fractionalize the treatment (“fractionalize” is a big word that means they split up the treatment into several visits).  This is not the case with Satomi.  

It is likely, however, that the treatment will be longer-maybe 2 to 3 hours on the Cyberknife table.  While this doesn’t seem long, the RO did concede that the table is quite hard and Satomi could not move her head and neck more than 5 mm in any direction.  For all you non-metric types, that is less than 1/4 of an inch.  It won’t be fun-I will definitely be ready with the massage lotion for her neck.

The typical side effects are fatigue, headache, nausea, and skin irritation however given the sensitive location of the tumor, there are some serious risks.  The most serious is nerve damage adjacent to the treament site.  It could be as minor as some hearing loss to serious brain stem damage which of course, is life threatening. 

The Cyberknife RO estimates the potential for some sort of adjacent nerve damage at 5%.  There is also some potential for temporary brain swelling and aggravation of existing symptoms but this issue can be managed with Decadron or similar steriods.

The RO estimates total success of tumor removal at 80%.  The 20% difference are for those tumors that may need an additional treatment. 

For anyone that is interested, I found an interesting and detailed acticle about Cyberknife and Gammaknife:  www.swmedctr.com/documents/Cyberknife/OncologyIssuesVol21No5.pdf

All-in-all, we remain optimistic and are proceeding as planned.