Santa Claus - CyberKnife UPDATED

Greetings,

Merry Christmas / Happy Holidays to you.

Our Medical Insurance Company approved our procedure for Johnny to have the CyberKnife treatment to his two liver tumors.  The liver tumors are of great concern now due to their growing in size.  Whilst having  treatment they will also look at the tumor around his stent, pancreas and lungs.  

This is certainly wonderful news for us.  To be approved, due to Johnny's complex situation.

We have our first appointment for his Fiducial Placement of Gold Nuggets on Tuesday 30th December, 2014. 

 

Below to help you understand CyberKnife and to allow you to understand what Johnny's new steps are,  I have written a summary - well a long summary sorry, as it is so incredibly complicated.  I hope the images help you understand as you follow the summary.

We will still need to have our new Chemo regime but this will happen after the Cyberkbife.  

Whilst reading and understanding CyberKnife, I am blown away to find that the medical field and technology has moved on masterful leaps and bounds.  

Treating liver cancer with radiation therapy is a challenge because liver tumors move with respiration.  In addition the tissue surrounding the liver tumors is very sensitive and can be damaged easily.  The CyberKnife Radiosurgery System is able to deliver very high doses of radiation to both primary and metastatic liver tumors with extreme accuracy. Working in conjunction with the CyberKnife System is the Synchrony Respiratory Tracking System, which enables the radiation beam to track tumor movement in real time and allows Johnnys to breathe normally during the treatment sessions. With the CyberKnife System, doctors can zero in on a moving target – the liver tumor – and irradiate it without harming the healthy surrounding tissue. As a result, the CyberKnife treatment will be more comfortable for Johnny, radiation is delivered accurately and treatments can be completed in one to five sessions.

The CyberKnife process involves four steps:

1. Fiducial placement (might need a bodyguard - don't want his gold to get nicked!
2. Set-up and CT imaging
3. Treatment planning
4. CyberKnife treatment

Fiducial Placement of Gold Nuggets: Johnny is scheduled Tuesday 30th December, for a short  procedure in which three to six fiducials tiny gold seeds each about the size of a grain of rice  are inserted into and around the liver tumor using CT guidance, ultrasound or via a camera that is passed through the mouth into the stomach and small intestine. The CyberKnife System uses those fiducial markers as "reference points" to identify the exact location of the tumor during treatment. Once fiducials are implanted, we have to wait one week before CyberKnife treatment planning can begin to ensure that fiducial movement has stabilized.

During set-up and imaging: Johnny will be fitted for a custom body cradle, which is designed to help keep him more comfortable to ensure consistent positioning for both imaging and treatment.  Johnny  will be fitted with a special Synchrony vest, which is worn during CyberKnife treatment and enables the robot to correlate chest motion and breathing patterns with the tumor position. The data generated with the vest allows the CyberKnife robot to precisely follow the tumor’s motion as it delivers "each beam of radiation", ensuring safe and accurate radiation delivery.

Whilst wearing the vest and positioned in his  cradle,  Johnny  will undergo a series of CT imaging studies, which will enable the CyberKnife team to determine the exact size, shape and location of the tumor. A CT scan will be necessary to fully visualize the tumor, liver and nearby anatomy. 

Next a treatment plan:  specifically designed by a medical physicist in conjunction with our doctors.  During treatment planning, the imaging data is downloaded into the CyberKnife System’s software. The medical team determines the size of the area being targeted by radiation and the radiation dosage, as well as identifying critical structures where radiation should be minimized.

 

Dr. Alex Gottschalk, may choose to deliver the liver cancer treatment in one session, or stage it over several days.  Note liver cancer treatments are typically completed within one week.

Time for treatment: Johnny will be asked to put on this Synchrony vest and lie on his custom body cradle. The radiation therapist will ensure the vest is properly adjusted and Johnny is positioned correctly on the treatment couch.

As treatment begins, the location of the liver tumor will be tracked and detected continually as Johnny breathes normally. The medical team will be watching every step of the way as the CyberKnife System tracks  Johnny’s liver tumor as it moves, and safely and precisely delivers radiation to it.

The CyberKnife System’s computer-controlled robot will move around  Johnny’s body to various locations from which it will deliver radiation. At each position, the robot will stop. Then, special software will determine precisely where the radiation should be delivered by correlating the location of the tumor using digital images of the fiducials and information from the Synchrony vest. The CyberKnife’s robotic arm will adjust the radiation source automatically, to follow the liver tumor as it moves.

 

Once treatment is complete, Johnny should be able to quickly return normal life.   Although we will will not know if he will need the full five series of treatments as determined by Dr Alex Gottschalk. 

We are  fully aware that his tumors will not all  disappear. Doctors will monitor the outcome in the months following Johnny’s treatment through physical exams, blood tests and imaging techniques, such as CT scans.