Stereotactic Body Radiation Therapy (SBRT) for lung metastas

[Olga]

There are locations of the lung mets when surgery or ablation may not be avail. - located within or touching a 2 cm zone around major airways, close proximity to carina, right and left main bronchi . In such a cases patient may be told to have unresectable lung mets. I have been reading PubMed reg. all the latest publication about the new developments for the lung mets treatments (as this is what my son has) and came across a few articles that there is a new treatment avail. in the situation like this:
First artcile is from Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
Stereotactic Body Radiation Therapy (SBRT) for lung metastases.
http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum
it can be searched by the its PubMed ID PMID: 16982544 in the search field.

and the other article from Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, Texas, San Antonio, USA.
Stereotactic body radiation therapy for centrally located lung lesions.
http://www.ncbi.nlm.nih.gov/entrez/quer ... s=16982543
PMID: 16982543
their results are promising and experience is getting gained so one more modality is getting avail. This treatment has it's own toxicity as it damages the lung tissue so it can not be used for the large number of the metastases but if there are a few metastases located in inaccessible location then this treatment might be worth looking into.

[amanda macdonald]

hi olga... these articles appear to be about tomotherapy specifically. do you know if cyber knife is different or who the expert would be to consult with regard to that? (i will have my most recent CT scan in electronic form tomorrow, so am anxious to send it out for some opinions. my radiation oncologist here is london is pushing for a decision right away.
thanks! amanda

[Olga]

Amanda, we only had one person treated with the Cyber Knife technique - Pamela Ham in LA. The procedure was kind of hard for her as it required a toracoscopic procedure to insert fiducial markers to track the tumor movements and she was very weak then so our community experience is very limited here.
About the technology:
CyberKnife® is a registered trademark of Accuray, Inc. It is a radiosurgery, it's main difference from the radiotherapy is that the treatment is delivered in high dose once or 2-3 treatments max. and not like the radiotherapy when they divide the whole dose they want to deliver in 2-3 weeks treatments. There are a few radiosurgical techniques in use - CyberKnife, Novalis, Trilogy... Every one is claimed to be the best, I personally can not be an expert to judge it as the technical details are not published and we do not know the target deviation and precision. Stanford is the institution that came up with Cyberknife in 1996 and they now use Trilogy as well so may be this is the places where doctor can compare and choose the appropriate tool. There is a CyberKnife support forum run by the Accuray designated doctor who answers questions
http://www.cyberknifesupport.org/forum/
There is also proton treatment avail. for unresectable lung mets in Boston.
Can I ask why do you look into the radiation treatment and not the cryoablation or the surgery. I do not think that there is a place with enough experience in Canada using Cyber Knife for lung mets.

[amanda macdonald]

hi olga! thanks so much for your prompt reply. you are a wealth of information!!! i am sending my scans to dr. rolle re. laser surgery, dr. littrup re. cryoablation, and dr. johnston re. RFA. my oncology team here in London has told me that they only option they think is feasible for me is external beam radiation to the centre of my chest to shrink the tumours which are compromising my airways. i don't want to go ahead with that until i know for sure from the experts in each field that other treatments are not possible. unfortunately between october and march, my cancer has grown immensely in the centre of my chest both inside and outside of the lung tissue.
is there a canadian centre for cryoablation? or is there anyone else you would recommend that i consult?
thanks so much!

[Olga]

Amanda, I have been told that dr.Johnston has moved to some other province, that he is no longer in Toronto, do you know that?

[Bonni Hess]

Dear Amanda,
I am so deeply sorry to hear about your increased lung and chest mets growth. The minimally invasive Cryoablation procedure appears to have been very successful in destroying three of Brittany's lung mets which were treated by Dr. Littrup at Karmanos Cancer Institute in Detroit, Michigan in November 2004. Unfortunately the procedure is limited by the size, number, and location of the mets, so your scans would need to be evaluated by a Cryoablation specialist to determine if any or all of your mets could be safely treated with Cryoablation. One of our ASPS patients is currently in Rochester, New York receiving a series of Proton treatments for two of his lung mets which cannot be safely resected or treated with Cryo. You can read more about this promising new treatment at the following link:
http://www.proton-therapy.org/questions.htm
Please let me know if you would like contact information for the patient's family so that you can further discuss the treatment and the outcome of his treatment with them if you are interested in exploring this procedure. In the meantime, please take care dear Amanda, stay strong, keep us updated on the Web site, and know that you are in our continued very special caring thoughts and prayers.
With special caring and continued Hope,
Bonni Hess