CyberKnife offers Fremont Hills resident alternative to surgery

Crocker and husband Randy hit the links at Fremont Hills after her CyberKnife treatment.

A year ago, 50-year-old Cheryl Crocker of Nixa thought she had a bad case of swimmer’s ear.

After it didn’t clear up, she saw her primary care physician, who thought it might be sinus drainage, and prescribed antibiotics.

Not long after, in addition to the feeling of having water in her ear, Crocker started having trouble hearing. Her primary care physician referred her to an ear, nose and throat specialist, Scott Estrem, M.D., who performed hearing tests, an MRI and a CT scan.

“Dr. Estrem warned me that it could be a tumor, but I didn’t believe it,” she says. “But the MRI confirmed it – I have what’s called an acoustic neuroma, a very slow-growing, noncancerous tumor located deep within my ear canal. It was close to an inch in diameter and by that time was causing tingling in the nerves in my ear and face.”

While the tumor was benign, it had interwoven itself among Crocker’s facial and hearing nerves, which caused the tingling and the hearing loss.

THREE TREATMENT OPTIONS

Dr. Estrem gave her three treatment options: 1) do nothing and hope the tumor didn’t cause further nerve damage, – unlikely, given her relatively young age; 2) surgically remove it, which could cause facial paralysis and further hearing loss and would take months to recover from; or 3) undergo a one-time treatment with St. John’s brand-new CyberKnife to try to kill the tumor with extremely precise, high doses of radiation while leaving the surrounding healthy tissue in her ear alone. One caveat to the CyberKnife treatment that Crocker had to consider was the radiation would harden the tumor, making it difficult to surgically remove if the treatment didn’t work.

Crocker, a mother of three, who works at St. John’s as a product line manager for St. John’s Resource Management department, had recently attended an open house for the CyberKnife, which is housed at St. John’s Radiosurgery Center on the St. John’s campus. While she was impressed with the technology and the new state-of-the-art facility at St. John’s, she wasn’t sure how she felt about being just the seventh patient in Springfield to be treated with the device.

MAKING THE DECISION

“I took a few weeks to think about my choices and I talked to my husband Randy about it. During that time, we met with Dr. Alan Scarrow, and he gave me some literature to read about the CyberKnife. We talked about it at length and he told me that if he were treating a relative the same age, with the same kind of tumor as mine, he would recommend the CyberKnife treatment.”

Dr. Scarrow, a neurosurgeon, joined St. John’s in 2003 and spearheaded the effort to acquire the CyberKnife.

“The introduction of the CyberKnife technology reflects St. John’s commitment to providing superior care to our patients,” Dr. Scarrow says.

CyberKnife radiosurgery is a painless, non-invasive radiation treatment that can be an alternative to conventional surgery. The CyberKnife system delivers radiation beams with “T4” or “tight to the tumor” accuracy. This means that CyberKnife radiosurgery is so precise, that radiation beams can target small, complex shaped tumors near critical structures of the body. The radiation beams penetrate the tumors while leaving healthy tissues unharmed.

“The CyberKnife is the most accurate means of delivering radiation available in the world today. Total error from the time of imaging to the actual delivery of radiation is 0.9 millimeters,”
Dr. Scarrow says.

Two weeks later, after researching and considering her options, the Crockers decided the CyberKnife treatment was Cheryl’s best bet. Dr. Scarrow performed the procedure in November 2005.

“It took about 30 minutes. They had already made the mask for me to wear to keep my head in place. The team there does everything they can to make you as comfortable as possible. You can wear your street clothes, which is nice. They pipe in music and you can take a break during the treatment if you need to, but I didn’t. I compared it to getting your X-rays done at the dentist’s office. They can’t be in the room with you during the treatment because of the radiation, but they talk to you over the intercom system. Randy was there and talked to me during the procedure. I had to be completely immobile, though, so I couldn’t talk,” Crocker says.

Since Crocker’s case, Dr. Estrem has received training on the CyberKnife. He began performing CyberKnife treatments in May. After the treatment, Crocker says she had a “pretty good headache” and nausea that lasted a few days. She took a week off work.

“Dr. Scarrow advised me to take a few days off work after the treatment to rest and recuperate from the stress it put on my body,” Crocker says.

Six months after the treatment, in March 2006, Crocker had another MRI and CT scan to see what effect, if any, the CyberKnife treatment had on the tumor in her ear.

“The doctors told me from the beginning that the treatment would not make the tumor go away; we were hoping it would cut off its blood supply so it couldn’t grow any more and further damage my hearing and nerve,” Crocker says. “After the MRI, they pulled the image of the tumor up on the computer screen and we could see all of these little dark spots in the white mass that was the tumor. That meant the CyberKnife had done its job – the tumor’s blood supply had been cut off and it was slowly dying.”

Crocker will have another MRI and CT scan in September to see if more of the tumor has died.

“I’m feeling pretty positive, but I won’t celebrate until I see more of those little black dots in the tumor,” she says. “Making the decision to undergo this treatment was a stressful one, but I’m glad I did it and it went as seamlessly as it did. I would make the same decision over again, in a heartbeat.”

CyberKnife Treatment - Step by Step

Preparation

• Making the mask or body mold.
  These are used to help minimize patient movement during treatment. The process is simple and painless.
• CT scan. The surgeon and radiation oncologist will use the scan to identify the exact size, shape and location of the tumor, along with the surrounding healthy tissues to be avoided.

Treatment planning

• Once the anatomy has been defined, your CyberKnife team will use the CyberKnife system’s state-of-the-art software to determine the number, intensity and direction of the radiation beams that the robotic arm will send to the tumor. This will help ensure that a sufficient dose is administered to the tumor in order to destroy it while avoiding the adjacent normal tissue.

Treatment

• Arriving for treatment
  Bring any X-rays you have. Wear comfortable clothing and no jewelry. We suggest you bring a bottle of water and a book to read or CD to listen to during your treatment.
   
• Positioning
  During treatment you will need to lie still. Generally no sedation or anesthesia is required because the treatment is painless.
   
• Treatment, Tumor Verification & Targeting
  The treatment itself involves the administration of radiation beams delivered from different directions. Prior to the delivery of each radiation beam, the image-guidance system takes X-ray images and compares them to the original CT scan. This information is used to ensure the radiation is targeted directly at the tumor while avoiding critical structures. The robotic arm then moves into position to deliver beam of radiation.
   
• Following treatment
  Patients generally leave the CyberKnife suite and resume normal activity immediately following treatment. Follow- up imaging is generally performed to monitor the tumor’s progress.