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December 9, 2008

v. CyberKnife


First, a stipulation: There’s no such thing as the best cancer treatment for every situation. That being said, there are different methods, and someone’s got to pick a favorite. It’s not going to be us, but we’ll let the docs speak for themselves. We checked out CyberKnife recently, so last week we visited Inova Fairfax’s Glenn Tonnesen, who thinks TomoTherapy has a leg up.


Here’s TomoTherapy in action (with patient consent, of course). Glenn, flanked by radiation therapists Alisha Niblett and Ryan Huntley, tells us Tomo can do anything CyberKnife can do, except Tomo is faster and cheaper. Also, it can irradiate tumors up to 140 cm long, while Glenn says CyberKnife is limited to masses about the size of a plum. Tomo works by delivering 64 beams of rotating radiation, so as the patient moves, a 3-D array attacks the problem area. Because each beam is individually controlled by a computer, it can deliver a high radiation dose to the known tumor, give a lower dose to nearby lymph nodes that might contain cancer, and still protect adjacent organs.


Sheri Cosler has a cool job title—Dosimetrist (a specialist in calculating radiation doses, if your vocab is rusty). She translates Glenn’s wishes into action by using a computer to outline where radiation should hit and miss. (Yes, this means the people best positioned to save your life are those who goofed off using Windows Paint during typing class.) Thanks to Sheri, Tomo can safely target cancer anywhere: head and neck without harming the parotid gland; breasts without frying the lungs or heart; and even malignant brain cells that have spread down the spinal fluid. One hospital in L.A. is even experimenting with using Tomo to treat Leukemia by limiting the radiation to the patient’s bone marrow.


He’s not playing Minesweeper. Glenn, who’s been with Inova since ’82, is checking the outlines around vital organs, ensuring Tomo deals them the least amount of radiation possible. We should point out that he was nothing but respectful toward his CyberKnife counterparts, though, he did use this opportunity to tell us that they require an extra surgery to implant four gold seeds in the tumor to guide radiation. He explains that TomoTherapy, instead, uses a 3-D CT scan to guide treatment, so it’s more reliably precise. If you think Glenn looks comfortable at the helm, perhaps that’s because he’s also a helicopter pilot, and even offered to take us up. We’re not swayed that easily, though. We’re willing to see if any CyberKnifers offer F-16 rides before picking which treatment is the best.

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