The CyberKnife® Robotic Radiosurgery System may blast targeted doses of radiation that shrink tumors, but it’s the nurses at Winthrop-University Hospital who prepare the patients for the procedure and provide the TLC.
What’s so wonderful is we can offer radiation to patients who have failed radiation or chemotherapy, says Elaine Montchal, RN, CyberKnife nurse coordinator at Winthrop -University Hospital in Mineola, N.Y. This gives another treatment option we can offer them.
CyberKnife directs precisely targeted radiation to tumors. Radiation oncologists can sculpt the beam to reach small, deeply imbedded masses considered inoperable or untreatable with conventional radiation or surgery. The bloodless, painless, outpatient procedure can treat primary and metastatic brain, spine, and soft-tissue tumors, aiming for a cure or palliation, and is used for some benign conditions such as trigeminal neuralgia.
It’s very important in patients with metastatic disease, because we can prolong their quality of life and give them time with their families, pain-free, Montchal says. It’s very rewarding when you see a patient come in in a wheelchair, and three weeks later, come walking in.
Winthrop-University is one of only about 100 centers in the nation using CyberKnife, developed and marketed by Accuray of Sunnyvale, Calif. More than 35,000 patients worldwide have received a CyberKnife treatment.
It’s an up-and-coming field, says Sue Carbone, RN, a staff nurse at the center. It’s a new technology, and it’s better.
Precision Makes a Difference
The CyberKnife delivers radiation with submillimeter accuracy. Consequently, it causes less damage to surrounding healthy tissue and produces fewer side effects. As it moves around the patient to deliver the radiation, it tracks respiration or other minor movement and adjusts beam delivery accordingly.
This machine can track [with] up to 1mm of accuracy, Montchal says. The machine actually goes up and down with the patient’s respirations, which is very important when treating the lung. We can target the tumor and spare the surrounding good tissue.
In patients treated for prostate cancer, The PSAs come down with little or no side effects, Montchal says. We have some initial urinary and bowel complaints, but when they come back at three weeks, whatever side effects they were having are gone.
Whereas conventional radiation therapy requires daily visits for weeks, CyberKnife treatments typically wrap up within one week, with the patient spending 45 minutes to 1.5 hours, one to five days a week at the center.
Patients come in for a consult several weeks prior to initiation of therapy. The nurses help with teaching and assess whether the patient can tolerate lying still and flat, and whether they will need oxygen or pain medication during therapy.
The patients really appreciate everything you do, says Maryann Miccio, RN, a CyberKnife nurse at Winthrop-University. They are getting good results, so you feel it is rewarding.
If the treatment involves soft tissue, fiducials (small markers that help the device track its position) are needed. CyberKnife nurses assist the physician, placing the fiducials in prostate cancer patients. The physician injects them between the scrotum and rectum, while watching on ultrasound.
A CT scan and MRI are taken to identify the size, shape, and location of the tumor. Imaging results are downloaded to the CyberKnife, and the radiation oncologist determines the number, intensity, and direction of the radiation beams. The patient comes in and is fitted with a customized, soft face mask or a body mold.
When the patient returns for treatment, that mask or mold helps ensure his or her identical placement on the table and will limit movement. No head frame or skull pins are needed.
Fighting to Provide the CyberKnife Option
Despite all of its benefits, many insurers do not cover the cost, which runs about $20,000 per treatment. Imaging studies, fiducials, masks, and molds are extra, and may be covered. Medicare does reimburse for CyberKnife.
Diane Accordino, RN, CEN, CCRN, works full-time as a CyberKnife appeals coordinator, educating insurers. She says it is not an easy process, and sometimes the hospital will pursue an appeal through the courts.
The best phone call to make is when we get to tell a patient ‘We did it, and you are on,’ Accordino says. That makes it all worth it. That’s why I love it.