The CyberKnife is transforming radiotherapy.
The machine would not look out of place in the villain's lair in a James Bond film, except that it is used for purely benign purposes. It was developed along the same lines as the "robotic arm" technology used in car manufacturing, but this arm travels around a patient to deliver hundreds of beams of radiation to a tumour from many different angles, with absolute precision. This marvel of engineering is called the CyberKnife and it is the latest hi-tech weapon in the war against cancer.
Conventional radiotherapy can destroy or reduce a tumour, allowing precious extra months or even years of life, but the large doses of radiation can damage healthy tissue. Now the CyberKnife (pictured above) allows clinicians to target certain cancers much more accurately without affecting the surrounding tissue. The new technology also offers an option for treating tumours that used to be inoperable.
Some of the first British patients to benefit from the CyberKnife, have been treated at the London Clinic since the beginning of the year, following the opening of a new, £80 million cancer centre. Dr David Landau, an oncologist at St Thomas's Hospital in London and chairman of the steering group for the new centre, says the machine will allow many difficult-to-reach tumours to be treated with radiotherapy.
"The problem with conventional radiotherapy is that some tumours are close to critical structures, such as blood vessels or vital organs, which can be damaged by radiotherapy over a number of treatment sessions. In some cases, the oncologist has to tell the patient that it would not be safe," says Dr Landau.
"The CyberKnife technology has two advantages in terms of accuracy: because it uses pencil-thin beams of radiation to attack the tumour, it does not damage surrounding, healthy tissue, and, because of this, we can use much higher doses of radiation to blast the tumour from many angles."
Yusuf Hussein, 75, a retired airline pilot, is among the first to have the treatment. He was diagnosed with lung cancer five years ago. Following treatment at University College London Hospital the cancer was in remission for more than three years, but then a second tumour was diagnosed just outside the bronchus, a main airway, which meant it could not be treated with conventional radiotherapy. In March last year he underwent three sessions of CyberKnife treatment and within 12 weeks his scan was clear.
"I have always been quite active, but before my treatment I was having difficulty getting around and was very short of breath," says Mr Hussein. "Within weeks of having the treatment, I could do most daily activities fairly easily."
Mr Hussein paid for the CyberKnife treatment privately. One CyberKnife machine has been in use at the private Harley Street clinic since last year and the facility at the London Clinic will take both private and NHS referrals. The first NHS hospital to have a CyberKnife machine is the Mount Vernon Cancer Centre in north London.
The UK lags behind many other European countries in the provision of CyberKnife treatment, and similar machines such as Novalis Tx and Gamma Knife. They have been in use in the US for 10 years, initially for brain tumours, and, in the past few years, for lung cancer. They are now also licensed in the US for use in head, neck, lung and pancreatic cancer.
So why aren't more machines in use here? At around £2 million each, they are costly. While many clinicians agree the machines are effective some argue that the NHS should not spend huge amounts on technology that will benefit only 5 per cent of patients.
They believe there are more pressing concerns and point to the fact that the UK has fewer linear accelerators, or "linacs", (the machines that deliver radiotherapy) per 100,000 population than most other European countries. Radiotherapy is used in the treatment of an estimated 40 per cent of all patients who are cured of cancer, according to NHS figures, and it is cheaper than surgery or chemotherapy.
A survey of the cost of radiotherapy among EU member states showed it to be 3,000 euros (£2,800), compared with 7,000 euros for surgery and 17,000 euros for chemotherapy. It is clearly cost-effective, particularly compared with the high cost of newer cancer drugs such as Herceptin. The National Radiotherapy Advisory Group, set up by the Department of Health, is due to draw up guidance on the use of stereotactic radiotherapy (very high-dose radiation delivered to a very localised site) such as that delivered by the CyberKnife on tumours in sites other than the brain.
Dr Michael Williams, oncologist and chairman of the advisory group, says that the availability of radiotherapy has improved dramatically in Britain, but that it still lags behind many other European countries.
"We need to improve availability further. These machines are expensive, but it is a very cost-effective form of treatment," he says.
Meanwhile, MPs from the health select committee saw a demonstration of the CyberKnife in January as part of a review of cancer treatment. Their report due later this year, will be awaited with interest.
The machine would not look out of place in the villain's lair in a James Bond film, except that it is used for purely benign purposes. It was developed along the same lines as the "robotic arm" technology used in car manufacturing, but this arm travels around a patient to deliver hundreds of beams of radiation to a tumour from many different angles, with absolute precision. This marvel of engineering is called the CyberKnife and it is the latest hi-tech weapon in the war against cancer.
Conventional radiotherapy can destroy or reduce a tumour, allowing precious extra months or even years of life, but the large doses of radiation can damage healthy tissue. Now the CyberKnife (pictured above) allows clinicians to target certain cancers much more accurately without affecting the surrounding tissue. The new technology also offers an option for treating tumours that used to be inoperable.
Some of the first British patients to benefit from the CyberKnife, have been treated at the London Clinic since the beginning of the year, following the opening of a new, £80 million cancer centre. Dr David Landau, an oncologist at St Thomas's Hospital in London and chairman of the steering group for the new centre, says the machine will allow many difficult-to-reach tumours to be treated with radiotherapy.
"The problem with conventional radiotherapy is that some tumours are close to critical structures, such as blood vessels or vital organs, which can be damaged by radiotherapy over a number of treatment sessions. In some cases, the oncologist has to tell the patient that it would not be safe," says Dr Landau.
"The CyberKnife technology has two advantages in terms of accuracy: because it uses pencil-thin beams of radiation to attack the tumour, it does not damage surrounding, healthy tissue, and, because of this, we can use much higher doses of radiation to blast the tumour from many angles."
Yusuf Hussein, 75, a retired airline pilot, is among the first to have the treatment. He was diagnosed with lung cancer five years ago. Following treatment at University College London Hospital the cancer was in remission for more than three years, but then a second tumour was diagnosed just outside the bronchus, a main airway, which meant it could not be treated with conventional radiotherapy. In March last year he underwent three sessions of CyberKnife treatment and within 12 weeks his scan was clear.
"I have always been quite active, but before my treatment I was having difficulty getting around and was very short of breath," says Mr Hussein. "Within weeks of having the treatment, I could do most daily activities fairly easily."
Mr Hussein paid for the CyberKnife treatment privately. One CyberKnife machine has been in use at the private Harley Street clinic since last year and the facility at the London Clinic will take both private and NHS referrals. The first NHS hospital to have a CyberKnife machine is the Mount Vernon Cancer Centre in north London.
The UK lags behind many other European countries in the provision of CyberKnife treatment, and similar machines such as Novalis Tx and Gamma Knife. They have been in use in the US for 10 years, initially for brain tumours, and, in the past few years, for lung cancer. They are now also licensed in the US for use in head, neck, lung and pancreatic cancer.
So why aren't more machines in use here? At around £2 million each, they are costly. While many clinicians agree the machines are effective some argue that the NHS should not spend huge amounts on technology that will benefit only 5 per cent of patients.
They believe there are more pressing concerns and point to the fact that the UK has fewer linear accelerators, or "linacs", (the machines that deliver radiotherapy) per 100,000 population than most other European countries. Radiotherapy is used in the treatment of an estimated 40 per cent of all patients who are cured of cancer, according to NHS figures, and it is cheaper than surgery or chemotherapy.
A survey of the cost of radiotherapy among EU member states showed it to be 3,000 euros (£2,800), compared with 7,000 euros for surgery and 17,000 euros for chemotherapy. It is clearly cost-effective, particularly compared with the high cost of newer cancer drugs such as Herceptin. The National Radiotherapy Advisory Group, set up by the Department of Health, is due to draw up guidance on the use of stereotactic radiotherapy (very high-dose radiation delivered to a very localised site) such as that delivered by the CyberKnife on tumours in sites other than the brain.
Dr Michael Williams, oncologist and chairman of the advisory group, says that the availability of radiotherapy has improved dramatically in Britain, but that it still lags behind many other European countries.
"We need to improve availability further. These machines are expensive, but it is a very cost-effective form of treatment," he says.
Meanwhile, MPs from the health select committee saw a demonstration of the CyberKnife in January as part of a review of cancer treatment. Their report due later this year, will be awaited with interest.
