Cancer treatment: Cyberknife, the radiosurgery robot at the Clinic Sainte-Clotilde

Reference and high-tech center for cancer treatment La Runion, Oncology-radiotherapy center of the Clinic Sainte-Clotilde, established in 1970, Runionnais provides a comprehensive offer of cancer care (radiotherapy, chemotherapy, cancer surgery, oncology department with a capacity of 30 beds) . Particularly involved in clinical research activity, in particular in the field of oncology, it contributes to improving the health of the population and offers innovative therapies (hormonal therapy, immunotherapy, radiotherapy in volumetric arthritis by intensity modulation. .

2021 was an eventful year for the center which completed the acquisition of the latest generation of radiotherapy equipment and which became the most complete center on the island of La Réunion with the second TrueBeam accelerator installed in January, and since August, Cyberknife, the first radiosurgery robot in La Réunion, has been installed Runyon and the Indian Ocean region’s most innovative technical achievement to date in the context of cancer treatment. With the acquisition of Cyberknife, new treatment avenues are opened for Reunion patients suffering from cancer.

Context before implementation:

Cancer is a disease that is better and better treated nowadays, provided that screening is done regularly and early enough, even before symptoms appear, for better treatment, but also to limit the consequences of the treatments used. In some cases, screening can prevent the onset of cancer, by identifying and treating abnormalities that can develop into cancer.

In 2020, La Réunion recorded about 2,200 new cases of cancer. The therapeutic perspectives developed by the Center for Radiotherapy and Oncology greatly increase the number of cancer patients that can be treated. 1500 radiotherapy is dispensed annually, which prevents patients from prolonged chemotherapy and improves their comfort of life, especially through the modern treatments offered.

Radiation therapy, in light of the development of technological developments and radiobiological knowledge is constantly evolving. Physical control of fine beams, biological control of higher doses, and improved control of the tumor target led to the development of focused radiation of the strotoxy-type and radiosurgery.

In response to the priorities identified in the regional health project of the regional agency of Saint-La-Runion:

The priority of preventing and treating chronic diseases
– Access to healthcare offer for all
Course fluidity and continuity

In its experience, taking into account the evolution of cancer cases in women and men and the potential for reduction of the most deadly cancers (lung, prostate, clonal, etc.), St. Clotilde Clinic faces an increase in indications of radiation saturating the current potential of healthcare offerings and changes in therapeutic standards . Since 2019, in her Department of Radiotherapy, she has modified her technology park in order to adapt her offer of care. The acquisition of the first TrueBeam in 2016, and then the second since the beginning of 2021, allows for the development of under-fractionated radiotherapy in slowdown states.

Configured symmetrically (mirrored) 2 Truebeams provide greater convenience and save time in patient care, while securing the path and continuity of care by providing the possibility to use the second device for a period of time during maintenance operations.

The construction of the third bunker with 1.90m thick lead walls began in August 2019 to allow the use of Cyberknife without the slightest risk of exposure by protecting the outside surface of the room (persons and users.) from the radiation placed inside.

The Cyberknife project required over 3 years of planning, from signing the appreciation to the first patient, not to mention preparation and discussions with the teams. Cyberknife, which has been in service since April 5, 2021, requires a long stage of formation and checks before it can be launched. In fact, in accordance with applicable regulations, the conformity of the facility was verified by the institution’s radiation protection personnel (PCR), followed by the Nuclear Safety Authority who inspected and issued the installation permission on August 2, 2021. .

In terms of professional training, two technicians from the Department of Radiotherapy benefited from an immersion course in Nice in partnership with the Lacasani Centre. Physicians and medical physicists, who have already verified their skills in stress radiotherapy at Lone Berard Lyon Center, also benefited from remote training taking into account the COVID period provided by ACCURAY. Then they completed an immersion course in expert services in the metropolitan area (Clinic Clerval Marseille, Center Hartmann Paris).

The Cyberknife in detail:

The first patient from Reunion Island benefited from cancer treatment with Cyberknife on August 9, 2021 at the Radiotherapy Center of the Sainte-Clotilde Clinic. Cyberknife, the department’s third accelerator, is the first and only robotic radiosurgery system. It allows treating tumors with an accuracy of less than a millimeter. With the radiation head mounted on a robotic arm making it mobile and able to irradiate the tumor in different directions, the Cyberknife rotates around the patient to deliver beams of rays from all angles, allowing them to strike points between tumor confluences, regardless of their location in the body. It allows tracking of the treated tumor by synchronizing the patient’s movements in real time with the movements of the tumor and following its movements during sessions, including those related to breathing. So the patient can continue to breathe freely during radiation exposure while the robot is constantly adapting the volume treated with radiation to the respiratory cycle.

In fact, having been programmed, it generates its own information that will enable it to ensure and, if necessary, permanently correct its position during treatment. Its ability to provide the best possible treatment while preserving the healthy tissues and organs around it also enables it to treat hitherto inaccessible tumors! It is also a solution for some patients for whom chemotherapy or surgery may have adverse effects.

The compression axes of the Cyberknife robotic system provide “surgical” precision, hence the name for radiosurgery, an accuracy of less than a millimeter like that provided by scans such as the scanner and MRI used during preparation for radiotherapy. This robot can be used for treatment at the level of the brain (inside the skull) or outside the brain at the level of the body. Cyberknife is especially used in the treatment of tumors where shot accuracy is necessary or even vital, in the treatment of a large number of small and medium-sized cancers: brain tumors, near the visual system, pulmonary, near the spine such as the spinal cord, pineal marrow, liver, pancreas, prostate.. .

This unique La Runion tool allows you to perform treatments between 1 and 5 sessions compared to 30-40 sessions with other accelerators. Strotaxis is a modern technique of radiotherapy that allows the administration of a high dose of radiotherapy (the usual dose for cancer treatment is 2 Gy per session; with this technique the doses are increased up to 20-25 Gy per session). The advantage is the reduction in the number of sessions: for example, a single dose for the treatment of prostate cancer requires between 35 and 38 sessions. With a radiosurgery robot, five sessions will be enough. It also makes it possible, due to its extreme precision, to introduce a second radiation (re-irradiation on an area already treated by radiotherapy) which makes it possible to control the recurrence of cancer.

The Cyberknife in the Care Path:

Like any proposed treatment, the medical team of radiation oncologists determines whether the CyberKnife treatment is appropriate for the patient’s condition. The decision on the appropriateness of treatment with Cyberknife, made in a multidisciplinary consultation during meetings, takes into account clinical experience and tumor (category, extent, location, and size). An RCP (Multidisciplinary Consultation Meeting) dedicated to Radiosurgery Therapies is being prepared. Depending on the different conditions, treatment with Cyberknife may be combined with surgery, chemotherapy, conventional radiotherapy, or an alternative formulation.

Consequences of treatment with Cyberknife:

Like traditional radiotherapy, treatment with Cyberknife may cause skin flushing, headache (headache) for the treatment of the brain, inflammation of the mucous membranes of the nose, mouth, or throat, nausea and vomiting, or even fatigue in the following days. It is usually well tolerated, and its side effects that are limited to the area targeted by rays usually disappear within weeks and usually go away with time. Other undesirable effects may appear in the long term.

However, CyberKnife significantly reduces the effects, allowing patients to lead a normal “close” life despite cancer treatment. Referring patients to supportive care (social esthetician, dentist, psychologist, social worker) helps relieve unwanted effects of treatment, relieve fatigue or pain and provide physical, psychological or social support throughout illness and after cancer.

Finally:

The acquisition of Cyberknife represents an investment budget of approximately €4.5 million, fully funded by the Indian Ocean Radiosurgery Civil Society, led by part of the medical and radiophysics team from the clinic. The Sainte-Clotilde Clinic supported the construction of the bunker as well as the outfitting of the building with a total funding of 1.5 million euros.

This investment aims to position Radiotherapy at Clinique Sainte-Clotilde as one of the most successful activities in the Indian region of Okan. La Réunion thus became the first marine supercenter in France and the first in the Indian Ocean to be equipped with this technological advancement. As part of its function as a high-tech center for cancer treatment, St. Clotilde Clinic maintains its commitment and readiness to maintain its level of requirements and the quality of patient care. It confirms the teams’ participation in this project, which would not have been possible without their investments. The clinic reminds the population of the importance of early detection in order to better treat the disease and/or to reduce its consequences.