Cancer Treatment: Radio Surgery Robot at Cyberknife, Saint-Clotilde Clinic

Reference and high-tech center for cancer treatment La Onion, the oncology-radiotherapy center of the Saint-Clotilde Clinic, was created in 1970, offering a comprehensive cancer care offer (radiotherapy, chemotherapy, cancer surgery, 30-bed oncology department) for runionis. . Participates especially in clinical research activities, especially in the field of oncology, which contributes to improving the health of the population and provides innovative therapies (hormone therapy, immunotherapy, radiotherapy in volumetric arthritis through severity modulation. And radiotherapy in the strootoxic state).

The year 2021 was a very eventful year for the center, which finalized the purchase of the latest generation of radiotherapy equipment and in January became the most complete hub on the island of La Rooney with its 2nd TrueBeam Accelerator, and has been the most technologically advanced robot and cancer treatment expert in cybernife, 1st radio surgery, La Rooney and the Winnipeg in the Indian Ocean region. . With the acquisition of Cyberknife, new therapeutic approaches became available to Reunion patients suffering from cancer.

Pre-implementation context:

Cancer is a disease that is getting better and better treated these days, and for better treatment, screening can be done regularly and early enough before symptoms appear, but it limits the consequences of the treatments used. In some cases, screening can prevent cancer by detecting and treating abnormalities that can lead to cancer.

In 2020, La Runion reported nearly 2,200 new cancer cases. Therapeutic approaches developed by the Oncology-Radiotherapy Center significantly increase the number of cancer patients who can be treated. 1500 radiotherapy treatments are distributed annually and prevent patients from prolonged chemotherapy treatments and improve their living comfort, especially through advanced treatments.

Radiotherapy is constantly evolving in the development of technology and radiobiological knowledge. Improvements in the physical control of micro-rays, high-dose biological control and control of tumor targeting led to the development of concentrated radiation of the strotoxic type and radiosurgery.

In response to the priorities identified in the Regional Health Project of the Regional Agency of Saint La Rయన్nion:

– Priority for prevention and management of chronic diseases
– Health care offer is available to all
– Fluidity and continuity of course

And with its expertise, the Saint-Clotilde Clinic is facing an increase in indications, taking into account the evolution of cancer cases between women and men and the possibility of reducing the most malignant cancers (lung, prostate, clone, etc.). Radiation that fills the current potential of health care offerings and changes in treatment standards. From 2019, for its radiotherapy department, it undertook a change in its technology park to receive its care offer. 1st TrueBeam acquisition in 2016, followed by the second from early 2021, will allow the development of hypofractated radiotherapy in strotoxic conditions.

2 Truebeams, similarly configured (mirror) provide more comfort and save time in patient care, while preserving the course and continuation of care by providing the opportunity to use a second machine for a while.

Construction of the 3rd bunker, with 1.90 m thick lead walls, began in August 2019, allowing cybernife to be protected from radiation (personnel and users) placed inside the room without the risk of slight exposure.

The Cyberknife project requires more than 3 years of planning, not to mention discussions upstream with preparation and teams, from signing the assessment to the 1st patient. Adopted April 5, 2021, requires a long phase of configuration and inspections before being put into cyber‌nife service. In fact, the installation was certified by the Institution’s Radiation Protection Competent Person (PCR) in accordance with applicable regulations, after which the Nuclear Safety Authority inspected and issued the installation on August 2, 2021. .

With regard to vocational training, two technicians from the Department of Radiotherapy have benefited from an immersion course in Nice in partnership with the Center Lacassagne. Physicians and medical physicists who have already certified their radiotherapy skills in strootoxic conditions at the Lone Beard Lyon Center‌ also benefit from distance training, taking into account the Kovid duration provided by the ACCURAY Company. They completed an immersion course in specialist services in the metropolitan area (Polyclinic Clairewall Marseille, Center Hartmann Paris).

Cyberknife Details:

The 1st patient from Reunion Island benefited from his cancer treatment through cyberknife on August 9, 2021 at the Radiotherapy Center at the Saint-Clotilde Clinic. Cyberknife, the 3rd accelerator in the division, is the first and only robotic radiosurgery system. This allows the tumors to be treated with sub-millimeter accuracy. Since its radiation head is mounted on the robotic arm and can radiate the tumor in different directions, the cyberknife rotates around the patient and delivers beams of light from all angles. Regardless of its location in the body. It allows the treated tumor to be tracked by synchronizing the patient’s movements with the tumor’s movements in real time and by following his movements during sessions, including respiratory ones. Thus the patient can continue to breathe freely during the radiation, while the robot constantly adjusts the volume treated by the radiation to conform to the respiratory cycle.

In fact, once programmed, it produces its own information, which allows it to permanently determine its location during treatment and to correct it if necessary. Its ability to provide as much proper treatment as possible while leaving surrounding healthy tissues and organs also allows it to treat tumors that were hitherto unavailable! It is also a solution for certain patients who have had adverse effects of chemotherapy or surgery.

The cytotoxicity of the cybernife robotic system provides “surgical” accuracy, hence its name less than a millimeter, as provided by tests such as the scanner and MRI used during the preparation of radiotherapy. This robot can be used for treatments at the brain level (intracranial) or at the body level outside the brain body. Cyberknife is especially used in the treatment of essential or significant tumors of the shot, in the treatment of a large number of small and medium-sized cancers: brain tumors, near the optic tract, pulmonary, proximal vertebrae and pineal marrow, liver, pancreas, prostate …

This unique La Runion tool allows you to perform between 1 and 5 sessions compared to 30 to 40 sessions with other accelerators. Strotaxis is a state-of-the-art technology of radiotherapy that allows high doses of radiotherapy to be given (the usual dose to cure cancer is 2 Gy per session; with this method the doses are increased to 20 to 25 Gy per session). Benefit of reducing the number of sessions: For example, 1 dose between 35 and 38 sessions is required to cure prostate cancer. With a radio surgery robot, five sessions are enough. Due to its high accuracy, it is also possible to provide a second radiation (radiation again on the area already treated by radiotherapy), thereby controlling the recurrence of the cancer.

Cyberknife on the way to care:

As with any proposed treatment, the medical team of radiotherapy oncologists will determine whether the cyberknife treatment is appropriate for the patient’s condition. The decision on the appropriateness of treatment with cyberknife is made in multidisciplinary consultations during the meetings, which take into account the clinical experience and the tumor (category, extent, location, size). An RCP (Multidisciplinary Consultation Meeting) dedicated to radiotherapy is being set up. Depending on the circumstances, treatment with cyberknife can be combined with surgery, chemotherapy or conventional radiotherapy or as an alternative.

Consequences of treatment with cyberknife:

As with conventional radiation therapy, treatment with cybernife can cause redness of the skin, headache (headache), swelling of the mucous membranes of the nose, mouth or throat, nausea and vomiting, or fatigue in the following days. If generally well tolerated, its side effects, which are limited to the target area by the rays, usually go away within weeks and usually subside over time. Other undesirable effects appear to be more or less chronic.

However, cyberknife significantly reduces the effects, allowing patients to live normal lives “near” despite treatment for cancer. Prescribing patients with supportive care (socio-cosmetologist, dietitian, psychologist, social worker) can provide relief from the undesirable effects of treatment, relieve fatigue or pain, and provide physical, psychological or social support throughout the disease and after cancer.

At the end:

The acquisition of Cyberknife will provide an investment budget of approximately 4.5 million euros, which will be fully funded by the Civil Society of Means of Radio-Surgery in the Indian Ocean, with the clinic leading a portion of the medical and radiophysics team. The Saint-Clotilde Clinic supported the construction of the bunker as well as the setting up of the premises for a total funding of 1.5 million euros.

The investment aims to place radiotherapy at the clinic Saint-Clotilde, one of the most successful operations in the Okan-Indian region. La Rనిunion became the first ultra-marine center in France and the first hub in the Indian Ocean with this technological advancement. As part of its mission as a highly technical cancer treatment center, the Saint-Clotilde Clinic maintains its commitment and willingness to maintain the level of its needs and quality of patient care. She stressed the involvement of teams in this project, which would not have been possible without their investment. The clinic reminds the public of the importance of early detection to provide better treatment for the disease and / or to limit its consequences.