Cancer treatment: CyberKnife, a radiosurgery robot at the Sainte-Clotilde clinic

The Sainte-Clotilde Clinic inaugurated the first radiosurgery robot in La Runion and the Indian Ocean to be offered to the population to improve cancer treatment: the “Cyberknife”. While in 2020, La Runyon has identified nearly 2,200 new cases of cancer, the robot could treat tumors with sub-millimetre accuracy. We publish below the Clinifuture Health Group press release.

Reference and high-tech center for cancer treatment La Runyon, the oncology-radiotherapy center of the Sainte-Clotilde clinic, created in 1970, with a comprehensive cancer care offering (radiotherapy, chemotherapy, cancer surgery, 30-bed oncology department) Runionice offers. , Particularly involved in the activity of clinical research, especially in the field of oncology, it contributes to improving the health of the population and provides innovative treatments (hormone therapy, immunotherapy, radiotherapy in volumetric arthritis by intensity modulation and strotaxic conditions). in radiotherapy). ,

The year 2021 was a momentous one for the center that finalized the acquisition of the latest generation of radiotherapy equipment and became the most complete center on the island of La Runyon with its second TrueBeam accelerator installed in January, and CyberKnife since August, The first radiosurgery in La Runyon and the most innovative technological achievement to date in terms of robots and cancer treatment in the Indian Ocean region. With the acquisition of CyberKnife, new therapeutic approaches are opening up for Reunion patients living with cancer.

Reference before implementation:

Cancer is a disease that is nowadays better and better treated, provided that screening is routine and sufficiently early, even before the onset of symptoms, for better cure, but also to limit sequences related to the treatments used. is also done for In some cases, screening can even prevent the onset of cancer, by identifying and treating an abnormality that may progress to cancer.

In 2020, La Runyon recorded approximately 2,200 new cases of cancer. Therapeutic approaches developed by the Oncology-Radiotherapy Center have significantly increased the number of cancer patients that can be treated. 1500 radiotherapy treatments are delivered annually and prevent patients from prolonged chemotherapy treatments and improve their comfort of life, especially through the modern therapies introduced.

Radiotherapy is constantly evolving under the development of technological advances and radiobiological knowledge. Physical control of micro-beams, biological control of high doses, and improvements in the control of tumor targets have led to the development of focused radiations of the strotaxic type and radiosurgery.

In response to the priorities identified in the Regional Health Project of the Regional Agency of Sant La Runyon:

Prioritizing the prevention and management of chronic diseases
– Access to healthcare offerings for all
– Fluidity and consistency of course

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And with its expertise, taking into account the potential for the growth of cancer cases among women and men and the reduction of the deadliest cancers (lung, prostate, clonal, etc.), the Sainte-Clotilde clinic is expected to increase the indications for facing. Radiation that saturates the current capacity to offer health care and changes in medical standards. Since 2019, for its radiotherapy division, it has amended its technical park to optimize its care offering. The acquisition of TrueBeam, the first in 2016, then the second since early 2021, allows the development of hypofractured radiotherapy in strotaxic situations.

2 TrueBeams, similarly configured (mirrored) provide greater comfort and save time in patient care, while ensuring continuity of care and continuity of care by offering the possibility of using a second machine for a period of time . maintenance operation.

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 radiation kept inside the room (personnel and users) outside the room.

The CyberKnife project required over 3 years of planning, not to mention the preparation and discussions discussed above with the teams, from signing the estimate to the first patient. Received from April 5, 2021, CyberKnife required a lengthy phase of configuration and testing before being put into service. In fact, as per the applicable regulations, the conformity of the installation was verified by the Radiation Safety Competent Person (PCR) of the establishment, followed by inspection by the Nuclear Safety Authority and the permission issued. Established on 2nd August, 2021.

With regard to professional training, two technicians from the Department of Radiotherapy benefited from an immersion course in Nice in partnership with the Center Laccagne. Doctors and medical physicists, who had already validated their radiotherapy skills in strotaxic situations at the Lone Berard Lyon Center, have also benefited from the distance training provided by the ACCURAY company in view of the COVID period. He then completed an immersion course in specialist services in the metropolitan area (Polyclinic Clairval Marseille, Center Hartmann Paris).

Cyberknife in details:

The first patient from Reunion Island benefits from his cancer treatment by CyberKnife at the Radiotherapy Center of the Sainte-Clotilde Clinic on August 9, 2021. CyberKnife, the department’s third accelerator, is the first and only robotic radiosurgery system. This allows tumors to be treated with sub-millimetre precision. With its radiation head mounted on a robotic arm and making it mobile and capable of irradiating the tumor in different directions, the CyberKnife moves around the patient to deliver rays of light from all angles, allowing them to be able to multiply. Between transforming into a tumor, regardless of its location in the body. This allows tracking the treated tumor, in real time, by synchronizing the patient’s movements with the tumor and following his movements during breathing-related sessions. The patient can therefore continue to breathe freely during the irradiation, while the robot continuously adapts the amount treated by the irradiation to the respiratory cycle.

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In fact, once programmed, it generates its own information that enables it to ensure and, if necessary, permanently correct its position during treatment. Its ability to deliver the most optimal treatment while sparing the surrounding healthy tissue and organs also enables it to treat tumors hitherto inaccessible! It is also a solution for some patients for whom chemotherapy or surgery may have harmful effects.

The strotaxis of the CyberKnife robotic system provides “surgical” accuracy, hence the name radiosurgery, less than a millimeter of accuracy provided by scanners used in preparation for radiotherapy and by examinations such as MRI. This robot can be used to treat brains outside the body at the brain level (intracranial) or at the body level. CyberKnife is particularly used in the treatment of tumors where the accuracy of the shot is essential or even important, in the treatment of a large number of small and medium-sized cancers: brain tumors, near the optic tract, pleural, Adjacent spinal cord such as the spine and pincer medulla, liver, pancreas, prostate…

This unique La Runeion tool allows you to have between 1 to 5 sessions of treatment as compared to 30 to 40 sessions with other accelerators. Strotaxis is a modern technique of radiotherapy whereby a high dose of radiotherapy can be given (the usual dose for curing cancer is 2 Gy per session; with this technique the dose is increased to 20 to 25 Gy per session). The advantage is to reduce the number of sessions: for example 35 to 38 sessions are needed for 1 dose to cure prostate cancer. With a radio surgery robot, five sessions would suffice. This, because of its extreme accuracy, makes it possible to offer a second radiation (re-irradiation to an area already treated by radiotherapy) which makes it possible to control cancer recurrence.

CyberKnife in Care Path:

Like any proposed treatment, the medical team of a radiotherapy oncologist determines whether CyberKnife treatment is appropriate for the patient’s condition. Decisions on the appropriateness of treatment with CyberKnife are made in multidisciplinary consultations during meetings, taking into account clinical experience and tumor (range, extent, location, size). An RCP (Multidisciplinary Consultative Meeting) dedicated for radiosurgery treatment is being set up. Depending on different circumstances, treatment with CyberKnife may be combined with surgery, chemotherapy or conventional radiotherapy, or may constitute an alternative.

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Outcomes of treatment with CyberKnife:

As with conventional radiation therapy, treatment with CyberKnife may also cause redness of the skin, headache for treating warts (headache), swelling of the mucous membranes in the nose, mouth, or throat, nausea and vomiting, or fatigue in the coming days. Is. Generally well tolerated, side effects limited to the area targeted by the rays usually go away within weeks and usually go away with time. Other undesirable effects may appear for a more or less prolonged period.

However, CyberKnife significantly reduces the effect, allowing patients to lead “near” normal lives despite cancer treatment. Referring patients to supportive care (social aesthetics, therapist, psychologist, social worker) to relieve undesirable effects of treatment, reduce fatigue or pain, and provide physical, psychological or social support during illness and after cancer helps in.

in conclusion :

The acquisition of CyberKnife presents an investment budget of approximately €4.5 million, fully financed by the Civil Society of Means of Radio-Surgery Indian Ocean, led as part of the medical and radiophysics team from the clinic itself. Is. The Sainte-Clotilde Clinic supported the construction of the bunker as well as fittings outside the premises, for a total funding of €1.5 million.

The objective of this investment is to establish radiotherapy at the Clinic Saint-Clotilde as one of the most successful activities in the Ocan-Indian region. La Runyon thus became the first Ultra Marine Center in France and the first in the Indian Ocean to be equipped with this technological advancement. As part of its business as a high-tech cancer treatment centre, Sainte-Clotilde Clinic maintains its commitment and willingness to maintain the level of need and quality of patient care they require. She outlines the teams participation in this project which would not have been possible without her investment. The clinic reminds people of the importance of early detection to provide better treatment for the disease and/or limit its consequences.

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