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Automaker`s robot arm finds use in cancer care


Posted on: 02/10/2004

Posted on Tue, Feb. 10, 2004

Automaker's robot arm finds use in cancer care

By John Dorschner
KNIGHT RIDDER NEWSPAPERS

MIAMI - The hottest new technology for zapping brain tumors, a CyberKnife, opened for business last month, but experts debate whether it's worth its $4 million cost.

"I feel very comfortable that this is the right piece of equipment at the right time," said James G. Schwade, the physician-developer of the CyberKnife Center of Miami who has made the huge investment on the device.

His CyberKnife, at a free-standing center in Kendall, Fla., is only the 12th in the United States.

Its value is delivering a beam of radiation with extreme accuracy -- to within 1/50th of an inch. Its primary use now is destroying brain tumors that can't be operated on, but it can be used for lung, spinal and other tumors as well.

An older device, a gamma knife, costs about as much as CyberKnife machines, and some wonder if there's a need for another expensive machine.

"I turned down a CyberKnife two years ago," said Aizik Wolf, a neurosurgeon who operates a gamma knife at Doctors Hospital in Coral Gables.

"What he's doing is a business deal. ... It's not the type of medicine that produces quality outcomes. It's the kind of medicine that a bunch of second-rate physicians do after a half-day of training."

Others disagree. Jorge J. Guerra Jr., a professor of radiology at the University of Miami, calls the CyberKnife "a quantum leap."

"I'm not sure it's cost-effective, but for grandma, we want the best possible therapy, regardless of the cost," Guerra said.

Treatment is not cheap. Medicare pays about $25,000 to $30,000 for CyberKnife treatment, which includes the costs of a neurosurgeon and radiation oncologist supervising the operation.

"Radiation is radiation," said Maria B. Freed, administrator for CyberKnife Center of Miami. The key is how accurate the beam is, so that it kills the bad cells while not damaging the surrounding healthy cells.

Gamma knives, developed in the late 1960s, were the first to emphasize extreme accuracy. A patient's head is locked in a frame to keep it absolutely immobile so that the radiation reaches precisely the right area.

After the procedure, which costs about the same as a CyberKnife treatment, a patient generally spends at least one night in the hospital.

Schwade, a veteran radiation oncologist who has worked at Jackson Memorial and several other South Florida hospitals, had done hundreds of gamma knife procedures.

Three years ago, after neck surgery, he stopped practicing medicine and focused on entrepreneurial health care.

He became fascinated with the CyberKnife, developed by a Stanford University neurosurgeon. It employs a massive robot arm made by Kuka, designed to weld parts on the Mercedes Benz assembly line.

A pair of X-ray cameras calculates the exact position of the head, and the CyberKnife beam has software to adjust accordingly, eliminating the need for a head frame and for an overnight stay in the hospital.

Virtually all existing gamma knives and CyberKnife facilities are parts of hospitals. Schwade decided to set up his as a free-standing facility, not connected to any hospital.

His idea is that any neurosurgeon and radiation oncologist in South Florida can bring their patients there. He provides training, which runs about 21/2 days.

"I'm providing maximum access to the maximum number of doctors," says Schwade. "This means continuity of care," he said, in which a patient can stick with the same physicians all the way through treatment.

Wolf's main argument against Schwade's facility is that the various doctors who go there will each do only a few procedures, while Wolf, the only user of the gamma knife at Doctors, does 400 a year.

"What every medical journal published in the last five years says is that experience makes a huge difference in outcomes," says Wolf.

The first patient at the CyberKnife center, even before it officially opened, was a woman with a brain tumor that couldn't be reached by a gamma knife, says Freed, and while gamma knives are used only for brain tumors, the CyberKnife can also be used for other areas, including benign facial tumors that can cause intense pain.

Software and uses for the CyberKnife are still being developed, Schwade says, and he anticipates that in the future its use for liver cancer, prostate cancer and other diseases may surpass its use for brain cancer.

That might also increase its cost-effectiveness. Even with gamma knives and the CyberKnife, brain cancer remains a deadly disease. Two out of three die within five years, according to the National Cancer Institute.

"Can you show the CyberKnife is worth the cost?" asks Guerra at the University of Miami. "The numbers of patients are still too small for a study, but if it adds months to your grandma's life, or to the quality of her life, what is a reasonable cost?"


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