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CyberKnife robot has been in Latvia for a year!

Cancer treatment with Cyberknife already one year Latvia

Radiosurgery Centre has been operating in Sigulda Hospital for a year, offering efficient and sparing tumour treatment using modern CyberKnife radiosurgery technique.

During this period the centre has achieved significant progress in its development, and now, regardless of tumour location in the body, it is able to help any patients this procedure is suitable for.

Patients who underwent treatment in Sigulda can be conditionally divided into two groups. One group includes patients with progress in tumour treatment, and tumour could not be treated due to its localisation. The second group consists of patients who have just been diagnosed with a tumour, as in these cases radiosurgery procedure ensures the best result possible and allows avoiding surgical intervention and subsequent recovery period.

In the hands of knowledgeable specialists CyberKnife robot allows precisely delivering the required amount of beams to the tissues affected by the tumour, stopping its further development in order to destroy it.The surrounding healthy tissues are minimally affected during the procedure. We interviewed the patients at Sigulda Centre who underwent treatment earlier this year, and they told similar things – it is unbelievable that all you need to do during the procedure is to lie still. There is no pain, and all you need to do after the procedure is to stand up and go back to your daily activities. Patients who have already done the first test 6 months after the procedure, have received the following answers: their treatment is performed according to plan. To give an overview of the opportunities offered by the modern CyberKnife M6 device we interviewed MĀRIS SKROMANIS, SRC SIGULDA director.

Sigulda Radiosurgery Centre is celebrating its anniversary – one year since the centre opened and became accessible to everyone.Whatare you most satisfied with?

The time since the opening of the Radiosurgery Centee has flashed by: it seems that it was a very short time ago, when we celebrated the opening of the Stereotactic Radiosurgery Centre Sigulda on November 24 last year, and on December 3 radiosurgery procedure was performed to the first three patients with benign tumours in the head during training.The number of our patients now exceeds 50. During these 11 months, we have mastered a lot of new indications, and in the first year of our work we can proudly say that we are ready to perform any radiosurgery procedure at a level that is not lower than in the best radiosurgery centres in Germany, Italy, and America. Now we can accept any patient, if his or her disease can be treated using CyberKnife. This is what we are most satisfied with.

This is undeniably very good news that you can help not only to patients suffering from tumours in the head.Who else can undergo treatment with this unique cyber-knife?

You are right, at first we offered services of the Radiosurgery Centre to patients suffering from tumours in the head only. In fact, in the first three months we mostly treated patients with tumours in the brain that were benign (neuroma and meningioma) and not so benign (oligodendroglioma and astrocytoma), but in the end of February we completed the first procedure to a patient with metastases in her back, and we performed a procedure which was unique for the Baltic States – to a patient suffering from uveal or choroidal melanoma.

In March and April last year we started to perform the first procedures to patients with abnormal vascular masses of the head, for example, the cavernous and arteriovenous malformations – these disorders are characterised by sudden episodes of bleeding with symptoms similar to stroke, and they only occur in young people.

In summer, we performed several radiosurgical procedures to patients with metastases in the brain, and in case of tumours localised elsewhere, for example, in case of breast, lung, prostate and kidney cancer. We treated patients with a large number of metastases and with very small – metastases – up to 5 mm in diameter.

In summer we also started to perform hypofractioned prostate radiosurgery in patients with prostate cancer of the first or second stage.This technique allows to destroy the tumour, avoid radical surgery, and significantly reduce the likelihood of local relapse, without any significant side effects and with minimal impact on potency.

In August we started to perform radiosurgery procedures to patients in case of small primary tumours or metastases located elsewhere, and radiosurgery procedure to patients with lymph nodes invaded by tumour cells, when radiosurgical procedure is synchronised with breathing.This technique allows to deliver a destructive dose of ionising radiation to tumours or metastases located in the lungs, mediastinum, liver, kidneys, pancreas and other sites that are hard to reach during a surgery. The main difference is related to the fact that this technique enables us to destroy tumours considered as radioresistant or insensitive to radiation. In such cases we carry out additional patients’ diagnostics by applying the most modern diagnostic methods before the treatment:multilayer computed tomography (CT), 3 Tesla magnetic resonance (MRI), and positron emission tomography (PET) with radioactive glucose (FDG); choline is applied as an active substance in case of prostate cancer.Accurate diagnosis is very important in our case, as we only treat what can be identified as abnormal by using the equipment.

How many people contacted you during this year and were you able to help them all?

 Since we started to work in early November 2015, we have received more than 500 electronic requests for treatment in our web site and e-mails from Latvia and neighbouring countries: Lithuania, Estonia, Russia, Ukraine, Belarus, and Finland.And also from Azerbaijan, Norway, Romania, Ireland, Great Britain, and exotic Brazil.During this period we gave at least 275 on-site consultations to patients (220 in Latvia, 55 in Lithuania, and five in Ukraine).64 patients have confirmed they were ready to undergo radiosurgery procedure using CyberKnife M6; 133 radiosurgery procedures (sessions) have been performed to 53 patients.

We have done a lot of work during a year, and I have to thank all our team for that.We have tried to carefully evaluate each case and indicate radiosurgery only when we could see significant benefit for the patient.We have given consultations about other treatment methods in situations when CyberKnife procedure was not suitable to the patient.We were able to help also in cases when the patient was refused treatment elsewhere.

Are there any cases that etched into your memory?

 Each patient who underwent treatment in our clinic is a special case, because, despite the large number of patients treated, each case is individual and unique.Situations may significantly differ even in case of similar diagnoses.We know and remember all our patients, and we inquire how our patients feel three, six, twelve or more months after the procedure.We always hope for a good result even when we are the last hope for a patient.We are very pleased when our treatment results exceeded previous expectations.

I remember a patient from Lithuania especially well; she suffered from uveal melanoma – a tumour that developed in the eye socket and grew from the eye tissues.The goal of therapy was to stop tumour growth in the patient’s eye to save the eye function.The procedure was technically complicated, as eyeball immobilisation using anaesthesia was required before the preparation for the procedures and during the radiosurgery to ensure the immobility of the injured eye.PET examination was performed three months after the procedure, it showed that the tumour activity in the eye had been stopped, and the size of the tumour continues to shrink.It has been nine months after the procedure, and the patient’s state has not deteriorated, there are no side effects as a result of our therapy.

There are situations when the diagnosis is very severe, for example, metastases in the brain.In this case we can talk about a good outcome only in case if we achieve local relapse control in more than 85% of cases and improve the patient’s quality of life.Unfortunately, we can’t always ensure significant improvement in the patient’s quality of life, but in this situation a patient may die within two or three months if left untreated.We succeeded in extending this time at least two- or threefold.Unfortunately, the benefit is measured in months, and not in years in case of the most aggressive brain tumour – glioblastoma, despite technological opportunities and our specialists’ performance.

What guarantees satisfaction of the patients leaving your centre?Is it just the merit of modern technology?

I think that technology in the hands of skilled specialists can work wonders, but often the most important factors are the time devoted by the physician, willingness to strike into each situation, and ability to understand true needs of the patient.We do hope that people feel calmer when they leave our centre, because the diagnoses treated here can hardly be called rejoicing.We hope that later on most of our patients will say that their life changed for the better in Sigulda at a time when they needed help.When we face decisive challenges in our lives, it is often the only opportunity to change the course of our life!

 However, those who have already tried this treatment technique can tell more about it.We asked the patients who underwent radiosurgery procedure in Sigulda right after it was opened to tell about their health state.

I chose the safest and easiest way

Artūrs (62), inspects the technical condition of ships

«Auditory nerve neuroma made itself felt for the first time in September of the last year. I flew back to Latvia and, when the plane reduced the altitude, my ear started to hurt. Then the pain disappeared, but a few days later I felt, that my ear is like plugged with cotton wool. I visited otolaryngologist, as I thought – maybe it’s a sulphur cork? There was no cork found, the doctor also measured my hearing level – it was okay. A few weeks later I had to fly again, and I thought – for being sure I have to ask my doctor to prescribe some ear drops. After the flight – again all the same: the ear was blocked, but this time I already felt, that I also couldn’t hear so well anymore. One and a half months passed, and I visited another otolaryngologist. Within one month my level of hearing had dropped by half. When magnetic resonance was made, it was detected, that a small tumour has formed at the end of auditory nerve. At the beginning, of course, I was happy, that the tumour is benign, but how something that is growing in my head can possibly be benign? I started to search information about auditory nerve neuroma on the internet. I found out, that this topic is widely discussed on German websites. Also about the CyberKnife that my doctor told about, saying that a new clinic opens in Sigulda and the CyberKnife will be available there. Feedbacks about this procedure were mainly positive. The only thing, which is characteristic of Germans, is that they can’t live with the thought, that a tumour is in their body, they rather want to remove it surgically. I understood that I am completely not depressed by such a thought. Also the doctor said – it’s worth trying. In my case it is the easiest way of treatment and also with higher guarantee. I sent my magnetic resonance image with a description to Sigulda and received a response that I can be their patient, and already in mid-February this radiological procedure was performed. The only thing I felt after the procedure – dizziness at the first moment. And that’s all. At the first examination, which had to be performed already six months later, it was confirmed, that the tumour is not growing larger, and it’s very good. Now, when I will visit the doctor already one year later, the tumour should be already a little smaller. At the moment, my ear – if I may say so – has opened again, the plugged feeling is gone and I can also use this ear during phone calls and hear everything».

I could be saved only by a robot

Georgs (63), company director:

«Suddenly, I felt dizziness in mornings, everything turned black, everything like doubled a little. Medical examination was started and magnetic resonance results showed that there is a tumour in my head (meningioma – a benign tumour, which grows from the brain meninges cells). When I visited the professor neurosurgeon IgorsAksiks, I was mentally ready, that the tumour will be removed surgically. But the professor shook his head and told, that it is inoperable, because the risk is too high – the meningioma was located very close to the brain stem. He told, that it is planned to open a radiosurgery centre in Sigulda, and that I should wait and receive treatment there. Another alternative was to perform the same procedure with the so-called cyberknifein Germany. I decided that I will better receive treatment at home. I had to wait two months and became one of the first patients of Sigulda Radiosurgery Centre.

The procedure was completely painless, I didn’t feel anything. The only thing I had to do – I had to lie stillwhile the robot was working, because I was not allowed to move. In my case three such procedures had to be performed sequentially. I continued living my daily life as if nothing had happened. After six months, I went to the centre for examinations – the tumour had already changed its shape. After the New Year, I will visit the centre again and then the meningioma already should be smaller than it was during the procedure. Now, I have dizziness only when having larger physical load. I feel incomparably better.»

I was the first patient

Ainārs (46), logistics specialists in a transport company:

«Already in 2013, I had an operation of auditory nerve neuroma and, in fact, I already was waiting in a queue for repeated operation at Pauls Stradins Clinical University Hospital, because the neuroma had grown again almost as large as it was before the first operation. But then my wife’s friend told that a new centre will open in Sigulda, where the latest robotized radiosurgery equipment in the Eastern Europe CyberKnife will be available. At the first moment, I didn’t even understand – what it will be. What she is talking about? But the doctor at Pauls Stradins Clinical University Hospital shed light on the situation, telling, that it may be my only chance. Because the tumour has literally grown into the trigeminal nerve, so it is impossible to completely remove it surgically and it only keeps growing. In case of cutting it, there is a possibility, that half of my face will become motionless permanently. The doctor mentioned, that such procedures are performed in Germany and, if I want, I can go there. The costs will be similar, but travelling and accommodation costs will be required additionally. I thought – why should I go? Surely, also in Latvia it will be dealt with by smart specialists. I was only concerned about whether this procedure will help me, because the tumour was large. I received a positive response and it is good, that my relatives and friends helped me to collect the money necessary for the operation. Still, the sum was significantly smaller than that required in Germany. As a result, five procedures were performed – I just focused on my positive thinking and was pleased, that I still can do it. The feeling after the procedure was not very good, but doctors had already warned, that it may happen in my case. Five months passed until the feelings became normal again. But it is all bearable, if you know – later, it will be better. I don’t want tolive with a paralyzed face and be unable to feel any taste in my mouth.»

I wish such an opportunity for all who need it

Loreta (50), personnel department specialist in Vilnius:

«I was advised to go to Sigulda by my doctor in Vilnius. I had problems with auditory and vestibular apparatus, and, after making magnetic resonance, a tumour (vestibular schwannoma or auditory nerve neuroma) was detected in the middle ear. The doctor said that in my case it would be safer to choose radiation instead of surgical intervention. The doctor himself called Sigulda Centre and arranged, that I will go there, also writing a cover letter for me. I went to Sigulda for the first time in March to make necessary examinations, and already one week later the procedure was performed. Everything was done very professionally – at each stage I was informed about the following step. Recently, in October, I had control examinations and everything is good. I wish such an opportunity for everyone who needs it. In addition, it is a completely different feeling than at a hospital – there is never the depressing feeling, that you are there because you have a tumour. And for me it was important, that doctors there are speaking Russian – I can’t speak English so well.»

 I don’t want another stroke

Agne (30), works in the financial sector in Lithuania:

«I was taken to hospital with a stroke and a hereditary pathologic blood vessel formation – arteriovenous malformation – was detected, which also served as the reason of stroke. Doctors said that, if I don’t want to suffer another stroke, only the radiosurgery method can save me. They told that such a procedure is available in the neighbouring country, Latvia, Sigulda, so I don’t have to travel anywhere far. Of course, I didn’t think long. I came to a consultation on 27 April and already on 29 April the procedure was performed. It is amazing – I only had to lie down for 40 minutes and that’s all. There wasn’t any bad feeling, completely nothing. At Sigulda Hospital I experienced a professional, understanding and kind attitude; everything was clarified and explained to me. There works fantastic personnel. I went home and thought – did it really happen in reality? (laughs)»


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