CyberKnife Patient Support Group  

Welcome to the CyberKnife® Patient Support Group forum!
Please post your medical questions into the "Ask the Doctors" section to communicate with doctors whom are skilled users of CyberKnife. CPSG claims no liability for nor endorses any medical opinions or advice given by doctors on this site. Doctors participating on this board are all volunteers and are not financially compensated in any way.
For more information visit About the Doctors.

Click here to read a welcome message from John R. Adler, Jr., MD

  HomeLog InRegisterCommunity CalendarSearch the ForumHelp
   
CyberKnife® Patient Support Group > Ask the Doctors > Spine > breast cancer metastases to spine  Forum Quick Jump
 
New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> | Show Newest Post First ]

63NED
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Mar 2006
Total Posts : 5
 
   Posted 3/12/2006 8:30 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
One year after surgery, chemo, & radiation for breast cancer, I have gotten the devasting news of metastases. Positive lymph nodes in auxilla & chest wall, but probably also has metastasized to spine. MRI’s of spine show some nodular enhancement which is identified as a demyelinating plaque and/or tumor @ C5-6 (approx. 1.2 cm). There is also a smaller area of contrast enhancement @ T-12 which again shows active demyelination. I am symptomatic with numbness/tingling R-arm & hand, some loss of function, feeling of band around chest and numbness/tingling fingertips L-hand. No highlighting was seen on Pet/CT scan which conflicts with MRI results. Have you ever dealt with metastatic spinal cord tumor that shows active demyelination? Would I possibly be a candidate for CyberKnife? Plans underway to resume chemo treatment again.
Back to Top
 

radsrus
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Jul 2004
Total Posts : 1295
 
   Posted 3/13/2006 3:16 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Obviously the first thing would be to establish the diagnosis. This sounds like a diagnostic problem. We would not want to treat lesions involving the spinal cord without fairly conclusive evidence that they were malignant. There are limitations to the size of the tumors that PET can detect. Other disease, including at least virus infections and multiple sclerosis, can cause demyelinating lesions (there are probably a lot more, but I’m way out of my area of expertise here). Yes, the CK could probably be used if necessary but it might be difficult and might be risky depending on the specifics. I would get the images to a CK center in a larger community where they may hve more diagnostic capability and let them help figure what is going on. A complete list is at http://www.accuray.com/contact/site_locations.htm


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

Back to Top
 

63NED
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Mar 2006
Total Posts : 5
 
   Posted 3/13/2006 8:47 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
Thanks for your prompt reply.

My oncologist has referred me to Mayo Clinic in Rochester, MN for diagnostic evaluation by Oncology, Neurology and Neurosurgy. Hopefully this evaluation will occur very soon.

However, which CK center in a larger community would you suggest for a CK evaluation? Would Dr Chang and Standford University have the most expertise and experience in spinal cord tumors/lesions? Can a message be sent directly to Dr Chang?
Back to Top
 

radsrus
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Jul 2004
Total Posts : 1295
 
   Posted 3/14/2006 3:12 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Stanford certainly has a long experience and Dr. Chang usually monitors these boards. THe other centers that have published large series of spine patients are Pittsburgh and Georgetown.

Mayo should be able to do the diagnostic work.


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

Back to Top
 

63NED
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Mar 2006
Total Posts : 5
 
   Posted 3/14/2006 8:52 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
Does a prospective patient ever have to accompany their scans, images, MRI’s, etc to the CK center for the initial evaluation or is everything just sent beforehand. Does the center charge for the evaluation and approximately how long does it take to have eval and results done? Does it take generally days, weeks? Also do you need MD referral?

Thanks again.
Back to Top
 

Jerome J. Spunberg, M.D.
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Feb 2006
Total Posts : 324
 
   Posted 3/14/2006 9:39 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
At our center, patients often bring or send their films or disks by mail and some records for review. I check them that day or the next, review relevant films with our physicist, and then report back to their oncologist or surgeon immediately with a recommendation regarding the feasibility of Cyberknife treatment for that patient. There is no charge for that service and a referral is not required, although welcome. I cannot speak for the policy of other facilities with the Cyberknife. Many patients, unfortunately, may not be good candidates for treatment at that time but may be reconsidered in the future depending upon their progress. Others are invited to come in for consultation and discussion. This system has worked out well for us so far.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

Back to Top
 

radsrus
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Jul 2004
Total Posts : 1295
 
   Posted 3/15/2006 3:28 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
I think that most centers (probably all) are willing to review to review cases for possible treatment. There are only about 40 operating CK’s in the USA< and therefore many people live some distance from the nearest one. We try to spare them unnecessary travel. We sometimes discourage the sending of films/disks if it is obvious that the case is not appropriate for CK treatment (plantar warts, fibromyalgia, diverticulitis, various cysts, Peyronie’s disease being some of the many things we have been asked about). I’ll probably make someone mad with this, but I would say that if the center is not willing to review images and records enough to see if it is worth you time and trouble and expense to come for consultation, then seek another center. I really don’t think there should be a charge for that. It does take some time, but there is a service to patients element in what we do. (Ask Dr. Spunbrg how much he is paid to take a lot of his time to answer questions. THe answer: nothing. We donate our time, because we believe in what we are doing.)


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

Back to Top
 

Jerome J. Spunberg, M.D.
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Feb 2006
Total Posts : 324
 
   Posted 3/15/2006 3:41 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
As Dr. Medbery points out, most patients do not live close to a Cyberknife facility and it would be impractical and unreasonable to ask them to travel long distances just to discover that treatment with CK is obviiously inappropriate for their condition. We enjoy what we do and want to be of service to the community at large. Answering questions, either on the phone or on this message board, is something that we take seriously with a sense of responsibility, and we are certainly not compensated for our time, at least not in the financial sense.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

Back to Top
 

63NED
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Mar 2006
Total Posts : 5
 
   Posted 3/15/2006 7:43 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
Thank you both for your prompt and thorough answers. As you can imagine this is a difficult time for me………..I certainly appreciate your sound advise and the time and effort you provide to the members of this forum. You are providing an excellent service to a lot of people looking for answers to some severe medical situations.

Thanks again.
Back to Top
 

63NED
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Mar 2006
Total Posts : 5
 
   Posted 3/19/2006 8:55 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
Unfortunately, I inadvertently deleted your recent message about the large community Cyberknife centers that have a lot of experience with spinal situations…..Stanford, Georgetown and Pittsburgh. Thanks for that reply. I have one further question, does the Boulder site have extensive experience and expertise with spinal cord tumors?
Back to Top
 

radsrus
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Jul 2004
Total Posts : 1295
 
   Posted 3/20/2006 2:59 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
As best I know, they have pretty extensive experience with all sites. I should emphasize that in most situations, CK sites are largely interchangeable. They generally have a team that is already very experienced in advanced techniques, often radiosurgery. There are exceptions for some special and unusual situations. For instance, we recently referred a patient to Stanford for a high spinal cord AVM because we felt they could treat that particular problem better than we could. But that is rare. Some centers are limiting the things they will treat.


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

Back to Top
 
New Topic Post Reply Printable Version
 
Forum Information
Currently it is Monday, May 29, 2006 5:52 AM (GMT -8)
There are a total of 4,914 posts in 1,162 threads.
In the last 3 days there were 1 new threads and 8 reply posts. View Active Threads
Who’s Online
This forum has 1158 registered members. Please welcome our newest member, aspenleaf.
2 Guest(s), 1 Registered Member(s) are currently online.  Details
aspenleaf