Dr. Sisti (left) & Dr. Isaacson in 1998 when The Gamma Knife Center opened

In 1998, Dr. Michael B. Sisti and Dr. Steven R. Isaacson  opened our Gamma Knife Center with nurses Nenita Magpantay-Nadera and Jeraldine Lesser.

Thirteen years later, we are proud to say, the same team is still here!

“The equipment has changed but the people have not,” says Dr. Sisti. ” Except, of course, we have a heck of a lot more experience.  We just did our 3000th Gamma Knife.”

Today they run the state-of-the-art  Gamma Knife Perfexion System, thanks to a recent multi-million-dollar upgrade.

The Gamma Knife isn’t really a knife, but a large machine that generates a highly concentrated beam of radiation that is used to specifically target a lesion in the brain.

The Gamma Knife is used to treat a multitude of problems including Brain Tumors, Cerebral Arteriovenous Malformations (AVMs), Epilepsy, and functional dsorders such as trigeminal neuralgia.

In 1998, Leksell’s Gamma Knife Treatment Statistics, showed 100,000 patients treated with the Gamma Knife, ten years later that number had increased to half a million and has kept on growing.

Though this new Gamma Knife technology can be found in other centers around the world now, few can boast the experience that our team has.

This experience has paid off too; in patient satisfaction. Earlier this year, we sent out a bunch of surveys and the results were incredible.

The Gamma Knife Team today from left to right: Jeraldine Lesser, Dr. Sisti, Dr. Isaacson and Nenita Magpantay-Nadera

On 100% of the patient surveys we received, patients said they would recommend our center to a friend who needed Gamma Knife treatment. They also consistently said our staff was pleasant, courteous, and made every effort to make them feel at ease before,during, and after treatment.

Additionally, we have received countless letters from our patients grateful for the treatment they received. Here are Some of the many positive comments received by the Gamma Knife team over the years:

The headaches are gone entirely and we thank each and every one of you from the bottom of our hearts. Everybody at the Gamma Knife Unit went out of their way to make me feel comfortable and at ease. We still cant believe the change in me.  Thank you all.

I’d like to thank you for making my Gamma Knife Treatment a pleasant and positive experience. Your professionalism and knowledge together with your warmth and humor made me feel comfortable and allayed my fears. You have effectively been able to create a comfortable, caring and cheerful atmosphere for your patients.

My parents and children can now kiss me on my face. This may not be such a significant acheivemet to others, but to me its an accomplishment I doubted could ever take place.

The new facility looks amazing and everyone was great. They made me feel very comfortable and informed me of every step during the day. They answered all of my questions, and questions my family had were answered and even followed up with me after the procedure to
make sure I was doing O.K.

I thought the care and attention was the best I have ever received. My overall experience was incredible. The 1:1 attention was by far the best.

Today, through our New Jersey Practice, we are also treating patients at Valley Hospital’s new Gamma Knife Center.

Related blogs: Check Out Our New Gamma Knife: Upgrade Complete, Valley’s New Gamma Knife is up and Running

His talk, GBM:A Story of Frustration and Hope, outlined the latest in treatment strategies including issues such as; overcoming temozolomide resistance, overcoming the blood brain barrier, targeted molecular Therapies, and inhibitors of angiogenesis.

It is called “surgery” because a result similar to an actual surgical procedure is created by the radiation therapy treatment. The beams of radiation are precisely focused to reach the tumor, lesion, or other area being treated with minimal effect on surrounding healthy tissue.

Radiosurgery may be used in situations where the brain lesion cannot be reached by conventional surgical techniques. It may also be used in persons whose condition is such that they might not be able to tolerate a surgical procedure, such as craniotomy, to treat their condition.

Radiosurgery works in the same manner as other types of therapeutic radiology: it distorts or destroys the DNA of tumor cells, causing them to be unable to reproduce and grow. The tumor will shrink in size over time. For blood vessel lesions such as an arteriovenous malformation (AVM), the blood vessels eventually close off after treatment.

Radiosurgery almost always involves a treatment team approach. The treatment team generally includes a radiation oncologist (a physician specializing in radiation treatment for cancer), a neurosurgeon and/or a neuroradiologist, a radiation therapist, and a registered nurse. In addition, a medical physicist and a dosimetrist work together to calculate the precise number of exposures and beam placement necessary to obtain the radiation dose that is prescribed by the radiation oncologist. Your treatment team may include other healthcare professionals in addition to or in place of those listed here.

There are three types of radiosurgery systems. They are:

• Gamma Knife system
  The Gamma Knife system uses beams of highly-focused gamma rays to treat small to medium size lesions, usually in the brain. Many beams of gamma radiation join to focus on the lesion under treatment.Gamma Knife radiosurgery is most often used to treat tumors and other lesions in the brain. It is also used to treat certain neurological conditions, such as trigeminal neuralgia (a condition in which pressure on the trigeminal nerve causes spasms of extreme facial pain) and acoustic neuroma (a noncancerous tumor in the brain that affects the nerves that control hearing).
• linear accelerator (LINAC) systems
  Linear accelerator (LINAC) systems use high-energy x-rays to treat a tumor or other lesion. Some common types of LINAC systems include CyberKnife®, X-Knife®, Novalis®, and Peacock®.In addition to using x-rays rather than gamma rays, LINAC systems also differ from the Gamma Knife in that the machinery moves around the patient during treatment. For this reason, LINAC systems are able to treat larger tumors and larger affected areas than the Gamma Knife. Areas other than the brain can be treated with a LINAC system.
  
• proton beam therapy or cyclotron
  Proton beam therapy is a type of particle beam radiation therapy. Rather than using rays of radiation, such as gamma rays or x-rays, particle beam therapy uses particles such as protons or neutrons. Proton beam therapy is the most widely-used type of particle beam therapy.Proton beam therapy may be used for radiosurgery procedures or for fractionated radiotherapy (several smaller doses of radiation over a certain period of time).There are only a few facilities in North America that provide proton beam therapy.

Perfexion Gamma Knife with its cover off before it left the factory in Sweden

Our multi-million dollar Gamma Knife up-grade is complete.  The new state-of-the-art  Gamma Knife Perfexion System is in place and our radio surgery program is back in full swing.

Dr. Michael Sisti from the Gamma Knife Center says, “We have had a great start for the week, with a total of eleven patients and the following conditions treated: three acoustic neuromas, four meningiomas, one Glomus Jugulare tumor, one brain metastasis, one lymphoma, and one case of trigeminal neuralgia.”

Our Centurion Perfexion Gamma Knife on Site

The Gamma Knife (not a literal knife) generates a highly concentrated beam of radiation that is used to specifically target these kinds of lesions in the brain as well as brain tumors, cerebral arteriovenous malformations (AVMs), and epilepsy.

The upgrade to the Perfexion system has expanded this capability to include more treatment areas within the brain, and an advanced planning system that enables even greater accuracy.

Reception

According to Elekta,the maker of the Perfexion System, there is also, “faster set-up and treatment delivery to one or more tumors in a single session[.]”

As the 100th unit produced by the company, Elekta gave the machine a unique gold finish and gold colored patient mattress.  Accordingly, Dr. Sisti and his group have coined it the Centurion Perfexion Gamma Knife!

Our Centurion Perfexion Gamma Knife on Site

Dr. Sisti says, “The unit is beautiful installed with its covering on too. We are happy to offer our patients the increased capability and accuracy of this new machine. Our treatments have been seamless.  We just treated our 2900th patient and we hope to treat our 3000th patient this year.”

Watch this video to learn more about the new Perfexion Gamma Knife.

Learn more from our page on Gamma Knife Radiosurgery and our previous blogs:Gamma Knife Upgrade Coming This Summer, One Picture Speaks a Thousand Words-These Neurosurgeons use Two and Radiosurgery Trials Looking Good for Epileptics.

It is especially important to get the right type of radiation for the right type of disease and it needs to be done by the right team of doctors and radiation therapy team.

There are two kinds of machines used for radiosurgery; one is the Gamma Knife, and the other is a linear accelerator and there is a BIG difference between the two.

The type of radiosurgery injury described in the Times article was done by a linear accelerator. It is a very sophisticated machine with a lot of moving parts that needs to be highly managed by electronics, computers, and treatment planning systems and should only be used by experts like our own, Dr. Steve Isaacson.

The Gamma Knife, on the other hand, is much simpler. It is one specific machine, made by one company for one purpose and can only be used in a certain way.  According to Dr. Michael Sisti from the Gamma Knife Center, “There are none of these compatibility or safety issues.  There are essentially no moving parts and it has been in use for fifty years (much longer than the linear accelerators).”

Gamma knife is also routinely used in the treatment of trigeminal neuralgia, the condition that caused severe face pain in Marci Farber.  Sisti says, “ This procedure is a slam-dunk, like penicillin, for the Gamma Knife. We have been doing this for 20 years and it’s fortunate we have not encountered this type of complication with Gamma Knife in the treatment of trigeminal neuralgia.”

For most problems we use the Gamma Knife whenever we possibly can; that is about 90% of the time.  To date we have done approximately 2,800 Gamma Knife procedures here.  There are some circumstances, however, where the Gamma Knife is just not going to do the job. For example, says Dr. Sisti, “If the patient has a very large or irregular lesion, or it involves the optic nerve, then we’ve got to go to a linear accelerator, but you have to go to a guy like Dr. Steve Isaacson and his team who are totally immersed in this stuff.”

What’s more important than the type of radiosurgery, is the experience of the team running it. We have been using linear accelerators since 1996 on hundreds of patients with state of the art equipment and experienced radiation physicists, therapists and specialized nurses.

We urge caution in reading the article in the New York Times. The incidences reported, though devastating, are indeed rare and radiation therapy has resolved more pain and saved more lives by far than it has harmed.  Let the article be a reminder to consider all your options and to choose your medical team wisely.

Related Blog: Radiation Treatment For Cancer; Don’t Throw The Baby Out With The Bath Water!

Also read the American Society for Radiation Oncology (ASTRO)’s response to the New York Times Article

Elekta, Inc. photo of new Perfexion® Gamma Knife.

Dr. Michael Sisti from the Gamma Knife Center tells us a multi-million dollar up-grade is coming to his Center this Summer.  They will be upgrading to a new state-of-the-art (5 million dollar plus) machine called the Gamma Knife Perfexion System.

The Gamma Knife isn’t really a knife, but a large machine that generates a highly concentrated beam of radiation that is used to specifically target a lesion in the brain.

The Gamma Knife is used to treat a multitude of problems including Brain Tumors, Cerebral Arteriovenous Malformations (AVMs), and Epilepsy.

The upgrade to the Perfexion system expands this capability to include more treatment areas.  Also, an advanced planning system means surgery will be performed with even greater accuracy.

According to Elekta, the maker of the Perfexion System, “System benefits include faster set-up and treatment delivery to one or more tumors in a single session[.]”

Watch this video to learn more about the new Perfexion Gamma Knife.

Dr. Sisti is excited about his Center‘s upgrade.  He says, “We will then have the two ultimate radiosurgery systems: Trilogy and Gamma Perfexion in one place.”

Also of note is that the whole Radiation Oncology Department at Columbia is undergoing a $50 million upgrade.  This is important to our cancer patients because many of them will receive their radiation therapy there.

Learn more from our page on Gamma Knife Radiosurgery and our previous blogs: One Picture Speaks a Thousand Words-These Neurosurgeons use Two and Radiosurgery Trials Looking Good for Epileptics.

The doctors named are: Robert A. Solomon, M.D., Department Chair and part of the Cerebrovascular Center; Michael B. Sisti, M.D. from the Brain Tumor Center and Gamma Knife Center;  Paul C. McCormick, M.D., M.P.H., from the Spine Center; and  Steven R. Isaacson, M.D. from the Gamma Knife Center.

Every one of these doctors also has the designation of being one of America’s Top Doctors (ATD) for 2010 as chosen by Castle Connolly.

Congratulations Doctors!

First he was spotlighted as the 2009 NREF/Spine and Peripheral Nerves Section Research Fellow for his paper entitled, A Novel Approach for Convection Enhanced Delivery of Nerve Growth Factors in a Peripheral Nerve Bridge Model to Bypass Spinal Cord Injury.

Dr. Sisti with Dr. Haque

He also won the Leksell Radiosurgery Award, which, according to the AANS website is for, “the best paper on stereotactic radiosurgery related to brain tumors.”   His paper was called, Efficacy of Facial Nerve-Sparing Microsurgery and Stereotactic Radiosurgery with Gamma Knife in Preserving Facial Nerve Function in Patients with Recurrent Acoustic Neuroma.

Finally, Dr. Haque was recognized as one of the authors of the AANS Medical Student Summer Research Fellowship paper entitled, Neural Proliferation of Bone Marrow Derived Cells in a Murine Model of Intracerebral Hemmorrhage.

Dr. Haque joined by his parents, Dr. Bruce and Dr. Sisti

Way to go Dr. Haque!

According the the National Cancer Institute, “more than half (about 60 percent) of people with cancer get radiation therapy.”  Radiation kills aberrant cells, stops them from multiplying, shrinks tumors and can save lives.  But, cancer is insidious and it is difficult to completely kill all the cancer cells without exposing some healthy tissue.

“Since the first description of radionecrosis by Fischer and Holfelder in 1930, injury to the brain and spinal cord is a feared complication, although irradiation is an essential treatment for many CNS (brain and spinal cord) tumors,” writes Dr. Steven R. Isaacson, from the Gamma Knife Center, in his chapter on Radiation Injury in the 12th edition of Merritt’s Neurology.

It is fair to say that balancing the benefits of the treatment with its known risks, has been a driving force in the development of radiation technology and treatment protocols since then.  The introduction of the MRI in the 1970′s and the PET scan in the 1980′s allowed 3D imaging of tumors to better target radiation.  Today, a fourth dimension has been added, time, using intensity-modulated radiation therapy (IMRT) allows for real-time adjustments for even more accuracy and less risk.

The New York Times reported uncommon errors, in particular with IMRT.  Dr. Isaacson says,” IMRT is a type of radiation delivery that is most commonly employed as a fractionated therapy, that is, given everyday over the course of several weeks.”

For tumors of the brain specifically, the Gamma Knife is often used instead of IMRT.  Unlike IMRT, the treatment is given in just one dose and according to Dr. Isaacson, “The Gamma Knife, although very complex itself, is not affected by most of these concerns.”

All of this technology is only as good as the people who run it, however.  In a letter to patients, faculty, and staff at Columbia, Dr. K.S. Clifford Chao, Head of Radiation Oncology was reassuring:

At the New York Presbyterian Hospital, Columbia University Medical Center, and Weill Cornell Medical College, we have rigorous guidelines for the planning and delivery of all radiation treatments, including IMRT and seed implant. The plan generated by the computer is independently reviewed by two qualified medical physicists and approved by the attending physician prior to treatment. Before beginning the first irradiation, the plan is re-reviewed by a radiation therapy technologist and a medical physicist, and the dose delivery is monitored continuously throughout the treatment. Equipment is examined and maintained on a regularly scheduled basis.

This is something that is taken very seriously, Our faculty and staff are trained and inculcated with the core principle that the safety and welfare of the patient is always our prime concern. Our clinical expertise and quality control mechanisms assure that the most cutting-edge radiation treatments will be safely delivered.

It is important to keep all of this in perspective and to remember that while knowledge of the risks is crucial in making the right treatment choices, radiation can ease suffering and save lives.  We don’t want people to throw the baby out with the bath water and not get the treatment they really need.