After spending countless hours and days of sleepless nights in a lab at Karolinska Institute in Stockholm, Sweden, Dr. Lars Leksell, a neurosurgeon, and his partner, Björn Larsson, a radiobiologist from Uppsala University, invented radiosurgery in 1949 and used it to irradiate brain tumor lesions

   Dr. Leksell and professor Larsson continued on with their work and, in 1968, they introduced the Gamma Knife®.  Today, the Gamma Knife is the treatment of choice for deep-seated brain abnormalities, including tumors that would otherwise be considered inoperable. In one 45-minute session, the Gamma Knife delivers a dose of precise radiation that is equal to 20-30 times the strength of traditional radiation.  Because of the very steep fall-off of the radiation field outside the specified target area, the dose to immediately surrounding tissue is minimized.

   While Dr. Leksell and Professor Larsson perfected the Gamma Knife, physicists Osvaldo Betti and Federico Colombo of the University of Florida College of Medicine were pioneering linear accelerator full-body radiosurgery in the mid 1980s.  Their work ultimately led to today’s advancements in full-body radiosurgery applications, including the Novalis Tx™ platform, produced by Varian Medical Systems and BrainLAB.

   The Novalis Tx performs radiosurgery in a matter of minutes, and often in five or fewer treatment sessions.  Its precisely-shaped and targeted radiation treats the array of malignant cancers and benign lesions, including brain, prostate, lung, spine, and liver cancers; and previously treated sites.  The Novalis Tx incorporates two complementary imaging systems: an in-room X-ray imaging system, called ExacTrac®, and a cone-beam CT imaging system.  ExacTrac provides real-time imaging and fine-tuning that ensures that the targeted lesion is aligned with the treatment beam during treatment.   The CT imaging system generates a 3-D image of the targeted lesion and surrounding tissues, allowing clinicians to see the precise location and shape of the tumor; fine-tune the patient’s position; and make certain that the internal anatomy has not shifted or changed prior to treatment.

   As defined by the International Radiosurgery Association, radiosurgery “replaces the surgeon’s scalpel with a single, high dose of radiation. The radiation eradicates the diseased area with a safe and effective approach. The painless, bloodless procedure takes just 15 minutes to one hour, depending on the size of the lesion being treated.  There is no risk of surgical complications like infection, hemorrhage or leakage of cerebral spinal fluid.”

   In addition to those benefits mentioned above, numerous of studies have demonstrated the effectiveness of radiosurgery in the treatment of cancer.  Cole A. Giller, MD, PhD, and Brian D. Berger, MD, of the Baylor University Medical Center Radiosurgery Center located in Dallas, Texas, concluded in their paper New Frontiers in Radiosurgery for the Brain and Body, that  technical refinements have improved the delivery of radiosurgery to the brain, expanding radiosurgical applications and allowing for radiosurgical treatment of virtually any organ in the body.  “The local control of tumors achieved by radiosurgery confers a survival benefit for patients with metastatic disease, and radiosurgical treatment of brain lesions such as AVMs and acoustic neuromas is now accepted as an essential part of the neurosurgical arsenal.”

   In the conclusion of a paper, Radiosurgery Techniques and Current Devices, a group of physicians from the Department of Neurological Surgery at the University of Pittsburgh and the Center for Image-Guided Neurosurgery at University of Pittsburgh Medical Center, stated that radiosurgery is now being used for spinal tumors, lung, liver, and prostate pathologies and that long-term results of radiosurgery are now available and have established it as an effective noninvasive management strategy for many brain disorders.

   South Nassau is the only hospital on Long Island and the New York City area with both the Novalis Tx and Gamma Knife and its Radiation Oncology Department is accredited by the American College of Radiology.

   Under the direction of Edward Mullen, MD, director of radiation oncology and co-medical director of Long Island Gamma Knife®, the department features a team of accomplished radiation oncologists who use advanced diagnostic and radiation oncology technologies to treat a wide range of cancers.  The department is equipped with multi-slice CT scanners that combine with a 3-D virtual patient planning system technology to develop patient-specific, precise treatment plans.  The department is also home to South Nassau’s Center for Prostate Health.  In addition to prostate brachytherapy, radiosurgery using the Novalis Tx, external beam radiation, hormone therapy and watchful waiting, the center now offers minimally-invasive, robotic assisted prostate cancer surgery using the revolutionary da Vinci robotic surgical system.

To schedule a consultation or for more information about the Novalis Tx, Gamma Knife, or the Radiation Oncology Department, call 516-632-3360, or visit southnassauradiosurgery.org.

   Comments or questions regarding this column can be sent to healthmatters@snch.org

Prevention And Rehabilitation Are Cornerstones Of Cardiac Care At South Nassau

Blood Clots: The Quick & Silent Killer

A blood clot can be a quick and silent killer.Ê It can strike any person, physically fit or unfit, young or old.. ÊA blood clot is a clump of blood cells that may form spontaneously in a blood vessel. It may also be caused by injury, invasive medical procedures, medications or cancer. Blood clots that would not dissolve on their own can block blood flow in arteries, capillaries, and veins located anywhere in the body especially those in the brain, neck heart, lungs, intestines, pelvic area, kidneys, legs and arms.Ê Pain caused by blood clots can be excruciating and is often worse at night making sleep difficult. Ê A blood clot formed in a large vein usually in the leg and sometimes in the pelvic area is called deep vein thrombosis.Ê If blood clots in the leg or other original location travel through the blood stream and lodge for example, in the pulmonary artery to the lungs, then it is called a pulmonary embolism. Blockage of a coronary artery could trigger a fatal heart attack. Blockage of an artery in the neck or brain could trigger a fatal stroke. Blockage of a femoral artery or vein in the leg could cause pain, walking difficulty, neuropathy, infection, decaying toes and tissue death. Blood clots can also cause fatal internal hemorrhage. Blood clots kill three times more Americans each year than cancer does: 1.A million Americans die of heart attacks each year, more than half of them women. (Cholesterol does not kill, but blood clot does) 2.Deep vein thrombosis in legs kills about 200,000 Americans a year.Ê (That is more than death from AIDS and breast cancer combined) 3.Pulmonary embolism kills about 60,000 Americans a year. 4.Strokes (brain attacks) kill 200,000 Americans a year. More millions of Americans have sufferings from blood clots than from cancer.Ê Though a blood clot can be a quick and silent killer, it can also be a slow killer.Ê It can inflict suffering for years and incur great medical expenses.Ê Stroke (brain attack) is the leading cause of disability in America.Ê Stroke is more physically and mentally debilitating than recovered heart attack or cancer in remission. ÊÊA 2003 study reported ÒDementia risk linked to silent strokesÓ.Ê 11 million Americans were estimated to have silent strokes in 2003.Ê Silent stroke is a stroke that causes real brain damage, but does not exhibit the classic symptoms of stroke such as vision changes, speech problems, weakness or paralysis on one side of the body.Ê Inadequate blood flow in the brain is an underlying cause of both stroke and AlzheimerÕs disease. ÊÊÊ17 million Americans knowingly or unknowingly have diabetes.Ê More than 55,000 diabetics have feet amputated each year. Why could many years of good control of diabetes with medications life style and protective foot care not prevent debilitating neuropathy, foot ulcers and decaying toes from occurring or getting worse?Ê What is the underlying cause, diabetes as medically known or blood clots in the legs? ÊÊÊBlood thinners neither dissolve existing blood clots nor improve neuropathy suffering. When blood clot broken up into tiny clots by invasive treatment procedures cluster and block again in the blood steam, sudden heart attack or stroke may result.Ê Blood thinners, though good medicine, also can thin or perhaps corrode walls of blood vessels leading to fatal internal bleeding if not caught early. ÊÊÊPainkillers do not relieve excruciating pain from blood clots.Ê Potential internal bleeding is one of painkillersÕ side effects. ÊÊÊDiagnosing and treating blood clots early will improve quality of life and save lives.Ê Pay close attention to health disorders and seek medical help when necessary. ÊÊÊ Ideally, a medical treatment or combination of treatments should offer: 1. To help dissolve blood clots, improve blood circulation and physical mobility 2. To help restore or alleviate memory loss caused by blood clots in the brain. 3.To not produce undesirable side-effects or risks. 4.To be cost effective. 5.To be taken for months not for years or life. 6.To help lower high blood pressure affected by blood clots. 7.To help lower high cholesterol. 8.To help quickly relieve pains or discomforts caused by blood clots. 9.To help heal or reduce occurrence of neuropathy, ulcers and decaying toes in feet so that amputation would not be necessary.

Additional Data Supporting Carotid Artery Stenting

Carotid artery disease accounts for approximately one third of the 500,000 strokes that occur annually in the United States. Carotid surgery (carotid endarterectomy) has been shown to be beneficial in preventing stroke in asymptomatic patients with an 80% or greater carotid blockage or a greater than 50% stenosis in patient with symptoms of stroke or warning stroke called a Transient Ischemic Attack (TIA). However, carotid surgery is generally performed under general anesthesia, has risks of injury to the nerves of the face, and carries with it a risk of stoke and death within 30 days of the procedure of 6-8%. Since 1994, thousands of patients with carotid disease in the United States have been treated with carotid artery stents (metal mesh tubes) as part of many research trials. Carotid artery stents can be placed under local anesthesia of the groin, in a manner similar to a cardiac catheterization or heart angiogram. No general anesthesia is required and the procedure typically takes approximately one hour, with the patient discharged the following day in most cases. A type of filter basket is used during the procedure to lower the risk of stroke by trapping dislodged particles that would otherwise travel to the brain. In the fall of 2004, the FDA approved the first carotid stent for commercial use in the United States. The ACCULINK STENT, manufactured by the Guidant Corporation was approved for use in patients who were at high risk for carotid surgery. In this population of patients the risks of carotid stenting were approximately half of the risk of carotid surgery. At a recent cardiovascular meeting, data from another trial was presented. In the CAPTURE TRIAL, 1600 patients of all levels of risk were treated with the Acculink stent. The stroke rate for the entire group of patients was 4.1% and compares favorably with prior surgical data for carotid disease. As more data has become available, the likelihood that carotid stenting will replace carotid surgery as the primary means of treating carotid disease has increased.