As a pioneer in the use of CyberKnife technology, Winthrop-University Hospital expanded its innovative treatment program from Long Island to New York City with the opening of the NYCyberKnife Center in 2014, providing access to breakthrough radiation technologies for patients throughout the tri-state area and beyond.
Winthrop-University Hospital physicians have treated more than 3,200 patients with CyberKnife radiosurgery since acquiring the technology at its Mineola facility in 2005. When introduced, CyberKnife’s non-invasive, incomparably precise radiation delivery capabilities revolutionized the field of radiation oncology. Recognizing the need for widely accessible CyberKnife treatment, Winthrop-University Hospital opened the Manhattan facility.
Matthew Witten, PhD, DABR, Chief Physicist of the Division of Radiation Oncology and Director of the Division of CyberKnife Radiosurgery at Winthrop-University Hospital, realized the need for an additional facility and was an early champion for the NYCyberKnife Center.
“Regarding access to CyberKnife treatment, all five boroughs are significantly underserved,” Witten says. “Combining this technology and these types of life-altering treatments with the accessibility Manhattan provides was a huge impetus for opening this office.”
“Patients previously traveled for CyberKnife treatment, but the new center makes the technology much more accessible. The NYCyberKnife Center fills a void for patients in the region and beyond who did not have the opportunity to receive CyberKnife radiosurgical treatment.”
— Jonathan Haas, MD, Chief of the Division of Radiation Oncology at Winthrop-University Hospital and Associate Professor of Radiation Oncology at Stony Brook University School of Medicine
Seth Blacksburg, MD, MBA, Medical Director of Winthrop NYCyberKnife Center and Associate Director of Radiation Oncology at Winthrop-University Hospital, speaks with a patient who is about to undergo CyberKnife radiosurgery.
To ensure the highest standards of care and patient satisfaction, Winthrop staffs the Manhattan facility with experienced professionals who also work in the Mineola office.
“We have a very healthy cross-pollination of staff members between both Winthrop CyberKnife locations, and patients receive amazing clinical care in a warm and collaborative environment,” says Seth Blacksburg, MD, MBA, Medical Director of Winthrop NYCyberKnife Center and Associate Director of Radiation Oncology at Winthrop-University Hospital. “The Manhattan center is an extension of a very robust radiation oncology division that has been performing CyberKnife radiosurgeries for the last decade. The team’s experience and attention to detail is an extraordinary advantage, and allows us to leverage both for the best outcomes possible.”
The Winthrop NYCyberKnife Center is equipped with the leading-edge CyberKnife M6 Series that enables clinicians to provide conventional stereotactic radiation therapy and stereotactic body radiation therapy.
Accuray’s CyberKnife M6 Series, the latest CyberKnife model, which offers cutting-edge radiosurgery treatment with unprecedented accuracy, is available at Winthrop’s NYCyberKnife Center.
Jonathan Haas, MD, Chief of the Division of Radiation Oncology at Winthrop-University Hospital and Associate Professor of Radiation Oncology at Stony Brook University School of Medicine, consults with a patient in the new NYCyberKnife Center.
“The technology has grown by leaps and bounds, and one of the advantages of the Manhattan office is the CyberKnife M6 has a second attachment,” says Jonathan Haas, MD, Chief of the Division of Radiation Oncology at Winthrop-University Hospital and Associate Professor of Radiation Oncology at Stony Brook University School of Medicine. “The first attachment performs standard CyberKnife radiosurgery. The second attachment is a multileaf collimator [MLC] that enables the CyberKnife to treat additional cases that otherwise would require a standard linear accelerator. This allows us to treat the majority of tumors seen in our practice using the CyberKnife.”
Designed to improve the accuracy of radiation oncology treatments, the CyberKnife M6 Series provides unparalleled capabilities for treating cancers that respond well to radiation therapies. While the machine can treat tumors anywhere in the body, its ability to provide targeted stereotactic body radiation is its distinguishing feature.
The M6 combines highly conformable beam shaping with real-time image guidance to lock on to a tumor and deliver highly fractionated radiation with sub-millimeter accuracy, killing tumor cells and sparing normal tissue.
Matthew Witten, PhD, DABR, Chief Physicist of the Division of Radiation Oncology and Director of the Division of CyberKnife Radiosurgery at Winthrop-University Hospital.
“This technology is a major advancement,” Dr. Haas says. “CyberKnife’s accuracy made it an excellent option for treating brain, lung, pancreatic and prostate cancers, and because of its continued evolution, we can expand the indications to treat more patients.”
The CyberKnife M6’s accuracy is due, in part, to its six-jointed robotic arm that houses the MLC. The arm’s broad range of motion allows physicians to deliver beams of radiation from the most effective angles.
“The MLC consists of tungsten leaves that rapidly manipulate the radiation beam geometry into arbitrary apertures that actually conform to the shape of the target,” Dr. Witten says. “We can deliver treatments so much more efficiently. A prostate treatment that might have taken 40 minutes to treat before, now takes 15–20 minutes, which definitely improves patient throughput.”
Kathleen Maloney-Lutz, RN, MSN, CNRN, (L) and Kelsey Flood, RN, BSN, (R) speak with a patient.
Researchers at Winthrop-University Hospital have found clear benefits associated with CyberKnife radiosurgery for prostate cancer treatment. Dr. Haas has personally treated more than 1,200 patients at the Long Island campus, where all data is meticulously tracked.
“There is now data looking at patients treated with CyberKnife at Winthrop for seven years,” Dr. Haas says. “Our outcome statistics are excellent — the majority of patients are cancer-free or have more than a 90 percent chance of being cured. In addition, we have a full time data manager who helps track all patients treated both in Mineola and Manhattan to help us remain at the forefront of Radiation Oncology, both clinically and academically.”
CyberKnife radiosurgery treatments are outpatient procedures that require no recovery period, surgical incision or blood loss. The most common side effects of radiation therapy for prostate cancer are urinary incontinence and impotence, according to the American Cancer Society. However, the Winthrop team finds CyberKnife patients experience these problems less frequently.
“CyberKnife delivers radiation to tumors with sub-millimeter accuracy, which is more precise than any other conventional system on the market. With five times the accuracy, as well as synchronized respiratory motion tracking of the tumor, CyberKnife makes it possible to expose normal tissue to less or no radiation, which results in fewer side effects.”
— Matthew Witten, PhD, DABR, Chief Physicist of the Division of Radiation Oncology and Director of the Division of CyberKnife Radiosurgery at Winthrop-University Hospital
“We treat a large number of prostate cancer patients and see far fewer side effects,” Witten says. “Five-year data shows a reduction in the incidence of complications such as rectal bleeding and bladder issues that result from radiation toxicity, which is a consequence of normal structures in proximity to the prostate gland having been exposed to less radiation. This is attributable to the non-isocentric, non-coplanar design of the CyberKnife.”
The CyberKnife’s unimpeachable precision not only enhances radiation delivery but also provides a far more convenient treatment schedule.
“Traditionally, we had recommended nine weeks of radiation or brachytherapy with radioactive prostate seeds, but we knew there had to be a better way,” Dr. Haas says. “Prostate cancer treatment that used to require nine weeks of daily visits now requires only five, 20-minute CyberKnife treatments. Patients return to their lives in a week or less.”
Prostate cancer has a low alpha/beta ratio — a measurement clinicians use to determine aparticular cancer’s responsiveness to radiation therapy — which makes it uniquely suitable for radiotherapy treatment, Dr. Haas notes.
“CyberKnife delivers radiation in such a way that makes it a perfect modality for treating prostate cancer,” he says. “The biology of prostate cancer is such that large doses of radiation over shorter periods of time are extremely effective.”
Although Winthrop providers work collaboratively, each member of the radiation oncology team brings a unique skillset.
Witten’s focus on radiation therapy research has led him to develop a methodology using computational intelligence for problem-solving techniques to address issues that may arise during radiotherapy treatment planning optimization.
“The field is trending toward radiation treatments that use high-dose fractionation in the way CyberKnife does,” Witten says. “Each study published seems to reflect that these treatments are effective for tumor control and produce acceptable rates of side effects, so it is wonderful that we are able to deliver high-dose fractionation on the CyberKnife with extreme accuracy every day.”
The team’s expertise and commitment to advancing the application and access of CyberKnife technology brings a new level of treatment options throughout the tri-state area.
Some of the members of Winthrop’s NYCyberKnife Center team
“Our physicists both have a real sophistication and comprehension of how the machine architecture works, and that is truly invaluable and speaks to the incredible expertise of this team,” Dr. Blacksburg says.
“Winthrop-University Hospital has pioneered the adoption of CyberKnife technology to treat different malignancies, and it seemed like a natural extension of the phenomenal clinical success in Long Island to branch out and serve patients in New York City and the tri-state area,” Dr. Blacksburg adds. “Many facilities offer stereotactic radiation, but CyberKnife offers a unique application of stereotactic technology that allows such an accurate delivery.”
The team’s research has led to a number of potentially game-changing treatment protocols tailored to tumors in other parts of the body. For example, Dr. Blacksburg, who was recruited to the Winthrop team from Icahn School of Medicine at Mount Sinai, also has experience using the CyberKnife to treat tumors of the brain and spine and liver lesions in addition to prostate cancer.
Dr. Haas has identified early-stage breast cancer as particularly responsive to CyberKnife radiosurgery.
“The indications are growing,” Dr. Haas says. “Breast cancer affects hundreds of thousands of women annually. If we can take the model for treating prostate cancer with CyberKnife, apply it to breast cancer treatment, and reduce radiation from 6 weeks of treatments to 5 days, that’s a major benefit to those patients. In conjunction with colleagues in Seattle, Washington, we recently published results of our experience treating women with early stage breast cancer using CyberKnife. Treatment that had historically taken six or more weeks to complete can now be done in five days very safely.”
The same features that make CyberKnife therapy ideal for prostate cancer treatment also indicate the modality for lung cancer therapy, Witten notes. Tumors in the prostate may shift as contents of the bowel or bladder move, so CyberKnife’s motion-tracking technology locks on to the tumor and provides real-time information pertaining to the target’s positioning.
When treating tumors in the lung, radiation oncologists have to account for movement concurrent with respiration. Traditional techniques, such as respiratory gating, are effective, but CyberKnife’s capabilities are far superior.
“No other system can do what CyberKnife does in terms of compensating for the respiratory excursion of a lung tumor,” Witten says. “During the respiratory cycle, the tumor moves, which makes it a constantly moving target — and movement caused by breathing is a significant change in position. Traditional delivery methods expose much more of the surrounding tissue to radiation.”
“The main advantage of CyberKnife radiosurgery is that it permits delivery of a higher ablative dose to a tumor in a much more controlled way than any other type of radiation therapy. There is nothing more fulfilling than optimizing a patient’s treatment with a superior technology.”
—Seth Blacksburg, MD, MBA, Medical Director of Winthrop NYCyberKnife Center and Associate Director of Radiation Oncology at Winthrop-University Hospital
External LEDs enable the system to track respiratory motion, and the CyberKnife system adjusts the radiation beams accordingly.
“The CyberKnife reduces margins of error associated with older technologies by essentially anticipating the location of the tumor,” Witten says. “CyberKnife significantly reduces the probability of complications attributable to radiation toxicity, such as pneumonitis, and is an excellent option for lung tumors.”
Winthrop’s NYCyberKnife Center, located at 150 Amsterdam Avenue at 66th Street, provides residents of Manhattan and the New York tri-state area with greater access to Winthrop’s CyberKnife services and will serve as a worldwide training center for practitioners.
With its state-of-the-art facility in Manhattan, Winthrop’s NYCyberKnife Center expects to impact prostate and other cancer patients’ outcomes by making more treatment options available to the greater New York Metropolitan Area. The department also has the privilege to work with Aaron Katz, MD, Winthrop’s Chairman of Urology, who is a world-renowned expert in prostate cancer and genitourinary malignancies and has provided guidance and support of the program.
“Patients do travel for the best medical care, and this new center makes CyberKnife so much more accessible,” Dr. Haas says. “We want to fill a void for those patients in the region and beyond who did not have the opportunity previously to be treated with CyberKnife radiosurgery technology and get them back to their lives, families, jobs and ultimately, cured.”
Expanding its services to Manhattan also opens the Winthrop NYCyberKnife Center’s team to working with other physicians in the region who may have patients who can benefit from the capabilities of CyberKnife radiosurgery.
“We treat a wide variety of sites such as prostate, lung, breast, liver, brain, spine, and soft tissue masses, as well as functional conditions like trigeminal neuralgia, and we can evaluate all patients to determine if treatment is appropriate,” Witten says.
Seth Blacksburg, MD, MBA, Medical Director of Winthrop NYCyberKnife Center and Associate Director of Radiation Oncology at Winthrop-University Hospital.
“Our expertise extends to all cancer types,” Dr. Blacksburg adds. “We have successfully treated patients for prostate cancer, breast cancer, benign and malignant tumors of the brain and spine, gastrohepatic malignancies, and other soft tissue tumors. For every treatment we perform, we always work collaboratively with the other members of the patient’s medical team, including their urologists, medical oncologists, or surgical team.”
The Winthrop NYCyberKnife Center team is equipped to provide a level of care unmatched by more traditional radiation treatments.
“We have been performing CyberKnife radiation therapies for prostate and other cancers at Winthrop-University Hospital since 2005, and it has been an absolute godsend,” Dr. Haas says. “The new Winthrop NYCyberKnife Center in Manhattan serves a broader geographic area, so cancer patients from the tri-state area and beyond have easier access to advanced technology that improves outcomes.”
For more information about the Winthrop NYCyberKnife Center in Manhattan, visit winthrop.org.