going under the cyberknife

I had radiotherapy prior to surgery and because the ‘margins were slim’, I also had radiotherapy after surgery, shortly after being discharged from hospital. The second bout of radiotherapy was quite different though – it was. wait for it, Cyberknife. I had already seen an excellent BBC program all about this innovative, new treatment which featured my oncologist, Dr. Nick van As.

The first stumbling block was that Cyberknife treatment isn’t currently a recognised treatment available on the NHS. Consequently, the insurance company wasn’t guaranteed to fund the treatment which is essentially undergoing clinical trials in the UK. I knew Cyberknife was expensive. While still in hospital I asked Dr. van As how much the 3 sessions would cost. The answer – ‘£40k’. A lot of money, a sum I’m not sure I could raise without selling my house and moving my family to a trailer park in Aberyswyth. Still, what price can you put on life or prolonged life ? And, anyway, my Dad had frequently offered financial help should I need it which was more welcome than his unforgettable advice to ‘Keep your chin up’. Dr. van As reassured me that ‘There will be some to’ing and fro’ing with the insurance company but I am confident they will agree in due course’.

A couple of days later, he reappeared in my hospital room with the glad tidings that the insurance company had agreed to fund the Cyberknife treatment and he wanted to kick things off by booking the planning scan. When I expressed surprise at the speedy turnaround, he explained ‘Professor T (the surgeon) wrote to them stating that ‘If Mr. Brightside should re-present to me with recurrence of his colorectal carcinoma, after Cyberknife treatment was denied to him, then we will be seeing you in court’. After that, he said smiling, they had received approval via FAX within 25 minutes. What fantastic news – my savings were safe and my Dad’s inheritance would also be fully intact.

The Cyberknife treatment is quite different to conventional radiotherapy. Instead of a single beam radiating the affected area, a complex computer model is created which allows the radiographer to dispense tens of different beams of varying strengths to the area. For example, a strong beam might be used to radiate the central core of the tumour while lesser doses administered to the peripheral areas which reduces the risk to adjacent organs and tissue.

I has some difficulty picturing exactly what they were to target in my case – there was no tumour and there was no central core. I knew this because it was in a jam-jar on my bedside cabinet. I had this vision of my backside being a bottomless, empty void but I guess they were just radiating the area in the bowel close to the pelvis trying to eradicate any residual, microscopic cancer cells to give me the best possible chance. Which was fine by me.

Bizarrely, the planning scan for the Cyberknife treatment was done using a CT scanner which allows the team to create the computer model and 10 days later, I was in the basement of the Royal Marsden in the sterile, white, clean, shiny and very expensive Cyberknife suite. Unlike, the conventional radiotherapy which lasts a couple of minutes, Cyberknife sessions are much longer (40 mins for me) and you have to lie motionless and perfectly still for this period. so you lie on a sunbed, you stare at the ceiling which is adorned with a lovely high resolution photo of spring blossom and get to choose your musical entertainment – Now That’s What I Call ’70’s, 80’s or 90’s.

The Cyberknife treatment is delivered by a robot – do you remember the famous robot that painted the Citroen car in the factory – well Cyberknife shares a lot of the same technology and the robot base uses a similar hydraulic system to position itself and then dispense the X-ray beams. It is a little disconcerting at first as the robot whizzes and whirrs all around you – in fact sometimes I thought it was looking inquisitively at me before it lost interest and accurately re-positioned itself by my knees and then promptly withdrew high above my stomach.

After 25 minutes, the robot paused for longer than normal. In fact, it stopped completely by my feet. The senior radiographer came and explained ‘The robot wants to go where your feet are. Because we do the planning scans using CT, it doesn’t cater for people who are over 6 foot with size 10 feet’. I offered to twist my feet flat but it was no good – the session was aborted and they would have to recalculate the entire computer model – omitting the areas around my feet. I suspect this was a ‘Version 1.0’ type software problem that would be fixed in the next maintenance release.

Anyway, Dr. van As was summoned to re-jig the model and, within 4 hours, I was back on the sun bed with the Cyberkinfe robot doing its bizarre dance around my body.

Some people ask ‘Does it hurt ? What does it feel like ?’ No, it doesn’t hurt at all – there’s no burning sensation, discomfort, any faint warm glow or even any feeling at all. In fact, you’d be hard pressed to know you’d been subject to a leading edge medical treatment that costs as much as a semi-detached house in Burnley.

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