However, because this is not a very precise therapy, surrounding normal tissues are also irradiated, and this limits the dose of radiation to the tumour.

Yet limiting the dose can make standard radiotherapy fairly ineffective. It’s a catch-22.

CyberKnife delivers an identical type of radiation, but in a more sophisticated, accurate and targeted way. This means the side-effects are greatly reduced.

While conventional radiotherapy uses large beams from three or four treatment angles, CyberKnife uses a flexible robotic arm which is attached to a miniaturised radiotherapy machine.

This gives enormous manoeuvrability, firing hundreds of pencil-thin beams of radiation from thousands of angles around the patient, which converge on the tumour.

This allows odd-shaped tumours in critical places to be targeted extremely accurately, with little damage to surrounding healthy tissues, so higher doses can be given over a shorter period of time.

The machine also has sophisticated software that tracks the location of the tumour with millimetre precision every few seconds using tiny gold markers as a guide. The robot can also follow tumour movement as the patient breathes in and out.

The treatment session is longer than for conventional radiotherapy, which lasts ten to 15 minutes. But 1 – 5 sessions are needed, instead of up to 30.

CyberKnife can be suitable for patients whose cancer is inoperable but has not spread. It can also be used as retreatment following previous radiotherapy.

CyberKnife has been used to treat many sorts of cancers – lung, liver, spine, pancreatic, prostate and brain cancers.

It is still fairly new for pancreatic cancer, but early research data from the U.S. and Europe shows that in up to 80 per cent of cases, it controls the primary pancreatic tumour for a significant period of time – usually six months – or, in some cases, even eradicates it completely.

The problem is that while it is a very good ‘local’ treatment, CyberKnife doesn’t stop the cancer spreading elsewhere.

That’s why CyberKnife should usually be combined with chemotherapy, and not used on its own in this disease.

Around 150 patients have undergone CyberKnife treatment since its UK launch last March – 10 per cent of whom have pancreatic cancer. The majority of patients paid privately.

The cost is likely to come down by next summer, when there will be up to five CyberKnifes in use in Britain. It is a innovative treatment which can give people a lot of hope and a few more precious months.

I’d never any problems with my health. But while on holiday in the U.S. in 2008 I developed a peculiar sensation in my gut that kept me awake at night.

It wasn’t painful, and to begin with I thought I’d eaten something funny, but when I totally lost my appetite, I knew something was wrong.

Back home, I had blood tests and a camera put down my throat to look into my stomach, but they came back clear. By this time, my weight had dropped from 16 to 12 stone.

My GP sent me for a CT scan. I didn’t suspect anything sinister but two days later I was told I had pancreatic cancer. The tumour was inoperable, because it was so large and wrapped around a major artery. It was a terrible time for all the family.

An initial course of chemotherapy shrunk the tumour by 30 per cent. Doctors then put me on an aggressive chemotherapy and radiotherapy regimen to further shrink the tumour. But this time the results weren’t spectacular, and the regimen made me feel very sick and ill.

I had heard about CyberKnife and was keen to try it. No one knows whether CyberKnife will extend your life by months, a year, or longer but my doctor said he hoped it would destroy 80 per cent of my tumour.

I had gold ‘markers’ inserted in my pancreas and liver under local anaesthetic. These were to help the robot ’see’ and target the tumour with great accuracy.

The treatment itself was carried out on three consecutive days, in July last year.

The machine has a robotic arm that moves around your body. Radiographers put you in the right position depending on the location of the tumour – then you must not move or cough.

The robot hovers around you as it lines up to deliver the beams of radiation – in my case, 309 times. Each session took about two hours and was totally painless – with no after- effects either.

The group, which meets twice a month, offers a range of services to breast cancer patients including visits to the breast cancer unit, support during chemotherapy and once treatment has finished.

It also arranges charity events to raise vital funds for women diagnosed with the disease.

One of the members is Julia Clay who was diagnosed with ductal carcinoma in-situ (DCIS) – the very early stages of breast cancer – following her first mammogram at 49.

After undergoing a small operation to remove the cancerous cells and radiotherapy, she took the drug tamoxifen for five years and was regularly monitored.

But a year later the DCIS had returned and this time she needed a mastectomy. After having the surgery which included a reconstruction of her breast, Julia decided to join the Pink Buddies support group.

“We are there to help people who are newly diagnosed with breast cancer or going through chemotherapy or who have had breast cancer and just want to join the support group,” explains Julia.

“Although our primary purpose is there to help new people, the Pink Buddies themselves often want to talk about the treatment they have had over a long period of time.

“We feel we can talk to each other about this but we can’t necessarily talk to other people about it, especially if you are over the treatment and supposedly have moved on. It is still always there at the back of your mind.”

Another member of the group is breast cancer survivor Lorna Jones.

“We provide visits to the breast cancer units, talk to people who are going through chemotherapy and provide bi-monthly support sessions so that patients can come along and talk to survivors and gain that inspiration. They can see that having breast cancer isn’t necessarily a death sentence,” she says.

The group has got the full support of the medical team at London Bridge Hospital.

Vanessa Kendell, Breast Care Specialist Nurse, says the inspiration it gives other patients can make such a difference to how they deal with their diagnosis and treatment.

“In our support group we have various ladies who have had different types of breast cancer and different types of surgery,” she explains.

“The group is fantastic at supporting those patients who are going through their treatment and who need to see that there is actually light at the end of the tunnel.”

For more information go to www.pinkbuddies.co.uk

Patients and their families want to know they are being treated in an environment that is not going to put them at risk of catching a hospital acquired infection.

But keeping hospitals clean, it is a challenging process and requires much more than a bucket and mop.
Dr Vanya Gant, an expert in hospital hygiene inspections, says: “If you have a dirty environment you as a patient are more likely to get sick.

“Operating theatres are places that can be very risky for patients. We have been inspecting hospitals and operating theatres for a long time now.”

Traditionally, hygiene inspections have been carried out using a pen and paper. However, errors can creep into these reports.

So Dr Gant and his colleagues at University College London Hospitals have developed a state-of-the-art piece of equipment known as the e-QIT (The Electronic Quality Inspection Tool).

The hospital’s blue print is downloaded onto the machine – a handheld computer – and the inspector then uses it to go through every part of the hospital.

The computer asks questions which are designed to check whether the hospital is clean and makes sure nothing is missed.
Where hygiene standards are not met, a camera within the device takes pictures of the problem areas. All the information can then be downloaded at the touch of a button.

Dr Gant, divisional clinical director of infection, explains: “The software asks us the questions about each area and machine in the room. We tick the answers and then when we press a button we get a report. It is fantastically efficient.

“If things aren’t right, I tell the machine that I have got a problem and I can also take a photograph of the problem area.
“E-QIT has fantastic potential. An inspection that would normally take half an hour with a clip board can be done in four minutes. That means infection control experts will be able to spend more time with patients.”

The highest cleanliness award using e-QIT is five stars.

So far there are only six private hospitals in the UK that have achieved that level – they are the Wellington Hospital, the London Bridge Hospital, the Princess Grace Hospital, The Harley Street Clinic, the Portland Hospital and the Lister Hospital – all HCA hospitals.

Dr Gant says: “It is not easy to get five stars so they should be very, very proud of the level of cleanliness of their estate.”

Doctors at the Harley Street Clinic are among the first in the UK to be treating prostate cancer patients with a new radiotherapy machine called RapidArc. Here they explain what it does.

Prostate cancer is the most common cancer among men in the UK. It is also the second most common cause of cancer death after lung cancer.

In the past, men would fear prostate cancer treatment as much as they feared the disease because of the side-effects.
This is because radiotherapy to treat the cancer would also damage surrounding organs.

Dr Ron Beaney, consultant clinical oncologist, explains: “Unavoidably one would give some radiation dose to the bladder and to the bowel. If the bladder gets inflamed, the patient gets cystitis – passing urine more frequently and maybe getting discomfort when passing urine.

“If the rectum or the bowel gets inflamed, then there is a tendency towards diarrhoea.”

Over the last 10 to 15 years, there have been major advances so that radiotherapy can now be delivered more accurately and with fewer side-effects.

Dr David Landau, Consultant Clinical Oncologist, says: “Rapid evolution in technology means we are increasingly accurate in our ability to deliver radiotherapy. This means we can treat cancers effectively with a higher dose while avoiding nearby structures so the side-effects are less.”

RapidArc is the biggest advance in linear accelerator radiotherapy for many years.
RapidArc delivers radiotherapy faster and with greater accuracy than pervious therapies. Using a unique tumour mapping system, RapidArc travels around a patient, targeting tumours from 360 degrees.

Ashley Richmond, Chief Physicist at The Harley Street Clinic, explains: “As the machine rotates around the patient, the jaws inside the machine, move and shape the radiation to precisely target the shape of the tumour at that particular angle. We increase the dose at certain points and reduce it at other points in the arc depending on how clear a shot we have of the tumour at that particular point.”

The key benefit of RapidArc for patients is that the treatment is much quicker than traditional radiotherapy – while most cancer radiation sessions last between 30 and 40 minutes, Rapid Arc treatments take approximately two and a half minutes.

Dr Landau says: “The fact that the treatment is so much quicker relieves a certain stress from the patient. A lot of patients will come into clinic and say, I lay there as still as I could for as long as I could but I am not sure it was good enough.

“If the patient knows they only have to lie still for a couple of minutes, then that stress is taken away. Overall, the main thing that patients want to know is am I getting the very best treatment and with RapidArc they certainly are.”

 Andry said that unsurprisingly she was shocked to find that she had breast cancer but her diagnosis and treatment process was extremely quick. “I had the operation within a week and then I had further tests to see if the cancer had spread. Finding out that it had spread and that I would have to go through another operation to drain my lymph nodes, followed by 6 sessions of chemotherapy and radiotherapy was the most upsetting part of my journey,” She said. “However, the support I received throughout this time was incredible.  As well as my consultant, the breast cancer nurses were there for me at every step of the way. I received complimentary therapy and time with a psychologist which was great – it meant that I had someone to talk to throughout everything,” said Andry.

After the chemotherapy, Andry had a break for 5 weeks and then went onto have radiotherapy. Subsequently,  she was given the all clear and goes  back for follow up appointments every 3 months to make sure the cancer hasn’t come back. Even during this aftercare, the medical team and her specialist breast cancer nurse were on hand at all times and the support continued. On her second annual check up, surgeon Mr Hadjiminas noticed something abnormal in Andry’s right breast. He had detected more precancerous cells.

“After being clear for 2 years I thought that was it, then Mr Hadjiminas told me this news and that he wanted to remove both my breasts,” said Andry. This was a very emotional time but knew that I had to go through with this to stand a chance of surviving the cancer. I had a double mastectomy and reconstruction at the same time. My follow up care was amazing and without the help of all the staff at the Harley Street Clinic the journey would have been a lot more painful. I couldn’t have asked for a better level of care, support and guidance.” she said.

Eight months later Andry looks and feels great. She still comes to the Harley Street Clinic for check-ups every month and her advice to other women is to check themselves as regularly as possible because early detection is vital to have the best chance of beating cancer.

Molecular Imaging (or Nuclear Medicine and PET/CT) is the medical specialisation that uses very small amounts of radioactive materials for diagnosis and therapy. Uniquely it provides doctors with information about both the function and structure of virtually every part of the body.

Much of the information that the technology obtains cannot be obtained by other diagnostic methods and by enabling doctors to see anatomy as well as physiology, it enables more accurate evaluation of a particular disease.

The new centre is equipped with two state of the art Phillips BrightView nuclear medicine gamma cameras – one with SPECT/CT capability, which provides true 3D imaging and improves diagnostic sensitivity.  The SPECT/CT machine is the first of its kind to be installed in the UK.  SPECT/CT enables the investigation – both physiological and anatomical – in greater detail than was possible previously, of all areas of the body.  The technology is frequently used for investigating the functions of organs including the heart, the kidneys, liver, lungs, the skeleton and thyroid.

 The unit also has a GE Discovery 64 slice PET/CT which is used for cancer diagnosis, mapping tumours before and after treatment, as well as examining abnormalities in the brain.

“A brain tumour is a very frightening and rare diagnosis. It creates a lot of panic not just among patients and their families but also among some doctors if they are not used to looking after these rare conditions,”says Mr Thorne.
While traditionally patients diagnosed with a brain tumour have been admitted to hospital for long periods of time, this is not always necessary.

“I tend to see patients after they have had their first scans showing some kind of lump,” he says.

“Often this will trigger an unnecessary admission to hospital – it is not because the patient needs to be hospitalised but fear has arisen because a lump has been found.

“Yet some tumours could have been there for decades, certainly years. At this time most of my patients are walking, they are looking after themselves and with good symptom control they could be at home.

“They should see me soon so that we can assess how serious the symptoms are, what the nature of the tumour is, whether it is something that could be observed, whether it requires a biopsy or whether it requires surgery.

“However, a lot of care can happen as an outpatient or during short hospital stays. This is much easier for patients and their family.

“For instance, people needing a biopsy can come in, have it done and be home the next day whereas typically people were spending days, even weeks in hospital to have this kind of procedure.

“If you have a tumour that has been there for years, it is often not an emergency to take it out. You can use that time to let people know what is happening to them and get some more scanning, functional imaging and neuropsychological assessments done so you can get a real understanding not only of whether surgery is practicable and safe but also what you can expect in terms of results.”

The key to successful management and treatment of a brain tumour is accessing medics with the appropriate experience, says Mr Thorne.

“The Wellington Hospital has a track record in performing cranial-neuro surgery. You also want a unit that has a team approach. We are a neurosurgical team working here, that means we are always available and for people who haven’t had their diagnostic imaging we can arrange that very quickly and appropriately.

“As we learn more about the biology of tumours and how they perform, the interaction between surgeon and other clinicians is also incredibly important.

“The key to any neurosurgical operation is safety. There is an obvious intrinsic danger in operating on the brain. So the role of the surgeon is minimising all dangers. There will always be an underlying element of risk, but actually the complication rate with neurosurgery is probably lower than most other kinds of surgery. It’s just the potential of these complications is far more worrying. By having an intensive care and close supervisory environment, any post-operative problems are going to be picked up very rapidly.

“Treatment begins with surgery, it does not end there. The ability of the brain to repair is far higher than people used to believe and the key to maximising recovery is safe surgery and quality rehabilitation.”

A man from Greater London has become the 100th person to be treated at the UK’s first CyberKnife Centre at the renowned Harley Street Clinic in London.

The man, who has been suffering from prostate cancer, could not be treated by other forms of radiotherapy. He is among a growing number of patients sent to the Harley Street Clinic for CyberKnife radiotherapy treatment by their NHS trusts.

The patient’s oncologist, Dr Stephen Karp, said that the unique characteristics of the CyberKnife system made it an extremely valuable new tool in the treatment of difficult cancers. “For a select sub group of patients CyberKnife may be the only machine that can deliver the appropriate dose of radiation to a tumour. It is absolutely ideal for the close distribution of radiation without damaging surrounding tissue,” he said.

CyberKnife has a compact linear accelerator fitted with a variable Iris system which can shape thin beams of radiation as required. It is mounted on an extremely manoeuvrable robot arm and is able deliver pencil thin beams of radiation in pre planned pulses of varying strength from many different directions.

By mapping a tumour three dimensionally prior to treatment, oncologists and physicists calculate the dose of radiation to match the shape, density and position of a tumour. The tumour is then ‘marked’ with tiny particles of gold and during treatment the robot is guided by an ultra sensitive X-ray guidance system allowing the CyberKnife to compensate for a patient’s breathing and ensuring sub millimetre accuracy. Radiation is delivered from many directions avoiding damage to surrounding tissue and so many tumours that were previously impossible or very difficult to treat, can now be treated by CyberKnife.

The Medical Director of the CyberKnife Centre at The Harley Street Clinic, is Dr Nick Plowman, one of Europe’s leading authorities in the use of radiosurgery. “CyberKnife enables us to deliver more radiation to a tumour than we can with orthodox technology and we are very pleased with the results we have seen with this new machine,” he said.

“Over the past year we have broken new ground and achieved a world first by treating an intracardiac tumour and we have had referrals for others. So we are developing the technique. It’s great to be part of a new service developed here with the help of a top quality team,” he said.

More information about CyberKnife available on the CyberKnife London website alternatively feel free to leave us a comment and we’ll do our best to answer your questions in a timely manner.