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Surgery With The CyberKnife
 Janet Marek-Ruf sorts through a bag of CDs, settles on Supertramp and eases into her form-fitted pillow.

Assisted by the music, she drifts into a meditative state, while an intimidating, rotating robotic arm administers the latest in radiation cancer treatments: the Cyber-Knife.

Marek-Ruf was diagnosed with breast cancer 10 years ago. She underwent a mastectomy, followed by chemotherapy and radiation sessions. After years of intermittent remissions, she recently learned her cancer had spread to the spine. Because of their small size and sensitive location, the tumors were too risky to remove through surgery.


"Having already received standard radiation, that was not an option," says Dr. Brian Beyrel, a neurosurgeon and chief of radiation oncology at Overlook Hospital in Summit, N.J.

This made her the perfect candidate for the CyberKnife, a noninvasive, image-guided approach to treating tumors of the spine, brain, lung, pancreas, pituitary and adrenal gland.

CyberKnife also is used for noncancerous conditions including facial pain and abnormal vessels in the brain, says radiation oncologist Dr. Louis Schwartz.

Schwarz and Beyrel are co-directors of the CyberKnife program at Atlantic Health System. The doctors take a multiexpert approach to individualizing patient treatments. Beyrel first rules out the possibility of surgery and then, along with Schwartz and a radiation physicist, develops a treatment plan.

On average, a CyberKnife patient undergoes three sessions, lasting anywhere from one hour to 90 minutes each, with a week or two off between treatments. Most insurance companies cover the procedure.

After learning about her lower spinal lesions, Marek-Ruf was referred to Beyrel by her oncologist. He suggested CyberKnife.

A confirmed candidate, she entered treatment two months after her diagnosis, a "decision made rather quickly," she says.

Marek-Ruf was scheduled for six sessions. Her third was produced live for the Internet by slp3d, an Internet broadcasting company specializing in health-care information.

A marriage of technology and robotics, the CyberKnife delivers target-specific radiation to tumors once considered untreatable. The pinpoint accuracy spares surrounding healthy tissue from excess radiation exposure, Schwartz says.

Additionally helping in positioning the patient are tiny screws called fiducials that were implanted above and below the tumor sites in Marek-Ruf's spine prior to treatment.

While Marek-Ruf meditates on the table, radiation therapists Joanne Winnick-Merullo and Bonnie Pyne DePortillio assume their positions in the control room. Two buttons marked "beam" and "off" flash intermittently as the CyberKnife focuses on each of the 100 nodes on the treatment path. As the robot makes its way around Marek-Ruf, her image is depicted at all times on a computer screen.

"Janet is the model patient," Winnick-Merullo says. "Look how still she is."

Because of her stillness, the treatment is completed in one hour.

Marek-Ruf is assisted off the table, gathers her CDs and prepares to pick her son up from school.

"I'm just a little tired, but I feel OK," she says.

Marek-Ruf completed her last treatment recently, but is still undergoing chemotherapy and medication.

A patient generally waits about six to eight weeks before having a follow-up magnetic resonance image or computed tomography scan, to measure the tumor's response rate. The wait is necessary to allow possible internal swelling to subside, Beyrel says.

"The ultimate goal of CyberKnife is to stop the growth of the tumor," Beyrel says. Response rate is about 80 percent, a hospital spokeswoman said.

More than 150 patients nation and worldwide have been treated at this location There are currently 35 CyberKnife treatment areas in the United States and 26 internationally.