Treatment of stage I non-small cell lung cancer with CyberKnife, image-guided robotic stereotactic radiosurgery

Treatment of stage I non-small cell lung cancer with CyberKnife, image-guided robotic stereotactic radiosurgery.

Ahn SH, Han MS, Yoon JH, Jeon SY, Kim CH, Yoo HJ, Lee JC.

Department of Internal Medicine, Korea Cancer Center Hospital, Seoul 139-706, Korea.

The object of our study was to evaluate the clinical characteristics and outcomes of patients with stage I non-small cell lung cancer (NSCLC) who underwent radiosurgery using the CyberKnife, a newly developed technology to deliver radiation from multiple angles with a real-time target tracking system. A retrospective analysis of eight patients with stage I NSCLC who were treated with curative intent using the CyberKnife between 2002 and 2007 at a cancer center in Korea was performed. Among eight patients (seven men and one woman), three patients were ineligible for surgery due to poor lung function while four patients refused surgical treatment. Tumor size ranged from 19 to 50 mm in the maximal diameter (12 to 113 ml in volume). The administered radiation dose varied from 36 to 54 Gy in three fractions. All of the patients tolerated the treatment very well without any significant side effects. Complete response was achieved and was sustained for almost two years in one male patient until the patient died from a cerebrovascular accident. Seven patients showed radiographic partial response at 1-3 months. Re-growth of tumor at the treated site was observed in only one patient demonstrating an excellent local control rate, although systemic spread or regional lymph node metastasis of disease occurred in six patients during follow-up.

CyberKnife treatment is very safe and is able to achieve a high local control rate, suggesting its role as a reasonable alternative therapeutic modality in early lung cancer.

nice comments on the Lexus Remote Touch System

from the Passionate Pursuit:

>>Trying the Lexus Remote Touch System @ The Toronto Auto Show

After reporting stories and videos about the new Lexus Remote Touch system, I had the chance yesterday to try the technology for myself — and managed to record it despite my (noticeable) excitement:

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Comments

We have a 2010 RX350 on the showroom floor now. The Remote Touch controller is much easier to use than the touch-screen navigation of the past. The controller has two electric motors attached to it that allow it to create resistance and “feel” to the inputs. The controller does return to center after the car is shut off.

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The haptic feedback is strangely nice, it’s almost like there are notches, it’s hard to explain.

LG XNote P510: textured notebook with LEDs & haptics

Immersion technology?

>>LG XNote P510: textured notebook with LEDs & haptics

LG have announced their latest notebook, the LG XNote P510, complete with a 15.4-inch LED backlit 1,440 x 900 LCD, NVIDIA GeForce GT130M graphics and a choice of three Intel Core 2 Duo processors. In an attempt to make using their new flagship more stimulating, there’s also haptic feedback from certain controls - such as the power button - and LED illumination of the trackpad.

Baron Capital Group, Inc. - Equinix

SCHEDULE 13G


1 NAME OF REPORTING PERSON
S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON

Baron Capital Group, Inc.
-----------------------------------------

9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON

3,047,023


11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)

8.2%

Treatment of Spinal Tumors Using Cyberknife Fractionated Stereotactic Radiosurgery

OBJECTIVE: Benign and malignant tumors of the spine significantly impair the function and quality of life of many patients. Standard treatment options, including conventional radiotherapy and surgery, are often limited by anatomic constraints and previous treatment. Image-guided stereotactic radiosurgery using the CyberKnife system (Accuray, Inc., Sunnyvale, CA) is a novel approach in the multidisciplinary management of spinal tumors. The aim of this study was to evaluate the effects of CyberKnife stereotactic radiosurgery on pain and quality-of-life outcomes of patients with spinal tumors.

METHODS: We conducted a prospective study of 200 patients with benign or malignant spinal tumors treated at Georgetown University Hospital between March 2002 and September 2006. Patients were treated by means of multisession stereotactic radiosurgery using the CyberKnife as initial treatment, postoperative treatment, or retreatment. Pain scores were assessed by the Visual Analog Scale, quality of life was assessed by the SF-12 survey, and neurological examinations were conducted after treatment.

RESULTS: Mean pain scores decreased significantly from 40.1 to 28.6 after treatment (P <>P <>P <>

CONCLUSION: CyberKnife stereotactic radiosurgery is a safe and effective modality in the treatment of patients with spinal tumors. CyberKnife offers durable pain relief and maintenance of quality of life with a very favorable side effect profile.

Broadcom to supply single-chip solution for Samsung Edge phones

two interesting posts by cellodude on the IV MB:

>>Broadcom to supply single-chip solution for Samsung Edge phones (with built-in haptics naturally)

First time I've seen an integrated haptics controller on a chip from a major manufacturer. I wonder if IMMR gets any $$$ from Broadcom, or only from the final phone manufacturer?

Top phrases:

"Key features include touch-based graphical user interfaces with tactile feedback..."

"... the EDGE segment of the mobile phone market is projected to grow from 308 million units in 2008 to over 483 million units in 2012, making EDGE the largest volume sector."

>>IMMR first: LG Multi-Touch haptic phone to be introduced this week

LG Arena KM900 will sport LG multi-touch for the first time and new uses for haptics (haptics & multi-touch never seen before in the same phone)

Czech Republic to get a cyberknife soon

from a post by yyy60 on the IV MB:

>>This is a cutting-edge robotic irradiator, the first of its kind in the territory of Central and Eastern Europe ....

Reconstruction of the pavilion will be divided into two stages. The first cancer clinic will be reconstructed, in the second Department of Nuclear Medicine. "We not only significantly upgrade the building, but also to restructure the system of care. It will have created haematological bed department, our oncology intensive care unit goes under the Institute of Clinical Hematology, which significantly improve the care of patients with destructive tumors haematopoiesis. Cancer clinic is focused primarily on the treatment of other cancers, with an emphasis on radiation oncology, which belong to the peaks in the field, "stated Feltl.

Doc shares FMH experience at national conference

first hand experience from a Frederick News-Post article:

>>Much of Dr. Paul Chomiak's day revolves around a $6 million machine.

...

Chomiak has become used to travel: He said he's on the road once every two months, presenting the history of the CyberKnife and the patient outcomes he has seen. Most recently, he shared his experiences from both Sinai and FMH at the annual Society of Thoracic Surgeons conference, held in San Francisco in January.

The FMH CyberKnife Center is part of an international trial studying the effectiveness of the CyberKnife versus traditional lobectomy to treat lung cancer.

Chomiak is passionate about using and sharing the new technology.

Though it's relatively new, the CyberKnife could transform the practice of cancer treatment, he said.

"The outcomes have been wonderful," he said. "We're heading toward the CyberKnife being used for all cancers. There's literally no down time, and the risks are minimal."

report from 8th Annual Cyberknife Users' meeting

this is taken from two posts on the Yahoo MB:

>>8th Annual Cyberknife Users' meeting (Feb 4-9, 2009)

http://messages.finance.yahoo.com/Stocks_%28A_to_Z%29/Stocks_A/threadview?m=tm&bn=51532&tid=11616&mid=11616&tof=4&frt=2

Heavy emphasis on prostate ca (only lung ca had as many presentations), so I guess ARAY is putting many of its eggs in the prostate basket. The prostate data could hardly be better, with rapid PSA drops, virtually no local failures, and minimal morbidity (the main concern of critics). The data is finally substantial, with at least 3 series of over 200 pts (one with nearly 400), with many pts 3 years post-rx. Much eye-glazing data on quality of life indices and AUA scores was presented and will be published, but the bottom line was well-summarized by a Naples, Florida urology who spoke of the over 300 CK-treated pts he has seen in follow-up. He always asks pts if they would have the same treatment again and recommend it to others, and to a man the pts ethusiastically endorsed CK (something not true of his daVinci pts). I think I'm quite good with the rectal ultrasound and prostate needles (if I may say so myself), but I can tell you without any doubt that 100% of my seed pts would not recommend seeds to others or do it again. I'm still skeptical that ARAY will make substantial inroads into the prostate market given the politics and turf-infused history of treating prostate cancer. Hopefully I'm overly cynical and wrong about this.

Very good data presented on treating AVMs, acoustic neuromas, and ocular and pediatric tumors. This is very good news for the small number of pts afflicted with these rare diseases, less so for investors who want machines moved with large volumes of pts. Very little presented on pancreatic cancer, which was somewhat disappointing.

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http://messages.finance.yahoo.com/Stocks_%28A_to_Z%29/Stocks_A/threadview?m=tm&bn=51532&tid=11618&mid=11618&tof=3&frt=2

The early stage lung cancer data was extremely impressive, with several retrospective studies presented with smaller numbers of pts than the prostate studies. I would have been skeptical if not for the fact I've seen similar results in the 30 or so pts I've treated. It will take a randomized trial for the medical world to take note of this. The Roth trial is off to a slow start accruing pts, which is predictable given the vastly different treatment arms. (It is much easier to convince a lung pt he needs surgery, or needs CK, than it is to convince him to flip a coin to decide between the two.) Pts have been randomized to the surgery arm and dropped out to get CK, or initially interested in the study but refused to be randomized because they wanted CK. Since the study deals with operable pts it is not surprising that there is a non-surgical bias in those attracted to the study. I was told Chinese pts would be needed to meet accrual targets (apparently they don't have the option of dropping off study after randomization!), and that it would be 3 years before there was meaningful data.

I don't understand why ARAY limits those attending this meeting to current CK users or those with a signed contract with ARAY. It seems paranoid and self-conscious, when the data presented is largely impressive. Why not let any doc attend who was interested?

CK installed in the UK?

According to this source, it seems that the first CK is now installed in the UK:

>>UK docs to use ”Cyberknife” to treat cancer

London, February 8 (ANI): Doctors in Britain will for the first time use a robotic radiotherapy machine to treat cancer this week.

...

Ten people are lined up for treatment in the Harley Street Clinic in London, at a cost per patient of 15,000 to 20,000 pounds.
Dr. Nick Plowman, a consultant oncologist at St Bartholomew’’s hospital, who will oversee the treatment.
“If you get a discreet little tumour in an awkward place, under the liver or next to the kidney, then there’’s really nothing better than the Cyberknife,” the Telegraph quoted him as saying.

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see also the previous posts on this matter:

http://nortiaresearch.blogspot.com/2009/01/breakthroughs-that-will-change-lives-in.html

http://nortiaresearch.blogspot.com/2008/12/cyberknife-boost-to-cancer-care.html

Equinix 4Q 2008 Earnings Forecast

Equinix (EQIX) will be reporting 4Q 2008 and full year results on February 11 [the same day as Dupont Fabros Technologies (DFT), another Company that operates in the same sector but with a different business model, as they are wholesaling data centers to large corporations].

Consensus is for revenues of $ 190,54 million (with a low estimate at $ 188,60 million, and a high one at $ 191,83 million), and EPS of $ 0,25 (with a large bracket between the analysts estimates, $ 0,17/0,39).

Equinix guidance (mid point) was for revenues of $ 190,1 million and EBITDA of $ 79,6 million (the Company, so far, has never issued an outlook for EPS). As a side note, Equinix has about one third of revenues allocated in currencies different from the US$. Given today's volatile exchange rate market (an example could be the recent fall in value of the British Pound, that represents a good part of Equinix European revenues), it will probably be necessary to examine some numbers on a same currency basis, to get a feeling of Equinix real growth. We do expect the Company to mention, at least for the three main currencies (Euro and Singapore Dollar, British Pound) that represent most of its foreign revenue stream, the exchange rate ratio taken into consideration in its forecast of future results.

Guidance issued for 2009 forecasts revenues of $ 870/892 million, and EBITDA at $ 365/385 million. Capex is foreseen at $325/375 million, comprised of $265/315 million of expansion capital expenditure, that includes about $ 50 million still not allocated (more on this later).

Here is a small chart resuming Equinix revenues and EBITDA for the last few quarters (you may click on the images for a larger view):

While these numbers will be fundamental to evaluate Equinix performance, there are some other metrics that will give a great insight into the Company's performance – let's go through some of them.

Cabinets addition

Equinix has always delivered a steady growth Q/Q, with net cabinet additions ranging from 1,250 to 1,600 in each quarter in 2008 (these numbers exclude the European operations). We do expect this positive trend to continue.

Interconnection business

There is no doubt that the Company is enjoying a great growth in the volume of data going through its centers. This is a chart showing the aggregate numbers for the US IBXs, and relates exclusively to traffic passing through the GigE Exchange (common switch), that represents just a small percentage of the total traffic happening at Equinix (as Companies prefer to use private cross connections in the US, unlike in Europe). Still an effective way to visualize what's happening as far as traffic is concerned (a peak of over 330 Gbps was achieved in January 2009):

This is the link to the real time data.

Getting back to Equinix metrics, it will be interesting to check the number of cross connects and ports on the GigE exchange (and especially 10 Gig ones) added in the quarter. We also hope that some more disclosure on these data will be given for the European operations. As a side note, we noticed, looking at www.peeringdb.com, that some large customers are already showing ports at 20,000 Mbit/sec.

MRR per cabinet (Monthly Recurring Revenue)

Another key metric, although the recent exchange rate fluctuations make this number less effective. These data are for US and Asia only. We just remind you that the average MRR in the US was $ 1,756 in the 3Q 2008, as the US market enjoys, on average, higher rates for colocation and has a higher incidence of interconnection business.

Further expansion

This is a small chart resuming Equinix forecasted expansion in 2009:

If we go back to the last conference call, Equinix CEO mentioned an un-allocated part of the forecasted Capex (transcripts available from Seeking Alpha):

Stephen M. Smith

Turning now to Capex, we expect a total of $325 million to $375 million of which $60 million is for ongoing cap ex. Within this range we have also included approximately $50 million in expansion cap ex to be allocated for additional capacity in key markets.

Our crystal ball forecasts two major markets where Equinix might need to start planning new centers, Silicon Valley and Ashburn (Washington DC metro). While the Company owns a campus in Ashburn, and will probably consider adding capacity within it, it will need to look for a new greenfield building in the Silicon Valley or for the acquisition of a distressed asset in the area.

A brief look at some numbers to support our speculations:

Silicon Valley

• 2Q 2000 – first center opened (SV1). After the dot-com bubble burst, Equinix was one of the survivors in the industry and started a growth phase also in this very important market:
• 4Q 2003 – SV2 opening (1^st phase) – 800 cabinets
• 1Q 2005 – SV3 opening – 1,400 cabinets
• 3Q 2006 – SV4 opening – 1,800 cabinets
• 2Q 2008 – SV2 opening (2^nd phase) – 1,100 cabinets

If the previous numbers represent a trend in capacity needed, Equinix might have the necessity to start planning for a new center. A similar trend could be foreseen for the Washington DC area:

Ashburn

• 4Q 1999 – first center opened (DC1)
• 4Q 2000 – second build by Equinix on the Ashburn campus (DC2)
• 4Q 2004 – acquisition of a previous Exodus data center (DC3) – 1,900 cabinets
• 1Q 2007 – first greenfield build since the bubble burst (DC4) – 1,700 high power cabinets
• 2Q 2008 – additional build on the same campus (DC5) – 1,650 high power cabinets

Bond exchange

On the last conference call, it was alluded to the conversion of the 2012 - 2.50% convertible subordinated notes (transcripts available from Seeking Alpha):

Keith D. Taylor

We’ve assumed that the $32.3 million of 2.5% convertible debt will convert in to equity in February, 2009.

Lastly, the Company has a three-year option to purchase the New York (NY4) building for $39,000,000 that expires in September 2009. Although we do not expect this aspect to be mentioned at the conference call, we do take this into consideration when examining Equinix cash flow, as we would probably expect the Company to buy the land as they have strategically done for most locations in the US.

Apollo to invest Rs 80 cr to buy cancer treatment systems (India)

It sounds like the intention to buy more CKs is solid:

>>Apollo to invest Rs 80 cr to buy cancer treatment system

Chennai: Apollo Hospitals expects to invest about Rs 80 crore in acquiring two CyberKnife – a robotic radio surgery system.

Addressing a press conference after setting up the first CyberKnife facility in Chennai, Dr Prathap C. Reddy, Executive Chairman, Apollo Hospitals Group, said the company plans to set up two more robotic radio surgery systems in two cities but the locations are yet to be decided. This system is designed to treat tumours anywhere in the body with sub-millimetre accuracy.