Robotic image-guided radiosurgery for the treatment of neoplastic vertebral pain

Pantaleo Romanelli, MD
IRCCS Neuromed IRCCS, Via Atinense 18, 86077 Pozzilli, Italy

Abstract

Metastatic spinal lesions are common in cancer patients. Spinal metastases usually involve the vertebral bodies and are characterized by severe pain. Surgical treatment, as a consequence of its high invasiveness, is rarely offered to patients with metastatic disease and expected limited life span. Spinal radiosurgery provides high rates of pain and local growth control with limited risk of neurological complications. The use of radiosurgery to treat spinal lesions has been strongly facilitated by the development of image-guided robotic radiosurgery, a technique able to deliver stereotactic irradiation to intra- and extra-cranial targets.....

INTRODUCTION

.... Three image-guided linear accelerator (LINAC)-based devices are currently used to deliver spinal radiosurgery : the Novalis Tx...TomoTherapy® Hi-Art® ...and the CyberKnife...

Radiosurgery

Several studies have demonstrated that radiosurgery is feasible and effective for palliation of spinal metastases. Cyberknife radiosurgery has been used and reported much more than other modalities of spinal radiosurgery, due to the intrinsic ability of the system to provide accurate single stage irradiation to the spine. A limited number of studies reporting the outcome of spinal radiosurgery using the Novalis and the Hi-Art systems will be discussed first....

Future Perspectives

Although spinal radiosurgery remains in its infancy, the data reported in the literature clearly show an effective role for it in the treatment of spinal metastases. Stereotactic delivery of radiation to metastatic lesions near the spinal cord can result in good tumor control, rapid and durable pain relief, and in some cases recovery of neurologic function, with little evidence of radiation-related side effects or radiation necrosis. The largest studies of spinal radiosurgery have consistently shown excellent clinical outcomes without complications using single-fraction approaches. Gerszten et al. presented outcome of a 115-patient study including 108 metastatic lesions (14). They treated all patients with a mean single-fraction dose of 14 Gy (12-20 Gy) prescribed to the 80% isodose line. No acute radiation toxicity or new neurological deficits occurred during the follow-up period (median, 18 months). Axial and radicular pain improved in 74 of 79 patients. In the large-scale study from the same group, not a single instance of radiation-induced neurological complications was observed.

Taken along with the current findings, pain control and local control after single-fraction or hypofractionated radiosurgery are equivalent. This is consistent with results of randomized studies that have failed to show significant difference in pain control between single- and multifraction regimens for external-beam radiation therapy. We can conclude that single-fraction radiosurgery is effective in most cases of spinal lesions, and that hypofractionated radiosurgery should be reserved for treatment of special cases (e.g., larger tumors). The efficacy and safety of highly conformal radiation therapy against metastatic spinal lesions appears to be well established based on the data in the literature....


Conclusions

Spinal radiosurgery is a fast, non-invasive treatment used with good results in a growing number of patients with vertebral metastatic pain. In particular, radiosurgery is rapidly becoming the main treatment option for patients with stable vertebral disease, offering high rates of pain and tumor growth control and low incidence of neurological complications.

Miami's 3rd CK will be installed at Mercy Hospital (the 17th CK in Fl)

from the IV MB, by yyy60:

Miami's 3rd CK will be installed at Mercy Hospital (the 17th CK in Fl)

** Florida is the state that has the most CK (15). Including the new CK at U.of Miami and Mercy Hosp-Miami, there will be 17 CK in Fl.

The CyberKnife Institute at Mercy Hospital is scheduled to open February, 2010, and will be the first hospital based CyberKnife system in the Greater Miami metropolitan area. The CyberKnife system offers State-of-the-Art “Image Guided Radio Surgery”, the most advanced tool available in fighting cancer through radiation oncology. Providing patients with world class doctors, technology, and research, the CyberKnife Institute represents the highest quality of care obtainable.

Accuray shares rise on UBS upgrade

NEW YORK — Shares of Accuray Inc. rose Wednesday after a UBS analyst upgraded the maker of medical radiation equipment, citing stable orders of the company's CyberKnife system.

UBS analyst Erik Schneider raised his rating to "Neutral" from "Sell" and reaffirmed a $6 share price target.

NUOVA TERAPIA CEFALEA A GRAPPOLO

Campobasso, 13 nov. (Adnkronos) -

Una nuova cura per le cefalee a grappolo. E' quanto presentato da Pantaleo Romanelli, esperto di neurochirurgia funzionale dell'Istituto Neuromed di Pozzilli (Isernia), all'European Protocol Development Committee della Cyberknife Society, durante la riunione dei maggiori esperti del settore che si e' svolta a Milano nei giorni scorsi. Si tratta di un nuovo protocollo per il trattamento di forme gravi di cefalea a grappolo resistenti alla terapia medica.

Il protocollo presentato da Romanelli si base sull'utilizzo del Cyberknife, un robot radiochirurgico capace di inviare fasci sottili di radiazioni su bersagli intracranici con precisione submillimetrica, al fine di fronteggiare una patologia che incide sensibilmente sulla qualita' della vita di coloro che ne sono affetti. Questo robot finora e' stato utilizzato per il trattamento non invasivo di tumori intra ed extra cronici con ottimi risultati. Romanelli, applicando la tecnologia Cyberknife nel trattamento di casi severi di cefalea a grappolo resistenti alla farmacoterapia, ha selezionato come bersaglio del trattamento il ganglio sfenopalatino, una struttura nervosa della faccia coinvolta nella genesi della cefalea a grappolo.

Il trattamento e' efficace, del tutto non invasivo e presenta rischi molto contenuti. In seguito alla presentazione di questo protocollo la Cyberknife Society ha incaricato il dottor Romanelli di coordinare uno studio multicentrico internazionale al fine di trattare casi selezionati di cefalea a grappolo con questa nuova metodica.

Equinix Appoints Kei Furuta as Managing Director in Japan

David Wilkinson, the Former Managing Director, Becomes Senior Director, Business Development for Equinix Asia Pacific

Tokyo, Japan, 9 December 2009 – Equinix, Inc. (Nasdaq: EQIX), a provider of global data center services, today announced that Kei Furuta has joined Equinix as the managing director for Equinix Japan K.K.. In this role, Furuta will be responsible for the overall performance of Equinix’s operations in Japan, where the company currently operates two data centers. David Wilkinson, the former managing director for Equinix Japan K.K, will take on the new regional role of senior director, Business Development, Equinix Asia Pacific, to oversee the company’s growing business from financial services companies in the region.

Furuta comes to Equinix with a wealth of experience, having held various executive positions with industry leading companies. He served as regional head at AboveNet and Sprint where he managed operations in Japan and Korea. He was also a founder of Energy Initiative Japan (EIJapan), an engineering and consulting firm for energy-saving and environmental technologies. Furuta started his career 15 years prior at leading trading company, Marubeni Corporation.

Wilkinson, in his new capacity as the senior director, Business Development, Asia Pacific, will lead the regional strategies and business development for Equinix Financial eXchange, to support the community of global capital market participants that locate within Equinix data centers to establish highly reliable and low latency connectivity. Wilkinson spearheaded Equinix’s expansion to Japan and has built a strong team of professionals and foundation in Japan over the past seven years.

Equinix entered the Japan market in 2002. It is currently the third largest Internet Exchange in Japan via operating two International Business Exchange™ (IBX®) data centers in Heiwajima and Shinagawa, Tokyo, respectively. The two data centers, interconnected directly by Equinix’s IBXLink service, serve as a major Internet exchange platform for the interconnection of enterprise, service provider and content company networks. Both local and foreign corporations entrust the highly secure infrastructure and network density of Equinix’s Tokyo facilities to optimize network performance and efficiency.

“We are very committed to Tokyo as a strategic market for Equinix in the region. Kei Furuta will bring new vision and leadership to drive further success in Japan, while David Wilkinson assumes his new role to develop Equinix’s positioning in the financial service market in Asia Pacific, including Japan,” said Samuel Lee, president, Equinix Asia Pacific. “Our proven business model, coupled with our local market expertise, ensures that our Japan customers will enjoy strong support within the country as well as at Equinix locations globally.”

A new CK in Pasadena CA will be installed soon

from the IV MB, by yyy60:

>>I called more than one neurosurgeon's office at 630 S.Raymond Ave, Pasadena, CA and have confirmed that a new CK will be installed on the 1/F of the building, probably this month. The CK will be co-owned.

Samsung bada

Samsung bada has now been officially unveiled, and a Developer SDK is available from Samsung's new developer site.

Samsung today unveiled its new smartphone platform, Samsung bada. Based on Samsung's signature TouchWiz user interface, the Samsung bada platform will provide flash control, web control, motion sensing, fine-tuned vibration control as well as face detection and recognition. Samsung bada will also support sensor-based, context-aware applications. By using various sensors such as accelerometers, tilt, weather, proximity and activity sensors, application developers can implement context-aware interactive features in applications.

...

Samsung bada also supports Open GL ES 2.0 for advanced gaming capabilities. For haptic functionality, Samsung bada uses Immersion's TouchSense Player. Another key feature in Samsung bada is Lifelog, which lets developers create intelligent call logs to let users quickly figure out who they call most often etc.

AsiaEtrading.com reports on the Low Latency Trading Solutions seminar:

Low Latency Landscape

By Steve on Dec 06, 2009

This was the 5 minute speech I gave at the Low Latency Trading Solutions seminar with RTS Realtime Systems and Equinix before the FIA event in Singapore began this past December 2, 2009.

Good morning everyone. My name is Steve Edge Director of AsiaEtrading.com. I would like to thank you for attending our Low Latency trading solutions seminar. Our hosts today are RTS Realtime Systems a leading global trading systems provider. And Equinix a provider of global data center services.

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Low Latency Solutions Seminar A Great Success

By Steve on Dec 08, 2009

Our low latency trading solutions seminar held December 2nd preceding the Futures Industry Association (FIA) conference in Singapore was a great success. With 79 attendees in the standing room only venue at the St. Regis hotel the 90 minute event ran without a hitch.

...

John Knuff the Director of Business Development of Equinix was on hand to present the final part of the low latency trading solutions seminar. He touched on the firms approach to data centers and low latency connectivity worldwide. His polished performance made a great anchor to what was otherwise a very successful seminar.

President International Investment Holdings Ltd.

selling ARAY shares:


a summary of their activity:

President (BVI) International Investment Holdings trading history

PIPE International Chooses Equinix Sydney Data Center As Global Interconnect Provider For New Undersea Cable

Global Carrier also Deployed at Equinix Centers in Sydney, Tokyo and San Jose, CA

​Equinix, Inc. (Nasdaq: EQIX), a provider of global data center services, today announced that PIPE International (Australia), a wholly-owned subsidiary of PIPE Networks (ASX: PWK) has selected Equinix as a key interconnect provider for its new PIPE Pacific Cable (PPC-1) undersea cable. Through Equinix Sydney-1 (SY1) International Business Exchange™ (IBX®) data center located in its Sydney campus, Equinix will provide PIPE with convenient, secure and cost-effective access to the aggregation of Australia’s leading carriers operating within the center.

In addition to the Sydney IBX data center, PIPE is also utilizing Equinix’s global footprint and operational expertise, with deployments to Equinix centers in Tokyo, Japan and San Jose, CA, USA.

PIPE International’s newly laid PPC-1 undersea cable runs 6,900 km from Guam to its landing point on Sydney. With a capacity of 2.56 terabits per second, the PPC-1 system will provide significant additional capacity to Australia, and also will provide onward connectivity to Asia and the United States.

“We are extremely pleased to have been selected by PIPE International to help create market interest for the PPC-1 undersea cable project,” said Samuel Lee, President, Equinix Asia Pacific. “We provide a very efficient and secure means to distribute optimized traffic to the Australian market as well as increase the options for international transit and transport services out of Australia. The new PPC-1 cable system will also enable our customers to increase the resilience of their international network and provide additional redundancy.”

“Our landing of the new cable is to provide Australia with enhanced, competitive connectivity to the rest of the world,” Bevan Slattery, CEO of PIPE International said. “Equinix’s global data center services create an ideal partnership for us in the mission-critical project.”

Equinix operates IBX data centers in 18 countries, including a Sydney campus that houses two facilities, Sydney-1 (SY1) and Sydney-2 (SY2). With a combined floor space of approximately 120,000 square feet (11,145 square meters) and featuring state-of-the-art power, cooling and security systems, they provide the utmost reliability and connectivity for cable operators.

Letters of intent

• Oakwood Hospital and Medical Center, Dearborn, add MRT (“cyberknife”) unit, $4.8 million.