The 1st radiosurgery robot in Réunion and the Indian Ocean area
A reference and high-tech center for cancer treatment in Reunion, the Oncology-Radiotherapy Center of the Sainte-Clotilde Clinic, created in 1970, provides Reunion Islanders with a comprehensive cancer care offer (radiation therapy, chemotherapy, surgery oncology, 30-bed oncology medicine department).
Particularly involved in the activity of clinical research, particularly in the field of oncology, it contributes to the improvement of the health of the population and offers innovative therapies (hormone therapy, immunotherapy, radiotherapy in volumetric arc therapy by modulation of intensity and radiotherapy in stereotaxic condition).
The year 2021 has been very eventful for the center which has finalized the acquisition of the latest generation radiotherapy equipment and which becomes the most complete center on the island of Reunion with its 2nd TrueBeam accelerator installed in January, and since August the Cyberknife, the first radiosurgery robot in Reunion and the Indian Ocean area and the most innovative technological feat to date in the treatment of cancer. With the acquisition of a Cyberknife, new therapeutic perspectives are opening up for Reunion patients suffering from cancer.
The background before implementation:
Cancer is a disease that can be treated better and better these days, provided that screening is carried out regularly and sufficiently early, even before the appearance of symptoms, and this to provide better care, but also to limit the sequelae related to treatments. used. In some cases, screening can even prevent the appearance of cancer, thanks to the identification and treatment of an anomaly that could have progressed to cancer.
In 2020, Reunion identified around 2,200 new cases of cancer. The therapeutic perspectives developed by the Center for Oncology-Radiotherapy considerably increase the number of cancer patients who can be treated. 1,500 radiotherapy treatments are provided annually and save patients long chemotherapy and improve their comfort of life, in particular through the modern treatments offered.
Radiotherapy, under the rise of technological developments and radiobiological knowledge, is constantly evolving. The physical control of microbeams, the biological control of high doses, and the improvement of control of the tumor target have led to the development of stereotactic-type concentrated irradiation and radiosurgery.
In response to the priorities identified in the Regional Health Project of the Reunion Regional Health Agency:
- priority of prevention and management of chronic diseases
- accessibility of the health care offer to all
- fluidity and continuity of the course
And on the strength of its expertise, taking into account the evolution of cancer cases between women and men and the prospects for reducing the most deadly cancers (lung, prostate, colon, etc.), the Sainte-Clotilde Clinic is facing the increase indications for irradiation that saturate the current potential of healthcare provision and changes in therapeutic standards. Since 2019, it has undertaken, for its Radiotherapy department, a modification of its technological park in order to adapt its care offer.
The acquisition of the 1st TrueBeam in 2016, then the second since the beginning of 2021, makes it possible to develop hypofractionated radiotherapy in stereotactic conditions.
The 2 Truebeams, configured identically (mirror) provide more comfort and save time in patient care, while securing the course and continuity of care by offering the possibility of using the second machine during maintenance operations.
The construction of the 3rd bunker with 1.90 meter thick lead walls started in August 2019 in order to allow use of the Cyberknife without the slightest risk of exposure by protecting the outside of the room (staff and users ) radiation emitted inside.
The Cyberknife project required more than 3 years of planning, from the signing of the estimate to the first patient, not to mention the preparation and discussions carried out upstream with the teams.
Received since April 5, 2021, the Cyberknife required a long phase of configuration and checks before being put into service. Indeed, in accordance with the regulations in force, a verification of the conformity of the installation was carried out by the Competent Person in Radiation Protection (PCR) of the establishment, followed by the Nuclear Safety Authority which inspected and returned its installation authorization on August 2, 2021.
Regarding professional training, two technicians from the Radiotherapy department benefited from an immersion course in Nice, in partnership with the Lacassagne Center. Doctors and medical physicists, who had already validated their radiotherapy skills in stereotactic conditions at the Léon Berard Center in Lyon, also benefited from distance training taking into account the Covid period provided by the company ACCURAY. They then completed an immersion internship in expert services in mainland France (Polyclinique Clairval in Marseille, Center Hartmann in Paris).
The Cyberknife in detail:
The first patient from Reunion benefited from his treatment against cancer with the Cyberknife on August 9, 2021 at the Radiotherapy Center of the Sainte-Clotilde Clinic. The Cyberknife, the service's 3rd accelerator, is the first and only robotic radiosurgery system.
It allows tumors to be treated with sub-millimeter precision. With its radiation head mounted on a robotic arm making it mobile and able to irradiate the tumor from different directions, the Cyberknife rotates around the patient to deliver beams of rays from all angles, allowing it to multiply points entry point converging on the tumour, regardless of its location in the body. It makes it possible to track the tumor to be treated by synchronizing, in real time, the patient's movements with those of the tumor and by following its movements during the sessions, including those related to breathing. The patient can therefore continue to breathe freely during the irradiation while the robot continuously adapts the volume to be treated by the irradiation to the respiratory cycle.
Indeed after being programmed, it generates its own information which will allow it to ensure and, if necessary, to correct its positioning permanently during the treatment.
Its ability to deliver the most optimal treatment possible while sparing the surrounding healthy tissues and organs also allows it to treat tumors hitherto inaccessible! It is also a solution for certain patients for whom chemotherapy or surgery could have harmful effects.
The stereotaxy of the Cyberknife robotic system provides “surgical” precision, hence its name radiosurgery, precision of less than one millimeter like that provided by examinations such as scanner and MRI used during the preparation of radiotherapy. This robot can be used for treatments at the cerebral level (intracranial) or outside the brain at the body level. The Cyberknife is used in particular in the treatment of tumors where the accuracy of the shot is essential or even vital, in the treatment of a large number of small and medium-sized cancers: brain tumors, near the optical pathways, pulmonary, near the vertebral column such as the spine and spinal cord, the liver, the pancreas, the prostate...
This unique tool in Reunion allows treatments to be carried out between 1 and 5 sessions compared to 30 to 40 sessions with the other accelerators. Stereotaxy is a modern technique of radiotherapy allowing to give a high dose of radiotherapy (the usual dose to cure cancer is 2 Gy per session; with this technique the doses are increased up to 20 to 25 Gy per session). The advantage is to reduce the number of sessions: For example 1 dose to cure prostate cancer requires between 35 and 38 sessions. With the radio surgery robot, five sessions will be sufficient. It also allows, because of its extreme precision, to propose a 2nd irradiation (re-irradiation on an area already treated by radiotherapy) allowing to control a cancerous recurrence.
The Cyberknife in the care pathway:
Like any proposed treatment, the medical team of radiation oncologists determines whether CyberKnife treatment is suitable for the patient's situation. The decision on the relevance of treatment with Cyberknife, carried out in multidisciplinary consultation during meetings, takes into account clinical experience and the tumor (category, extent, location, size). An RCP (multi-disciplinary consultation meeting) dedicated to radiosurgery treatments is currently being set up.
Depending on the different cases, treatment with Cyberknife can be combined with surgery, chemotherapy or conventional radiotherapy or constitute an alternative.
The consequences of treatment with Cyberknife:
Like conventional radiotherapy, treatment with Cyberknife may cause redness of the skin, headache (headache) for treatment of the brain, inflammation of the mucous membranes in the nose, mouth or throat, nausea and vomiting, or fatigue in the following days. Generally well tolerated, its side effects restricted to the area targeted by the rays usually disappear in the following weeks and generally fade over time. Other side effects may appear in the more or less long term.
However, the CyberKnife can significantly lessen the effects, allowing patients to lead "nearly" normal lives despite cancer treatment.
The orientation of patients towards support care (socio-esthetician, dietician, psychologist, social worker) helps to relieve the undesirable effects of treatments, to reduce fatigue or pain and to provide physical, psychological or social support while throughout the disease and after cancer.
In conclusion :
The acquisition of the Cyberknife has an investment budget of around 4.5 million euros entirely financed by the Société Civile de Moyens Radiochirurgie Océan Indien, itself supported by part of the medical and radiophysics team. of the clinic.
The Sainte-Clotilde Clinic supported the construction of the bunker as well as the fitting out of the premises, for a total financing of 1.5 million euros.
This investment aims to position radiotherapy at Clinique Sainte-Clotilde as one of the most successful activities in the Indian Ocean area. Reunion thus becomes the first Ultra Marine center in France and the first center in the Indian Ocean to be equipped with this technological advance.
As part of its vocation as a high-tech cancer treatment center, Clinique Sainte-Clotilde maintains its commitment and its desire to maintain its level of standards and the quality of patient care. She underlines the involvement of the teams in this project which would not have been possible without their investments.
The clinic reminds the population of the importance of early detection in order to provide better treatment for the disease and/or to limit its sequelae.
