Photo by Graham Cullen FMH's new CyberKnife Center at the hospital's Regional Cancer Therapy Center is lead by thoracic surgeon, Dr. Paul Chomiak.

Now add to that vision a robotic arm directing radiation directly into a tumor in your lung, and you have the newest cancer therapy at Frederick Memorial Hospital.

The CyberKnife, a robotic radiosurgery system, removes tumors without sedation or incision using concentrated bursts of radiation, and patients are on their feet and back to their daily routines immediately after surgery, said Dr. Paul Chomiak, a thoracic surgeon who directs FMH's new CyberKnife Center at the hospital's Regional Cancer Therapy Center.

"You don't need a huge surgery for a small cancer," he said.

CyberKnife's radiation treatment targets tumors while sparing surrounding healthy tissue, eliminating long recovery times, potential for infection, and other side effects encountered in traditional cancer surgery.

Before surgery, CyberKnife patients meet with Chomiak, as well as an oncologist and a physicist, to design a treatment plan. Pre-op and same-day X-rays of the tumor site direct the machine's radiation.

Before getting on the operating table, the patient puts on a vest with small sensors that will monitor his or her breathing rate and other chest movements, which is especially important during treatment of lung cancers. If the patient moves, coughs or sneezes during the procedure, the CyberKnife responds in real time, adjusting its arm or the patient table to continue treatment, Chomiak said.

Patients can get up during surgery to take a break, and the procedure will resume when they lie back down on the table. The CyberKnife can treat up to five tumors at the same time, he said.

Most sessions last about an hour, and complete removal of a tumor may take several sessions, Chomiak said. Just a few CyberKnife sessions can yield the same result as 36 conventional radiation sessions, he said. In most cases, the only side effect of CyberKnife surgery is mild fatigue.

Radiology has a relatively short history in medicine. In 1968, Swedish physician Lars Leksell developed the Gamma knife, the first form of radiosurgery. The Gamma knife used radiation to remove brain tumors without sedation or incision, but patients were required to wear a metal helmet-like device and could not move during surgery. The Gamma knife and other subsequent forms of radiation can also damage healthy tissue around a tumor, Chomiak said.

A team of Stanford University physicists and researchers including John Adler, who studied under Leksell, used Gamma knife technology to develop the CyberKnife in the 1990s.

The U.S. Food and Drug Administration approved the CyberKnife for commercial use in 2001, and its popularity has grown drastically since then. In 2004, only four centers in the nation had one of the devices; FMH is now the 76th medical center to have its own. About 40,000 people worldwide have been treated with a CyberKnife, Chomiak said.

The $6 million machine sits behind a 12-ton door at the FMH Cancer Center, making the room "the safest building above ground in Frederick County, other than at Fort Detrick," Chomiak said. The door and lead walls keep the machine's radiation from affecting areas outside the room.

FMH's CyberKnife treated its first four patients last week, and will treat nine more this month, said Janet Russo, FMH's CyberKnife coordinator.

For now, FMH will use the CyberKnife for inoperable lung tumors and all spine and brain tumors, but will later begin treating liver, prostate and other cancers as well, Chomiak said.

Chomiak himself has treated more than 100 patients with the CyberKnife, mostly at Sinai Hospital in Baltimore, and he's one of three surgeons in Maryland certified to administer thoracic CyberKnife treatment.

"I saw how patients were responding to this, and so we brought it here to Frederick ," he said.

FMH's CyberKnife team includes a physicist, a radiation oncologist and several radiation therapists who have undergone extensive training on the technology over the past year.

CyberKnife surgery is covered by Medicare and all traditional insurance policies, Russo said. The cost of a CyberKnife procedure is about the same as open surgery, but since CyberKnife surgery reduces recovery time, it's actually more cost effective, she said.