Karachi’s million-dollar robot zaps tumours for nothing at JPMC

CyberKnife is a $4 million robotic system that treats tumours and causes minimal damage to healthy cells.

KARACHI:

Bilal Tariq, 26, was all set to apply for a Master’s programme in his hometown Rawalpindi, when things started going wrong - blurred vision and headaches were followed by a shift in the alignment of his right eyeball. These were the results of the pressure being exerted from what was diagnosed as a seven-centimetre-wide tumour at the front of his brain.

Medical tests conducted at Pakistan Institute of Medical Sciences and at Shaukat Khanum Memorial Cancer Hospital (SKMCH) revealed that the young man’s tumour was benign. The doctors suggested that the only way forward was neurosurgery.

“We were scared to opt for brain surgery as it could damage a lot of healthy tissue,” said Tariq’s cousin Masroor. “That is when doctors at SKMCH recommended the CyberKnife radio surgery treatment in Karachi.”

With help from its generous donors, the Patients Aid Foundation (PAF) has purchased the CyberKnife Stereotactic System - a $4 million robotic system invented by a Stanford University neurosurgeon that treats tumours with high dosage precision radiation and causes minimal damage to healthy cells.

The frameless equipment can shoot up to 1,200 beams of radiation at small tumours in areas that are difficult to reach, such as the brain and the spine, explained CyberKnife project director Prof. Tariq Mahmood, who is also Jinnah Postgraduate Medical Centre’s (JPMC) head of radiology. “The words ‘cyber’ and ‘knife’ will tell you that this is a computerised surgery,” said Dr Mahmood. “The procedure is pain-free and each session wraps up in about two hours.”

The system was brought to Pakistan for the first time in December 2012, and has been treating up to four patients per day at JPMC’s newly built CyberKnife unit.



This machine is extremely expensive and the treatment plus patient care costs around $90,000 dollars per person all over the world. “Thanks to the PAF, the therapy is absolutely free-of-charge here - out of the 240 CyberKnife installations in the world, we are the only place that gives treatment for free, without discrimination of caste or religion,” said Dr Mahmood. “Our benevolence impressed the manufacturer so much, that he sold the CyberKnife to us at a discounted rate!”

Right next to the Rangoonwala building at the JPMC premises, the impressive new CyberKnife unit has opened its doors to patients. In this wing - which is complete with monitoring equipment, a UPS system, a trained team and the multi-million dollar robot - the case of a patient opting for CyberKnife treatment is discussed by a radiologist, radiation oncologist, physicist and radiation therapist. The team then decides the dosage and frequency of therapy required to destroy the tumour, and begins treatment.

“For a cancer patient, regular surgery is a good option if the damage to vital organs can be minimised,” said Dr Mahmood, referring to the various ways in which a tumour can be tackled. “Chemotherapy has side effects and regular radio therapy destroys between five to 20mm of healthy tissue. CyberKnife destroys less than 1mm of healthy tissue, so it can treat tumours in areas where surgery is inconceivable.”

Moments after his fifth and final session of CyberKnife treatment ended on Friday, Bilal sat patiently in a waiting room in the newly constructed wing, excited about going home. He said that the procedure was pain-free and that he was conscious for the hour-and-a-half he spent in the special room that houses the CyberKnife. “The pain has definitely decreased since the therapy started,” he explained. “My vision is also improving. We are hoping that the next MRI will bring some good news,” he said with a smile.



Dr Mahmood said that with the help of ongoing donations, about 1,000 patients such as Tariq can be treated every year.

He also hoped that as the confidence of the team at JPMC grows, it will start treating prostrate and lung tumours along with the ongoing brain and spine treatment.

The machine moves with the patient’s breathing, he explained, so it accurately locks onto tumours deemed untreatable due to their close proximity to major blood vessels. Movement such as breathing is monitored by cameras, so the robot repositions the beam in order to minimise damage to healthy tissue.

“This has all been made possible by the charity of the PAF’s private donors,” says Dr Mahmood. “We need donations worth $1 million every year to cover the cost for the upkeep of this building, its equipment and staff.”

The Patient’s Aid Foundation has organised a fundraising musical evening for guests and donors at the Mohatta Palace on Saturday evening, where singers Shafqat Amanat Ali and Meesha Shafi are set to perform. With the help of funds from such events, and ongoing donations throughout the year, the foundation hopes to sustain the work and expansion it has undertaken at the JPMC.

Published in The Express Tribune, February 9^th, 2013.