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KARACHI: With a plastic mesh shell fitted on his face, Mohammad Rehan lay down flat on his back, completely still, and the machine atop his bed began to bombard the tumour in his brain with a battery of high dose beams.

“I didn’t feel a thing and on my first session, which was yesterday, I’d even gone to sleep,” said Rehan who had come for the second session that lasted another 30 minutes. After his time was up, the 29-year-old accountant just got up and walked out.

CyberKnife radiosurgery may sound like a surgery but there is no blood, no needles and no gown. The cancer patient, in most cases, is not even given any sedative or anaesthesia and is conscious during the entire session lasting from 30 to 45 minutes, wearing their own clothes. A majority walk out of the facility feeling well enough to resume their activity for the rest of the day.

Just two months back, Rehan had gone through a major operation to get a tumour, which was “the size of a tape ball”, removed. He had been suffering from headaches for the past six or seven years, but since May the pain on his left side of the forehead got so intense that he felt that “his right eye was about to pop out”.

But some 2cm of it was left untouched as it was “risky” for the surgeon to dig that deep. He was advised to go to the CyberKnife Robotic Radiosurgery at Jinnah Postgraduate Medical Centre (JPMC) and get the residual mass removed through radiation. “I have to go through five or six sessions,” he said.

Areas once considered too risky to be operable because of their close proximity to sensitive areas can be reached through CyberKnife technology

Retired naval captain Farooq Harekar was diagnosed with prostrate cancer in 2014. Luckily for him, it was diagnosed at a very early stage and required just 30 days of a 10-minute radiation, but another alternative before him was three days of sessions at the JPMC. Of course, he opted for the three days over 30 days as anyone would. “In conventional radiotherapy sessions, it’s not possible to direct the radiation beams at the cancerous tissue and therefore much less radiation is used to minimise the damage to healthy tissue.

“But in CyberKnife, which moves at 360 degrees, doctors can administer a much more potent dose of radiation at different angles and much more precisely. With the result far fewer sessions are necessary,” explained Dr Tariq Mahmood, head of the radiology department of which CyberKnife radiosurgery is a section.

And because these robots and micro-bots offered pinpoint accuracy, it also meant, explained Dr Mahmood, that “radiation exposure to healthy tissue around the diseased one is minimal. In addition, areas once considered too risky to be operable because of their close proximity to sensitive areas, structures or organs can be reached,” he said.

Since 2012, 1,300 to 1,400 people suffering from various cancers, malignancies in the brain, liver, lungs, abdomen and prostrate, arteriovenous malformations (AVM) and nerve pain like trigeminal neuralgia have literally walked out of the facility on their feet. “Eighty per cent of the patients we treat have malignancies in brain and spine,” said Dr Mahmood.

And it’s not just patients from Karachi but from across Pakistan (48 per cent from the rest of Sindh, 31pc from Punjab, 11pc from Khyber Pakhtunkhwa and 6pc from Balochistan) as well as from other countries (3.5pc) come to the JPMC that provides the treatment for free. In the US, the same radiosurgery costs between $50,000 and $90,000.

With less than 250 such machines (each costs Rs400m) in the world, the one at the JPMC stands out as it is the only one offering free treatment, thanks to Patients Aid Foundation (a non-profit organisation formed by a group of citizens in 1990). Its running cost has surpassed Rs157m a year.

Pakistan may still be years away from using robotics in medicine but if one takes a leap of faith, many people in the country living with cancer may have their fortunes turned in three years’ time.

“The PAF is setting up the Jinnah Institute of Cancer and Research Centre that will have myriad machines similar to CyberKnife in addition to two more of the same for the smooth running of the 12 therapy units which will provide radiotherapy to 600 patients a day. In addition, it will have diagnostic facilities and clinical oncology to serve 200 patients a day,” said Dr Mahmood. As the PAF has already arranged $30m, the Sindh government has pledged to provide another $30m for it.

Also, there will be satellite centres at Hyderabad, Nawabshah, Sukkur, Larkana, Jacobabad, Badin, Lahore, Islamabad, Peshawar, Quetta, Muzaffarabad and Gilgit. Whoever is referred from these centres will be able to get treatment at Karachi’s centre free of cost. However, CyberKnife is no magic wand and it’s not for treating every kind of cancer. No two cases are ever alike, and each patient is different as is the tumour he or she is carrying.

“We would ideally like every patient with malignancy walking in here to be referred to us by their primary oncologist,” emphasised Dr Kamran Saeed, radiation oncologist, while speaking to Dawn. But those having liver, prostrate and pancreas cancer could just walk in for treatment, he added.

“The decision for what kind of treatment would be the best is not made by one doctor but by a whole team and after very careful deliberation,” said Dr Saeed. For every patient, there’s a team of doctors — from the patient’s own primary oncologist to the surgeon, to a physicist, and a radiologist to radiation oncologist as well as technologists — looking out for the patient, Dr Mahmood added.

Dr Saeed also explained that for benign tumours radiosurgery “reduces or stabilises the abnormal growth of the tissue for many years to come”. In the case of malignant tumours the radiation will “completely ablate” or basically vaporise the DNA and the vascular tissues and thereby destroy cancer cell’s ability to reproduce.

Sometimes patients are sent away when CyberKnife is not the treatment they need while at times the invasive surgery, like in the case of Rehan, is complemented with CyberKnife.

There is another targeted therapy available in the form of Gamma Knife radiosurgery in Karachi but it can treat cancer only above the ear or in the cervical spine.

With just one robot at the moment, for benign tumours, the waiting period at JPMC can be as much as three weeks though patients can jump the queue if there is malignancy or their life is at risk.

Published in Dawn, September 5th, 2017

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