Robert Wood Johnson Medicine • Spring 2011 • Population Science

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A Lean, Cancer-Fighting Machine
Despite a name that conjures images of Star Wars,
the patented “Gamma Knife” is no movie prop —
nor is it even a knife.
In fact, the Leskell Gamma Knife “Perfexion” stereotactic
radiosurgery system is a sharp, powerful, supremely
advanced cancer-fighting machine that aims exceptionally
focused radiation beams into the brain to combat
tumors and other abnormalities.
“This technology allows us to carefully guide radiation
beams with extreme focus. That’s a key advantage because
it’s this precision that helps ensure the beams directly hit
their target without damaging healthy surrounding tissue,”
says Shabbar F. Danish, MD ’01, assistant professor of surgery
and director, stereotactic and functional neurosurgery,
RWJUH.
“This precision is a vast improvement over earlier generations
of the Gamma Knife, which means we can now offer
patientsa safer and more effective treatment option,” he adds.
While the Gamma Knife technology has been in existence
for some time, its newest and most advanced
model, the “Perfexion,” was purchased in 2010 and was
clinically operational in March 2011, according to Ning
Jeff Yue, PhD, professor and vice chair, Department of
Radiation Oncology. It has been installed at RWJUH and
radiation oncologists and medical physicists from The
Cancer Institute of New Jersey will provide the radiotherapy
services at the Gamma Knife Center at RWJUH.
With nearly perfect accuracy, the Gamma Knife offers
the most advanced protocol known for treating brain
abnormalities and tumors, says Atif Khan, MD, assistant
professor of radiation oncology. “It was the first machine
developed that could localize with a high degree of precision
small intercranial targets for pinpoint irradiation.
The ‘Perfexion’ is even more advanced. It can localize and
treat multiple targets in a very efficient and elegant way.”
All three of these chief proponents of this technology
will use the Gamma Knife “Perfexion,” along with specialized
teams of radiation oncologists, neurosurgeons,
and medical physicists.
Where Cardiac Patients Turn for Hope
There’s nothing more we can do.” These are probably
the most difficult words any doctor must say
to a patient, and this all-too-common sentence, or
something like it, is uttered every day in countless hospitals
and medical offices around the world.
For cardiologists, it becomes necessary when a patient
with end-stage heart disease or a member of the patient’s
family anxiously looks to the doctor for other options, for
next steps, for hope — when there are no other options,
there are no next steps, there is no hope — because the
patient is simply not eligible for that last-resort option, a
human heart transplant.
Although technology might never render these devastating
conversations obsolete, medical breakthroughs are
holding out the promise that one day there will be a
diminished need for such a bleak moment.
Cardiologists treating end-stage heart disease can now
offer the promise of a new, life-enhancing possibility to
some patients, thanks to an unusual collaboration involving
a medical device manufacturer, the U.S. Food and
Drug Administration (FDA), a skilled team of cardiac
surgeons, and the extraordinary bravery of one man who
briefly contributed to the advance of medical knowledge.
That man was the 76-year-old recipient of the world’s first
totally artificial heart approved by the FDA. Known as the
AbioCor Total Replacement Heart, this fully implantable
and self-contained device is capable of taking over when a
patient’s own organ fails. The AbioCor was implanted in a
patient for the first time in June 2009 at RWJUH. Mark
Anderson, MD, associate professor of surgery and chief,
division of cardiothoracic surgery at RWJMS and RWJUH,
led the surgical team performing this precise, highly specialized
procedure. Sadly, the first AbioCor patient survived for
only a few months following surgery.
In addition to its pioneering work with the AbioCor,
RWJUH is among the first medical centers to offer another
highly advanced treatment option for patients for whom
a cardiac dysfunction may eventually prove reversible. This
procedure involves inserting a tiny mechanical pumping
device known as the Impella 5.0 — a new, miniaturized
version of the typically permanent Left Ventricular Assist
Device (LVAD) used today.
Even more compelling than the cost-effectiveness of the
Impella 5.0 are the patient health and recovery benefits
that the device offers, according to Dr. Anderson.
“One of the device’s main advantages is the time it
buys for both patient and doctor, as it temporarily assists
the heart in pumping blood until a patient’s condition
and treatment options can be fully assessed,” he says. Dr.
Anderson adds that the insertion procedure is much less
invasive than it is for the LVAD; it involves introducing
the catheter-based device into the aorta through small
incisions in the patient’s groin area.
“We have found that the Impella is useful as a temporary
pumping aid, especially in cases where a patient is too
ill for immediate corrective surgery,” says Dr. Anderson.
“It’s also helpful in cases where a patient has just suffered
a heart attack or when they’re recovering from surgery.”
Robert Wood Johnson ■ MEDICINE 49