Joey Wahler (Host): May is Brain Cancer Awareness Month and Southeast Georgia Health System is one of the busiest users of CyberKnife treatment in the world. So we're discussing this innovative technology. Our guest, Dr. Tim Jamieson, a Radiation Oncologist and Medical Director of the Cancer Care Center and CyberKnife for Southeast Georgia Health System.

 This is Health Matters from Southeast Georgia Health System. Thanks for joining us. I'm Joey Wahler.

Yeah. Hi there, Dr. Jamison. Thanks so much for being with us.

Timothy Jamieson, MD, PhD: Thank you. Nice to be here.

Host: Great to have you aboard. So first, in a nutshell, what is CyberKnife for those unaware and how do its process and results compare to traditional radiation treatment?

Timothy Jamieson, MD, PhD: Well, sure. So, traditional radiation is a small treatment each day, five days a week, for several weeks. CyberKnife is five treatments or less, much higher doses per day. It's all done in one week or less. And instead of two or three beams, CyberKnife utilizes about 20 to 100 beams from all these different directions. So, it's extremely accurate. And we essentially treat tumor a lot faster and at a lot higher dose per day.

Host: Gotcha. Now, interestingly, you were actually instrumental in bringing CyberKnife to Glynn County, both professionally, and personally, why was having this innovative technology in Brunswick so important to you?

Timothy Jamieson, MD, PhD: Yes, so, you know, I started the CyberKnife program at Virginia Hospital Center in Arlington, Virginia, and noted the extreme power of the modality, not only in terms of giving very high doses in a small amount of time that it does a better job of killing the tumor, but people are much more likely to get through treatment the shorter the number of treatments they have.

 And the results, particularly in lung cancer, are so much better than conventional that, you know, I saw it as the wave of the future in radiation oncology. And I wanted to bring this down to Southeast Georgia.

Host: Wow. So after a cancer diagnosis, especially for first time cancer patients, what are the next steps someone can expect?

Timothy Jamieson, MD, PhD: Sure, so after staging is completed, the main steps are deciding how best to approach, how best to treat. And for some things, there's not a lot of options, but for certain cancers, such as breast o,r or prostate, there are a slew of options. And so, it's really incumbent on a patient to try to get all the options available to them from more than one doctor.

 For instance, if you're recently diagnosed with prostate cancer, you want to talk to more than your urologist or more than just your radiation oncologist. You need to get from the horse's mouth from different specialists and get a better idea of what the options are, the pros and cons of each, and then you can make a much more informed decision.

Host: So whether it be brain tumors or benign brain conditions, how does CyberKnife compare with traditional treatment?

Timothy Jamieson, MD, PhD: So, when we're treating a brain tumor, there's options to do it conventionally over six weeks typically or in one week with CyberKnife. A lot of the times, one is much better than the other. For instance, if it's a small tumor, we often can just give five large treatments and get done with it.

If it's enveloped, with a very sensitive structure, like the optic nerve, if it wraps around your optic nerve, you've got to fractionate it over several weeks. It's more gentle on the nerve. When it's safe to do it, we like to do it, faster because it gives a higher biologically effective dose, meaning it's a better chance of controlling the tumor.

And a lot of the most common brain tumor we treat is a metastatic lesion. So it's a tumor that went to the brain from somewhere else. And historically we used to treat the whole brain on everybody. So even if there's one small tumor, the whole brain got hit. It's two or three weeks of treatment. There's a lot of side effects. There's a lot of long term side effects. Fortunately, that's changed. We now just treat the tumor, if it's 1 or 2 or 3, we treat those 1 or 2 or 3 in one treatment or two treatments total, we don't treat the whole brain. It's two things. We do a much better job of controlling the tumor and much less side effects because most of the brain is spared. So you don't have that downstream problem of long term side effects.

Host: And it seems, not just in this area, but so much throughout the medical world, surgery with robotic surgery and the like is becoming much more accurate. And maybe just talk a little bit in general, if you would, please, about how much better that makes your job and how much better that is for the patient, of course, as well.

Timothy Jamieson, MD, PhD: Sure. So, the CyberKnife, it's on a robot arm. So it's free to shoot from essentially infinite different angles. And it's constantly tracking the target. So for instance, in the brain, the patient is wearing this plastic mesh mask that goes over their face, secures the table, so they're kind of semi locked in, but there still can be subtle motion.

So throughout all the treatment, when the CyberKnife is moving around, shooting all the beams, every 30 seconds, we have a 45 degree x-ray coming in. We're seeing the skull anatomy. And we're comparing it to where it's supposed to be and any subtle motion we're correcting. So it's extremely accurate. So the constant detecting of the target with the robotic ability to move around from all these different angles combines the accuracy and the conformality of the dose; which is much more effective. We're hitting the target, we're missing the normal things much better than we used to.

Host: And hitting that target is what it's all about here, right?

Timothy Jamieson, MD, PhD: Absolutely.

Host: So, you alluded to it earlier briefly by mentioning the lungs. Besides brain tumors, what other cancers can CyberKnife treat?

Timothy Jamieson, MD, PhD: Well, CyberKnife can really treat anything. Sometimes it's much more appropriate than conventional. Sometimes conventional is more appropriate. But whenever there's a single target, like a solitary lung tumor, a stage one breast cancer, any prostate cancer, CyberKnife can deliver that dose much more effectively, a higher dose with less side effects.

Anytime we're treating a big, large prophylactic area, we want to use conventional radiation. The two are complementary. For lung, we're seeing an epidemic of stage 1 lung cancer. We used to not see very much stage 1 lung cancer, but with this new low dose CT scan screening, where we're screening high risk people, we're getting a CT scan to assess for this, we're finding a lot of stage 1 lung cancer.

You know, some people are scared to do the CT screening because they think if they find something, there's nothing they can do. But frankly, over 80 percent of lung cancers detected by the CT scan screening, are stage 1. And we cure the vast majority of those.

Host: And, if I'm correct, with prostate cancer, using CyberKnife can really cut down on a lot of the side effects that men often dread, right?

Timothy Jamieson, MD, PhD: Absolutely. So, CyberKnife is extremely successful and easy to treat a prostate. It's just five treatments. It takes about 10 to 15 minutes a day. It's just outpatient radiation. We're shooting 50 to 60 beams very precisely at the prostate. The prostate has little gold markers in it. So when you're lying down, your prostate moves around because the gas in the rectum is moving that prostate because the prostate's sitting right on top of the rectum.

So every 30 seconds we have our 45 degree x-ray and we see exactly where the prostate is. We adjust for prostate motion. So very safely, we can deliver this high dose. So we can give a higher effective dose in 5 days than you can do in 9 weeks of conventional radiation. It's a higher effective dose to the tumor, it's less dose to bladder and rectum, the side effects are better, and the cure rates are exceedingly high.

And a lot of the reasons people don't do this is because they don't know about it. So, it's very important to learn about this.

Host: One of the reasons we're here right now, right?

Timothy Jamieson, MD, PhD: Absolutely.

Host: So, Doc, we alluded to this earlier, Accuray, which is a developer of CyberKnife, they say Southeast Georgia Health System is among the world's busiest users. So number one, you and yours are obviously doing something right to say the least. And number two, how long have you offered it? And about how many procedures are done annually here?

Timothy Jamieson, MD, PhD: Sure. So, we opened our CyberKnife Center in January 2011. We got our latest upgrade late 2017. We're on course to treat about 550 patients this year. It's kind of steadily grown throughout that decade. The average CyberKnife center probably treats 150, so we're much more active than the typical center.

And that's, the reasons for that is because in order to treat on the CyberKnife, it's, it's got, you have to have a proponent. And so, you know, the Radiation Oncology team believes in it. We educate the patients, the referring doctors, and it's gotten to the point the referring doctors like it. Because their patients are getting treated well, with less side effects, and they've really bought into the program.

 They're our biggest proponents of it. And it's, and it really is a team effort. It's not just, you know, he radiation being done in the basement. It's a whole team effort. The surgeons have to put in markers. They have to diagnose the patient. They have to inform the patient. So it's really a collaborative effort. And we work together well here, Southeast Georgia Health System.

Host: And that's an important point you make, isn't it? Because we're talking about the technology here. Much of the focus is on that when you talk about something like CyberKnife. But there are still people behind the technology, right?

Timothy Jamieson, MD, PhD: Absolutely. And they have to believe in it. Because patients are going to, I mean, for the most part, patients are going to do what their doctor recommends that they do. We're not the first people to see the patient. We're the last person to see the patient. We don't make the diagnosis. We're radiation oncologists. We don't make the diagnosis. Surgeons do that. Pulmonologists do that. And so they have to get to us, and the surgeons, they're free to do whatever they want to do with them. So they're committed to this program, and that's why we're so successful.

Host: Sounds like it indeed. So, you have so many CyberKnife success stories. Can you share any of those with us?

Timothy Jamieson, MD, PhD: Well, sure. I mean, some of the biggest success stories are not even the curative ones. I mean, we, a friend of mine who had a stage four cancer several years ago that spread to her brain. And, you know, historically she would have gotten a whole brain and, probably not done that well. And so, you five or six years later, she was still doing well, having treated two or three brain metastases very quickly and effectively. It controlled the tumor there, and she went on to live, you know, many productive, happy years with a terminal diagnosis. Obviously, there's a lot of early stage people we cure, and those are success stories as well. I just, this one, you know, personally, I knew her before her diagnosis, which is different, but it was very gratifying to see her have several happy years that otherwise she wouldn't have had.

Host: I'm sure. And speaking of which, Doc, how rewarding is it using this cutting edge technology to literally save lives?

Timothy Jamieson, MD, PhD: It's really rewarding. It's very, it's fantastic. I mean, and beyond the, you know, the reward of people coming back, happy and healthy, we're able to treat a lot of people that otherwise couldn't be treated. I mean, there's a lot of people who can't go through six or seven weeks of radiation, or they don't have access to it.

And when you're treating only five treatments or less, you know, the radius of geography that can come for that type of treatment, greatly expands. So we treat a lot of folks from far over who otherwise wouldn't have this opportunity. The hospital has the Nunnally House where people can come and stay in this hotel that's on our property for free and receive their treatment. And so we're really helping a lot of people get state of the art technology that's otherwise not available. And that's very rewarding.

Host: You mentioned earlier that there are still people, of course, that are unaware of this being available. So other than platforms like this, how do you get that crucial word out there?

Timothy Jamieson, MD, PhD: We've advertised in other towns, but frankly, word of mouth has been our biggest advertiser. I have a patient in, in Charlotte, and the next thing you know, we're getting all these cases from North and South Carolina, panhandle of Florida. We had a group of three relatives that all got treated in a short amount of time.

 So word of mouth and the longer that we've been doing this, the broader and more robust that is. We get a lot of patients from the VA because, you know, it's a great treatment for them and they come from a very wide area. But focused, I think podcasts, and the like, do a lot. Our website with interviews has helped a lot to educate people.

So I'm hoping that the podcast will help reach out to more people and much more easy for them to find out what's going on.

Host: Absolutely. Couple of other things, naturally going through cancer can be extremely difficult for patients, their caregivers, their loved ones. What advice do you offer them? What advice can you offer them here?

Timothy Jamieson, MD, PhD: Sure. So when you're first diagnosed, unless it's an emergency, you need to take time and figure out what you want to do. And the very first time you hear that your diagnosis, a lot of people blank out and they don't hear a word that's been said. So you need to kind of revisit. Go back to your surgeon or whoever made your first diagnosis, talk to them and ask to be referred to other specialists.

Go online and look, which can be a little scary, but go online. The podcast will help and find out more information. Talk to people who've had a similar diagnosis, kind of get the whole landscape before you rush in and do your treatment. Some cases, it's really not an option.

There's really only one treatment that you can do. But a lot of cases, particularly early stage breast, early stage lung, any prostate cancer, there's a lot of options. Take your time and explore them all.

Host: And when you talk there, Doctor, about how scary that moment of learning the diagnosis can be for patients, how do you overcome that? How do you both put the patient and their loved ones at ease and also get your message across?

Timothy Jamieson, MD, PhD: Well I mean, I think we, when we're talking to them, it's got to be a conversational thing. You know I have to be relaxed, it makes the patient relaxed, I have to be confident; and it puts them much more at ease. And, you know, rather than focusing on statistics and all the potential bad side, you focus on what you can do, how, you know, it's going to be relatively easy to do it. You got a pretty good shot. Let's, do A, B, and C, and then see where we are. I think if you kind of focus people in on what they need to do, it helps a lot.

Host: Absolutely. And that brings us back to what we discussed a little bit earlier. The fact that there are people behind the CyberKnife, right?

Timothy Jamieson, MD, PhD: That's right. We have a great team of nurses and physicists and therapists, nurse practitioners. It's really, it's a team effort. Our CyberKnife coordinator, Whitney Poleski, people call her all the time. She's talking to them and helping with some of the, the anxiety. She kind of takes the brunt of that from patients and talks and talks. Our nurse practitioner, Julie Slall, talks to patients all the time. So it really is a team effort. We do our best to make people happy and treat them appropriately.

Host: That's great to hear. So, in summary, Doctor, why would you say people should consider Southeast Georgia Health System for CyberKnife and for cancer treatment in general for that matter?

Timothy Jamieson, MD, PhD: Well, we have a great team, extremely experienced in CyberKnife. I mean, we treat probably more than, two or three places in the country. And so we're very good at it, very proficient at it. We can treat prostates quickly, lungs, and one thing we didn't mention was early stage breasts. I mean, that's probably our most rapidly growing thing we're treating.

So stage one breasts we're treating the tumor bed in five treatments, sparing treating the whole breast. So we have a tremendous amount of experience in that. So it's an excellent place to get your treatment.

Host: Well, folks, we trust you're now more familiar with CyberKnife treatment of brain cancer and beyond. Dr. Tim Jamieson, valuable information indeed. Keep up the great work of you and yours, and thanks so much again.

Timothy Jamieson, MD, PhD: Thanks for having me. I appreciate it.

Host: Same here. And for more information, please visit sghs.org/cyberknife. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being part of Health Matters from Southeast Georgia Health System.