Milestone 1000th Patient Treated Using Gamma Knife at Miami Cancer Institute

Leading the fight against brain metastases, Baptist Health Miami Cancer Institute hit a new milestone recently. The center treated its 1000^th patient using Gamma Knife radiosurgery, an incisionless radiation therapy that precisely targets a tumor, importantly minimizing damage to otherwise healthy brain tissue.

(Watch now: Rupesh Kotecha, M.D. discusses the benefits of Gamma Knife© radiosurgery and the significance of Miami Cancer Institute treating its 1000^th patient using this advanced technology. Video by Eduardo Morales.)

The accomplishment reflects the rapid growth of the Institute since its opening in 2017 and is particularly significant because with more than 4,000 tumors treated ― and the only Gamma Knife Icon system in South Florida ― Miami Cancer Institute is the most experienced in the region in using the newest Icon technology.

“We treat very complicated cases,” says radiation oncologist Rupesh Kotecha, M.D., speaking of the unique expertise of the Institute. “It’s not just the number of patients we have treated, it’s the number of tumors we have treated, as well. Each patient typically has more than one tumor.” Dr. Kotecha is chief of Radiosurgery and director of the Central Nervous System Metastasis Program at Miami Cancer Institute.

The Basics About Brain Metastases

Rupesh Kotecha, M.D., radiation oncologist with Baptist Health Miami Cancer Institute

Any cancer can spread to the brain from its primary, or original, site. The most common cancers that cause brain metastases, however, are breast cancer, lung cancer, kidney cancer and melanoma. Estimates place new cases of brain metastases in the U.S. at 150,000-400,000 each year.

Up to 20 percent of patients with cancer may go on to develop a secondary cancer in the brain, and it can happen in all sexes and age groups, even children. The numbers have risen in recent years largely, physicians believe, because advances in cancer treatment are enabling patients to live longer.

Depending upon the size and location of the tumor or tumors, treatment may include surgery, medications, whole-brain radiation and stereotactic radiosurgery (such as Gamma Knife) or a combination of treatments. Usually not curative, care is aimed at extending survival and improving quality of life by diminishing symptoms that can include headaches, balance and speech problems, memory loss and seizures.

Collaboration Ensures Rapid, Evidence-Based Care

Teams from Miami Cancer Institute and Baptist Health Miami Neuroscience Institute work together to develop individualized plans for each patient and hold weekly Tumor Board and Radiosurgery Conferences to discuss patients.

“The importance of this is that you get multiple opinions from different disciplines as to the best form of treatment,” says Michael McDermott, M.D., chief medical executive of Miami Neuroscience Institute and co-director of the Radiosurgery Program at Miami Cancer Institute. “It’s not a single doctor’s opinion, which actually may not be up-to-date or evidence-based.” The multidisciplinary healthcare team also includes experienced medical physicists, medical oncologists, radiation therapists, nurses and advanced practice providers, such as physician assistants.

Michael McDermott, M.D., chief medical executive of Baptist Health Miami Neuroscience Institute and co-director of the Radiosurgery Program at Baptist Health Miami Cancer Institute

The collaboration is especially crucial because the Institute is the only facility worldwide that offers every modality of radiation therapy under one roof, from proton beam radiation to Cyberknife, MR-Linac and Intensity Modulated Radiation Therapy. Patients with the same type of cancer may undergo very different treatment based on everything from a tumor’s biomarkers to how well controlled their original cancer is.

“Sometimes patients come in the door and they want a particular technology or treatment,” Dr. Kotecha says. “Sometimes that option is the correct treatment. We believe that patients should come in and be evaluated by a radiation oncologist who has experience in not just one technique, machine or platform, but who has a multidisciplinary approach.”

By having vast experience with multiple platforms, the Institute’s team can compare treatment plans for each patient across multiple platforms. Other facilities are limited due to a lack of technology or the expertise necessary to evaluate, compare and utilize numerous techniques and equipment.

The 1000^th Patient

Miami Cancer Institute’s 1000^th Gamma Knife patient was a 78-year-old woman who had already been treated for lung cancer. When the cancer spread to her brain, she opted for Gamma Knife treatment. Eventually new lesions formed in her brain and she again chose Gamma Knife, which is especially good at eradicating smaller tumors.

“We discussed various options with her, including radiosurgery and whole-brain radiation,” says Dr. Kotecha. “Whenever a patient develops cancer in the brain, we have to think about the patient’s goals of care, the extent of disease in the brain, the number of lesions, the size, the location. She elected stereotactic radiosurgery primarily driven by her desire to avoid any of the neurocognitive side effects associated with whole-brain radiation therapy.”

Studies have shown whole-brain radiation can cause cognitive decline, including memory loss; it does not improve overall survival. In addition, whole-brain radiation requires multiple sessions over several weeks while patients undergoing Gamma Knife usually have just one outpatient treatment. Radiosurgery can also be used to treat other problems in the brain, including benign tumors, arteriovenous malformations and seizure and movement disorders.

Training the Next Generation

Miami Cancer Institute’s experience with Gamma Knife will have an impact on the future of cancer care for years to come, Dr. Kotecha says. By leading and participating in international and national clinical trials and collecting large amounts of patient data and outcome measures, the Institute has published results in top clinical journals and become a go-to source for input on future technological improvements and recommended treatment changes.

They are also training the next generation on the newest, most sophisticated equipment. “Not only are we the most experienced in using this latest technology and have the most patient volume, we are also a dedicated teaching facility,” Dr. Kotecha adds. Already one of a few sites for introductory Gamma Knife training, Miami Cancer Institute has been chosen by Elekta, the manufacturers of the Gamma Knife Icon, to be the first site in the world to offer an advanced training course for experienced providers.

“There’s so much technology being developed every year,” Dr. McDermott says. “You really have to keep up with it. Technology is amazing and the therapeutic benefits for patients are really exciting.”

For more information on Gamma Knife options or other therapies at Miami Cancer Institute, click here.