CK vs GK "Head to Head Comparison"

[Ted A]

Hello All:

In my quest for objective information about CK, GK, my doctor forwarded me this web site from Wake Forest University Baptist Gamma Knife Center. http://www1.wfubmc.edu/gammaknife/Gamma+Knife+vs+CyberKnife/

What I am finding is that, in general, those experts that administer CK prefer it, and those that administer GK prefer it. The group at Wake Forest claims to "set the record straight". They make 5 key comparisons, which to even the informed patient seem reasonable. I have also posted this link on the CyberKnife® Patient Support Group in order to solicit their retort. http://www.cyberknifesupport.org/forum/default.aspx

Here is an exceprt from the Wake Forest site:

Gamma Knife versus CyberKnife - Setting the Record Straight
Competition to treat benign and malignant brain lesions, vascular malformations, and functional conditions with stereotactic radiosurgery (SRS) has increased dramatically in recent years. All-in-one systems like the Accuray CyberKnife are aggressively positioning themselves as being comparable to the Leksell Gamma Knife® in effectiveness and efficiency.

As one of the most experienced Gamma Knife treatment teams at one of the most active Gamma Knife centers in the country, we at Wake Forest University Baptist Medical Center feel compelled to set the record straight.

Gamma Knife stereotactic radiosurgery is the gold standard for the treatment of intracranial SRS procedures. Its clinical efficacy has been documented across nearly four decades, with more than 350,000 cases treated worldwide providing the data for 2,000+ publications in peer-reviewed medical literature. It is used as the performance metric against which other technologies (such as CyberKnife) are measured.

Perhaps the easiest way to state our case is to compare, point for point, the Gamma Knife with the CyberKnife.

ETC, ETC......

(Please follow the URL to see the tabular comparison.)
www1.wfubmc.edu/gammaknife/Gamma+Knife+vs+CyberKnife/

I would be happy to see your comments if you can defend either position on any item they compare.

Thanks,

[ppearl214]

Hey Ted,

I saw your posting of this discussion as well on the CK boards.... and saw Dr. Medbery's comment of "great marketing" by Wake Forest to help promote their GK.... interesting.... will sit tight here... this should be a great discussion as well.  Curious to see (like you) what others here think... and hoping someone that was treated at Wake Forest will chime into the discussion as well.

Phyl

[sgerrard]

My response to the five points in the table:

Item 1, Design: Correct, and not a problem to me.
Item 2, Accuracy: See forums for exhaustive accuracy discussion.
Item 3, Immobilization: Only CK uses real-time imaging during treatment.
Item 4, Sessions: Correct. 3-5 treatments is gentler.
Item 5, Positioning: Only CK uses real-time imaging during treatment.

Bottom line: it is results that count, not features, and both systems have good results.

Steve

[Mark]

The garbage presented on the Wake Forest site re: GK vs. CK is the worst kind of marketing abuse and an embarrassment to the academic reputation of that institution which I generally hold in high regard. For entertainment, one could go to the UVA web site and see essentially the same language verbatim. Kind of suggests that someone might have written it for both of them.  There are more than enough adequate responses to this particular web site in the archives here to not require further discussion of it and as Phyl pointed out I think Dr. Medbery gave a very reasoned and balanced explanation to Ted's post over on the CPSG web site. It just raises my blood pressure when I read nonsense like that so I'm going to ignore it and go back to my happy place 

Mark

[sgerrard]

Medbery's last comment on that topic is a bit disconcerting:

"I think it is instructive to look at the situation here in OKC. The neurosurgeons push strongly to treat at the Gamma Knife because it is a 2 minute walk from their office, as opposed to a 20-25 minute ride to the CK facility."

Whatever else may be said, travel time for the neurosurgeon should not be the basis for deciding on treatment.

Steve

[Mark]

Steve,

I caught that as well and certainly didn't consider the neurosurgeon's behavior to be a great example of being "patient centric". However, I was also not surprised as I think variations of that thinking by physcians (what's easy for them vs. best for the patient) occurs more often than most of us would expect. It just reinforces the need for us as patients to take charge of our healthcare process to insure we really understand our options and pick doctors who really are focused on our ultimate outcome. That thinking should be part of any medical expereince , not just dealing with AN's

Mark

[GRACE1]

Mark, my happy place was Wake Forest University Baptist Medical Center.  I had GK there in 2006.  The staff was very professional and caring.  I only have good things to say for my experience there.  I did much research before I decided on Wake Forest, and I am very picky about my medical resources.  Apparently this "marketing" issue with Wake Forest comes up from time to time, and they get some pretty bad press on this site - deserved or not.  Someone who is new to this might discount Wake Forest soon after finding this site because of the bad press, and that is very unfortunate.  They treat a large number of ANs there.  For someone who has decided on GK, Wake Forest is a great place to be treated.  I traveled 6 hours to get there and have never regretted my decision to use them. 

To quote Steve, "Bottom line: it is results that count, not features, and both systems have good results." 

[okiesandy]

Let me try to set the record straight. There are a limited amount of neuro-surgeons that treat AN's here in the Oklahoma City area. There is one, only one neurotologist in the state. There are others who pose as neurotologist or suggest they are. They are not. I went to very well known hearing clinic here in OKC and later found out the doctor was plain old ENT. I will be forever grateful that they did an MRI early on. All that doctor could talk about was surgery.

I later went to Oklahoma University Med Center when there were two neurotologist. The one I went to only did surgery (he has since left the state). I now go to the only remaining one. He only has GK available to him by virtue of parcticing at OU Med. He said he wished OU would offer CK for AN's. He also said all he know about GK is what he is told and has never compared the two although rumor has it that CK is a little better for AN's, his words not mine.  As far as I know that is the only hospital he practices at.

My neuro-surgeon is also with OU Med. She does surgery, CK and GK. Does surgery at OU, GK at OU Med and St. Anthony's and CK at St. Anthony's. Dr. Medbery left OU Med to go to St. Anthony's so that he could have the option to add CK to his treatment agenda. I know Dr. Medbery's very first CK AN patient. She is doing very, very well. She herself works at a hospital and is very confident about her treatment choice.

No matter what your treatment choice is, it is always better to ask someone who does it ALL about results. Not the surgeon, not the GK person, not the CK person.  When I submitted my MRI's to Dr. Medbery he did not make the decision it was placed before a panel that included neurosurgeons, radiation oncologist and others. They reviewed my MRI's and came back with the decision that I was a candidate for any treatment, just not watch and wait. I had 3 sets of MRI's that showed Ivan the Terrible Tumor was growing rapidly. When I decided I wanted radiation Dr. Medbery left the decision to have CK or GK up to me. I did't not have hearing so GK was a viable option. I am the one who decided to have CK. There is no marketing issue going on with Dr. Medbery. It is my firm belief that if there was a better option for any kind of radiation treatment Dr. Medbery would jump on the band wagon ASAP. Look him up, he is consistantly named amoung the top 100 doctors in the US. That is high praise in this state. We have very poor medical treatment. He is very right about going a couple of steps down the hall or going to a differnt facility. After all OU Med gets the money for using the GK machine at their facility. Like it or not money is a great motivator. Just like HEI that said surgery was the only way, now offers radiation as a treatment option. I have read the Wake Forest stats before treatment and almost fell for it before I found Dr. Medbery. My son lived in Raleigh at the time and the good doctors here in Oklahoma just never mentiond Dr. Medbery.

[ppearl214]

gawd, I've missed you, Sandy! 



Thanks for sharing this Sandy... it's a great elaboration for those located in OK that are researching their options locally.  Although I'm not glad you had to do the leg work on much of this, boy, I am sure glad you did!  and you KNOW I'm thrilled that Ivan is now in brain booger heaven. Continued wellness to you!!!!!!

Phyl

[Mark]

Grace,

Glad you had good results with wake Forest, and nothing in my comments addressed their competence in treating AN's or GK as a perfectly adequate machine for treatment. I have seen a lot of hospital web sites which were "pro" whatever machine they happened to utilize, but i have never come across one that essentially slandered another technology through false or misleading claims as the wake forest one does. In that context I stand behind my low opinion of the institutions credibility for allowing it to exist. in Ted's original post of the link he referenced it as part of his effort to find "objective" information. In reality, with a few exceptions, most hospital web sites are the least objective sources of information and while not always perfect, clinical studies on performance and results are a much better source of information

mark

[okiesandy]

Just wanted to those who are reseaching CK vs GK that when they got to the Cyberknife Patient
Support group that they are getting advice from someone who does both kinds of treatment. Really not just an Oklahoma thing. Dr. Medbery seems to be a well kept secret here.  Just by accident I have come across about 6 of his CK patients and all are doing well. I also know one who had GK with him and he is also doing well. Now if I could get all of my other medical problems fixed I would be a happy camper.

[Nancy Drew]

I haven't read the research yet, but I must admit that I agree with Steve when he says,

 Bottom line: it is results that count, not features, and both systems have good results.

I am still deciding and will probably go with GK for my own personal reasons.  My new AN doc said he does GK and surgery.  He said he has never done CK, but he would gladly set me up with a doc at the CK center should I choose to go that way.  He has no connection with the CK center so he wouldn't be putting any money in his pocket by referring me there.  He gave me the pros and cons of all of the treatments and said it was my decision.  He doesn't do CK, but he respects it. And, of course he would favor GK more because he doesn't do CK.  I admire and respect the honesty of this AN doc.  I didn't get the feeling that he wanted to put another notch in his GK belt. 

Websites are websites.  Take them for what they are.  And if you go looking for something on the internet, you can find it.  I personally like that I can find a website that says dark chocolate is good for you.  Now I am looking for the one that says you can eat a pound every day instead of the little nibble they recommend.  Maybe one day they will determine that dark chocolate cures ANs.  Wouldn't that be "sweet".

Nancy

[Nancy Drew]

Actually I was wrong about my AN doc not doing CK.  The neurosurgeon I saw yesterday said he and my AN doc do CK at the Boulder facility.  Both just preferred to do the GK, but they gave me the pros and cons of each and said my choice.  For personal reasons I chose GK, but it is nice to know that the docs have used both to treat ANs (and both do surgery, also).  If you are fortunate enough to have a choice of how you want to treat your AN, then that is great.  You have to weigh your odds and go with what your "gut" tells you.  I think we are all going to be "protective" of our final decision because treating an AN is a big deal.  Someone here said there is no need to explain your decision to anyone, and I think that is good advice.  For me, I found the internal debate about which way to go was hard because there is so much conflicting information out there.  My thoughts are with all of you out there who are trying to make the "right decision for you." 

Nancy

[TOM101]

The one thing I disagree with in their comparison is the 1 vs more than 1 treatment. I have read on numerous sites that it is much better to get a group of small doses to reduce chances of radiatiing the surrounding area. They have recommend this approach on both GK and CK.

[ppearl214]

The one thing I disagree with in their comparison is the 1 vs more than 1 treatment. I have read on numerous sites that it is much better to get a group of small doses to reduce chances of radiatiing the surrounding area. They have recommend this approach on both GK and CK.

Hi Tom and welcome..... good to have you here participating.

Ok, from what I have been told.... surrounding brain structures will tend to take a hit of radiation regardless of how many fractions vs. single dose.  Now, the key is making sure the radiation hit of surrounding structures takes the lowest hit possible. Example... brainstem (in the case of CK) should take a hit of no more than 10-12Gy.  (not sure what GK/single dose  docs are noting but if someone wants to chime in, please do).    There is no guarantee, regardless of which radio-treatment option is chosen, of the minimal hits of surrounding structures... they just try to minimize it as much as possible.

Ok, more coffee for me!
Phyl