CyberKnife
The CyberKnife is a dedicated stereotactic radiosurgery and stereotactic radiotherapy system which is distinguished for its innovative design and ground-breaking technology. It was the first system to obviate the need for a mechanical fixation frame for intracranial treatments by utilizing real time image-guided technology coupled with a robotic manipulator. With CyberKnife, radiosurgery can be applied for the treatment of lesions (malignant, benign, or functional) anywhere in the body upon clinical indication.
Radiotherapy department of IATROPOLIS Clinic has the most experience in Greece in performing Stereotactic Radiosurgery treatments, having treated more than 7500 patients (Greek citizens as well as citizens of neighboring countries) with a variety of lesions, as presented in the diagram below:
5 main part cooperation to perform medical Stereotactic Radiosurgery
Cyberknife consists of 5 main parts, used in cooperation to perform medical Stereotactic Radiosurgery, these are:
- A special compact 6 MV linear accelerator with a dose rate of 600 MU/min (Monitor Units per minute).
- A robotic arm capable of movement in six axes (6 degrees of freedom), to allow directing the beam anywhere in space. This arm is guided and controlled by a powerful computer, which does not allow deviation errors greater than 0.2 mm.
- An (image-guided) Digital Radiography System, which guides the robot and hence the beam to monitor patient movement and thus the target (tumour or other pathological focus) to automatically correct the corresponding parameters
- A specially designed treatment table A treatment planning system with modern and powerful computers and sophisticated software with many great features (forward and inverse treatment plan, single, multi, iso & non-isocentric treatment)
- The special "Synchrony" system, consisting of devices and software used for treatments in organs that move during pulmonary function (lungs, liver, pancreas, etc.)
What are the advantages of CyberKnife?
- Using a dedicated image-guided system and artificial intelligence, the system can detect patient movements and adjust accordingly the therapeutic beam to maintain delivery accuracy. Removal of the skull mechanical fixation enabled the delivery of radiosurgery treatments, not only in the brain, but anywhere in the body.
- Larger lesions can be treated with hypofractionation schemes. The use of image guidance enabled the treatment of larger lesions or lesions adjacent to sensitive structures, in more than one fraction and up to five fractions.
- Precise targeting (within 1mm) of the lesion, irrespective of the treated body anatomy. The achieved sub-millimetric accuracy helps to significantly reduce side effects and assure an increased quality of life for the patient.
- Delivery of dose distributions that conform with the target shape. The system uses multiple non-coplanar with different shape beams to create dose distributions that conform with the shape of the treated lesion and at the same time have an increased spatial dose gradient to minimize irradiation of the surrounded healthy tissue.
- Treatment of lesions that move with respiration. The CyberKnife uses Synchrony system to synchronize the position of each beam with the target, as the patient breathes normally on the treatment couch. With this technology, lesions in the lung, liver, kidney, and pancreas that move with respiration can be treated with increased accuracy and minimal side effects.
- Treatment is pain free and does not require anaesthesia. Patients can continue normal activity straight after treatment.
Conditions treated with CyberKnife
Lungs• Stage I or II non-small cell lung cancer (NSCLC)
• Local relapse of NSCLC, after radiotherapy
• Solitary pulmonary metastasis
Liver
• Hepatocellular cancer
• Cholangiocarcinoma
• Hepatic metastases
Pancreas
• Adenocarcinoma:
/ for local disease, as monotherapy or in combination
/ for disseminated disease - combined with chemo or radiotherapy)
Spine
- Spine metastases
Prostate
- Early stage adenocarcinoma (T1 or T2a)
Central Nervous System (Brain and Spinal Cord)
- Meningiomas
- Accoustic Schwannomas
- Pituitary Adenomas
- Arteriovenous Malformations
- Metastases
- Glioma relapses after radiotherapy
- Functional lesions (e.g., trigeminal neuralgia)
CyberKnife can be used for the treatment of the above in the following ways:
Either as a first-line option or:
- as an alternative to surgery
- as an adjunct to surgery
- as an adjunct to radiotherapy
- in combination with chemotherapy
- in combination with chemotherapy and radiotherapy
The decision as to whether and how the patient will be treated is taken after evaluation of his/her medical file by the CyberKnife scientific team (a radiotherapist-oncologist, a doctor specialising in the treated organ and a radiation physicist).
What types of lesions could be treated
Vascular malformations of the brain
Arteriovenous malformations (AVMs)
- Incipient brain, skull base and spine tumours, including:
Meningiomas, schwannomas, including acoustic neuromas and certain cases of NF2, chordomas, pituitary adenomas, craniopharyngiomas, haemangeiopharyngiomas.
- Primary, recurrent or residual tumours of the spinal cord and spinal column:
Sarcomas, malignant chordomas etc., arteriovenous malformations (AVMs) of the brain and spinal cord.
- Metastases in the brain and spinal cord by neoplasms such as: lung, breast, prostate, thyroid tumours, melanoma.
Dysfunctions: trigeminal neuralgia, Parkinson's disease, epilepsy.
What are the advantages over open surgery:
- It prevents hospital stays and hospitalisation after the end of treatment, so the patients can return to their daily activities.
- It entails no procedures for surgery, general anaesthesia, postoperative pain, recovery time, possible nosocomial infections.
- It avoids potential damage to adjacent sensitive nerve formations from unavoidable surgical handling and accesses.