APOLLO HOSPITALS INDIA - CYBERKNIFE THERAPY

Glomus Jugulare Tumour successfully treated with cyberknife

2011-11-16T22:53:00.000-08:00

MEDICAL REPORT

This 41 years old gentleman a case of glomus jugulare tumour was diagnosed in 2005. He underwent embolisation in 15.03.2005 followed by excision of tumour on 18.03.2005 at Kerala.
On follow up in 5.05.2005 MRI showed residual lesion of size 3.4 x2.2 cm. Patient underwent SRS on 26.07.2005 for a dose of 10 Gy to 80% isodose at elsewhere.
On follow up found recurrence in 2007 for which he went to same center where no further treatment was offered.
Then he went to another hospital in Kerala where he was offered 2nd open surgery for which patient was not willing. Then in April 2010 MRI done showed increase in lesion size about 4.3 cm x 4.21 cm x6.0 cm in size.
TREATMENT

Patient came to Apollo speciality bospital for further treatment. Patient was treated with Cyberknife boost and IMRT after discussion through our tumour board
Now follow MRI revealed good regression of size of tumour and volume analysis showed almost close to 40 to 50 % of reduction in tumour volume.

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INDICATIONS FOR CYBERKNIFE TREATMENT

2011-11-16T22:48:00.000-08:00

The indications for which cyberknife treatment could be useful is indicated below : Dr.Rathna devi, Senior consultant, Radiation oncology
Intra Cranial Tumours – Indications

• Skull base Tumours
• Meningiomas
• Brain Metastases
• Acoustic Schwannoma
• AVM
• Pituitary adenoma
• Low/Hi grade Glioma
Boost Re- irradiation
• Functional
• Trigeminal Neuralgia
• Spinal Tumors - Primary
Re irradiation - Metastases
• Craniophrangioma
• Chordoma
• Hamartoma
• Harmangio blastoma
• Glomus Jugular Tumor
• Boost for Nasopharynx carcinoma

EXTRA CRANIAL SITES – INDICATIONS
. Lung - Primary
- Metastases
• Liver - Primary
- Metastases
• Head & Neck - Tonsil
(Re Irradiation) - Larynx
- Pharynx
- Lacrimal Gland

• Sino Nasal Carcinoma - Boost
- Re –irradiation
• Carcinoma Pancreas
• Carcinoma Gall Bladder
• Para arotic lymph nodes
• Melanoma
• Carcinoma prostate
• Recurrent Orbital Tumours Renal Tumours
• Soft tissue sarcoma

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Stereotactic body radiotherapy for low-risk prostrate cancer

2011-11-16T22:38:00.000-08:00

Stereotactic body radiotherapy for
low-risk prostate cancer:
five-year outcomes
Debra E. Freeman1 and Christopher R. King2
1 Naples Radiation Oncology, PA, USA
2 Department of Radiation Oncology, UCLA School of Medicine, CA, USA
Radiation Oncology 2011, 6:3doi:10.1186/1748-717X-6-3
Purpose
Hypofractionated, stereotactic body radiotherapy (SBRT) is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT.
Method and Materials
Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35-36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method) and RTOG toxicity outcomes were assessed.
Results
At a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%). Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated
urologic instrumentation.
Conclusion
Five-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach.

Source: www.accuray.com

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Lung Optimized Treatment with the CyberKnife® Robotic Radiosurgery System

2011-03-21T00:09:00.000-07:00

Lung Optimized Treatment with the CyberKnife® Robotic Radiosurgery System
Worldwide, lung cancer is the most common cancer in terms of both incidence and mortality, with 1.61 million new cases and 1.38million deaths in 2008.1 An ever growing number of patients with early stage disease are categorized as poor surgical candidatesdue to co-morbidities such as advanced lung and heart disease. For decades these patients were left with few treatment options and were most often treated with external beam radiation therapy (EBRT). EBRT has limited efficacy due to the inclusion of large volumes of normal tissue within the treatment field, limiting the ability to deliver the high doses needed for tumor control.2 Stereotactic body radiation therapy (SBRT) for the lung directly addresses the dose limitations of EBRT. SBRT allows clinicians to deliver much higher
biologically equivalent doses in one to five fractions. Clinical evidence and publications over the last several years have demonstratedsuperior local control results for SBRT as compared to EBRT3-5, and SBRT has become a standard for the treatment of medically inoperable early stage lung cancer.6

Delivering high doses of radiation in five or fewer fractions to lung tumors demands a high degree of precision and accuracy. The Synchrony® Respiratory Tracking Systemis the only available system that provides real-time tracking for tumors that move with respiration.7 Accurate alignment of each treatment beam with the moving target is
maintained by moving the beam dynamically during treatment.

One challenge to offering CyberKnife® SBRT treatments to lung cancer patients has been the system’s reliance on implanted fiducial markers for tracking.8 Developmentsover the past several years, specifically the advent of the Xsight® Lung Tracking System technology9, allow clinicians to offer fiducial-less treatments to a subset of these
patients (typically peripherally located tumors with a minimum dimension of 15 mm). Using the Synchrony System, with or without fiducial markers, CyberKnife SBRT lung cases have been treated with a total GTV-to-CTV expansion of 3 mm and a CTV-to-PTV expansion of 2 mm.10-12

Now, with the introduction of Lung Optimized Treatment, clinicians can offer the option of fiducial-less treatments to all CyberKnife lung patients, regardless of the location
of the tumor. Lung Optimized Treatment includes the current Xsight Lung Tracking System and provides two new tracking modes: 1-View Tracking and 0-View Tracking.

1-View Tracking is designed for cases in which the treatment target is clearly visible and therefore can be tracked in only one of two the X-ray projections. With 1-View Tracking, motion in the non-tracked plane is accounted for using an Internal Target Volume (ITV) expansion in one direction (along the source-detector imager axis of the
visible view). The ITV expansion needed for 1-View Tracking is expected to be slightly larger than the CTV-to-PTV expansion used with the Xsight Lung Tracking System.
0-View Tracking is designed for cases in which the treatment target is not clearly visible in either of the two X-ray projections. In this case, ITV expansion is used in all directions.

The CyberKnife System tracking technology for treatment of lung tumors includes:
1. The Synchrony Respiratory Tracking System, which provides real-time tracking for tumors that move with respiration
2. The Xsight Lung Tracking System and the Fiducial Tracking System, which allow the target to be treated with no ITV expansion
3. The new 1-View Tracking mode, which requires ITV expansion only along the axis normal to the tracking plane
4. The new 0-View Tracking mode, which requires ITV expansion in all directions

Source: www.accuray.com

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HEPATOCELLULAR CARCINOMA - CK TREATMENT FOR PATIENT FROM MIZORAM

2010-12-15T01:00:00.000-08:00

This 46 years old gentleman plumber from Mizoram, who was infected with HIV infection (also has the habit of alcohol & smoking) was diagnosed to have hepatocellular carcinoma Right lobe of liver in January 2010. He underwent chemotherapy treatment & TACE treatment else where, still the disease persisted he came for cyberknife radio surgery in June 2010.
After assessing him with PET CT and other investigations, we decided to take him up for cyberknife radio surgery.

With help of our interventional radiologist. Patient underwent gold fiducial insertion into his lesion under image guidance, after 1 week, he was taken up for treatment planning and verification.

He was treated between 28/6/2010 to 3/7/2010 with five fractions of cyberknife radio surgery, he tolerated the treatment very well.
The whole procedure was done as out patient basis.
Patient came for his 1st follow up in October 2010, he was absolutely feeling better after the treatment with steady improvement in his health.

PET CT in October 2010 showed complete resolution of lesion.
Both patient and we (doctors) are very happy to see the good result.

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organ preserving treatment for small localized choroid melanoma

2010-10-10T22:03:00.000-07:00

Title: Radiosurgery with CyberKnife as an organ preserving treatment for small localized choroid melanoma
Authors: KR Prasanna Kumar*, MBBS; Debnarayan Dutta*, MD; Prativa Mishra^, MS; Raghunandhan* MD; P Mahadev * MD, DNB; AN Vaidhyswaran* MD; Sanjay Chandrasekhar* MD; Janos Stumpf *MD, PhD; Rathnadevi* DMRT; V Murali# PhD; PG Kurup# PhD;
*Department of Radiation Oncology, #Medical Physics, Apollo Speciality Hospital, Chennai
^Department of Opthalmology, Apollo Speciality Hospital, Chennai

Abstract

Aim: To evaluate robotic radiosurgery as an organ preserving treatment for localized choroid melanoma of the eye.
Case report: Thirty six year old female patient had complaint of progressive dimness of vision of right eye for six months. Fundoscopy examination showed small lesion (2.5 x 2.5 mm) in macular region. 320 slices CT scan showed organ confined 2.5 x 2.5 mm nodular lesion in the macular region (3 mm superior and 2.5 mm temporal to the origin of optic nerve at fovea) of right eye and was diagnosed with localized choroid melanoma of right eye (visual acuity 6/18 ). Metastatic workup was normal. She was planned for SRS (CyberKnife) as an organ preserving approach. Planning CT scan and CyberKnife treatment (dose 18 Gy single fraction, prescription isodose 85%; treatment time 22 min, GTV 111.6 mm3, 2mm PTV margin, PTV 403 mm3) were done with retro-bulbar anesthesia. Mean dose to right eye, left eye, right eye lens and pituitary gland was 4.9, 0.4, 0.4 and 1 Gy respectively. Maximum dose to optic chiasm, brainstem, right (2% vol) and left optic nerve were 1.4, 2.1, 15 and 0.4 Gy respectively. Skull tracking method was used as tumour tracking method. She completed treatment without any acute complication and visual acuity was preserved.
Conclusion: Robotic radiosurgery is a feasible, acceptable and an appropriate treatment modality as organ preserving approach in small choroid melanomas.

Keywords: Choroid melanoma, Robotic radiosurgery, Organ preserving approach

Rectal Carcinoma with Lung Metastasis

2010-07-12T02:28:00.000-07:00

Rectal Carcinoma with Lung Metastasis

Case History
A 77-year-old male was presented to Apollo Speciality Cancer Hospital reporting rectal carcinoma that was diagnosed in the year 2006. The patient was then undergone surgery (anterio perineal resection), radiation therapy and chemotherapy. The patient was clinically stable until the year 2009. In the year 2009, he developed repeated episodes of cough and pain on the right side of the chest. Owing to these complaints, the patient was evaluated by performing whole body PET scan. The scan revealed increased metabolic activity in lower lobe of the right lung and posterior basal segment pleural base mass. No other sight in the body showed activity (disease) in the PET scan. Biopsy from the lung mass was suggestive of metastatic adenocarcinoma.

The patient was diagnosed with solitary lung metastasis with controlled primary site disease and was planned to treat with radical intent using CyberKnife®. He was treated with 45Gy in five fractions in 1 week through CyberKnife® radiosurgery. The patient tolerated the radiosurgery well.

A follow-up CT scan was performed at 6-month post-CyberKnife®. The scan revealed a significant reduction in the lung mass.

Discussion
Generally, patients having solitary (single) or ‘oligo metastasis’ (<3 metastasis) with otherwise good general health and controlled primary disease are treated with curative intent. Surgery (metastectomy) is the preferred treatment. However, surgery may not be possible in a large
number of patients because of their medical condition or age. Therefore, these patients can be treated with radiosurgery using CyberKnife®

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Cholangiocarcinoma treated with CyberKnife

2010-07-12T02:19:00.000-07:00

Cholangiocarcinoma treated with CyberKnife

Introduction: Cholangiocarcinoma is a relatively rare disease, however has poor prognosis. Liver resection or transplantation is only curative treatment (1). Unfortunately, majority of the patients present with locally advanced, unresectable disease with extensive tumor spread (2). The treatment is not yet standardized. They are treated with either chemotherapy or radiotherapy or in combination (2-6). CyberKnife is recent advancement in radiation therapy delivery system which has high accuracy and flexibility in targeting the tumor through image-guided stereotactic body radiotherapy (SBRT) system (7).

Case history: Forty eight year old gentleman from Uttar Pradesh, India was diagnosed with inoperable cholangiocarcinoma eight months back. He was treated with chemotherapy for four months. However, post-chemotherapy imaging evaluation did not show any significant response. He was diagnosed as chemo-resistant inoperable cholangiocarcinoma. His liver function was maintained and general condition was good. As he was suffering from inoperable, chemotherapy resistant cholangiocarcinoma, he was referred for radiation therapy and was evaluated for robotic radiosurgery (CyberKnife) treatment. After appropriate evaluation, imaging (PET scan), fiducial placement and planning he was treated with CyberKnife. He received 30 Gy in 5 fractions in one week. Dose to the target was adequate and to adjacent normal structures were within normal limits. He completed treatment without any severe toxicity and is on regular follow up.

Discussion: In early operable choloangiocarcinoma, 3-year overall survival rate after curative surgery is only 40-60% (1-2). Advanced unresectable cholangiocarcinoma patients have poorer prognosis as well as severe complications due to biliary stasis (3,4). They are mainly treated with supportive or palliative care. Main aims of treatment in these patients are to preserve quality of life and improve survival rate. Palliative therapy options in these patients are chemotherapy, radiotherapy, photodynamic therapy and biliary drainage procedures (5). Median survival with palliative chemotherapy and external beam radiation therapy are 5 to 9 and 9 to 12 months respectively (2-6). Inoperable, advanced cholangiocarcinomas remain localized and distant metastasis is not common (1). Hence, these tumours may be treated with localized treatment options with maximum effect. However, cholangiocarcinomas are relatively resistant to both radiation and chemotherapy. Hence, high dose radiation therapy is required to have desired loco-regional control (7). CyberKnife radiosurgery is a SBRT using real time respiratory-motion tracking system, and is known to exert minimal normal tissue injury. High dose of radiation treatment in few fractions are possible with CyberKnife which increases tumour control probability without increasing toxicity (7). High dose radiation therapy with proton beam therapy also has shown promising loco-regional control without additional severe toxicity (2). We suggest that CyberKnife might be a safe and useful treatment option in advanced, unresectible cholangiocarcinoma.

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Breast Carcinoma with Lung Metastasis

2010-06-08T01:19:00.000-07:00

Breast Carcinoma with Lung Metastasis
Case History
A 44-year-old female diagnosed with carcinoma of the left breast in the year 2004 and was treated with mastectomy, chemotherapy and
radiation therapy was brought to Apollo Speciality Cancer Hospital. The patient was on hormonal therapy.

In the year 2006, the patient developed carcinoma of the contralateral breast (left) and had undergone surgery, followed by chemotherapy and radiation therapy to the left chest wall.

A PET scan was done in 2009. The scan revealed solitary metastasis in the lower lobe of the right lung. Owing to this, the patient was planned for CyberKnife® treatment. The patient was treated with 45Gy radiation dosage in three fractions to the lung lesion and had tolerated the treatment well. Complete response was seen in 3-month post-CyberKnife® follow-up scan

Discussion
Radiation therapy or surgery are frequently advised especially if chemotherapy is less efficient for patients suffering from single-lung metastasis.

However, as the lung mass moves with respiration, it is difficult to perform radiation therapy. Only respiratory-gated radiation therapy techniques deliver appropriate dose to the target and spare normal lung tissue. CyberKnife® has one of the most efficient respiratory tracking mechanisms (Synchrony) and this technology makes ‘real-time’ tracking possible by providing correct radiation dose to the tumour and avoiding the normal tissue in the vicinity. In addition, ‘See and Shoot’ technology in CyberKnife® helps to verify the target position prior to each treatment delivery and is the most accurate ‘online’ gated radiation therapy technique.

Doctor’s Comment
‘CyberKnife® is a fantastic option of providing the radiation therapy to the tumours which are mobile, like the one in this case. It avoids radiation exposure to normal tissue to a great extent.’
Dr. A. N. Vaidhyswaran

Patient’s Comment
‘I thought the treatment would be difficult, but the doctors at Apollo reassured me and they were true. The treatment was absolutely painless and I could go home immediately after the treatment’.

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Radiosurgical Treatment of Primary Liver Cancer: Baylor Radiosurgery Center Experience

2010-06-08T01:10:00.001-07:00

Radiosurgical Treatment of Primary Liver Cancer: Baylor Radiosurgery Center Experience

John O’Connor, M.D., Medical DirectorBaylor Radiosurgery Center, Dallas, TXRobert Goldstein, M.D., Director, Liver and Pancreas Disease CenterBaylor University Medical Center, Dallas, TX

Hepatocellular carcinoma (HCC) is the fifth most common cancer and third leading cause of cancer death, with 626,000 new cases and 598,000 deaths per year.1 Although it is less common in the United States, its incidence has tripled in the past 30 years principally in relation to the spread of hepatitis C infection.2 Survival for patients with hepatocellular cancer remains poor, about 10% at 5 years.3 HCC is potentially curable with hepatic resection or transplantation, but fewer than 30% of patients are eligible for surgery.4,5 Liver transplantation is the primary treatment for patients with cirrhosis and unresectable HCC, with low rates of recurrence and 5-year survival of about 70%.6,7

Stereotactic body radiotherapy (SBRT) has the ability to deliver high, focused doses while limiting irradiation of normal liver tissue. The use of SBRT for both primary and metastatic liver cancer is increasing worldwide at an impressive rate as clinicians are encouraged by favorable safety and efficacy data.8-11 CyberKnife® researchers have been active in the use of SBRT for liver as well.12-14 At the Baylor Radiosurgery Center we have been treating unresectable HCC since April of 2005. In March 2010 we updated our findings at the CyberKnife Scientific Meeting in Dallas.

We presented outcomes of a retrospective review of 24 patients with 27 tumors. All patients were evaluated by a liver transplant surgeon prior to radiosurgery and were deemed unresectable. The median tumor diameter was 4 cm and we have successfully treated liver tumors as large as 11 cm in diameter. Patients were treated with the CyberKnife System using Synchrony® Respiratory Tracking. The median dose was 42 Gy (range 27 - 54 Gy) to the median 66% isodose line (range 50 - 80%), delivered in 3 daily fractions in 22 patients and 5 fractions in four patients. We followed our patients using MRI obtained at 3-month intervals.

To date our outcomes have been encouraging. Grade 1 or 2 toxicity (based on CTCAE 3.0 guidelines) occurred in four patients (17%); a single Grade 3 toxicity was observed. There were no Grade 4-5 toxicities and no occurrence of radiation-induced liver disease. Overall local tumor control in all patients based on RECIST criteria was 87% at a median follow-up of 12 months. One-year Kaplan-Meier survival was 43%, and median survival was 11 months.

An additional eight patients with HCC (and nine tumors) were treated as a “bridge” to liver transplantation, that is, to control the growth of their tumors so that they may remain on the organ waitlist until a liver is available for transplant. We presented our preliminary findings on these patients at the 2009 meeting of the American Society for Radiation Oncology (ASTRO).15 All of these patients proceeded to transplant in a median of 90 days (range 8 – 209 days) after radiosurgery. We assessed the tissue response in the explanted tissue; three of the lesions responded completely, three were reduced in size, and three were stable.

The CyberKnife System has become a valuable component of our treatment program for unresectable HCC. Its ability to track liver tumors as they move with respiration has allowed us to deliver high doses of radiation accurately to achieve excellent rates of local control.

Source: Accuray Newsletter April 2010

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Cerebellopontine Angle Haemangioblastoma Successfully

2010-05-11T22:20:00.000-07:00

Cerebellopontine Angle Haemangioblastoma Successfully

Treated with CyberKnife®
Case History

A 15-year-old boy was presented to Apollo Speciality Cancer Hospital with complaints of neck pain, tingling sensation and weakness of upper limbs for the past 2 weeks. MRI of the brain and MR angiogram showed an expansile mass in the left cerebellopontine (CP) region. The patient was diagnosed with haemangioblastoma.
Craniotomy was planned as management measure. During the surgery, surgeons found that tumour was highly vascularised, adherent to medulla hence further surgical intervention was not done and patient was referred for CyberKnife®.

The patient was treated with CyberKnife® at a total dosage of 21Gy in three fractions (7 Gy/Fr) to the target. The patient tolerated the treatment well. A significant improvement in the clinical symptoms and a significant decrease in the contrast-enhancing solid mass were observed at third month following the treatment. Currently, the patient is doing well and is on regular follow-up.

DISCUSSIONS

Haemangioblastomas are low-grade tumours, which are seen in young patients and are characterised by signs related to increased intracranial pressure. Surgery is the mainstay of treatment and complete excision of the contrast-enhancing nodule along with cyst amounts to cure.Radiation therapy is required in situations where complete excision is not possible due to either location or size of the tumour. CyberKnife® is the most precise treatment in these situations. The regression treatment achieves of the mass, with minimal dose to the adjacent critical structures.w

Doctor’s Comment

‘In this patient, having CyberKnife® treatment in the armamentarium was a boon. Highly vascularised tumour, which was inoperable, could be managed successfully’.

Dr. R. Rathna Devi and Dr. Janos Stumpf

Patient’s Comment

‘This is a very good treatment. Painless and effective too’ith CyberKnife®

WHOLEBODY STEREOTACTIC RADIO SURGERY " ON THE EIGHT OF MAY 2010.

2010-04-24T00:37:00.000-07:00

APOLLO HOSPITALS IS CONDUCTING A WORKSHOP AND A SYMPOSIUM ON "WHOLEBODY STEREOTACTIC RADIO SURGERY " ON THE EIGHT OF MAY 2010.

WE INVITE RADIATION ONCOLOGISTS TO JOIN US IN THE SYMPSOIUM AND THE WORKSHOP

THE WORKSHOP WOULD BE AT APOLLO SPECIALITY HOSPITAL and THE SYMPOSIUM IS AT TAJ CONNEMARA STARTING FROM 7. 30 P.M

The Symposia is to share Apollo Cyberknife Clinical Experience with Panel discussion, where around ( 150 Medical / Radiation Oncologists & other Key Refering Specialists) will participate.

The Highlight for the event is the International Speaker , Dr. Andrew Gaya, London.

Dr Andrew Gaya BSc MD MRCP FRCR

Consultant Clinical Oncologist

Guy's & St Thomas' NHS Foundation Trust

Westminster Bridge Road

London SE1 7EH

FOR MORE INFORMATION YOU MAY PLEASE WRITE TO lakshmipriya_b@apollohospitals.com.

CYBERKNIFE -INTRACRANIAL TREATMENT REVIEWS

2010-04-15T23:11:00.000-07:00

CYBERKNIFE -INTRACRANIAL REVIEWS
Source: http://www.accuray.com/clinicans/clinical-development/applications/clinical-publications.aspx#Reviews

Intracranial:

Staged stereotactic irradiation for acoustic neuroma. Chang et al. 2005. Stanford researchers show that fractionated treatment using the CyberKnife System for acoustic neuromas may improve hearing preservation.

Robotically guided radiosurgery for children. Giller, et al. 2005. Researchers from Baylor University Medical Center used the CyberKnife System to achieve local control for children with some types of CNS tumors.

Visual field preservation after multisession CyberKnife radiosurgery for perioptic lesions. Adler, et al. 2006. Stanford University researchers used the CyberKnife System to obtain high rates of tumor control for tumors near (less than 2 mm from) the optic apparatus; over 90% of patients treated maintained or improved their vision.

Stereotactic radiosurgery using CT cisternography and non-isocentric planning for the treatment of trigeminal neuralgia. Lim et al. 2006. Researchers from Stanford University used the CyberKnife System to treat trigeminal neuralgia. Ninety percent of patients treated rated their pain control as excellent with limited facial numbness at 10 months follow-up.

Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Soltys, et al. 2007. Researchers from Stanford University used the CyberKnife System for adjuvant treatment of brain metastases by targeting post-resection cavities. They obtained a 79% local control rate at 12 months, which compares favorably to historic whole brain radiation treatment results.

A volumetric study of CyberKnife hypofractionated stereotactic radiotherapy as salvage for progressive malignant brain tumors: initial experience. Giller et al. 2007. Researchers from Baylor University Medical Center used the CyberKnife System to perform fractionated stereotactic radiosurgery on lesions that are difficult to treat in a single fraction approach.

Survival following CyberKnife radiosurgery and hypofractionated radiotherapy for newly diagnosed glioblastoma multiforme. Lipani et al. 2008. Researchers from Stanford University performed CyberKnife System treatment on 20 GBM patients after tumor resection. The overall median survival was 16 months, which compares favorably to post-surgical external beam radiation therapy.

Cost-effectiveness analysis for trigeminal neuralgia: CyberKnife vs microvascular decompression. Tarricone et al. 2008. Investigators from Milan, Italy show that both radiosurgery using the non-invasive CyberKnife® System and a surgical treatment, microvascular decompression (MVD), produce high rates of pain relief. The costs of a hospital stay and surgery, however, make MVD more expensive than CyberKnife SRS.

CyberKnife radiosurgery for benign meningiomas: short-term results in 199 patients. Colombo et al. 2009. Researchers from Vicenza, Italy demonstrated a 5-year actuarial tumor control rate of 93.56% and a 0.5% complication rate. According to the authors, the ability to conveniently treat in multiple sessions allowed them to treat “63 patients (30%) who could not have been treated by single-session radiosurgical techniques.”

Quality of radiosurgery for single brain metastases with respect to treatment technology: a matched-pair analysis. Wowra et al. 2009. This study compares the technical features of the Gamma Knife and the CyberKnife® System, and their clinical outcomes in the treatment of single brain metastases, using the method of matched-pair analysis. Clinical outcomes were nearly identical between groups.

Nonisocentric radiosurgical rhizotomy for trigeminal neuralgia. Adler et al. 2009. Stanford researchers examined outcomes after radiosurgery using the CyberKnife® System for trigeminal neuralgia using treatment parameters that have evolved over several years. This “optimal” treatment approach resulted in pain relief judged as excellent or good by 96% of patients, with relatively low rates of facial numbness.

Early results of CyberKnife radiosurgery for arteriovenous malformations. Colombo et al. 2009. Researchers using the CyberKnife® System in Vicenza, Italy conducted a prospective study of 279 patients with arteriovenous malformations (AVMs) treated with the CyberKnife System. The overall rate of complete obliteration was 81.2% in patients with 36 months of follow-up, and no permanent complications were observed.

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CYBERKNIFE & TRIGEMINAL NEURALGIA

2010-03-10T22:31:00.000-08:00

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CYBERKNIFE RADIOSURGERY FOR HYPOTHALAMIC HAMARTOMAS

2010-03-08T23:02:00.000-08:00

CYBERKNIFE RADIOSURGERY-TREATMENT OPTION FOR HYPOTHALAMIC HAMARTOMAS (A CASE PRESENTATION)

Dr.Sanjay Chandrasekhar, Dr.S.Balaji Subramanian, Dr.B.Subathira, Ms.S.Mahalakshmi

Department of Radiation Oncology, Apollo Specialty Hospital, Chennai.

INTRODUCTION:

Hypothalamic neuronal hamartoma is a rare congenital, non neoplastic heterotopia

variably associated with central precocious puberty and gelastic (laughing) seizures1,2,3,4 They are classified into sessile and pedunculated lesions depending on the width of their attachment to the tuber cinerium and pattern of growth which can be respectively contained inside the hypothalamic parenchyma or mainly expanding toward the ventricular or interpeduncular space4,5,6. Diagnosis is based on the characteristic location,

isointensity to normal brain, lack of contrast enhancement and absence of change in size

and morphology of the mass at follow up. Treatment options include medical management, surgery & radiosurgery.The main limitation of surgery lies in its inability

to completely resect intrahypothalamic lesions without causing neuro metabolic complications.Radiosurgery is an emerging modality to treat hypothalamic hamartomas, providing excellent seizure control7,8,9,10.Cyberknife radiosurgery technique does not require a stereotactic frame which may facilitate its use in children and young adults, offering a noninvasive option of treatment with lower complication rates.

CASE REPORT:

17 year old male patient was evaluated for intractable headache, vomiting &intermittent drop attacks of 2 months duration. Physical examination revealed bilateral papilloedema & diminution of vision in left eye with visual field defect of bitemporal hemianopia.

MR imaging of the brain showed a large suprasellar SOL with mass effect and hydrocephalus. After craniotomy, bilateral VP shunting was done. Biopsy from the vascular tumor showed neuronal cells in nests and loose aggregates separated and admixed with a fibrillary stroma. The cells ranged from normal appearing ganglion cells to more rounded cells with moderate to clear cytoplasm, small clusters of stromal calcification & areas of hemorrhage. IHC was positive for synaptophysin and neurofilament & negative for GFAP. These features were consistent with hypothalamic neuronal hamartoma. Considering the challenging neural and vascular anatomy surrounding the tumor, surgery was deferred in our patient and taken up for Cyberknife radiosurgery. Being the most accurate image guided procedure, providing submillimeter accuracy, Cyberknife allows treatment of the entire lesion as visible on neuroimaging studies including hypothalamic components. A total dose of 27.5Gy was delivered in 5 fractions to the tumor. A dose of 5.5Gy was prescribed to the 80 % isodose line covering 93% of the target volume. The entire treatment was done as outpatient and the patient tolerated the treatment well.

RESULT:

Follow up MRI done at 8 months revealed minimal regression in the size and vascularity of the tumor. Patient had a good clinical response as evidenced by seizure free interval of about 8 months post radiosurgery .There were no neurological complications post-treatment.

CONCLUSION:

Cyberknife radiosurgery is a safe and effective treatment for hypothalamic hamartomas. Radiosurgery provides substantial seizure improvement. Distinct from other surgical treatments, it is non invasive and virtually free of major complications.

PURPOSE OF PRESENTATION:

This case is being presented for its rarity and also to share our experience of treating hypothalamic hamartoma using Cyberknife radiosurgery for the first time in India. In concordance with other reports11,12, Cyberknife Radiosurgery appears to be an effective local treatment option with early clinical outcome and decreased morbidity.

COMPETING INTERESTS:

The author(s) declare that they have no competing interests.

ACKNOWLEDGEMENTS:

The authors would like to place on record the involvement of Dr.B.Chidambaram, Paediatric Neurosurgeon, Childs Trust Hospital, Chennai in the discussions regarding this case and for his academic inputs.

PET CT WITH T-O-F TECHNOLOGY AND CYBERKNIFE ROBOTIC RADIOSURGERY

2010-02-16T01:47:00.000-08:00

FIRST TIME IN INDIA - CYBERKNIFE ROBOTIC RADIO SURGERY SYSTEM AND PET CT WITH T-O-F TECHNOLOGY AT APOLLO SPECIALITY HOSPITAL.

GREAT DIAGNOSTIC AND TREATMENT FACILITY NOW AT APOLLO SPECIALITY HOSPITAL

Apollo Speciality Hospitals, Teynampet, Chennai has installed the latest state-of art Positron Emission Tomography system. The advanced 64 slice PET-CT system with time-of-flight technology is the first and the only one of its kind installed in India is known to provide for increased patient comfort and access, delivers unprecedented high quality imaging leading to better diagnosis for patients for Cancer, Cardiology and Neurology complications.

Speaking on the occasion, Dr. Cornelis A Hoefnagel, MD, Ph.D, a leading Consultant, eminent speaker, in Nuclear Medicine and a pioneer in PET-CT imaging from the Netherlands Cancer Institute, Amsterdam said, “The Hybrid imaging with the PET -CT, matching function with anatomy provides the greatest accuracy and newer insights in Oncology, Cardiology and Neurology and Infection.

The Advantages

It enables lower radiation dose as a result it lowers cost significantly.

It reduces imaging time which benefits scan time and increased throughput.

It offers excellent image quality increasing diagnostic confidence`

FOR MORE INFORMATION ON PET CT YOU MAY PLEASE BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com

Rationale and Potential Clinical Applications for CyberKnife Robotic IMRT™

2010-01-20T22:50:00.000-08:00

The CyberKnife® System as an Image-guided Intensity Modulated Radiotherapy Device: Rationale and Potential Clinical Applications for CyberKnife Robotic IMRT™

Donald B. Fuller, M.D., Radiation Oncologist Radiosurgery Medical Group (RSMG); CyberKnife Centers of San Diego

In clinical practice, the CyberKnife® Robotic Radiosurgery System has been almost exclusively used as a radiosurgical device, engineered to deliver conformal, ablative radiation treatments in one to five fractions to a wide variety of malignant lesions in the CNS, head and neck, lung, liver, pancreas, prostate and other sites.1-8 Although there is no medical reason why this device has not been used to deliver conventionally fractionated radiotherapy, this function has not previously been described, presumably due to the long treatment times associated with early-generation CyberKnife Systems. Nevertheless, the MultiPlan® Treatment Planning System is capable of computing very elegant intensity modulated radiotherapy (IMRT) dose distributions, and improvements in device efficiency have made the delivery of these IMRT plans feasible in clinical practice, thus leading to new CyberKnife treatment applications that would best be described as “Robotic IMRT™.”

The new CyberKnife VSI™ platform includes a number of enhancements that improve efficiency, including Sequential Optimization treatment planning, the Iris™ Variable Aperture Collimator (which allows for modulation of the beam during treatment9,15), the increased dose rate of a 1,000 MU/min linear accelerator and a 20% increase in robotic traversal speed. In addition, a treatment time reduction tool accessed during plan optimization allows the user to reduce the total number of treatment beams and nodes while still meeting treatment plan objectives.

Collectively, these enhancements create a device that can reduce treatment times by over half compared with predecessor CyberKnife Systems, while maintaining the precision and accuracy of the CyberKnife product.

SOURCE: ACCURAY FOCUS NEWSLETTER JAN, 2010

LIVER METASTASES TREATMENT

2010-01-20T22:34:00.000-08:00

Stereotactic body radiation therapy for liver metastases

O Dawood, A Mahadevan, K Goodman ,European J Cancer 2009;45:2947-2959.

This review focuses on stereotactic body radiation therapy (SBRT) as an alternative, non-invasive approach to the treatment of liver metastases. Treatment considerations of SBRT for liver metastases are presented with particular emphasis on the challenges of organ motion and the low tolerance of the surrounding hepatic parenchyma. Multiple approaches to tumor motion are discussed, including tumor tracking versus motion-compensation techniques. Issues of patient eligibility criteria, patient set-up, target definition, treatment dosimetry and fractionation are also discussed. Clinical results to date from 15 published reports, including a summary of the latest in-press results from Stanford using the CyberKnife System, are presented. These clinical reports demonstrate the safety and efficacy of SBRT for liver metastasis with 18-month and 2-year local control rates ranging from 71-93% and 71-86%, respectively.

The review concludes by stressing the importance of addressing hepatic tumor motion to ensure the dose reaches the tumor and spares the surrounding normal tissue. The authors suggest more rigorous phase II clinical studies are necessary to establish the long-term durability of efficacy and toxicity results.

SOURCE : FOCUS NEWSLETTER - JAN 2010

CYBERKNIFE FOR GASTRIC CANCERS

2010-01-05T02:12:00.000-08:00

Stereotactic body radiotherapy for isolated para-aortic lymph node recurrence after curative resection in gastric cancer

Metastases from gastric cancer are common and can progress rapidly; even with aggressive treatment 5-year survival rates are low. However, researchers from Korea Institute of Radiological & Medical Sciences hypothesized that there is a certain population of such patients in whom the disease follows a more indolent course, based on studies of patients with
resected liver metastases. This population may benefit from SRS of isolated metastases from
gastric primaries. Thus, they treated 7 such patients with the CyberKnife® System, delivering 45 to 51 Gy (median 48 Gy) in 3 fractions. The patients were followed for 14 to 33 months (median 26 months). Local control was achieved in 6 of 7 patients; 2 patients were disease-free, 3 were alive with disease, and 2 patients died of disease progression. Three-year actuarial overall survival was 43%, and disease-free survival was 29%. The authors conclude that the results support their hypothesis that an indolent subgroup with less aggressive disease progression who could benefit
from the use of local treatments such as CyberKnife Radiosurgery.

Source: Accuray's focus newsletter

PROGRESS IN RADIATION ONCOLOGY

2009-12-13T23:20:00.000-08:00

PROGRESS IN RADIATION ONCOLOGY

Dr. Janos Stumpf - ADVISOR ONCOLOGY – CYBERKNIFE SERVICES

End of the month November, was an academic feast for the Indian Radiation Oncologists at Hyderabad.

The content of the conference can be summarized in three words: It was about Research, Discipline and Development, especially that of the new machines. It is our pride to realize and say that even latest knowledge about the technical progress has found its way to India, no matter how expensive the machines are. “Precision in Delivery of Radiation” is the mantra for all these technical aspects. Tomotherapy, Cyberknife and Rapid Arc are all the ways to do radio therapy on an extremely precise way.

Cyberknife was covered by two speakers. An eminent guest from California Dr.Nissar Syed was kind enough to give an over-all review about the machine. His talk was followed by the ‘Indian experience’ with Cyberknife based on more than hundred fifty cases treated already at ASH Chennai. Characteristics of the first 150 cases were presented. Apollo has considerable success:- partial remission even in majority of the ‘lost’ cases.

Beside the advantage of saving normal tissue in the brain or extracranially, CK represents a huge leap forward in treating moving targets like cancer in the lung, liver or in the prostate. All these three organs, move during the radiotherapy.

The first patient, Master Shanka had very serious neurological complaints at the time when he came to Apollo. He was attended by Sr. Consultant Neurosurgeon Dr.Balamurugan. However his attempt to remove the haemangioblastoma from the patient’s brainstem was confined to fail due to the dangerously high vascularity which is the nature of that kind of tumors. But this surgical nightmare can be converted into an advantage with the help of High Precision Irradiation (HPI). High vascularity means high density of endothelial cells which are covering the inner surface of the vessels. These vulnerable cells can react with an overgrowth for the exposure of radiation.

Few months after the success full Stereotactic Radiosurgery with CK, part of the tumor has been obliterated its overall size started to come down.This is why the patient has improved and could resume his normal life.

Fate of a patient with inoperable lung cancer is practically known at the time of the diagnosis. Only a very minimal percentage of the inoperable lung cancer cases can be saved by the combination of conventional irradiation with chemotherapy. CK seems to bring a new hope for these patients. A 57 year old gentleman from the neighboring Srilanka successfully conquered one cancer 10 years ago with the help of Apollo Speciality Hospital. He came with hope again when an inoperable lung cancer in his chest was diagnosed. Chemotherapy has failed unfortunately. And then Cyberknife seemed to come for his rescue. High precision and short duration, biologically very intensive radiation has resulted in an impressive remission of his advanced lung cancer without any side effects. This aggressive cancer does have the capacity of invading the rest of the body. As a matter of fact the same has been observed with that particular patient too. But for him this is not the “end of the road”. A second CK treatment is planned to attend all the new sites of cancers shown on the PET CT. Highly sophisticated tools in radiation oncology do allow us to provide longer control with reasonable if not excellent quality of life even in an aggressive cancer.

There is a beautiful sentence told by Rabindranath Tagore about the disease in general. “DEATH DOES NOT HURT US, BUT DISEASE DOES, BECAUSE DISEASE CONSTANTLY REMINDS US OF HEALTH AND YET WITHOLDS IT FROM US.”

This is double true for cancer. Quality of life of a patient has to be one of the primary concerns of an oncologists. Many cancers have a tendency to migrate to the bone, to the spine. These metastatic lesions have the capacity to paralyze the patients by compressing the spinal cord. Chemotherapy frequently has only temporary control over the progress and so does conventional radiotherapy. But high precision in CK helps. We have the technical skill and opportunity to give high precision irradiation to the spine and to arrest this type of tumours even before they cause the extremely bad condition of transverse lesion of the spine. A Professor from George-Towns University in Washington DC said “by now we hardly deal with paralysis due to metastasis to the spine. It is being attended with CK at a curable and controllable stage and the patient will not be confined to bed for the rest of his/her life.

The basic question: ‘How cancer can be tamed in general’ still remains unanswered. But the tremendous progress gives hope for both temporary control with good quality of life and for cure in many cases. It is our job and duty to know about new developments and to apply them with wisdom. This conference was all about this.

CYBERKNIFE SUCCESS STORY - TREATMENT OF PROSTATE CANCER

2009-12-06T21:43:00.000-08:00

CYBERKNIFE SUCCESS STORY - TREATMENT OF PROSTATE CANCER

DR.MAHADEV Senior Consultant, Radiation Oncology

71 Yrs old Mr.Birendra Singh from Gopalganj, Bihar was devastated when he was diagnosed to have Prostate cancer. He had gone to his urologist for just a routine checkup because he was having difficulty in passing urine for the last couple of months. A routine PSA done was in the range of 15ng/ml. A transrectal biopsy revealed grade 2 adenocarcinoma of the prostate gland with a Gleason’s score of 3+4.

Mr.Singh went to Delhi for an opinion. He consulted various doctors which included several urologists, surgical oncologists and radiation oncologists.The options given to him included wait and watch, bilateral orchidectomy(removal of both testis), Radical prostatectomy, Brachytherapy(seed /HDR implant).The opinions were so varied that the family could not take a decision for 3 months.

Patient also consulted Apollo Hospitals at Ranchi in Jharkhand where he was advised to go to Apollo Speciality Hospital Chennai as all the treatment options were available there and he was also told that a full team of doctors decide on a treatment in the tumor board.

Mr Birendra Singh’s nephew who lives in the United States, meanwhile contacted his uncle from there and told him about a new treatment called the cyberknife which he had read on the internet. His nephew was very impressed by what he had read on the net- outpatient treatment, non-invasive, very precise radiation delivered robotically and just 5 sittings with practically no side effects. He asked his uncle to come to US for treatment as he thought it was unlikely that this treatment option would be available in India.

After going through all the treatment options Mr.Birendra Singh decided he would go in for Cyberknife as he found that to be the best treatment modality in his opinion. He visited Chennai in March 2009 to take a final decision. We had just then started using Cyberknife and we told him that the latest version of Cyberknife is now available here. He was told that the cost of cyberknife would be around 40,000 US dollars in US. We told him that the cost of treatment here would be Rs 400,000.

As we had just started Cyberknife Mr Singh was anxious about our technical capability. But when he came to know that the entire team was trained at the Stanford University, California, where actually the cyberknife was invented, he immediately decided to have the treatment here.

The first step in the treatment process was counselling him about the various treatment aspects.This included explaining to him the various stages of the treatment preparation ,planning and execution.The expected benefits and the various side effects that can be expected was explained to him in detail.The side effects that are normally seen with this treatment can be increased frequeny of micturition and bowel movemens.Very rarely, rectal bleeding can be seen as a late effect of radiotherapy.

The second step was placing 5 gold fiducials into the prostate gland transperinealy under transrectal guidance which took about half an hour. These fiducials are necessary for the machine to track the prostate gland during the entire course of treatment. Normally, we have to wait for a week after placing the fiducials for doing the planning CT scan. This is necessary because in the first couple of days, the seeds can migrate.

The third step in his planning was the making of a special type of bed called Vacloc for immobilization of the patient during treatment. Vacloc is a vacuum bed which takes the shape of the patient so that daily reproducibility of the patient in the same position can be achieved easily. This took about 10 minutes following which a CT scan was done with the patient lying in the vacloc in the treatment position.

Next, the Radiation oncologist contours the prostate gland, bladder and rectum. Then, the medical physicist puts on the treatment beams. The treatment plan was ready the next day and was reviewed by the oncologist and urologist.The treatment plan was finalized and the patient was asked to come for treatment the following day which happened to be a Tuesday. Patient was asked to have a light breakfast before 8 am and report for treatment at 10am.He was also asked to take a laxative the previous night and antacids.This preparation is a very important part of the treatment as improper bowel evacuation and gas in the bowel can interfere with the accuracy of the treatment.As cyberknife can achieve submillimeter target accuracy and continuously tracks the target while treatment ,it is absolutely essential that patients follow this preparatory regimen very carefully.Mr Singh was prescribed 5 treatment sittings on consecutive days.

Each treatment lasted for about 45-50 minutes and Mr.Birendra Singh completed his treatment on schedule on Saturday.He had initially booked his tickets for Sunday but as he did not have any side effects he preponed his journey to Saturday night.He was advised to have a PSA after 3 months which confirmed that the PSA had come down to normal values.

MR. BIRENDRA SINGH AFTER COMPLETING 5 TREATMENT SITTINGS

Mr.Singh Reported back to us in the first week of December. His PSA which was repeated was less that 1ng/ml which shows excellent response to treatment. There were practically no side effects during and after the treatment.

FOR MORE INFORMATION ON CYBERKNIFE TREATMENT IN PROSTATE CANCER< YOU MAY BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com

Cyber Knife Radio surgery in Pediatric Patients

2009-12-06T21:25:00.000-08:00

Cyber Knife Radio surgery in Pediatric Patients

Dr.R.Rathna Devi, Sr. Consultant Radiation Oncologist

“One little girl told me “ I want to go to school” she was one of my early pediatric patient with AVM for the new facility, Cyber Knife. That’s what was on her mind. And that’s what she did. She went to school immediately after her treatment. This made a tremendous difference to the family and to the child, and I was very happy to have offered her this”.

Cyber Knife radio surgery has a great advantage in treatment of pediatric intra and extra cranial lesions which includes non – invasive immobilization, low radiotherapy exposure to the developing normal brain other tissues and ability to fractionate the treatment.

Young patients in the past were usually required to wear a of head frame (Gamma Knife, other kind of radiosurgery equipments), and had to remain anesthetized during the entire, often day long procedure.

These procedures uses rigid metal frame attached directly to the patient’s skull to orient the radiation beams, making it difficult to treat young children with small/ fragile heads. Because the frame cannot be removed between the initial imaging and subsequent treatment, doctors also had to work fast with the other types of radio surgery. With the clock ticking, we had to place the frame, perform CT/MRI or other imaging studies; get everyone involved to meet, plan the treatment and then treat the patient, while the patient is intubated and asleep. This is not an optimal situation.

Fortunately now at Apollo Speciality Hospital we can treat young patients (who can hop off the table and go home or to school) after the initial imaging step while we plan the treatment strategy. The non invasive process uses tiny focused beams of radiation to perform radio surgery on a patients head or body. This technique allows us (Doctors) to attack trouble spots deep within the brain while minimizing the dose of radiation to surrounding healthy tissue. This is particularly important in children, whose brain is still developing.

ADVANTAGE - CYBERKNIFE

Cyberknife which was developed by John Adler, uses a mesh mask to stabilize the head. The technology tracks any unintentional movement on the part of the patient and adjusts the radiation path as necessary. Children who can understand the importance of holding still can undergo the treatment while conscious, younger kids can have short term anesthesia for approximately hour – long diagnostic and treatment session. The recovery from anesthesia is usually quicker because they don’t usually have to be intubated.

At Apollo specialty hospital, till date we had the opportunity to treat 11 children with Cyberknife radio surgery. Our first Cyberknife patient was a pediatric patient with cervico medullary haemangioblastoma 15 years male patient from Tripura . He presented with neck pain, poor cough reflex, and difficulty in swallowing and upper limb tingling sensation. Investigations revealed cervico medullary expansile lesion involving medulla to C2 C3 level.

He underwent occipito cervical craniotomy and decompression, because of high vascularity, surgery was abandoned. He underwent Cyberknife radio surgery between 24th to 26th March 2009. In the first follow up after 3 months, his symptoms completely disappeared follow up MRI showed reduction in size of lesion and contrast enhancing portion of the lesion reduced significantly.

This boy really benefited out of Cyberknife radio surgery. Treating only the affected area with out affecting adjacent brain tissue. He is due for his 10th Std board exam now.

Intracranial

We have treated 4 patients with AVM, and other treated indications include :

1 patient with Supracellular Hemartoma

1 patient with pineliocytoma

1 patient with Recurrent Meningioma

1 patient with Brainstem Glioma

1 patient with Pilocytic astrocytoma (residual)

Spine

1 patient with vertebral Haemangioma

To conclude, Cyberknife: represents an entirely new approach to radiosurgery. It is the only system that combines robotics, and advanced image guidance to deliver frameless radio surgery.

Cyberknife features robotic arm and proprietary image guided technology. The robotic arm is computer controlled and has an arm movement precision of 0.5mm.

Greatest advantage is an out patient basis treatment.

FOR MORE INFORMATION REGARDING CYBERKNIFE TREATMENT IN PEDIATRIC CASES YOU MAY BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com

DR. SURESH H.ADVANI at APOLLO SPECIALITY CANCER HOSPITAL - CYBERKNIFE CENTER.

2009-11-23T02:57:00.000-08:00

Padma Bhushan Prof.(Dr.) Suresh H.Advani , a well known renowned specialist in Oncology visited Apollo Speciality Cancer Hospital recently.

He visited our Cyberknife facility and during a recent interview to" News Today "had the following to say :
‘I used to refer cancer patients to Malaysia where the CyberKnife procedure was available and now Apollo Hospitals, Chennai, has acquired the latest Asia Pacific’s most advanced CyberKnife robotic radiosurgery system, PET scanning, MRI, Radiography, bone marrow transplant unit which is to be set up at the earliest, with expertise in the field, all under one roof that makes Chennai city the medical destination,’ said Dr Suresh Advani

To read the interview with dr. Suresh H,Advanui please log on to www.newstodaynet.com Monday, 23 November, 2009

It was our previlige to have him here and get his valued opinion

DR.ADVANI in the center, with the cyberknife panel of radiation oncologits at Apollo Speciality Cancer Hospital .

FOR FURTHER INFORMATION ON CYBERKNIFE TREATMENT,PLEASE BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com

CYBERKNIFE IN LUNG CANCER

2009-11-23T02:40:00.000-08:00

Dr.Sanjay Chandrasekar, Senior Consultant Radiation Oncology presented on Cyberknife in Lung Cancer in the 11th Napcon 2009 (National Conference of Indian Chest Soceity ) conference in Calicut betweeb 5-8th November 2009.

The excerpts from his presentation on Cyberknife in Lung Cancer are :

FOR MORE INFORMATION ON CYBERKNIFE TREATMENT IN LUNG CANCER YOU CAN BLOG YOUR COMMENTS OR WRITE TO lakshmipriya_b@apollohospitals.com

CYBERKNIFE SUCCESS STORY FEATURED IN "THE WEEK" magazine

2009-11-19T21:12:00.000-08:00

The 1st Cyberknife Success Story , featured in " The Week " Nov 15 edition on Week-IMRB exclusive survey on Best Hospitals 2009.

The Success story of Master Sanka Subradey , aged 15 from Tripura was the 1st Patient in India to undergo Cyberknife Treatment at Apollo Speciality Cancer Hospital, Chennai.

Post treatment , the follow up in September 09 showed in MRI significant reduction in tumour size & he is back to normal life busy preparing for his Class X board examination , thanks to Robotic Radiosurgery system like Apollo Cyberknife

FOR MORE INFORMATION ON TREATMENT PLEASE WRITE TO lakshmipriya_b@apollohospitals.com

TRIGEMINAL NEURALGIA

2009-11-05T22:47:00.000-08:00

CYBERKNIFE IN TREATMENT OF TRIGEMINAL NEURALGIA

Dr.M.Balamurugan, Senior Consultant - Neuro Surgery

"The Suicide Disease" or tic douloureux(also known as prosopalgia) is a neuropathic disorder of the facial trigeminal nerve. The trigeminal nerve the fifth cranial nerve, is responsible for sensory data (pressure, tempereature & pain) and also responsible for the motor function of the muscles involved in chewing but not facial expression.

SYMPTOMS

The disorder is characterised by episodes of intense facial pain that usually last from a few seconds to several minutes or hours. The attacks are said to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable.

Unfortunately, the symptoms of trigeminal neuralgia are often falsely attributed to a pathology of dental origin. Because of this difficulty, many patients go untreated unless a correct diagnosis is made.
There is evidence that points towards the need to quickly treat and diagnose TN. It is thought that the longer a patient suffers from TN, the harder it may be to reverse the neural pathways associated with the pain. Therefore it is essential that physicians are made aware of the seriousness of TN and the level of pain that their patient

TREATMENT OPTIONS

Medical treatment may involve usage of Anticonvulsants such as carbamazepine, oxcarbazepine, topiramate, phenytoin, or gabapentin and sometimes low doses of some antidepressants such as amytriptiline is used.

Surgically there are five options available . Of the five surgical options, the microvascular decompression is the only one aimed at fixing the presumed cause of the pain. Three other procedures use needles or catheters that enter through the face into the opening where the nerve first splits into its three divisions. Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression are available. This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression.

Other options involve using glycerol injections and radiofrequency rhizotomies. Glycerol injections involve injecting an alcohol-like substance into the cavern that bathes the nerve near its junction. This liquid is corrosive to the nerve fibers and can mildly injure the nerve enough to hinder the errant pain signals. In a radiofrequency rhizotomy, the surgeon uses an electrode to heat the selected division or divisions of the nerve. Done well, this procedure can target the exact regions of the errant pain triggers and disable them with minimal numbness.

Stereotactic Radio Surgery The nerve can also be damaged to prevent pain signal transmission using Gamma Knife or a linear accelerator-based radiation therapy (e.g. Trilogy, Novalis, CyberKnife).

Cyberknife Radiosurgery : Of these, the development of CyberKnife radiosurgery (Accuray, Inc., Sunnyvale, CA) in 1994 added a promising new treatment option for this disease. Using noninvasive head immobilization and advanced image-guidance technology, the CyberKnife dynamically tracks skull position and orientation during treatment, thereby ensuring targeting accuracy throughout the entire procedure, and patients are spared the discomfort of frame fixation onto their skulls. CyberKnife radiosurgery offers the ability to deliver nonisocentric, conformal and homogeneous radiation doses to nonspherical structures such as the trigeminal nerve. There are no risks of infection, cerebrospinal fluid leak or wound healing from Cyberknife Radiosurgery. However, some patients may develop additional numbness in the face or may experience abnormal facial sensations. This occurs in less than 10% of patients.

For more information please write to : lakshmipriya_b@apollohospitals.com;

CME on Robotic RadioSurgery in Brain & Spine - Recent Advances by Prof. John Adler on 5th October

2009-10-12T02:09:00.000-07:00

During a recent visit to Chennai , on the 5th of October 2009 ,Professor Dr. John Adler presented a CME on Robotic RadioSurgery in Brain & Spine - Recent Advances was conducted . Around 65 Drs attended (Neuro Physicians & Surgeons / Spine Surgeons / Radiation Oncologists from different institutions in Chennai) attended the CME and were benefitted by the insights and guidance of Dr. Adler, on the usage of Cyberknife in Neurosurgery.

Some of the photographs taken during the CME

CYBERKNIFE® AT APOLLO – THE FIRST SUCCESS STORY

2009-10-12T01:43:00.000-07:00

PROFILE

Master Sankha Subhra Dey, 15 year old bright young boy from Tripura and the only son of Mr. Bimalendu Dey visited Apollo Speciality Cancer Hospital, Chennai which houses the Asia Pacific’s first and latest Cyberknife® on the 31st of January 2009.

Mr. Bimalendu Dey, is a School Teacher with Govt of Tripura and belonged to the lower income group. When his son was first brought to the Apollo Hospitals, he complained of severe headache, and was registered with our Neurosurgery department.

Before coming to Apollo, the boy was treated at local hospitals in Tripura but there was no relief. Instead his symptoms worsened. That was when, Mr. Bimalendu Dey decided to bring him to Apollo Speciality Cancer Hospital. He was seen by one of our eminent Neurosurgeon Dr.M.Balamurugan.

SYMPTOMS

At the time of presentation patient had neck pain, weakness of upper limb associated with tingling numbness. Poor cough reflex and difficulty in swallowing was also seen. His motor sensation and power was 4/5 all four limbs.

DIAGNOSIS
He was hospitalized and investigated MRI brain Angio and Venogram revealed expansile lesion involving the medulla and Cervico medullary Junction extending to C2 -C3 level.

TREATMENT
After Pre – operative wok up and consent the patient was taken up for tracheostemy , and occipito-cervical craniotomy, decompression was performed.
During surgery highly vascularised tumor seen in brainstem, possibility of Hemangioblastoma was decided.Surgery was abandoned because of high vascularity,critical position and poor out come. His post-op period was uneventful.

Patient was referred to Dr.RathnaDevi, Senior Consultant Radiation Oncology for possibility of Radiation therapy treatment. This was the time that Apollo Hospital had introduced Cyberknife® system the world’s first and only robotic radiosurgery system designed to treat tumors with sub milli-meter accuracy. Cyberknife can also be used to treat tumors previously considered inoperable.The location of the lesion was in a critical area of the brain stem. It was a challenge to treat the lesion with such accuracy without affecting other adjacent critical structures which was possible only with CyberKnife radiosurgery.

A TOUGH DECISION MADE EASY!

As there was no possibility of surgery the only option of treatment was Radiosurgery.

Having a thought that Master Sankha Subhra Dey could find an answer in Cyberknife® ® treatment, Dr.Rathna Devi discussed the case in Cyberknife® ® advisory board, and the same was opined and agreed by the Cyberknife® board.

The doctor also posted the case in the CK society and opinion was sought with renowned CK specialists all over the world.Fortunately, Dr.John Adler (Father of Cyberknife® ) visited our hospital to inaugurate Cyberknife®. His valuable advise was also sought.

Patient and his father was counseled about Cyberknife treatment and that was the only option of treatment. They understood clearly and consented for Cyberknife treatment and even waited till the Cyberknife machine was commissioned and functional. HE WAS OUR 1ST CYBERKNIFE PATIENT.

CYBERKNIFE TREATMENT

After proper immobilization and imaging planning was done taking utmost care to protect the critical organs which were at risk. An additional benefit with Cyberknife is that it can be done on a Outpatient basis. After successful planning and verification, treatment delivery was done. Patient underwent 21Gy in three sittings from 24th to 26th March. Patient tolerated the treatment well.

This was also a moment when we saw the deep emotional bonding in the family. Master Sankha Subhra Dey was unable to speak during treatment because of he had tracheostomy. During treatment the patient and the father always communicated with their eyes. (Guess that was their special language and it carried so much of emotions). Of course, they had lot of hope and trust on us . They were extremely cooperative as well.

FOLLOW UP

Patient reported for his first follow up after three months. There was a dramatic improvement in his health. His cough reflex improved. Dysphagia (difficulty in swallowing)disappeared. There was no weakness of upper limbs and no neck pain.

Tracheotomy tube was removed. He had a good weight gain, his skin and eyes were literally glowing. He was handsome and beaming with confidence.

Follow up MRI revealed reduction in the size of lesion, contrast enhancing portion of the lesion has reduced significantly.

This young boy who was unfortunately suffering of brain stem SOL, and had no options of surgery was benefited by Cyberknife Robotic Radio Surgery. The patient who comes from a middle income group for whom the same treatment abroad would have been next to impossible could find a cure……………. a treatment ………………. Fortunately at Apollo!

Treatment at par with international standards at a very affordable price.. made this a fantastic first success story that every Apolloites are very proud to talk about………………..!, TOUCHING LIVES

CT PICTURES BEFORE AND AFTER CYBERKNIFE

LESION IN THE BRAIN STEM SIGNIFICANT REDUCTION AFTER CK

CONTRAST ENHANCING PORTION ALMOST DISAPPEARED

FOR MORE INFORMATION PLEASE WRITE TO lakshmipriya_b@apollohospitals.com

CYBERKNIFE IN TREATMENT OF ACOUSTIC NEUROMAS

2009-09-14T00:26:00.000-07:00

CYBERKNIFE IN TREATMENT OF ACOUSTIC NEUROMAS

Dr.Sanjay Chandrasekhar – Senior Consultant Radiation Oncology

Acoustic Neuromas have always been considered ideal targets for radiosurgery.
These tumors generally cause diminished hearing or loss of hearing, giddiness or dizziness, loss of equilibrium or balance and facial nerve paralysis.

Traditionally these tumors have been treated either surgically or with radiation. Surgical removal of these tumors has been associated occasionally with injury to the facial nerve.

Either conventional radiotherapy, Stereotactic radio therapy or single fraction Gamma knife or X-knife radio surgery have been used for patients with Acoustic Neuromas depending on size, symptoms at presentation, cost factor etc.,

Small Acoustic Neuromas are considered ideal targets for stereotactic radiosurgery. Large series of such patients treated with either Gamma Knife or X-knife have been published. The earlier experience with Gamma knife or X- Knife in treating these tumors with a single fraction radio surgery had yielded reasonably good responses and long term tumor control rates.

The incidence of facial nerve injury and diminution of hearing in a sizeable number of patients while using single high dose radio surgery prompted investigators to explore the possibility of using fractionated radio surgery of Acoustic Neuromas.

Fractionated radio surgery has evolved recently with the increased use of the CyberKnife as a potent tool in the management of these benign tumors. The frameless feature of the cyberknife has resulted in bettering patient compliance and comfort. The entire treatment is completed over 3-5 days on an outpatient basis. In addition, the entire treatment is robotically guided increasing the accuracy to a sub millimeter level.

The cyberknife experts worldwide are convinced about the efficacy and safety of the use of fractionated Cyberknife radiosurgery in the treatment of Acosutic Neuromas. The long term tumor control rates and hearing preservation rates have been extremely satisfactory according to them(University of Stanford experience).

You can also read a success story through the following link : accuray.com/uploadedFiles/Suzanne_Patient_Story.pdf

Cyberknife Experience - Patient Profiles

2009-06-25T01:55:00.000-07:00

Patient Profile: Mr. C.V.G

Mr. C.V.G is a senior gentleman aged 86 years with a sharp mind with shining eyes. He was diagnosed with cancer of the prostate in 1999. He underwent TURP plus Bilateral Orchidectomy and was on hormonal management. A second cancer was detected three years later. This time a much more aggressive tumour in the nasal area. Conventional radiotherapy was able to control the disease for a year. But the nasal tumour kept on coming back. Laser surgery could remove only part of the tumour so it kept on re-growing. Chemotherapy was not considered for him being above 80 at that time. By the end of 2008 patient was having a completely blocked nose with epistaxis and permanent discharge. He was unable to breath properly anymore. His eyes were not shining anymore. Another course of radiotherapy to this area with eyes in close vicinity did not come to the picture, and hence Cyberknife was the only treatment option. We completed the procedure April 2009. Few weeks later, Mr. CVG returned smiling and had an opened up nasal cavity and with no complaints. Even the radiation oncologists were surprised by the fact that this radiation has targeted the inside tumour almost exclusively. Though it was a second irradiation there was hardly any radio-reaction on the skin. He thinks of visiting his son in the US again …

Patient Profile: Mr. JT

A young man aged 17 years was diagnosed with Hypothalamic Hamartoma
This young man had a long history of Gelastic seizures. The cause for this was a large space-occupying lesion in the suprasellar region. He underwent surgery but the tumour could not be removed as it appeared very vascular and per-operatively there was a lot of bleeding.
The only option for him was stereotactic radiosurgery. The CyberKnife treatment was done for him over 5 sittings in one week. He did not experience any side effects either during
or after the treatment. In fact, he used to travel all the way from Kovalam daily for this treatment. It has been over 2 months following therapy, he is doing fine and his symptoms have reduced. Since this tumour responds slowly to radiation, a post treatment scan has been scheduled for one month from now.

Patients from Asia, Middle East & Africa benefit from the Apollo CyberKnife Treatment

2009-06-25T01:46:00.000-07:00

A new ray of hope. An innovation in the treatment of cancer

Apollo Speciality Cancer Hospital is the first hospital in India to treat patients with the revolutionary CyberKnife.

Since the recent clinical inauguration, over fifty patients have undergone treatment and the results are very promising

Chennai, June 17, 2009: With the launch of Asia Pacific’s most advanced and India’s first CyberKnife^®, Apollo Speciality Cancer Hospital has joined the global league of hospitals equipped to provide 360-degree cancer care. Since the recent clinical inauguration by Prof. Dr. John Adler, the father of the CyberKnife, the hospital has reviewed around 600 cases and over 50 patients have already benefited from the treatment.

Addressing the media, Dr. Janos Stumpf DMS, Director Research in Oncology, representing the Apollo Cyberknife Clinical Panel said, “Over fifty patients with Intracranial, Spine, Lung and Prostate Tumors have benefited from the Apollo CyberKnife treatment and the results are very promising. Many of the patients had tumours that would have been considered inoperable or even untreatable earlier. The CyberKnife treatment offered them a new ray of hope. In quite a few cases, the CyberKnife treatment was even preferred to avoid the risks associated with conventional surgery. Apollo Speciality Cancer Hospital has received patients from across the country, Bangladesh, Malaysia, Oman, Sri Lanka, Iraq, Iran and Pakistan.”

While introducing a few patients present at the media briefing, Dr. Sanjay Chandrasekar, Senior Consultant Radiation Oncology said, “The CyberKnife offers precise, painless and non-invasive radiosurgery treatment. Most patients who undergo the Apollo Cyberknife treatment are free to resume their daily routine almost immediately even after the procedure.”

Benefits to Patients

· A new treatment option: This extraordinary sophisticated treatment can be used as an alternative to open surgery. Occasionally CyberKnife^® treatment can even convert a technically inoperable tumor to operable.

· Pain free: Treatment does not cause pain and therefore does not require anesthesia.

· Recovery Time: Vast majority of CyberKnife^® treatments are out patient procedures allowing patients to continue their activities.

· Comparative comfort: Many of the available high precision radiation techniques require application of some kind of frame around patient’s body, CyberKnife^® can spare that particular inconvenience for the patient. In many of the cases, it is a frameless procedure.

The CyberKnife^®system has significant benefits. Many of the complications associated with other conventional cancer therapies are minimized or eliminated by the CyberKnife^® system. In addition, it is possible to treat multiple tumors at different locations in the body during a single treatment session. Patient normally experiences dramatic pain relief after the CyberKnife^® treatment”.

All patients are reviewed by the Apollo CyberKnife^® Advisory Board prior to a decision on treatment

ACCURAY PRESS RELEASE ON THE FIRST CYBERKNIFE TREATMENT IN INDIA

2009-05-27T01:41:00.000-07:00

First Patients Treated in India Using CyberKnife Radiosurgery
Newly Installed System at Apollo Hospital Treats Six and Preps Eight Patients in First Week
SUNNYVALE, Calif., April 3, 2009

To read more .... log on to http://www.accuray.com/; http://www.accuray.com/Content.aspx?id=2406&terms=india

Source: Accuray Inc

Cyberkife In India

2009-05-06T22:14:00.000-07:00

Apollo Speciality Hospitals, Chennai has been the first Hospital in India to have started treatment with Cyberknife . We have so far treated 40 patients with Intracranial, Spine, Lung and Prostate tumors and the results are very promising.

For More Information regarding CyberKnife at Apollo please feel free to call Cyberknife Helpline, Ms.Lakshmi @ 044-24334455 or 9941056677 or SMS Apollo at 56677 . Email enquiries can also be to be sent to cyberknife@apollohospitals.com.

You may also visit us at http://www.cyberknifeindia.in/ and http://www.cyberknifeinindia.com/

Cyberknife Resource Team

Is the cyberknife really a knife?

2009-03-04T03:24:00.000-08:00

Is the CyberKnife really a ‘knife’?
Though its name conjures up images of a scalpel – the CyberKnife in fact is the alternative to surgery! It is a Robotic Radiosurgery System. It is non-invasive procedure ideal for the treatment of both cancerous and non-cancerous tumors anywhere in the body. It uses image guided technology and computer controlled robotics to continuously track, detect and correct for tumor and patient movement throughout the treatment allowing for its extreme precision.
Here are more FAQs about the cyberknife:
1. Will a CyberKnife procedure be like a minor surgery?
In fact, much less strenuous! It involves no incisions, no blood, no anesthesia, and virtually no recovery time.

2. What does non-invasive procedure mean?
- It simply means that the procedure involves no invasion into the body – which means no cuts or incisions are made during the CyberKnife procedure.

3. How does a CyberKnife work?
- CyberKnife performs robotic radiosurgery during which precise radiation beams are focused on tumors while minimizing damage to surrounding healthy tissue.

4. Will patients have to get admitted to the hospital for this procedure?
- Certainly not. CyberKnife is a simple, outpatient procedure. Patients can undergo their treatment and immediately resume normal activities – as the side effects are minimal.

5. How long will the session last?
- Each treatment session may be between 30 - 90 minutes, depending on the type and location of the tumor. Sometimes the treatment is offered in stages in which case patients may have to return for additional sessions over a few days (not more than a week) – as advised by the doctor.

6. What are the pre-preparations for this treatment?
- Before starting treatment, the medical team will perform a high resolution CT scan to determine the size, shape and location of the tumor. Once this data is obtained it is transferred to the Cyberknife database and the treatment is planned in detail.

7. What can one expect during a CyberKnife treatment?
- Each case is unique depending on the health of the patient and the type as well as location of the tumor. Some patients need just one sitting while other may need to come for repeat sessions. A detailed orientation is given to patients – based on their specific case so that they know what to expect before they go in for treatment.

8. What types of conditions are considered for CyberKnife treatment?
- The CyberKnife is capable of treating tumors anywhere in the body, but its precision makes it ideal for sensitive zones like the brain, spine, lung, prostate, liver and pancreas.

9. They say CyberKnife does not require a headframe – what does that mean?
- Radiation treatment needs to be extremely precise – wrong tissues exposed to radiation could cause irreparable damage. Hence traditional radiation treatment like Lenear Accelerator use headframes or immobilization devices that are used to hold patients still. These could be extremely uncomfortable and painful. But CyberKnife eliminates all that! It has a built in sensor that only works at a particular body rhythm,. When the rhythm varies or when there is body movement (like coughing or sneezing) it automatically stops functioning.

11. Who determines if CyberKnife is the ideal treatment option for a particular case?
- The physician or a specialist can determine if CyberKnife is the ideal treatment option after evaluating the condition of the patient.

12. Can the elderly and children be treated with the CyberKnife?
- In most cases – yes. CyberKnife is less risky than traditional surgery as it involves no incisions at all. This makes it a suitable option for the elderly and the very young. The decision to perform the procedure will however be taken in consultation with the concerned physicians and anesthesiologist. The safety and comfort of the such patients are always kept in mind.

13. How is CyberKnife different from traditional Radiosurgery?
- While traditional radiosurgery methods (like the Linear Accelerator or Gamma Knife) worked on the same principle of focused radiation beams – none of the previous forms of treatment offered the precision and flexibility that CyberKnife does. Because of its robotic arm like structure the Cyberknife can reach tumors at angles that were previously inaccessible. Moreover CyberKnife uses a combination of a robotic arm, linear accelerator (high energy X-ray source), and image guidance technology – to give high precision results.

14. What are the advantages of CyberKnife?
- It has several inherent advantages. It is a pain free, non-invasive, outpatient procedure and the patients need virtually no recovery time. Moreover, there are no intrusive body or head frames and no breath-holding required during the procedure.

15.Is the CyberKnife safe?Being a non-invasive procedure, the CyberKnife is radically different from traditional surgery. It requires no anesthesia, no incision, no bleeding and no post-operative pain or unpleasant anesthesia after effects. Because of its precision, CyberKnife does not affect the surrounding healthy tissues thereby minimizing side effects – something that is not always possible with traditional radiation therapy.

16. After treatment, when will my tumor or lesion disappear?The effects of radiosurgery are not always immediately visible. Tumors also behave differently – depending on their location and the patient’s metabolism. Some tumors resolve more slowly than others and may or may not eventually disappear completely, while others simply stop growing and present no further biologic activity. After CyberKnife treatments patients will need to periodically undergo tests to assess their progress.

17. Will CyberKnife cause hair fall out or skin burn?The radiation delivered by the CyberKnife is so focused on a specific target that it is highly unlikely that hair loss or skin burn will occur. In the event that a treated lesion is very close to the scalp or skin though, the adjacent hair or skin may be affected. If so affected, this hair or skin will typically recover over time. All medical procedures, including CyberKnife treatment, have potential side effects and associated risks, and every patient will be individually evaluated and counseled in detail before a final plan of treatment is made.

18. Where in India can patients go for CyberKnife treatment?
Apollo Hospitals, Chennai, is the only hospital in India to have the CyberKnife. It is not just India’s first, but also Asia’s most advanced CyberKnife. Apollo Hospitals has trained technicians, doctors and counselors who can guide patients through the treatment process.

19. What are the facilities available for cancer care at Apollo Hospitals? Apollo Hospitals, across India have dedicated centers that offer comprehensive cancer care. The hospital's cancer centers have experienced surgical and radiation cancer specialists as well as diagnostic consultants. The center's teams of doctors examine each case jointly and decide on the best line of treatment for the patient. Since treatment of cancer involves tremendous physical and emotional strain, the hospital provides extra support to cancer patients by counseling them to stay positive and to eat right - thereby speeding up the recovery process. Specially trained medical counselors, speech therapists, dieticians and other professionals, appropriate to the individual case, provide support to the teams of doctors. The measurable success that the hospital has achieved in cancer care attracts thousands of national and international patients each year

Cyberknife

2009-03-02T22:38:00.000-08:00

The CyberKnife® is a state-of-the-art, radiotherapy equipment for robotic radiosurgery that allows radiation oncologists to treat pathologies painlessly, without the need for an operation.
CyberKnife® uses pencil beams of radiation which can be directed at any part of the body, from any direction with the help of a robotic arm. The system tracks the tumour's position, detects any movement of the tumour or patient, and automatically corrects its positioning .It then targets the tumour with multiple beams of high-energy radiation, destroying abnormal tissue without damaging surrounding areas.The treatment is so accurate that it's now possible to treat tumours previously thought to be inoperable. Although the results of treatment do not always show immediately, in most cases, the procedure will initially stop the growth of tumours, before gradually reducing their size.As there is no open surgery, the risk complications normally associated with an operation are eliminated, as is the need for a long recovery time. This makes treatment suitable even for those who are not well enough to cope with surgery. Most patients leave the hospital the same day.