CyberKnife - Hemicranial Meningioma

Successful CyberKnife Irradiation of 1000 cc Hemicranial Meningioma: 6-year Follow-up

Meningiomas are common benign tumors with accepted treatment approaches and usually don't challenge healthcare specialists. We present a case of a huge unresectable hemicranial meningioma, which was successfully treated with hypofractionated irradiation.

A male patient, sixty-two years of age, suffered for over 12 years from headaches, facial deformity, right eye displacement, right eye movement restriction, right-sided ptosis, and facial hypoesthesia. MRI and CT studies revealed an extended hemicranial meningioma. Prior to irradiation, the patient underwent four operations. Eventually, the tumor was irradiated with the CyberKnife in August 2009. Tumor volume composed 1085 cc. The mean dose of 35.3 Gy was delivered in 7 fractions (31.5 Gy at 72% isodose line comprising 95% of tumor volume). The patient was followed during six years and experienced only mild (Grade 1-2 CTCAE) acute skin and mucosa reactions. During the follow-up period, we observed target volume shrinkage for 17% (for 26% after excluding hyperostosis) and regression of intracranial hypertension signs.

Due to the extreme volume and complex shape of the tumor, spreading along the surface of the hemisphere as well as an optic nerve involvement, the case presented would not be generally considered suitable for irradiation, especially for hypofractionation. 

We regard this clinical situation not as a treatment recommendation, but as a demonstration of the underestimated possibilities of hypofractionation regimen and CyberKnife system, both of which are limited with our habit of conventional treatments.

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PROSTATE CANCER - TREATMENT THROUGH CYBERKNIFE

Recent studies have reported results of more than 1,000 patients treated with CyberKnife for prostate cancer, with follow-up up to eight years, which has shown that CyberKnife is very effective at treating localized prostate cancer.

Twenty-one CyberKnife centers in the United States have conducted a trial in which patients with early prostate cancer received five treatments of accelerated hypofractionated treatment the same way the Stanford researchers treated their initial patients. To date, more than 320 patients have taken part in this study. (Forty-two patients are from BIDMC's Keith C. Field CyberKnife Center.)

Results concerning the first 250 patients have been reported; the rate of minor side effects was low, acceptable and similar to what is observed with external beam radiation. Cancer control rates also have been excellent.

Based on these results, most (but not all) insurance compaines cover CyberKnife treatment for prostate cancer. Before you proceed with treatment, ask BIDMC for help determining whether your insurer is one of them.

Many patients with early-stage prostate cancer are candidates for CyberKnife therapy.

To know more about cyberknife kindly blog your comments or you can write to me at lakshmipriya_b@apollohospitals.com or call 9940675877