Radiosurgery in gastro-intestinal malignancies

Radiosurgery in gastro-intestinal malignancies 

DR.DEBNARAYAN DUTTA, Radaitaion oncologist, Apollo speciality Hospital

Common gastro-intestinal (GI) malignancies are colon cancer, carcinoma rectum and anal canal, pancreatic cancer, cholangiocarcinoma, carcinoma stomach, hepatocellular carcinoma (HCC) and liver metastasis. Other uncommon tumours include gastro-intestinal stromal tumour (GIST), klaskin tumour and neuro-endocrine tumour. Surgery is the treatment option in these tumours. Unfortunately, majority of these tumours are inoperable at presentation and treated with supportive/palliative intent. Majority of these tumours are relatively chemotherapy (CT) resistant. Role of conventional radiation therapy (RT) in gastro-intestinal malignancies are also not well defined in many of these tumours.

Response rate with delivered dose is not acceptable, and dose escalation is not possible with conventional RT without compromising in critical structure (small intestine, duodenum) tolerance. With modern stereotactic whole body RT (SBRT) higher dose of radiation can be delivered in shorter duration and normal tissue tolerance is respected. SBRT has evolved in recent years and also have promise to improve local control in these relative resistant tumours. Pre-operative and adjuvant RT is established in carcinoma of rectum.

In recent years, short course RT (hypofractionated RT, 25 Gy/5 Fr) had shown to be equally effective as conventional RT (1.8-2 Gy/Fr) in inoperable rectal cancer. Role of conventional RT in inoperable pancreatic cancer has been argued in the EORTC study. Whereas, short course RT (fractionated radiosurgery) is slowly being accepted as an option to complete RT early, start adjuvant CT at the earliest and also improve quality of life (QOL). In liver metastasis, radiosurgery is a non-invasive alternative to surgery. Higher equivalent radiation dose delivered with radiosurgery there may have comparable survival function in selected patients.

Radiosurgery is an option in liver tumour close to porta, sub-diaphragmatic location (segment VIII), nodal involvement and in medically inoperable patients. In hepatocellular carcinoma (HCC), fractionated radiosurgery is an option as ‘bridge therapy’ for patients waiting for liver transplant, medically inoperable patients, chemotherapy resistant, post TACE residual and in recurrent HCCs. Radiosurgery is also consider as primary treatment in suitable patients. There is an ongoing multicentric randomized trial comparing chemotherapy and radiosurgery in HCCs.

In uncommon slow growing tumours such as cholangiocarcinoma, neuro-endocrine tumour and klaskin tumour fractionated radiosurgery have excellent response rate and improve symptoms. In conclusion, modern fractionated stereotactic radiosurgery is an option in many of the GI malignancies improves response rate and also may improve QOL. In coming years with publication of more matured data from randomized and prospective phase II studies the role of radiosurgery will be established. ours , 2) require only thermoplastic mask, no need for invasive frame, 3) has inverse planning system, can spare critical structure, 4) there is a ‘intra-fraction’ correction technology with imaging, 5) there is no need to change the source, hence may be more cost effective and 6) can be used to treat extra-cranial tumours also. CyberKnife has a linear accelerator attached with a robot and is capable of treatment from various coplanar and non-coplanar field arrangements. CyberKnife has sub-millimeter accuracy and unmatched dose distribution. 

The advanced technology behind CyberKnife uses image guidance technology and computer-controlled robotics to deliver and extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue, and adjusting for patient and tumor movement during treatment. In conclusion, CyberKnife is an extension of gammaknife radiosurgery delivery system. This machine has immense promise to treat with short course regimens with high dose and improve local control without increasing toxicities.

Radiosurgery in brain tumours

Radiosurgery in brain tumours Dr.DEBNARAYAN DUTTA, CONSULTANT RADIATION ONCOLOGIST< APOLLO SPECIALITY HOSPITAL CHENNAI

Short course radiation therapy is the one of the most talked about subject in recent years and also a fascinating research zone. Hypofractionated radiation therapy is an old concept, but only in recent years with tremendous improvement in radiation therapy delivery technologies there is a significant visible surge in it’s applicability in clinical practice. Modern radiation therapy technology is capable of delivering high dose to the target while sparing majority of the adjacent critical structures. Hence, it is possible to deliver short course of treatment regimen with higher dose per fraction without increasing in toxicity. In brain tumours, radiosurgery with gamma-knife is considered standard of care in many of the clinical indications such as small meningiomas, acaustic schwannomas, residual low grade gliomas, AVMs and solitary/ oligo brain metastasis. Gamma-knife radiosurgery is in clinical practice for more than five decades.  There are several prospective and randomized studies (level I evidence) with long-term follow up data supporting the use of radiosurgery in these clinical indications. Other indications of radiosurgery are pituitary tumour, craniopharyngiomas, glomus tumours, chordomas and others. Robotic radiosurgery (CyberKnife®) is precision radiosurgery delivery system and an extension of gamma-knife system. CyberKnife uses the principle of gamma-knife, but with linear accelerator source instead of multiple cobalt sources. CyberKnife is capable to treating all tumours indicated for gamma-knife with similar accuracy. This modern tool has some additional advantages from gamma-knife, such as 1) CyberKnife can use fractionated treatment, hence relatively larger tumours can be treated, 2) require only thermoplastic mask, no need for invasive frame, 3) has inverse planning system, can spare critical structure, 4) there is a ‘intra-fraction’ correction technology with imaging, 5) there is no need to change the source, hence may be more cost effective and 6) can be used to treat extra-cranial tumours also. CyberKnife has a linear accelerator attached with a robot and is capable of treatment from various coplanar and non-coplanar field arrangements. CyberKnife has sub-millimeter accuracy and unmatched dose distribution.  The advanced technology behind CyberKnife uses image guidance technology and computer-controlled robotics to deliver and extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue, and adjusting for patient and tumor movement during treatment. In conclusion, CyberKnife is an extension of gammaknife radiosurgery delivery system. This machine has immense promise to treat with short course regimens with high dose and improve local control without increasing toxicities. FOR more information you may please blog your comments or write to lakshmipriya_b@apollohospitals.com

CyberKnife Radiosurgery in lung cancer

Stereotactic radiosurgery in lung cancer DR.DEBNARAYAN DUTTA, Consultant Radiation Oncologist, Apollo speciality hospital Chennai

Radiosurgery is a non-invasive option in early lung cancer. High dose precise radiosurgery has immense potential. Early data from phase II studies have shown excellent loco-regional control and survival function. CyberKnife Radiosurgery in lung cancer has following advantages: 1.     Cyberknife has the unique technology of ‘see and shoot’. In this technology before each treatment field matching of the target and ‘intra-fraction motion correction’ is done, hence minimal normal lung comes in the radiation field. 2.      Cyberknife has sub-millimeter treatment accuracy. Margin (planning target volume) required (where normal lung comes) is minimal around the target. High dose region volume is minimal with Cyberknife and lung toxicity is expected to be lower compared with conventional treatment. 3.     Cyberknife has the multiple isocentric technique with non-coplanar field arrangement, hence have unmatched conformity index (uniform dose is delivered). Cyberknife use ‘pencil beam’ with multiple small beamlets delivered from various angles (maximum 1200 different position) hence ‘penumbra’ margin is less. 4.     As dosimetry is favorable and total dose delivered with Cyberknife is not higher compared with conventional fraction (usual dose delivered with Cyberknife 60 Gy/3 fr/ 1 week) there is no expected increase in lung toxicity with Cyberknife. Phase II prospective studies with Cyberknife have not shown any increase in radiation induced pneumonitis. 5.     ‘STAR trial’ is a multicentric randomized study initiated by MD Anderson Cancer Centre may provide answer to impact of Cyberknife on lung toxicity. There are other few ongoing clinical studies with hypofractionated radiation therapy on lung cancer that will provide useful information in near future   For more information of successful treatments using cyberknife you may please blog your comments or write to lakshmipriya_b@apollohospitals.com Radiosurgery in brain tumours Short course radiation therapy is the one of the most talked about subject in recent years and also a fascinating research zone. Hypofractionated radiation therapy is an old concept, but only in recent years with tremendous improvement in radiation therapy delivery technologies there is a significant visible surge in it’s applicability in clinical practice. Modern radiation therapy technology is capable of delivering high dose to the target while sparing majority of the adjacent critical structures. Hence, it is possible to deliver short course of treatment regimen with higher dose per fraction without increasing in toxicity. In brain tumours, radiosurgery with gamma-knife is considered standard of care in many of the clinical indications such as small meningiomas, acaustic schwannomas, residual low grade gliomas, AVMs and solitary/ oligo brain metastasis. Gamma-knife radiosurgery is in clinical practice for more than five decades.  There are several prospective and randomized studies (level I evidence) with long-term follow up data supporting the use of radiosurgery in these clinical indications. Other indications of radiosurgery are pituitary tumour, craniopharyngiomas, glomus tumours, chordomas and others. Robotic radiosurgery (CyberKnife®) is precision radiosurgery delivery system and an extension of gamma-knife system. CyberKnife uses the principle of gamma-knife, but with linear accelerator source instead of multiple cobalt sources. CyberKnife is capable to treating all tumours indicated for gamma-knife with similar accuracy. This modern tool has some additional advantages from gamma-knife, such as 1) CyberKnife can use fractionated treatment, hence relatively larger tumours can be treated, 2) require only thermoplastic mask, no need for invasive frame, 3) has inverse planning system, can spare critical structure, 4) there is a ‘intra-fraction’ correction technology with imaging, 5) there is no need to change the source, hence may be more cost effective and 6) can be used to treat extra-cranial tumours also. CyberKnife has a linear accelerator attached with a robot and is capable of treatment from various coplanar and non-coplanar field arrangements. CyberKnife has sub-millimeter accuracy and unmatched dose distribution.  The advanced technology behind CyberKnife uses image guidance technology and computer-controlled robotics to deliver and extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue, and adjusting for patient and tumor movement during treatment. In conclusion, CyberKnife is an extension of gammaknife radiosurgery delivery system. This machine has immense promise to treat with short course regimens with high dose and improve local control without increasing toxicities.

Factors influencing quality of life in adult patients with primary brain tumors

Factors influencing quality of life in adult patients with primary brain tumors

Rakesh Jalali and Debnarayan Dutta

NeuroOncology Group, Tata Memorial Hospital, Mumbai, India (R.J.); Apollo Specialty Hospital, Chennai,

India (D.D.)

We performed a literature reviewwith respect to factors influencing health-related quality of life (QOL) in adults with

primary brain tumors. A comprehensive, peer-reviewed literature search was performed including studies examining

QOL in adults with high-grade gliomas and lowgrade gliomas and in routine neuro-oncology practice. The interpretation and implication of QOL domain scores may be different in high-grade, low-grade, and benign brain tumors. Several patient-related, treatment-related, and sociocultural factors influence QOL scores. Pretreatment baseline QOL domain scores have been shown to be a predictive parameter for survival function. Implementation of QOL scores in routine clinical practice is underused. QOL is an important outcome measure in the treatment of patients with brain tumors and should be incorporated as a surrogate end point along with traditional end points, such as disease-free and overall survival in most current trials.

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Lung metastases treated by CyberKnife at 41 months.

OBJECTIVES:


Based on the reported success of stereotactic body radiotherapy in treating extracranial tumors, we used CyberKnife to treat patients with metastatic lung cancer.

METHODS:

This is a retrospective report of treatment details and outcomes of 35 patients, ranging in age from 33 to 91 years, with 69 histologically proven pulmonary metastases, treated by image-guided robotic stereotactic radiosurgery Tumor volumes ranged from 0.7 mL to 152 mL. Total doses ranged from 5 to 60 Gy delivered in one to four fractions with an equivalent dose range from 6 to 110 Gy NTD delivered in 2-Gy fractions assuming an alpha/beta of 20 Gy.

RESULTS:

All patients tolerated radiosurgery well with fatigue as the main side effect. Grade 3 and grade 4 pulmonary toxic reactions were observed in one patient who had undergone a repeat treatment. Of the 35 treated patients, 27 (77%) were still alive at a median 18-month (range 2-41 mo) follow-up. Local control was 71% with 25 tumors showing a complete response, 16 a partial response, and 7 stable with disease. Eight had progressive disease.

CONCLUSIONS:

The delivery of precisely targeted radiation doses to lung tumors in a hypofractionated fashion is feasible and safe. Image-guided robotic stereotactic radiosurgery of pulmonary metastases with the CyberKnife achieves good rates of local disease control with limited toxicity to surrounding tissues and in many cases may be beneficial for patients for whom surgery is not an option.

Source : http://frederickcyberknife.com/physician-info/research-articles/

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Treatment of spinal tumors using cyberknife fractionated stereotactic radiosurgery: pain and quality-of-life assessment after treatment in 200 patients.

OBJECTIVE:


Benign and malignant tumors of the spine significantly impair the function and quality of life of many patients. Standard treatment options, including conventional radiotherapy and surgery, are often limited by anatomic constraints and previous treatment. Image-guided stereotactic radiosurgery using the CyberKnife system is a novel approach in the multidisciplinary management of spinal tumors. The aim of this study was to evaluate the effects of CyberKnife stereotactic radiosurgery on pain and quality-of-life outcomes of patients with spinal tumors.

METHODS:

We conducted a prospective study of 200 patients with benign or malignant spinal tumors treated at Georgetown University Hospital between March 2002 and September 2006. Patients were treated by means of multisession stereotactic radiosurgery using the CyberKnife as initial treatment, postoperative treatment, or retreatment. Pain scores were assessed by the Visual Analog Scale, quality of life was assessed by the SF-12 survey, and neurological examinations were conducted after treatment.


CONCLUSION:

CyberKnife stereotactic radiosurgery is a safe and effective modality in the treatment of patients with spinal tumors. CyberKnife offers durable pain relief and maintenance of quality of life with a very favorable side effect profile

Source : http://frederickcyberknife.com/physician-info/research-articles/

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Image-guided stereotactic body radiation therapy in patients with isolated para-aortic lymph node metastases from uterine cervical and corpus cancer.

PURPOSE:


The aims of this study were to evaluate the role of stereotactic body radiation therapy (SBRT) as a local treatment for isolated para-aortic lymph node (PALN) metastases originating from uterine cervical and corpus cancer.

METHODS AND MATERIALS:

We retrospectively enrolled 30 patients with isolated PALN metastases originating from uterine cervical and corpus cancer who had received SBRT using the CyberKnife (CK). All patients were shown to have isolated PALN metastases by computed tomography (CT) and/or positron emission tomography (PET)-CT. The overall survival (OS), local control (LC) rate, and disease progression-free survival (DPFS) rate were calculated according to the Kaplan-Meier method. Comparison between prognosis groups was performed using log-rank analysis. Toxicities were also evaluated.

CONCLUSION:

The OS and LS rates were promising, and the incidence of toxicities was low. Use of SBRT with the CyberKnife is an effective modality for treating isolated PALN metastases in patients with uterine cervical and corpus cancer.

source :

http://frederickcyberknife.com/physician-info/research-articles/

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Cyberknife radiosurgery for breast cancer spine metastases: a matched-pair analysis.

Abstract


BACKGROUND:

There are few options for breast cancer patients with spinal metastases recurrent within a previous radiation treatment field. To evaluate their outcomes, as there are no comparable radiation treatment options, the outcomes were compared between 18 patients with spinal metastases from breast cancer treated with CyberKnife stereotactic radiosurgery, 17 of which had prior radiotherapy to the involved spinal region and were progressing, and 18 matched patients who received conventional external beam radiotherapy (CRT) up-front for spinal metastases.

METHODS:

Radiosurgery was delivered in 3 to 5 fractions .Women were matched to patients in a CRT group with respect to time from original diagnosis to diagnosis of metastases, estrogen receptor / progesterone receptor (ER/PR) status, presence or absence of visceral metastases, prior radiotherapy, and prior chemotherapy. Survival and complications were compared between treatment groups. Surviving patients were followed out to 24 months.

RESULTS:

The CyberKnife and CRT groups were comparable along all matching dimensions and in performance status before treatment. Outcomes of treatment were similar for patients in both groups; ambulation, performance status, and pain worsened similarly across groups posttreatment. Survival and the number of complications appeared to favor the CyberKnife group, but the differences did not reach statistical significance.

CONCLUSIONS:

The statistical comparability of the CyberKnife and CRT groups reflects the small sample size and stringent requirements for significance of the matched-pair analysis. Nevertheless, comparability in these difficult cases shows that salvage CyberKnife treatment is as efficacious as initial CRT without added toxicity

Source :

http://frederickcyberknife.com/physician-info/research-articles/

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CYBERKNIFE FOR PROSTATE TREATMENT - WHAT PATIENTS FEEL

CYBERKNIFE FOR PROSTATE CANCER _ WHAT PATIENTS FEEL

Compensating for Prostate Movement: The prostate gland can move unpredictably throughout the course of treatment that makes the ability to track, detect and correct for motion critically important. Unlike any other radiation treatment, the CyberKnife System continually tracks and automatically corrects for the movement of the prostate in real time. This enables the system to correct the beam direction so that it is focused on the prostate throughout the entire treatment. The robot constantly monitors and aligns the real time location of the prostate to ensure any adjustments in the beam delivery match the prepared treatment plan while automatically correcting for any movement during a treatment by relaying critical logistical information to the system software. Safety mechanisms are in place to ensure that the beam of radiation is ‘locked on’ to the intended target should your prostate move out of acceptable range. For example, if a gas bubble is moving through the rectum or the bladder starts to fill during treatment, a system correction compensating for movements of the prostate automatically occurs.



Reduced Treatment Time: Compared to alternative treatments that can take up to 8 - 9 weeks (including relocation in some cases) or 40 - 45 sessions of radiation therapy, an entire CyberKnife® treatment plan can be completed in 4 to 5 sessions. Each treatment session is typically completed in one hour or less. the CyberKnife System is designed to treat with a higher per-fraction dose given its superior accuracy. This substantially reduced treatment timeframe is advantageous for busy men seeking the least amount of disruption to their daily lives.



A Non-Invasive Procedure: Aside from the placement of tiny gold markers called fiducials inside of the prostate, a pre-treatment procedure that assists the imaging system to more accurately target tumors, the CyberKnife treatment process is completely non-invasive. No incisions, anesthesia or hospitalization are required. The CyberKnife robot moves quietly around a patient who lies comfortably on the treatment table. The robot will move in nearly every direction to fully deliver the prescribed treatment dose.This is in contrast to laparoscopic surgery or a traditional prostatectomy that involves incisions and associated risks. Surgical procedures usually involve general anesthesia which may last up to several hours. As with any surgical procedure, potential risks include bleeding and infection and, depending on a patient’s overall health condition, other complications including incontinence and/or erectile dysfunction. In addition, surgery requires mandatory hospitalization and catheterization.

And compared to High-Dose-Rate brachytherapy (HDR) the CyberKnife System delivers the same dose of killing radiation to the prostate, but does so without the insertion of multiple catheters. HDR typically involves a hospital stay, over a 24 hour period, and places 15-20 catheters into the prostate, through the perineum. Through these catheters a machine pushes a single highly radioactive iridium seed into the catheters one by one. Low-Dose-Rate, or LDR brachytherapy (also known as seed brachytherapy) is also an invasive procedure in which dozens of radioactive seeds are permanently implanted in the prostate with needles inserted through the perineum to deliver radiation over many weeks.



WHAT PATIENTS SAY ABOUT PROSTRATE CANCER



A CyberKnife Coalition survey conducted between February – March 2011, 304 participants were asked why they chose CyberKnife SBRT over other treatment options.

Here is what they said:

84% Most comfortable with risk/side effects

81% Seemed like the best options among my choices

66% Offers the latest technology

59% Convenience

59% Most likely to eradicate/eliminate the cancer

36% Least amount of time away from work

18% Not a surgical candidate

Additional results of this survey found that:

99% of patients described their treatment as successful

93% of patients indicated that SBRT did not interrupt their normal life routine

98% of patients indicated they would recommend SBRT treatment to others

99% of patients indicated they would choose to be treated with SBRT again

 

APollo Hospitals has treated more that 70 prostate cases and the results have been very promising. Patient have been under 2-3 year follow up.

 

Source. www.cyberknifeforprostate.com/

 

 

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CYBERKNIFE IN THE TREATMENT OF SPINALCORD TUMOURS

CYBERKNIFE IN THE TREATMENT OF SPINALCORD TUMOURS

When treating benign spinal tumors with radiosurgery, the primary intermediate objective is to stop all tumor growth. Over the long term, these tumors will gradually shrink in size which may take a period of several years. Preliminary results with CyberKnife radiosurgery for meningioma and schwannoma show excellent control of tumor growth.

Treatment with CyberKnife radiosurgery utilizing a hypofractionated treatment regimen was indicated for maximum local control and to minimize the chance of injury to the spinal cord.

Outcome and Follow-Up
At 3-month follow-up:
* Neck, shoulder and arm pain dramatically decreased
* Neck and left arm mobility much improved
* MRI study showed no progression of meningioma
9-month follow-up:
* Improved neck and left shoulder mobility
* Left arm strength increasing
* Some numbness in left upper arm but improved compared to last visit
12-month follow-up:
* Increased left shoulder and neck mobility
* Increased left arm function
* No new symptoms or problems
22-month follow-up:
* Left arm range of motion improved, arm strength stable,
mild residual weakness
* No new problems
* No neck pain
* Follow-up MRI reveals no evidence of tumor progression and stability
of the previously treated lesion
Conclusion
The patient has experienced significant improvement since undergoing stereotactic radiosurgery. MRI shows no evidence of tumor progression. Follow-up will occur on an annual basis with continued MRI surveillance.


SOURCE : http://www.utmedicalcenter.org/lib/file/manager/pages/cancer-institute/resources/-utmc-cyberknife-annual-report_011711.pdf


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CYBERKNIFE IN TREATMENT OF PITUITARY ADENOMAS

CYBERKNIFE IN TREATMENT OF PITUITARY ADENOMAS


In recent years, CyberKnife has emerged as an important treatment modality in the management of pituitary adenomas. Treatment results after performing CyberKnife and the complications of this procedure are reviewed.
Methods
Twenty-six patients with pituitary adenomas received stereotactic radiosurgery with the CyberKnife (CKRS). The follow-up periods ranged from 7 months to 47 months (mean±SD : 30±12.7 months). The patients consisted of 17 with non-functioning adenomas, 3 with prolactinomas and 6 with acromegaly. The change in the tumor volume, visual acuity, hormonal function, and complications by this therapy were analyzed in each case.
Results
The tumor control rate was 92.3%. Hormonal function was improved in all of the 9 (100%) functioning adenomas. Hormonal normalization was observed in 4 of the 9 (44%) patients with a mean duration of 16 months. In two patients (7.6%), visual acuity worsened due to cystic enlargement of the tumor after CKRS. No other complications were observed.
Conclusion
CyberKnife is considered safe and effective in selected patients with pituitary adenomas. However, longer follow-up is required for a more complete assessment of late toxicity and treatment efficacy.

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CYBERKNIFE TREATMENT FOR SPINAL CORD TUMORS

Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution.
Gerszten PC, Burton SA, Ozhasoglu C, Welch WC.
SourceDepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. gersztenpc@upmc.edu

Abstract
STUDY DESIGN: A prospective nonrandomized, longitudinal cohort study.

OBJECTIVE: To evaluate the clinical outcomes of single-fraction radiosurgery as part of the management of metastatic spine tumors.

SUMMARY OF BACKGROUND DATA: The role of stereotactic radiosurgery for the treatment of spinal lesions has previously been limited by the availability of effective target immobilization and target tracking devices. Large clinical experience with spinal radiosurgery to properly assess clinical experience has previously been limited.

METHODS: A cohort of 500 cases of spinal metastases underwent radiosurgery. Ages ranged from 18 to 85 years (mean 56). Lesion location included 73 cervical, 212 thoracic, 112 lumbar, and 103 sacral.

RESULTS: The maximum intratumoral dose ranged from 12.5 to 25 Gy (mean 20). Tumor volume ranged from 0.20 to 264 mL (mean 46). Long-term pain improvement occurred in 290 of 336 cases (86%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Twenty-seven of 32 cases (84%) with a progressive neurologic deficit before treatment experienced at least some clinical improvement.

CONCLUSIONS: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.

Source : http://www.ncbi.nlm.nih.gov/pubmed/17224814

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Visual field preservation thru cyberknife radiosurgery

Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions.
Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD.
SourceDepartment of Neurosurgery, Stanford University Medical School, Stanford, California 94305, USA. jra@stanford.edu

Abstract
OBJECTIVE: The restricted radiation tolerance of the anterior visual pathways represents a unique challenge for ablating adjacent lesions with single-session radiosurgery. Although preliminary studies have recently demonstrated that multisession radiosurgery for selected perioptic tumors is both safe and effective, the number of patients in these clinical series was modest and the length of follow-up limited. The current retrospective study is intended to help address these shortcomings.

METHODS: Forty-nine consecutive patients with meningioma (n = 27), pituitary adenoma (n = 19), craniopharyngioma (n = 2), or mixed germ cell tumor (n = 1) situated within 2 mm of a "short segment" of the optic apparatus underwent multisession image-guided radiosurgery at Stanford University Medical Center. Thirty-nine of these patients had previous subtotal surgical resection, and six had previously been treated with conventional fractionated radiotherapy (6). CyberKnife radiosurgery was delivered in two to five sessions to an average tumor volume of 7.7 cm3 and a cumulative average marginal dose of 20.3 Gy. Formal visual testing and clinical examinations were performed before treatment and at follow-up intervals beginning at 6 months.

RESULTS: After a mean visual field follow-up of 49 months (range, 6-96 mo), vision was unchanged postradiosurgery in 38 patients, improved in eight (16%), and worse in three (6%). In each instance, visual deterioration was accompanied by tumor progression that ultimately resulted in patient death. However, one of these patients, who had a multiply recurrent adrenocorticotropic hormone-secreting pituitary adenoma, initially experienced early visual loss without significant tumor progression after both a previous course of radiotherapy and three separate sessions of radiosurgery. After a mean magnetic resonance imaging follow-up period of 46 months, tumor volume was stable or smaller in all other cases. Two patients died of unrelated nonbrain causes.

CONCLUSION: Multisession radiosurgery resulted in high rates of tumor control and preservation of visual function in this group of perioptic tumors. Ninety-four percent of patients retained or improved preradiosurgical vision. This intermediate-term experience reinforces the findings from earlier studies that suggested that multisession radiosurgery can be a safe and effective alternative to either surgery or fractionated radiotherapy for selected lesions immediately adjacent to short segments of the optic apparatus.

Source : http://www.ncbi.nlm.nih.gov/pubmed/18596432

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Nasopharynx Angiofibroma

Nasopharynx Angiofibroma

This 21 years old patient from Colombo Srilanka came to us in March 2010 with the following history.

He was diagnosed as a case of nasopharynx angiofibroma in 2005 after couple of episodes of nasal bleeding, he underwent surgery for the same, but his symptoms re-occurred within 8 months. CT scan revealed recurrence. He underwent re-excision in 2006. Again in 2008 he had recurrence and 3rd surgery was done. In January 2010 MRI scan revealed recurrent mass which measured 4.1x3.8x4.0 – Left nasopharynx with erosion of left Pterygoid plate and extension to extradural space. Patient being young and had faced multiple surgeries was very anxious. His parents were also stressed, we took up the case and subjected the patient for CyberKnife Radio surgery after proper planning and verification (patient received treatment from 3.3.2010 to 8.3 .2010).



Patient is on regular follow up. The follow up scans and volume analysis shows good response to treatment with couple resolution of disease. Patient is locally asymptomatic and is in a good job. His health has improved very well, looks handsome, Parents are having a nice smile in their face.

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Vertigo and right side hearing loss - Acoustic neuroma

Vertigo and right side hearing loss - Acoustic neuroma


A 50 years old gentleman presented with complaints of vertigo and right side hearing loss. MRI brain showed a well defined intracranial hemorrhage soft tissue lesion on the right side, possibility of an acoustic neuroma (1.1 x0.6 x0.5 cm). He was seen by ENT specialist. Audiometry revealed profound SN hearing loss on the right side and was referred to me for cyber knife radio surgery. Patient underwent Cyber Knife radio surgery from 11.10.2010 to 15.10.2010. Subsequent follow up with MRI and volume analysis has resulted not only arrest of tumour but also significant reduction in the volume of lesion, indicating success of treatment.

This patient was treated at Apollo Speciality Hospital, Chennai and has shown significant progress through cyberknife treatment


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CYBERKNIFE TREATMENT FOR ACOUSTIC NEUROMAS

CYBERKNIFE TREATMENT FOR ACOUSTIC NEUROMAS

An acoustic Neuroma, sometimes classified as vestibular schwannoma, is a noncancerous tumor which greatly affects the vestibulocochlear cranial nerve. This nerve is responsible for your perception of hearing and stability.

One treatment solution is cyberknife treatment . The reason for this treatment technique is to eliminate the tumor, particularly if it is already large enough to result in total deafness. Furthermore, a significant tumor can also affect and alter the capabilities of other regional organs.

The appearance of cyberknife approach is a less intrusive method for treatment is Cyberknife VSI’s noninvasive surgery for acoustic neuroma. This treatment procedure utilizes gamma radiation to eradicate the developing tumor and leave the site totally free of possibly damaging tumor cells. This type of intervention not simply guards healthy tissues, but produces minimal side effects, and boosts comfort for the patient when focusing on the cancer cells in a precise manner.

With cyberknife VSI’s noninvasive surgery for acoustic neuroma today, the apollo speciality hospital, chennai, India uses up-to-date research, technologically advanced technologies, and has professional physicians to deliver this revolutionary cyberknife treatment method for effective treatment of the acoustic neuroma.

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CYBERKNIFE IN TREATMENT OF VARIOUS CANCERS

Precision without Incision
One of the UK’s most senior Clinical Oncologists is St Bartholomew's Dr Nick Plowman and he heads this section. In his article 'CyberKnife® – cancer search and destroy’ he explains the use of this powerful new treatment option as both a stand-alone method and in collaboration with other treatments such as chemotherapy.

Then Dr Andrew Gaya, Consultant Clinical Oncologist at Guy’s & St Thomas’ Hospitals NHS Foundation Trust, explains: “Most advances in cancer treatment are small steps forward, but occasionally there is a giant leap.”

CyberKnife® has provided this leap and is now a viable alternative treatment option for:

•Major operations such as lung and liver resections,
•Removal of pancreas and prostatectomy
•Tumours in the body
•Tumours in the brain and spine including brain metastases, primary brain or brainstem tumours, pituitary tumours, acoustic neuromas, meningiomas, arteriovenous malformations and trigeminal neuralgia.

Source : http://www.totalhealth.co.uk/your-condition/cyberknife%C2%AE

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SUCCESSFUL AVM TREATMENT WITH CYBERKNIFE

SUCEESSFUL TREATMENT OF 19 YEAR OLD WITH AVM USING CYBERKNIFE

CASE HISTORY: This 19 years old college student presented with the complaints of acute onset headache, right hemiparesis and right hemianopia. MRI revealed haemorrhagic infart in left inferior thalamus extending to capsule and old left posterior capsular infart. DSA revealed left temporal AVM (feeder Medial lenticulostride branches of Left MCA draining into vein of galen through basal vein. On examination patient had right hemianopia. Patient underwent treatment with cyber knife radio surgery on 22.6.2009. Patient is on regular follow up with Volume analysis which showed good regression of nidus. January 2011 CT angio revealed complete resolution of AVM. Patient’s vision has dramatically improved.



This 19 year old girl is now 21 years, she is also entering into married life soon. We wish her a very happy married life.

DOCTOR NAME: DR. RATHNA DEVI SR. CONSULTANT RADIATION ONCOLOGIST & CYBERKNIFE SERVICES


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Cyberknife Radiation Successful For Treating Tigeminal Neuralgia

Cyberknife Radiation Successful For Treating Tigeminal Neuralgia
A small study published online in the Journal of NeuroInterventional Surgery shows that a technique in which highly concentrated beams of radiation are used, known as Cyberknife, can relieve the stabbing pain of the facial nerve condition trigeminal neuralgia.
For their study, the researchers treated 17 patients with trigeminal neuralgia between the ages of 36 and 90, with Cyberknife radio surgery between 2007 and 2009. All patients had suffered between 1 and 11 years from the condition and failed to respond to common methods of treatment.

The treatment consisted of zapping a maximum radiation dose of 73.06 Gy into a 6mm length of the trigeminal nerve, just 2 to 3mm from the root, after which the patients were frequently monitored for an average period of just less than 12 months.

Whist 14 patients reported either a partial or complete relief of symptoms; complete data was available for 16 patients. The average time before the symptoms were relieved was slightly less than two months, with variations from three weeks to half a year. The researchers noted a relapse after the procedure in four patients, occurring between 3 and 18 months later.

None of the patients reported any major complications as a result of the procedure, with only two patients reporting any sensory side effects. The researchers conclude that radio surgery provides a viable alternative to more invasive approaches and should be further investigated.

Written by Petra Rattue
Copyright: Medical News Today
Source: http://www.medicalnewstoday.com/articles/240938.php

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