Monday, June 11, 2012

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.


For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com

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


For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com

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 :


For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com

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 :

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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/

 

 

FOR MORE INFORMATION  YOU CAN BLOG YOUR COMMENTS OR WRITE TO Lakshmipriya_b@apollohospitals.com