CyberKnife therapy of 24 multiple brain metastases from lung cancer

CyberKnife therapy of 24 multiple brain metastases from lung cancer

Brain metastases from systemic cancer are the most common type of intracranial neoplasm in adults, being almost 10 times more common than primary malignant brain tumors, which cause a significant burden on the management of patients with advanced cancer (1). The lungs represent one of the most frequent sources of metastases to the brain, with a probability of (36–64%) (3). Symptoms suffered by the patients include headaches, epilepsy, focal weakness, numbness or changes in mental status. The prognosis of patients with brain metastases is not optimistic and the median survival time is ∼1–2 months if left untreated. The 1-year survival rate has been recorded as 10.4% (4,5). The treatment of metastatic brain tumors is complex; not only due to being able to provide local control and improve neurological function, but also due to factors such as age, performance and systemic disease status and the size, volume, location and number of metastases at presentation

CyberKnife is a robotic radiosurgery system with a linear particle accelerator (linac), which is coupled with real-time imaging to track and compensate for the patient’s or target’s motion. As a relatively non-invasive treatment modality, CyberKnife demonstrates certain benefits, including a more accurate target localization and improved dose delivery for the management of metastatic brain tumors that allows higher biologically effective dose delivery without increased incidence of toxicity.

In the present case, the results for the treatment of multiple brain metastases after CyberKnife surgery with a 7–8 Gy marginal dose was promising. CyberKnife for metastatic brain tumors is an effective and safe method for reducing the marginal dose prescribed for multiple brain metastases and for minimizing the radiation-related neurotoxicities. In conclusion, CyberKnife, a focused, highly-targeted radiosurgery and fractionated radiotherapy is particularly useful for multiple brain metastases. CyberKnife provides the advantage of the management of local recurrence and a tolerable complication rate. Although the treatment of brain metastases has been performed with CyberKnife, the clinical significance and optimal dose fractionation scheme require further investigation.

Source : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788854/

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CYBERKNIFE -INTRACRANIAL TREATMENT REVIEWS

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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