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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