CyberKnife® Stereotactic Radiosurgery

The CyberKnife® System is the only radiation delivery system which features a linear accelerator (linac) directly mounted on a robot to deliver the high-energy x-rays or photons used in radiation therapy. The robot moves and bends around the patient, approaching the tumor from potentially thousands of unique angles, significantly expanding the possible positions from which radiation beams can be delivered. The more angles and points in space from which to approach the tumor, the better a physician will be able to maximize radiation dose delivered to the tumor and help minimize dose to surrounding healthy tissues.

The CyberKnife System can essentially “paint” the tumor with a high-dose of radiation by targeting the tumor from almost any conceivable angle. The CyberKnife System is the only device designed to accommodate all forms of patient and tumor motion, even while the treatment is being delivered. The CyberKnife System uses advanced technologies to track tumors anywhere in the body, while its unique robotic design synchronizes the radiation to the target.

Before delivering the radiation beam, the CyberKnife System is the only device that verifies the exact tumor position, then adjusts the robot to precisely target the tumor. This helps to ensure radiation is delivered where the tumor is, enabling smaller treatment margins around the tumor and helping to minimize the amount of healthy tissue exposed to high dose radiation.

The CyberKnife System eliminates the need to use invasive and uncomfortable methods to minimize movement. These immobilization techniques can include attaching a metal frame directly into a patient’s skull, compression of the abdomen to limit breathing and movement during treatments, stabilizing body casts, and placement of rectal balloons into the rectum to stabilize the prostate, to name just a few.

• The CyberKnife® System was cleared by the FDA in 1999 to treat diseases in the head and base of the skull. In 2001, the FDA cleared the CyberKnife System for the treatment of tumors anywhere in the body.
• The system is used to treat conditions throughout the body, including the brain, head and neck, spine, lung, liver, pancreas, kidney and prostate, and can be an alternative to surgery for patients who have inoperable or surgically complex tumors.
• CyberKnife accuracy is sub-millimetric, which can help significantly reduce the risk of the side effects that too often disrupt the lives of patients during and after treatment.
• CyberKnife treatments are typically performed in 1 to 5 sessions
• The CyberKnife System has more than two decades of clinical proof
• Hundreds of thousands of patients have been treated with the CyberKnife System

• Relaxing, pain-free procedure
• Non-surgical and non-invasive
• Outpatient procedure
• Majority of patients can continue normal activity during and immediately following treatment
• No breath holding or “respiratory gating” required during treatment
• No incisions and a greatly reduced risk of infection
• No need for anesthesia
• Unlimited range of motion to treat tumors once considered untreatable
• No damage to surrounding healthy tissues

CyberKnife can treat tumors in the following areas of the body:

• Head
• Neck
• Spine
• Lung
• Pancreas
• Liver
• Kidney
• Pelvis
• Prostate
• Other sites as appropriate

• The CyberKnife System is designed to treat tumors throughout the body. Below is a typical treatment process for a man diagnosed with prostate cancer as an example. The CyberKnife System treatment process begins with a consultation with a radiation oncologist who will provide perspective on this as a treatment option specific to the patient’s condition. The physician will review the patient’s PSA, Gleason score, biopsy results, imaging, and other medical conditions.
• Should the patient and doctor agree to proceed with CyberKnife procedure, gold pellets (fiducials) will be implanted. These fiducials are used in many SBRT procedures as imaging reference points so that the tumor can be tracked. These three to four gold pellets are implanted about 2 weeks before the actual treatment sessions in an outpatient procedure, like a prostate biopsy, under conscious sedation.
• About one week after the fiducials are implanted, the patient will return for imaging that then allows the radiation team to develop an individualized treatment based on the patient’s unique anatomy.
• Approximately one week later the treatment sessions will begin. There are usually 4-5 sessions of short duration over 1-2 weeks*. The patient lies on the table, and the CyberKnife System uses the Synchrony tumor tracking software to synchronize the radiation beam with movement of the prostate caused by natural bodily functions.
• The procedure to implant fiducials would be performed under local anesthesia. The treatment sessions themselves are non-invasive outpatient procedures, and no anesthesia is required.

 How does my physician typically determine if I am a candidate for CyberKnife® treatment?

Following a cancer diagnosis, patients may be faced with numerous treatment options. Each person should consult their physician regarding their own specific case. Among the considerations that a physician will factor into a treatment recommendation are their clinical experience, the tumor type, location and size of the tumor, and extent of disease. Other factors that may influence their opinion are the patient’s health, age and lifestyle. It is important to keep in mind that sometimes there are many different approaches and opinions can differ. The CyberKnife® System is versatile and can treat cancers from early stages to advanced disease and, in some cases, the treatment can be partnered with surgery, chemotherapy, immunotherapy and conventional radiation therapy. The CyberKnife System may provide an effective radiation treatment option even for patients who have previously received radiation therapy.

For more information, call the St. Mary's Cyberknife Center at 304.399.7460 or (800) 9ST-MARY, ext. 7460.

Despite the higher dose rate associated with SRS and SBRT, multiple studies have validated that treatment with the CyberKnife® System is well tolerated with minimal side effects. The ability to deliver precise doses of radiation enables clinicians to decrease exposure to surrounding healthy tissue and minimize negative side effects that can impact a patient’s quality of life. The majority of patients can continue normal activity during and immediately after treatment. Nonetheless, as with any radiation treatment, side effects can also be severe in some patients and lead to permanent injury or even death. Discuss your specific case with your physician/s to fully understand the potential risks associated with your treatment.

What questions should I ask?

Many patients find it helpful to bring someone with them to their physician appointment to take notes. It can be difficult to focus during conversations about diagnosis and treatment options, so having a caring partner in the room can be advantageous when later trying to recall the details.

Specifically, take the time to understand:

• What are the most common treatment options?
• What treatment option would best preserve my quality of life?
• What is my recommended treatment option — and why?
• Am I a candidate for CyberKnife® treatment?
• What results should I expect?
• What are the side effects and risks of the procedure; and which side effects are short-term, and which ones may be long-term?
• How are these side effects managed and can they be prevented?