May 2009

CyberKnife surgery sans scalpel : Dr. P.Mahadev, MD, DNB, DMRT, Apollo Speciality Cancer Hospital, Chennai

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The CyberKnife Robotic Radiosurgery System is a non-invasive alternative to surgery for treating both cancerous and non-cancerous tumors anywhere in the human body, including, the prostate, lung, brain, spine, liver, pancreas and kidney. 

This treatment, which delivers high doses of radiation to tumors with extreme accuracy, offers new hope for patients who have inoperable or surgically complex tumors, or who may be looking for a non-surgical option. Till date, more than 60,000 patients have been treated and more than 150 systems are installed worldwide. CyberKnife has revolutionized the way radiotherapy is delivered and its applications are increasing day by day

CyberKnife combines advanced robotics and missile-guidance technology to pinpoint the position of tumors and deliver highly focused beams of radiation without damaging surrounding tissues.

Can you think of surgery without a scalpel? Today it is possible… thanks to a high tech tool that treats tumors without needing to undergo any physical surgery.

The Apollo Speciality Cancer Hospital in Chennai recently launched its ‘CyberKnife Center’, making it the first such centre of Asia-pacific region to offer this treatment.

The word ‘knife’ conjures up an image of an invasive procedure with a scalpel at the hands of a doctor. In reality, the CyberKnife is an outpatient, totally non-invasive, painless, bloodless procedure and does not involve a knife at all. This highly advanced radiotherapy machine can literally achieve what a knife can do in the expert hand of an experienced surgeon.

At first sight the CyberKnife looks like a space age robot seen in sci-fi movies or in children’s toy shops. It is actually a compact linear accelerator mounted on a robotic arm. The CyberKnife works by delivering multiple beams of high dose radiation from a wide variety of angles. X-ray cameras monitor the patient’s breathing and re-position the radiotherapy beam in order to minimize damage to healthy tissue. Such level of accuracy enables treatment of tumors that are located in difficult or dangerous-to-treat positions inside the body, such as those near those near spinal cord.

CyberKnife is the world’s first and only whole body radiosurgery system that can treat tumors anywhere in the body with sub millimeter accuracy. The CyberKnife uses extremely precise beams of radiation, combined with data from three-dimensional scans, to target tumors and lesions all over the body. It can eradicate malignant and benign tumors that were previously thought non-treatable by conventional surgical and radiation methods.

In essence, with its high precision and accuracy, a CyberKnife procedure can provide surgery-like results, without surgery. It’s a painless outpatient procedure without the risk and complications associated with traditional surgery.

CyberKnife combines advanced robotics and missile-guidance technology to pinpoint the position of tumors and deliver highly focused beams of radiation without damaging surrounding tissues.

A computer program uates the unique shape and location of the tumor to decide the orientation of each of the 1,200 or more beams of radiation that will target the tumor.

An x-ray source located on the CyberKnife’s robotic arm delivers concentrated beams of radiation to the tumor from multiple positions and angles. Individual beams are not strong enough to damage any healthy surrounding tissue by themselves. The beams are targeted to intersect at the tumor, where their combined strength is intense.

The very flexible range of motion offered by the robotic arm allows the CyberKnife to reach tumors that are not reachable by other means.

The CyberKnife continually checks and corrects for any patient movement during the treatment, ensuring superior accuracy. Some of the technologies used are the Synchrony respiratory tracking, X-sight spine, and X-sight Lung. With this accuracy, the CyberKnife can use higher doses of radiation to attack tumors. One of the major advantages with this technology is that now even moving targets like those in the lung, liver, pancreas and prostate can be treated accurately with Radiosurgery.

Treatment Process

CyberKnife treatments involve a team approach in which several specialists like Radiation oncologists, Neurosurgeons and medical physicists participate.  Prior to the procedure, the patient is imaged using a high-resolution CT scan to determine the size, shape and location of the tumor.

Following scanning, the image data is digitally transferred to the CyberKnife System’s workstation, where the treatment planning begins. A qualified clinician then uses the CyberKnife software to generate a treatment plan. The plan is used to match the desired radiation dose to the identified tumor location while limiting radiation exposure to the surrounding healthy tissues.

Once the treatment plan has been developed, the patient is ready to undergo the CyberKnife procedure. After arriving at the CyberKnife Center, patients are comfortably positioned on the treatment table. Following this, the CyberKnife System’s computer-controlled robot slowly starts moving around the patient to various locations from which it will deliver radiation to the tumor.

Each treatment session will last between 30 to 90 minutes, depending on the type of tumor being treated. If treatment is being delivered in stages, patients will need to return for additional treatments over several days (typically no more than five), as determined by the doctor. Patients may experience some minimal side effects, but those often go away within the first week or two after treatment.

What is Stereotactic Radiosurgery?

Radiosurgery refers to the use of a high-energy beam of radiation. Stereotactic refers to the three-dimensional targeting system used to deliver the beam to the precise location desired. Radiosurgery can be performed in a single session or with divided doses, when it is known as fractionated radiosurgery. Previously, stereotactic radiosurgery was primarily confined to the head and neck, because the patient must be kept completely still during the delivery of the radiation in order to prevent damage to surrounding tissue. The motion of the patient’s head and neck was restricted by a stereotactic frame that holds them in place. It was difficult to immobilize other body regions in this way. However, with advanced technology used in CyberKnife system, the stereotactic frame is totally done away with and hence radiosurgery now can be done for lesions anywhere in the body.

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