Dr S Hukku, Chairman, Roentgen-BLK Radiation Oncology Centre, BLK CyberKnife Centre, in conversation with Shahid Akhter, ENN discusses the advent and advantage of Cyberknife in the treatment of prostate cancer.

What is the role of Radiation Therapy in urological cancers?

Radiotherapy plays both a curative and palliative role in these cancers. The main cancers which benefit with the use of curative radiation are cancer of the prostate and cancer of the urinary bladder.

In prostate cancer, modern dose escalated radiation therapy has shown results to be equivalent to surgery at a follow up of 10 years. Moreover, the complications are reduced drastically due to the use of organ sparing radiotherapy techniques.

In muscle invasive cancer of the urinary bladder, a combination of radiotherapy and chemotherapy has opened a new possibility of bladder conservation. The palliative role of radiotherapy is in the treatment of bone, and brain metastasis.

What are the new radiation therapy techniques ?

Intensity Modulated Radiation Therapy (IMRT) and Image guided Radiation Therapy (IGRT) have changed the way radiotherapy was given earlier. Use of these techniques have enabled us to escalate the dose to more than 80 Gy which has resulted in better cure rates. At the same time, the protection of normal tissues around the treated area has reduced the radiotherapy complications to a bare minimum.

These techniques have become a standard of care in treatment of urological malignancies, especially prostate cancer.
These techniques are delivered by modern machines called Linear Accelerators and three dimensional treatment planning is done on the computers before the patient is taken up for treatment.

What is the role of CyberKnife in the treatment of prostate cancer?

Radiotherapy delivered by using IMRT/IGRT takes approximately 7-8 weeks for completing the treatment. With the introduction of CyberKnife, this treatment time can be reduced to five days. This machine is a robotic linear accelerator through which a very high dose of radiation is delivered in a very short time. This is possible because of the real time imag- Prostate Cancer – Radiation Therapy for Prostate Cancer ing possible with this machine which leads to a very high degree of precision in protection of surrounding normal tissues.

This treatment can be offered as monotherapy (CyberKnife alone) in patients with low and intermediate risk prostate cancers. This can be used as a boost following IMRT/IGRT in patients with high risk prostate cancer. When used as a monotherapy, the treatment is over in five days. A three day treatment is required as a boost after five weeks of IMRT/IGRT.

CyberKnife is also a useful tool for treating bone, brain, lung, and liver metastasis from cancer of the kidney, prostate, urinary bladder, and testis. The treatment is short (three days) and much more effective than conventional radiation.

Please share your experience at BLK CyberKnife Centre in treatment of urological cancers?

We are offering CyberKnife radiosurgery as a treatment modality to all patients of prostate cancer.
Over the last one year we have treated ten patients with this modality. At a follow up ranging from 2-13 months. All patients have a biochemical control. There have been no bladder or bowel complications n these patients till now.
In addition we have treated bone. Liver, and brain metastasis in patients with this modality with excellent results.

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