CyberKnife Radiosurgery

Overview

Radio-neurosurgery reduces radiation exposure to healthy tissue surrounding the tumor. When compared to traditional radiosurgical procedures, the CyberKnife provides patients with various benefits, including immediate alleviation from pain and other problems.

Treatments are given on an outpatient basis, with each session lasting 30 to 90 minutes. The number of treatments necessary varies based on the size, location, and form of the tumor, but normally just one to five daily sessions are required. The CyberKnife lets patients to lie comfortably on the operation table without anesthesia while the robotic arm glides to treat all parts of the tumor without touching them. Because of the low risk of complications and injury to good tissue, recovery is frequently quick.

Some disorders may be treated using the CyberKnife, a non-invasive radiotherapy device that similarly provides a single, carefully focused, high dosage of radiation. The CyberKnife is mostly used to treat minor benign or malignant brain tumors, epilepsy, trigeminal neuralgia, and aberrant blood vessel forms in the brain.

 

Indications for Cyber Knife Neurosurgery

Early detection of brain tumors can have a significant impact on their outcome. Brain tumors are the second greatest cause of cancer mortality in children under the age of 15, as well as the second fastest rising cause of cancer death in people over the age of 65. More than 100,000 people in the United States will be diagnosed with a brain tumor in the coming year. All of the following conditions can be treated using Cyber Knife Neurosurgery:

• Primary Brain Tumors

Primary brain tumors are those that arise in brain tissue and are categorised according to the type of tissue in which they originate. Gliomas are the most frequent type of brain tumor, and they develop in the glial or supporting tissue. Gliomas are classified into numerous types:

1. Astrocytomas. These tumors develop from astrocytes, which are tiny, star-shaped cells. They can develop in any part of the brain or spinal cord. Adult astrocytomas are most commonly seen in the cerebrum. They occur in the brain stem, cerebrum, and cerebellum of youngsters. Anaplastic astrocytoma is another name for a grade III astrocytoma. A grade IV astrocytoma is also known as a glioblastoma multiforme.
2. Gliomas of the brain stem. These tumors develop in the brain's lowest, stem-like region. Many critical activities are controlled by the brain stem. The vast majority of brain stem gliomas are high-grade astrocytomas.
3. Ependymomas. These tumors often form in the ventricular lining. They are also possible in the spinal cord. These tumors can appear at any age, although they are more frequent in childhood and adolescence.
4. Oligodendrogliomas. These tumors develop in the cells that make myelin, the fatty sheath that protects neurons. These tumors often develop in the cerebrum. They are uncommon, develop slowly, and seldom disseminate into neighboring brain tissue. They are most common in middle-aged individuals, but they have been observed in persons of various ages.

There are other types of brain tumors that do not begin in glial tissue. Some of the most common are described below:

1. Medulloblastomas. Glial cells were originally assumed to be the source of these malignancies. Recent research, however, reveals that these tumors grow from primitive or developing nerve cells, which do not ordinarily survive in the body after birth. As a result, medulloblastomas are sometimes known as primitive neuroectodermal tumors (PNET). Medulloblastomas are most commonly seen in the cerebellum, however they can also develop in other regions. These tumors are particularly frequent in children and affect boys more than girls.
2. Meningiomas. These tumors develop from the meninges, which are the membranes that surround the brain and spinal cord. They are typically harmless. Because these tumors develop at such a slow rate, the brain may be able to adapt to their presence. Meningiomas often develop to be fairly big before causing symptoms. They are most common in women between the ages of 30 and 50.
3. Schwannomas. These benign tumors arise in Schwann cells, which generate the myelin that covers the acoustic nerve, or hearing nerve. They mostly affect adults. Women are twice as likely as males to have these tumors.
4. Craniopharyngiomas. These tumors form in the pituitary gland area near the hypothalamus. They are normally benign, although they can press on or injure the hypothalamus, a part of the brain that affects key activities. These tumors most commonly affect children and teenagers.
5. Tumors of germ cells. These cancers emerge from developing sex or germ cells. Germinoma is the most common kind of germ cell tumor in the brain.
6. Pineal gland cancers. These tumors develop in or around the pineal gland, a small structure located in the center of the brain. The tumor can grow slowly (pineocytoma) or quickly (pineoblastoma). The pineal area is extremely difficult to access, and these tumors are frequently unremovable.
7. Arteriovenous malformation (AVM). AVMs are abnormal tangles of arteries and veins in your brain. In an AVM, blood flows from your arteries to veins, bypassing smaller blood vessels (capillaries). AVMs, if left untreated, may "steal" the normal flow of blood from the brain, causing a stroke, or lead to bleeding in the brain. Radiosurgery destroys the AVM and causes the blood vessels to close off over time

 

• Secondary Brain Tumors

Cancer spread is referred to as metastasis. Cancer that starts elsewhere in the body can move to the brain and generate secondary tumors. These tumors are distinct from primary brain tumors. Cancer that spreads to the brain is the same illness as the original or primary cancer and has the same name. If lung cancer spreads to the brain, for example, the condition is known as metastatic lung cancer because the cells in the secondary tumor resemble aberrant lung cells rather than abnormal brain cells.

Secondary brain tumor therapy is determined by where the disease began and the degree of its spread, as well as other criteria such as the patient's age, general health, and reaction to previous treatment.

 

Benefits of CyberKnife Treatment

CyberKnife is a noninvasive radio-neurosurgery technology used to treat malignant and noncancerous tumors, as well as other conditions. Radiosurgery is a sort of radiation therapy that is precisely focused on cancer cells and other types of sick tissue while limiting exposure to neighbouring, healthy tissue.

CyberKnife has several benefits over alternative radio-neurosurgery devices and traditional radiation therapy, including:

1. More radiation to the target: CyberKnife enables higher-dose radiation to the target region for faster, more effective treatment than with standard radiation therapy.
2. Less radiation to healthy tissue: Surrounding healthy tissues receive significantly less radiation than with traditional radiation therapy.
3. Safe alternative to radiation: CyberKnife can safely treat tumors that had previously received radiotherapy. It’s also safe and effective for other conditions and tumors that cannot be treated with traditional radiation because they are too close to critical brain, spinal cord, or other tissue.
4. Advanced imaging for treatment planning: Each tumor has a unique shape, size, and location. CyberKnife’s technology integrates and studies results from various forms of imaging, such as CT, MRI, and PET scans, to develop a treatment plan for targeting and delivering the radiation beam.
5. Real-time tumor tracking: Before administering the radiation beam, the device employs advanced imaging and tumor tracking capabilities to confirm the exact tumor site. The tracking continues during radiation administration, taking into account any movements you make, including breathing. This tracking guarantees that radiation is administered exactly to the tumor and not to healthy tissue in the surrounding area. It also preserves healthy tissue by preventing radiation delivery if the tumor moves out of its beam.

 

CyberKnife vs Gamma Knife

Both Gamma Knife and CyberKnife are clinically proven devices for administering high-dose radiation to malignancies with sub-millimeter precision. The similarities, however, end there. CyberKnife has developed from the traditional Gamma Knife technology to increase patient comfort during and after treatment and to broaden the areas of the body that may be treated. 

CyberKnife, like Gamma Knife, can perform dedicated stereotactic radiosurgery (SRS), but it can also deliver stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), allowing it to treat patients throughout the body rather than just the brain and cervical spine.

Both systems employ SRS to treat brain cancers, vascular lesions, and functional diseases include acoustic neuroma, trigeminal neuralgia, and arteriovenous malformations (AVM). SRS is commonly used as a first-line therapy for operable, inoperable, or recurring brain tumors. However, it can also be used in conjunction with surgery, chemotherapy, and other therapies. Despite the fact that both the Gamma Knife and the CyberKnife can administer SRS, there are significant variances.

Another difference between the two systems is the method of radiation delivery. Gamma Knife is limited in the number of angles it can approach the tumor, while CyberKnife can deliver radiation from thousands of angles, limiting the impact of radiation on healthy tissue or organs surrounding the tumor.

 

Preparing for Your CyberKnife Treatment

Generally, you will have consultation appointments with both the surgeon and the radiation oncologist. The CyberKnife nurse coordinator will arrange for insurance pre-authorizations and inform you of your dates for pre-treatment tests. These tests may include blood work and a CT scan, MRI or PET scan.

Men undergoing prostate cancer radiation therapy can benefit from this enhanced prostate cancer radiation therapy protection using Space OAR (Organs at Risk) hydrogels. 

To preserve rectal cells from harm and hence enhance results, the biodegradable spacers push the rectum away from the prostate and out of the high-dose radiation zone. Space OAR gels are injected in a minimally invasive technique, are safe to use, and disintegrate after therapy, leaving no trace.

• Scanning

You will undergo imaging examinations to identify the size, shape, and location of the tumor before to treatment with the CyberKnife System. A normal high-resolution CT scan is used to start the process. Other imaging modalities, such as MRI, angiography, or PET, may be employed for some cancers.

• Planning

Following the scanning procedure, picture data is digitally sent to the treatment-planning workstation of the CyberKnife system. The treating physician determines the exact size, shape, and location of the tumor here. The CyberKnife software is then used by a skilled physician to produce a treatment plan that delivers the required radiation dose to the diagnosed tumor area while minimizing damage to surrounding healthy tissue. You are not need to be present throughout this stage of the procedure.

 

What Happens During CyberKnife Treatment?

You'll lie on a bed that slides into the CyberKnife machine, and your head frame will be securely fastened to a helmet within.

During the day, an intravenous (IV) tube will feed fluids to your bloodstream to keep you hydrated. The IV's needle is inserted into a vein, most often in your arm.

Depending on the size and form of the target, the treatment may take less than an hour to four hours to complete. Throughout the procedure:

• You won't feel the radiation.
• You won't hear any noise from the machine.
• You'll be able to talk with the doctors via a microphone.

CyberKnife radiosurgery is usually an outpatient procedure, but the entire process will take most of a day. You may be advised to have a family member or friend who can be with you during the day and who can take you home. In some cases, an overnight stay in the hospital may be necessary.

 

Risks of CyberKnife Treatment

Because CyberKnife radiosurgery does not need surgical incisions, it is often less hazardous than standard neurosurgery. There are risks related with anesthetic, hemorrhage, and infection in traditional neurosurgery.

Early difficulties or adverse effects are typically transient. Some people have slight headaches, tingling on the scalp, nausea, or vomiting. Other potential adverse effects include:

1. Fatigue. Tiredness and fatigue may occur for the first few weeks after CyberKnife radiosurgery.
2. Swelling. Swelling in the brain at or near the treatment site might result in a range of symptoms, depending on which parts of the brain are affected. If post-treatment swelling and discomfort arise as a result of the CyberKnife treatment, they generally appear six months after treatment rather than immediately after the procedure as with traditional surgery. Your doctor may give anti-inflammatory drugs (corticosteroid medications) to prevent or treat such issues.
3. Scalp and hair problems. At the four locations where the head frame was attached to your head during the treatment, your scalp may feel red, itchy, or sensitive. However, the head frame leaves no lasting traces on the scalp. Some patients may have temporary hair loss if the region being treated is directly beneath the scalp.

Rarely, patients may develop late adverse effects months after CyberKnife radiosurgery, such as other brain or neurological issues.

 

CyberKnife Radiosurgery Outcome

Depending on the problem being treated, the therapy impact of CyberKnife radiosurgery is gradual:

1. Benign tumors. Tumor cells are unable to multiply as a result of CyberKnife radiosurgery. The tumor may diminish over the course of 18 to two years, but the primary purpose of CyberKnife radiosurgery for benign tumors is to prevent future tumor development.
2. Cancerous tumors. Cancerous (malignant) tumors may diminish more quickly, frequently in a matter of months.
3. Aortic and venous malformations (AVMs). The radiation treatment thickens and closes the aberrant blood arteries of brain AVMs. This procedure might take two years or more.
4. Trigeminal neuralgia. CyberKnife radiosurgery creates a lesion that blocks transmission of pain signals along the trigeminal nerve. Pain relief may take several months.

You'll receive instruction on appropriate follow-up exams to monitor your progress.

 

Conclusion

Patients treated with the CyberKnife today would have previously been declared untreatable with surgery or conventional radiation therapy in many circumstances.

CyberKnife radiosurgery is a cutting-edge radiation treatment that precisely delivers a high dose of radiation to tumors located anywhere in the body. It is named "radiosurgery" because of its accuracy and because it is a painless, non-invasive technique. It is classified as stereotactic radiosurgery.

To precisely target a tumor, the CyberKnife device produces a tiny beam of radiation from a robotic arm that travels around the patient's body. The robotic arm automatically tracks and adjusts for tiny movements using brain scans collected before and during the treatment. Throughout the operation, a precise map of the tumor's position in the brain is constantly updated, allowing the patient to lie down properly on the treatment bed without anaesthetic. 

The robotic arm's flexibility also allows it to treat regions of the body that previous radiosurgery procedures cannot, such as the spine and spinal cord.

Generally, CyberKnife radiosurgery treatments are split into 1-5 daily sessions, each lasting 30-90 minutes. The number and total dose of radiation treatment depends on the size, location, and shape of the tumor. 

The precision of advanced radiosurgery techniques minimizes radiation exposure to the healthy tissue surrounding a tumor.