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The CyberKnife® is a state-of-the-art, radiotherapy equipment for robotic radiosurgery that allows radiation oncologists to treat pathologies painlessly, without the need for an operation.
CyberKnife® uses pencil beams of radiation which can be directed at any part of the body, from any direction with the help of a robotic arm. The system tracks the tumour's position, detects any movement of the tumour or patient, and automatically corrects radiation delivery.It then targets the tumour with multiple beams of high-energy radiation, destroying abnormal tissue without damaging surrounding areas.
The treatment is so accurate that it's now possible to treat tumours previously thought to be inoperable and untreatable. Although the results of treatment do not always show immediately, in most cases, the procedure will initially stop the growth of tumours, before gradually reducing their size.
As there is no open surgery, the risk complications normally associated with an operation are eliminated, as is the need for a long recovery time. This makes treatment suitable even for those who are not well enough to cope with surgery. Most patients leave the hospital the same day.
How CyberKnife® works
CyberKnife® gives patients new hopes for treatment of tumours previously labeled as inoperable or untreatable. As mentioned earlier, the CyberKnife® uses pencil beams of radiation, that can be directed at any part of the body from any direction, via a robotic arm. The vast array of different angles/trajectories from which pencil beams of radiation converge upon the tumour lead to a high cumulative dose of radiation at the convergence point (the target/tumour), and yet a very fast 'fall-off' of dose towards the periphery of the carefully mapped target. The surrounding normal tissues/organs only receive a small fraction of the high dose to the target.
Whilst the tumour may be destroyed by an efficiently high dose of Cyberknife radiation conventional radiotherapy cannot usually do the same without exposing the surrounding organs leaving behind side effects. CyberKnife® often overcomes this problem by its capability to reach the target area with pinpoint accuracy.
CyberKnife® system consists of an advanced lightweight linear accelerator (LINAC) - this device is used to produce high energy ‘pencil’ beams of radiation.
There is a robot, that can make the linear accelerator point from a wide variety of angles. It’s movements are under the control of a central computer. This centralized computer controlled movement of the system that’s also called as the ’Brain’ of the machine
A pair of X-ray cameras are able to obtain frequent pictures of the patient during the treatment session. The computer uses this information to target the radiation beam with sub-millimeter accuracy.
The use of the robot in the CyberKnife® System is vital in delivering radiation beams accurately whilst movement of the patient or that of the target is closely monitored during the treatment. Any change in the position of the patient is detected by the cameras and then the robot adjusts its position accordingly to allow re-targeting of the linear accelerator before delivering the radiation beam. Use of the robot ensures that there is no need to manually reposition the patient during treatment as a result of movement, thereby slowing down the treatment process.
CyberKnife® with Synchrony
The Synchrony system is an additional, enhanced system that works along side the CyberKnife® System. According to Accuray (the manufacturer of CyberKnife®), the Synchrony system is the first technology in the world capable of delivering radiosurgery to tumours affected by the respiratory cycle. This includes tumours of the lungs, liver, kidney and pancreas.
Synchrony uses a complex system of cameras, motion tracking software, fibre-optic sensing technology, infrared emitters and a special tight-fitting elastic patient garment. As a patient undergoes CyberKnife® treatment the synchrony system
continually identifies patient breathing movement in conjunction with the internally placed fiducial markers and then updates the treatment delivery of the radiation beams. It means that the CyberKnife® system is always able to track the tumour in real time, thus allowing maximum precision of radiation delivery and minimum risk of damage to surrounding healthy tissue.
The majority of CyberKnife® centres around the world use Synchrony technology in conjunction with the CyberKnife® robot. Centres which only treat intracranial tumours do not need respiratory tracking and therefore may use CyberKnife® without the Synchrony system.
Astrocytoma, glioma, glioblastoma multiforme, oligodendroglioma :
CyberKnife® offers superior conformance to tumour shape, which is important especially for recurrence after surgery and conventional radiotherapy. CyberKnife® can also irradiate the tumour bed to delay or prevent recurrence.
Brain metastases :
Radiosurgery may be equal to surgery for single metastases and better for multiple metastases. Advanced imaging allows CyberKnife® to treat those that are widely dispersed.
Spinal tumours :
CyberKnife® is regularly used to treat spinal metastases. It may also serve as a treatment for many primary spinal tumours.
Pituitary adenoma :
CyberKnife’s® staged treatments may help to avoid or minimize the risk of visual loss and other side effects associated with single-session radiosurgery. Its superior conformance minimizes irradiation of normal tissue, including the optic chiasm and hypothalamus.
Hemangioblastoma :
CyberKnife® non-invasively treats the tumour nodule, usually in one session, even in hard-to-reach areas. This is especially beneficial for Von Hippel Lindau disease patients who can become disabled by multiple surgeries.
Skull base tumours :
The proximity of these tumours to vital nerve and vascular structures makes them surgically problematic.
Chordoma :
Since chordomas are relatively radioresistant and close to vital structures, they were frequently labeled as untreatable. Superior conformance and staged sessions permit higher doses therefore. CyberKnife® should be considered as a primary treatment option, the treatment of choice by now.
Meningioma :
For smaller meningiomas, radiosurgery is an ideally non-invasive therapy. CyberKnife® is especially safe for meningiomas adjacent to critical structures because it can be delivered in fractions.
Neurofibroma & Schwannoma :
While these tumours’ resistance to radiation makes conventional radiotherapy an option only when surgery is not, CyberKnife’s® conformance makes it an effective alternative to radiation therapy and surgery for selected patients.
Acoustic neuroma :
Studies show that CyberKnife® treatment in stages offers the highest rates ever achieved for hearing and facial-nerve preservation besides effective control of the tumour-growth.
Intracranial AVMs :
With CyberKnife®, we can treat locations that can’t be safely approached with microsurgery or endovascular therapy. Selected AVMs have an 80% chance of disappearing after a single treatment session though it may take some time. CyberKnife® can also be used in conjunction with other therapies to remove remnants.
Spinal AVMs :
CyberKnife® is the first and the only system to offer radiosurgical treatment of spinal AVMs .It provides the same or even more accuracy and success as for intracranial AVMs.
Trigeminal neuralgia :
Unlike invasive therapies and conventional radiotherapy, CyberKnife® is painless, frameless and less risky to be used in functional Neurological conditions like in Trigeminal neuralgia.
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