Cyberknife for extracranial sites – pro
Lay Summary: Body radiosurgery is still being explored for other then brain cancers. It can be useful but more studies in various body sites should ideally be conducted.
he CyberKnife belongs to a new class of radiotherapy techniques called IGRT (image-guided radiotherapy). It is a type of radiosurgery, a name for a group of techniques that uses computer simulated delivery of radiation. The CyberKnife is theoretically unique in that it uses a compact linear accelerator (LINAC) mounted on an image-guided robotic arm to deliver multiple beams of high energy x-rays to a target. The ability of the CyberKnife to shape the profile of radiation to conform to the patient’s individual anatomy allows for maximum sparing of surrounding normal tissues. The CyberKnife accomplishes this by accurately cross-firing approximately 150 beams of radiation at the target from multiple directions. There are no studies comparing cyberknife or radiosurgery to other conformal radiation techniques – IMRT, Tomotherapy, or to standard therapies, prostatectomy of standard radiation therapy.
While it is very well established in neuro-oncology, it is less well studied for extracranial sites. Only a few small studies are available for each body site and very few for the pelvis. A TEC assessment and other references below indicate that it is still considered to be investigational.
DP, Gibbs IC, Heilbrun MP. An analysis of the accuracy of the CyberKnife: a robotic frameless stereotactic radiosurgical system. Neurosurgery. 2003 Jan;52(1):140-6; discussion 146-7
TEC Assessment – http://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/STATEMENTS/CYBERKNIFE_TA_9.15.06.PDF
Timmerman R, Papiez L, Suntharalingam M. Extracranial stereotactic radiation delivery: expansion of technology beyond the brain. Technol Cancer Res Treat. 2003; 2(2):153-60.
Dewas S, Dewas-Vautravers C, Servent V, Mirabel X, Prevost B, Coche B, Castelain B, Nickers P, Lartigau E. Results and special considerations when treating elderly patients with CyberKnife(®): A review of 345 cases. Crit Rev Oncol Hematol. 2010 Dec 9.
Haley M, Gerszten PC. Stereotactic radiosurgery in the management of cancer pain.
Curr Pain Headache Rep. 2009 Aug;13(4):277-81.
SJhaveri P, Teh BS, Bloch C, Amato R, Butler EB, Paulino AC. tereotactic body radiotherapy in the management of painful bone metastases.Oncology (Williston Park). 2008 Jun;22(7):782-8; discussion 788-9, 796-7.