The Target Locating System for CyberKnife Neuroradiosurgery
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Cyberknife
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This chapter discusses the purpose, principle of operation, specifications, and applications of CyberKnife. CyberKnife, a robotic radiosurgery system, offers a noninvasive alternative to surgery for the treatment of both cancerous and non-cancerous tumours anywhere in the body. It is an image-guided stereotactic radiotherapy treatment, in which high doses of focused radiation beams from a linear accelerator are delivered using image-guided robotics from multiple locations outside of the body to destroy a tumour or lesion within the body. The CyberKnife provides the appropriate radiation dose that is confined precisely to the treatment volume and at the same time minimizes the risk of spinal cord injury. The working of the CyberKnife System depends upon sophisticated software and advanced imaging to track tumour and patient movement and adjust the beams of high-dose radiation for treatment with a high degree of accuracy.
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This study aims to evaluate the planned dose of stereotactic body radiation therapy (SBRT) for treating early peripheral non-small cell lung cancer (NSCLC) using the non-coplanar radiation from Cyberknife and Varian linac. Moreover, this study investigates whether Cyberknife and Varian linac are qualified for non-coplanar radiation SBRT for treating early peripheral NSCLC, and which one is better for protecting organs at risk (OARs).Retrospective analysis was performed based on the Cyberknife radiation treatment plans (RTPs) and Varian Eclipse RTPs of 10 patients diagnosed with early peripheral NSCLC. The dose distributions in the target and OARs were compared between the RTPs of Cyberknife and Varian Eclipse using Mim medical imaging software.For PTV, no significant difference in D98 and D95 between the Cyberknife and Eclipse was observed (t = -0.35, -1.67, P > 0.05). The homogeneity indexes (HIs) of Cyberknife plans are higher (t = 71.86, P < 0.05) than those of Eclipse plans. The V10, V15, V20, V25, V30 and Dmean of the lung with NSCLC and the V20 of the whole lung for Cyberknife were less than those for Eclipse (t = -4.73, -5.62, -7.75, -6.38, -6.89, -3.14, -7.09, respectively, P < 0.05). Cyberknife plans have smaller spinal cord Dmax, trachea Dmax, heart Dmax, chest wall Dmax (t = -2.49, -2.57, -3.71, -3.56, respectively, P < 0.05) and esophagus Dmax (t = -1.95, P > 0.05) than Varian Eclipse plans.To fulfill SBRT by non-coplanar radiation, Cyberknife is recommended for the institutions equipped with Cyberknife, while Varian linac can be applied for the institutions that have not adopted Cyberknife in clinical radiotherapy yet.
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The CyberKnife is a small linear accelerator mounted on a robot. The CyberKinfe has the IPS(Image Processing System) that evaluates the patient position during the treatment. If there is any movement of the patient, the robot chases the tumor. Invasive flame to fix the patient skull is not needed. From April 1998 through July 2000, we applied the CyberKnife treatment for 136 sites in 94 patients. Sixty-seven of 136 sites were metastatic brain tumors. Progression-free rate of tumors treated with 24-27 Gy at 3 months after treatment was 89%. There was no severe adverse effects except epilation. The CyberKnife treatment was applied for tumors in the body in USA. It will be available in Japan in near future.
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Background: CyberKnife is a frameless image-guided robotic system for stereotactic body radiotherapy. It can deliver an accurate and concentrated radiation beam to intracranial and extracranial targets for benign, malignant and some non-neoplastic conditions. Objective: To report the first hepatocellular carcinoma (HCC) treated with CyberKnife at Ramathibodi Hospital. Patient and methods: A 73- year-old man with a large right lobe hepatocellular carcinoma was treated with CyberKnife with the total dose of 4500 cGy in three fractions. Results: Two weeks after CyberKnife, he developed radiation induced liver damage (RILD). The patient was admitted for observation and supportive treatment. He was discharged with much improvement of symptoms. Abdominal MRI taken 1 and 3 months after the CyberKnife revealed a significant reduction in size of HCC. His serum alpha fetoprotein was also decreased from 833 ng/mLto 12 ng/mL. Conclusion: The present Robotic Radiosurgery was an effective alternative treatment for HCC. Early detection and proper supportive care was very important to decrease the morbidity from this serious radiation.
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We evaluated local control of hepatocellular carcinoma (HCC) treated with Cyberknife, stereotactic body radiation therapy (SBRT). CyberKnife, SBRT system with real-time tumor tracking has good efficacy and low toxicity.54 patients with 67 liver-confined HCC were treated with Cyberknife. Fiducials were implanted in the liver before treatment and were used as markers to track the lesion's movement. A total dose of 30 to 60 Gy in three fractions was prescribed to the 80%isodose line. Treatment response was evaluated by RECICL, CR: 82%, PR: 16%, PD: 2%. The local control rate was 92.3%at 1 year. Cyberknife was a safe, effective, noninvasive option for patients with HCC.
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Robotized system for radiosurgery CyberKnife (Accuray Inc., USA) is the first device dedicated and optimized for advanced irradiation during 1-7 fractions (i.e. radiosurgery and hypofractionation). CyberKnife is characterized by elaborate guidance system, high precision of dose delivery, possibility of conformal dose distributions with high gradient of target borderline dose which is most important in proximity of critical structures. The first CyberKnife system in Russia was installed in Burdenko Neurosurgery Institute. The paper presents 2-year experience of treating patients using CyberKnife. From April 2009 till October 2011 896 patients were treated using CyberKnife. Mean age was 48 years. Overall number of sessions was 2626. Radiosurgical procedures were performed in 21.8% of patients. 91% of cases were treated for intracranial lesions. Limited follow-up period in all kinds of pathology demonstrated results consistent with standard fractionation or radiosurgery. The rates of observed complications were also comparable with accepted techniques. CyberKnife system plays significant role in everyday activity of department of radiation therapy. In careful and thorough selection of patients it allows efficient and high-quality treatment of patients with neurosurgical diseases.
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