CyberKnife® Radiosurgery

What is CyberKnife?

Like radiotherapy, CyberKnife uses beams of X-rays to destroy the DNA inside tumour cells, but the similarity ends there.
Video from Accuray Inc., manufacturers of CyberKnife
CyberKnife radiosurgery
CyberKnife Treatments
Patient Assessment  
No, the name is misleading, because there is no knife. In fact CyberKnife is a precise, painless and non-invasive radiation treatment that can be an alternative to radiotherapy or to open surgery in certain cases.
CyberKnife is used for cancer or neurosurgical treatments, avoiding radiotherapy or invasive surgery.
Like any treatment, skill and experience of the specialists is key to successful outcomes.
CyberKnife is often referred to as a treatment, typically for cancer, but this is not correct.
CyberKnife is a powerful and effective piece of equipment, which can be configured in various ways and with different hardware and software for a range of medical conditions.
Like a scalpel, it is only as good as the surgeon and technical team who are operating it, so CyberKnife centres have different areas of specialisation and varying levels of expertise.

Is it a form of 'robotic' surgery?

Most treatments are delivered on an out-patient basis and without any pain, so no anaesthesia is required and there is no hospital stay.

How does it differ from surgery?

Because there is no incision and hospitalisation there is much lower risk of infection and complications, so much faster recovery.

How does it differ from radiotherapy?

CyberKnife beams are very much finer and more powerful than those used in radiotherapy, so they can be sculpted much more accurately to the shape of the tumour.
Because they can avoid sensitive organs much more easily, CyberKnife can be used to treat complex or otherwise inacessible tumours, e.g. wrapped around an artery or optic nerve, where surgery or radiotherapy would be too dangerous.
For soft tissue tumours in the abdomen this is made more complicated because tumours are constantly on the move, as the patient breathes in and out.
This is dealt with by implanting tiny metal markers (fiducials) around the target and leaving these to settle for a few days before treatment.
The CyberKnife 'Synchrony' software then uses these to track the tumour in real time and to ensure that the radiation does not impact sensitive tissue around the tumour instead.

How long does the treatment take?

Radiotherapy is delivered over several weeks, because the much wider beams used adversely affect surrounding tissues and these must be allowed time to recover to avoid serious side effects.
Unfortunately this also allows the target tumour some time to recover, so the whole treatment extends over a longer period.
Because the impact on surrounding tissues is so much less with CyberKnife, the safe dose to be delivered to the target tumour per treatment can be much higher.  This means that treatments are completed much more quickly.
An expert CyberKnife centre can treat certain brain tumours in a single 45-90 minute treatment. Most tumours can be treated within three treatments, usually on consecutive days and it is rare for a treatment to extend beyond one week.

Patients like to breathe

How quickly will I feel the results?

Obviously this will vary between patients and between types of treatment. For neurosurgical treatments such as trigeminal neuralgia, where a nerve is targeted without surgery the effect is almost immediate
For tumours it must be remembered that the dead tissue is still present and it will take time for the body to reabsorb it, which is quicker in some areas than in others.
Treatment is completed many weeks sooner than with radiotherapy though and without the pain and recovery time resulting from surgery.

Can I fly home after treatment?

Your surgeon will advise you, but in most cases there is no difficulty in flying after treatment, so many patients travel to an expert CyberKnife centre for treatment, stay a few nights in a local hotel and return home within a week.
Prostate cancer treatment at the Frankfurt CyberKnife centre
CyberKnife doctor and patients in Munich

How does CyberKnife achieve such accuracy?

CyberKnife beams are generated by a linear accelerator mounted upon a flexible robotic arm, which can move all around a patient and deliver beams from any angle, including from below.
This accuracy of delivery is only half the story though, because it is no use unless you can also locate the target with equal precision.
No matter how still a patient tries to lie, there are always small involuntary movements.  With beams of high power this would make safe treatment impossible unless the delivery can be adjusted in real time to where the target actually is.
For tumours in the head or close to the spine, CyberKnife's image guidance system, mounted upon the delivery head, uses the body's own bone structure to track the position of the tumour in real time and adjust the delivery of each dose of radiation accordingly.
CyberKnife radiosurgery
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