Why Am I Hearing So Much About CyberKnife?

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Radiation oncologist and CyberKnife expert Abraham Wu

Radiation oncologist Abraham Wu explains that CyberKnife is a brand name for one of several available stereotactic radiosurgery devices.

Note: This article was updated in November 2018.

Advertisements for a radiation delivery system called CyberKnife® have prompted a large number of questions from patients inquiring whether it employs a unique new technology.

CyberKnife is used in a type of radiation therapy called stereotactic radiosurgery (also known as stereotactic radiotherapy). This treatment destroys tumors with extremely precise, very intense doses of radiation while minimizing damage to healthy tissue, offering accuracy akin to the sharpness of a surgeon’s scalpel.

Memorial Sloan Kettering radiation oncologist Abraham J. Wu employs stereotactic radiosurgery to treat lung and gastrointestinal cancers. He explains that CyberKnife is a brand name for one of several available stereotactic radiosurgery devices that deliver radiation with linear accelerators, or devices that form beams of fast-moving subatomic particles. The beams are precisely directed through the use of advanced imaging technologies combined with a sophisticated computer guidance system.

“There are a lot of different machines and a lot of different marketing terms thrown around, but they all achieve the same goal, which has two critical components,” Dr. Wu says. “One is delivering a more intense dose of radiation in just a few sessions. This is called hypofractionated radiation therapy. The other is targeting the radiation very accurately by pinpointing the precise location of the tumor during treatment.”

At MSK, radiation oncologists use linear accelerators made by a company called Varian. The Varian machine Dr. Wu most often uses — primarily to treat lung tumors — employs a system called TrueBeamTM, which incorporates computed tomography (CT) imaging into the same device that delivers the radiation. This allows the radiation therapists to make sure patients remain in the proper position during radiation therapy and to adjust the radiation beams as needed.

MSK Precise: Larger Doses over a Shorter Period

MSK Precise incorporates the TrueBeam system to deliver hypofractionated radiation therapy. With this treatment approach, a radiation beam can be very precisely targeted to a tumor. The total radiation treatment can be split into fewer sessions, using larger doses given over a shorter period.

“Really, the big breakthrough in recent years has been the advent of CT imagers on the treatment machine itself — as we have with the TrueBeam — which allows us to ensure the accuracy of radiotherapy treatments with the highest precision,” he says. “Interestingly, CyberKnife does not incorporate a CT imaging machine into the device — it uses a different system of image guidance.”

In addition to using CT imaging, MSK Precise also employs MRI in the treatment of some cancers, particularly prostate cancer. When MRI is used to plan the treatment, CT scans are not needed. MSK is the only institution in the world to routinely use MRI for hypofractionated radiation therapy.

The main distinguishing feature of CyberKnife is that the linear accelerator is mounted on a robotic arm. While this offers more flexibility and freedom of movement in how the radiation beam is delivered, Dr. Wu says that “in practice this is rarely something that is going to make a difference in how precisely we treat someone. We can still deliver the radiation to a given target.”

What is important, he explains, is the skill and experience of the radiation oncologists and medical physicists who define the radiation target.

“There are a lot of different technical solutions to achieve the kind of accuracy that you need to deliver very high doses of radiation — it’s a variety of different means to the same end,” Dr. Wu says. “We’re convinced that our Varian machines enable us to perform stereotactic radiosurgery at the highest level.”

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Cindy, thank you for your comment. Cyberknife actually is a type of Image-Guided Radiation Therapy, (as is the Varian TrueBeam device used at MSK). Advanced imaging technologies combined with a sophisticated computer guidance system direct the radiation to the correct spot. Both Cyberknife and TrueBeam are stereotactic radiosurgery devices that deliver radiation with linear accelerators, forming beams of fast-moving subatomic particles to the precise location of the tumor.

Thank you for reaching out. Stereotactic radiosurgery (the technology used by TrueBeam and Cyberknife) can be used to treat colon cancer. As always, only a radiation oncologist who knows the details of the individual case can say for sure whether such treatment is feasible and appropriate.

If you would like to make an appointment with a physician at Memorial Sloan Kettering to discuss treatment options, please call Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

What is the newest type of ciberknife technology?

Mark, thank you for your comment. CyberKnife is a brand name for one of several available stereotactic radiosurgery devices that deliver radiation with linear accelerators, or devices that form beams of fast-moving subatomic particles. This treatment destroys tumors with extremely precise, very intense doses of radiation while minimizing damage to healthy tissue, offering accuracy akin to the sharpness of a surgeon’s scalpel.

An even newer form of radiation therapy now offered by Memorial Sloan Kettering experts is proton therapy, an advanced form of radiation therapy that delivers high doses of radiation to radio-resistant tumors. You can learn more about proton therapy here:

http://www.mskcc.org/cancer-care/doctor/oren-cahlon

If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks again for your comment.

i have stage 4 cancer. i was wondering if Cyberknife is an oppion for me ? it is in my lungs, limpnodes of the lungs, limpnodes of my stomach, and a spot of my liver

Dear Dennis, we are sorry to hear about your diagnosis. We cannot offer personal medical advice on our blog, but if you’d like to make an appointment with one of our specialists for a discussion about your treatment options, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

Can metastasis to the adrenal glands from lung cancer be treated with either CyberKnife or TrueBeam?

Gail, thank you for your comment. We passed your question on to Dr. Wu, and he replied:

Yes, either CyberKnife or TrueBeam may be used to treat adrenal metastasis. As always though, whether this is beneficial and technically possible depends on each patient’s situation.

Having been an advocate for cyberknife treatment for the past 5 years as I have seen the results and cure rate for complex tumors I now see that there is another type of targeted radiation called truebeam. How does the treatments differ between cyberknife and truebeam? Or are they essentially the same treatment? My mother in law travelled to ottawa for cyberknife treatment on 2 complex tumors one in each lung approximately 5 years ago and is completely cancer free.she required 7 treatments and nothing else.a fiducial had to be implanted in the tumor in her left lung as the tumor was close to the heart&the trial run showed that the cyberknife had problems tracking the tumor in her left lung and 50% of the time it targeted her heart until the fiducial was placed in the tumor. Thank you for your time as my father will have to have his prostate treated he is 89 and realistically too old for surgery.definitely the risks for surgery outway the benefits. Kgh has recently acquired a truebeam while Ottawa has a cyberknife. Thank you again.

Leslie, thank you for reaching out. We consulted with Dr. Abraham Wu, who responds: Cyberknife and TrueBeam are brand names for radiation therapy devices, both of which are specially designed to deliver stereotactic radiosurgery. Advanced imaging technologies are combined with a sophisticated computer guidance system to direct high doses radiation to small areas with great precision. In most cases, either CyberKnife or TrueBeam can be used to deliver stereotactic radiosurgery for a given tumor, even though the machines have certain technical differences. Decisions about the best therapy and best technology are based on each individual case, and we suggest your father consult with his physician on this.

Thank you so much for your prompt response. I saw an article from kgh saying they had acquired this truebeam. First patient had to have this treatment something like 35 treatments plus chemo. My mother-in-law only had 7 treatments with cyberknife no chemo. This would lead me to believe that cyberknife is more effective not to mention the fact that cyberknife cost was $4 million and the truebeam was $2 million. And I'll tell you my mother-in-law had to fight tooth and nail with kgh for a referral to Ottawa. Her g.p. ended up sending her for a referral. I am so glad I found this blog! This is the kind of info patients need and should have every option put on the table. I truly believe that between cyberknife and stem cell therapy every case of cancer should be curable. Thank you again...and as always people have a right to know every option for treatment. Keep up the fabulous work!

Hello,

My dad has liver cancer that has metasisized to his lungs. He has undergone radiation treatment in 2013 and 2014. When he received radiation treatment the first time, he had side effect but was able to recover from it. When he received radiation in 2014, he has not recover. It's been 4 month and he is still very weak. There is a tumor in his airway that is causing him to have shortness of breath. Doctors has said the last radiation treatment did quite some damage to his lungs. We have visited a Cyberknife center in our area and the doctor told us they have never treated a patient that has undergone 2 radiation treatments prior to cyberknife. would Cyberknife be an option for my dad?

Vicki, thank you for reaching out. We are sorry to hear about your father’s condition. Although MSK does not actually use Cyberknife, our doctors do use similar stereotactic radiosurgery devices to treat tumors. (The same technology.) If he is interested in a medical consultation to learn whether this treatment is possible for his specific case, we recommend that he contact our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

Thanks for your comment.

Hi i have tumour on my sacrum bone would cyberknife be any help for this ?

My husband has stage 4 reoccurring colon cancer since 2013. He has had two surgeries to remove part of the colon and part of the stomach and a third major surgery for a perforation. He has been in chemotherapy treatment since Sept 2014 with initial great results. CA #'s were 350 when he began is now at 2.5. In a recent PET scan a small (1.2cm) area was detected in the right upper abdomen that was not there in 12/14. The CT scan did not show the area affected. Oncology wants to change his chemotherapy regimen. He does not want to continue as the side effects are devastating to him and his quality of life. Is he a candidate for CyperKnife therapy? There were three clips placed during the last surgery as markers for any potential need for radiation at a later date near the head of the pancreas.

Dear Melissa, we are sorry to hear about your husband’s diagnosis. We sent your inquiry to radiation oncologist Dr. Abraham Wu and he responded:

“In general, we can use TrueBeam (which is described in the blog post) to deliver stereotactic body radiation treatments in the same situations where CyberKnife can. As always, only a radiation oncologist who knows the details of your husband’s case can say for sure whether such treatment is feasible and appropriate. But based on the information provided, it sounds like TrueBeam or CyberKnife is at least technically possible.”

If your husband would like to make an appointment with a physician at Memorial Sloan Kettering to discuss his treatment options, please call Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

Do you know if TrueBeam or CyberKnife is technically possible for the treatment of a recurrence of extramammary paget's disease in the scrotal area? This cancer was previously radiated but has returned and we are investigating possible alternatives to surgery. Would it be feasible or is that outside its realm of usage.

Thanks for your comment. We consulted with an MSK radiation oncologist about your question, and he responded: “This is an extremely unusual situation and really needs to be evaluated by a physician directly. It’s plausible that SRS (Cyberknife or Truebeam) could be used, but I doubt it would be appropriate.”

is cyberknife routinely used for bladder cancer?

Dear Suzanne, we reached out to Dr. Wu who says that the technology is not routinely used to treat bladder cancer, but could be used in certain instances for bladder cancer that has metastasized. Thanks so much for your question.

I HAVE BEEN ADVISED BY MANY..MSKCC IS BEST.
A SMALL QUESTION….WHAT IS THE DIFFERENCE IN DART & SBRT….

IS NANO PARTICLE IMAGING BETTER THAN OTHER SCANS LIKE FDG PET/CT ETC, IN LOCATING TUMOUR CELLS & KILLING THEM.

BETTER TREATMENT/RESULTS WITH DART/SBRT ??

WHICH ONE DART/SBRT/NANO PARTICLE IMAGING/ETC YOU HAVE AT YOUR CENTER & ARE THESE GOOD ENOUGH . PCA CASE TYPE.

THANKS VERY MUCH.

Munish,

Thank you for your comment. The use of nanoparticles is still experimental and not widely available, even for patients at MSK. SBRT is actually not an imaging method but a treatment that destroys tumors with extremely precise, very intense doses of radiation while minimizing damage to healthy tissue.

MSK’s prostate doctors use a technique called SHARP, which you can learn more about here:

http://www.mskcc.org/blog/treating-prostate-missile-delivery-high-dose-…

SHARP is a form of SBRT for the prostate, and many of the technologies involved in DART are also employed at MSK.

If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

For further questions about prostate cancer treatment, you also can call the National Cancer Institute’s Cancer Information Service at 800-4CANCER (800-422-6237). To learn more about the CIS, including Live Chat help and how to send them an email message, go to http://www.cancer.gov/aboutnci/cis/page3.

I have 2 tumors and a large protate. one side the tumor is 3+3 on the other side of the prostate it is 3+4. So I am looking at the options. Is cyberknife even considered for this??

Thank you for reaching out. Memorial Sloan Kettering does not actually use Cyberknife but uses the same technology, called stereotactic radiosurgery. If you are interested in a consultation to learn whether stereotactic radiosurgery might be appropriate for your case, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

Does Dr Wu use cyberknife for gleason 6 prostzte cancers?

Thank you for reaching out. Memorial Sloan Kettering does not actually use Cyberknife but uses devices employing the same technology, called stereotactic radiosurgery. If you are interested in a consultation to learn whether stereotactic radiosurgery might be appropriate for your case, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

You also might be interested to learn more about an approach for treating prostate cancer, called SHARP, which was pioneered by MSK’s prostate doctors:

https://www.mskcc.org/blog/treating-prostate-missile-delivery-high-dose…

Thanks for your comment.

I am suffering with Stage 2B Breast Cancer (Grade 3) with 3 Lymph Nodes involved as per CT scan. I have started with my Chemotherapy which will be 6 cycles at 3 weeks interval to help reduce the tumor size.

Can Cyberknife be used after the chemotherapy in the form of non-invasive surgery for my Breast Cancer. I mean can Cyberknife treatment act as a surgery plus radiation for me ?

Thank you for reaching out. Memorial Sloan Kettering does not actually use Cyberknife but uses the same technology, called stereotactic radiosurgery. If you are interested in a consultation to learn whether stereotactic radiosurgery might be appropriate for your individual case, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

For renal cell carcinoma metastases in the lungs, which is the better treatment, cyberknife or Trubeam? He has 3 lesions in the lungs

Because each individual medical case is different, it’s best for the patient to consult with their oncologist to see which treatment option is best for him. If you would like to make an appointment with a specialist at MSK, please call our Physician Referral Service at 800-225-2225. Thank you for reaching out to us.

Would Cyberknife be an option for a 2nd time breast cancer in the same breast that was 27 years ago? Had a lumpectomy and radiation 27 years ago. Now facing 2 very small lesions in the same breast (3 MM and 5 MM ). could this be an option?

Thank you for reaching out. Memorial Sloan Kettering does not actually use Cyberknife but does use this same technology — stereotactic radiosurgery. However, decisions about the best therapy and best technology are based on each individual case. We recommend you consult with your oncologist about your best treatment option.

If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

I've been told I have a bowel blockage, even tho it didn't show up on my PET or CT scans which is causing a backup of fecal matter, Would this kind of treatment be suitable for getting rid of a bowel blockage (narrowing?) due to tumor from Stage IV metastatic breast cancer?

Dear CH, we are sorry to hear about your diagnosis and about the blockage you have experienced. We recommend that you follow up with your oncologist to see if this type of treatment would be helpful for your particular circumstances. Thank you for reaching out to us.

Can Stereotactic radiation therapy be used for high grade prostate cancer and is it the optimum treatment for that particular cancer?

Thank you for reaching out. Every individual medical case is unique, but if you are interested in a consultation to learn whether stereotactic radiosurgery might be appropriate for your prostate cancer, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

You also might be interested to learn more about an approach for treating prostate cancer, called SHARP, which was pioneered by MSK’s prostate doctors:

https://www.mskcc.org/blog/treating-prostate-missile-delivery-high-dose

Thanks for your comment.

My dad recently diagnosed with squamous cell above the right orbit. which has invaded both the outer and inner tables of the frontal bone. It has created a tumor in the skull next to dura of the right frontal lobe. Proton therapy v.s. Cyber knife which is the better choice?

We are sorry to hear about your father’s diagnosis. Unfortunately, we cannot answer personal medical questions on our blog. Decisions about the best therapy and best technology are based on each individual case, and we suggest he consult with his physician on questions such as this.

If he would like to make an appointment with a Memorial Sloan-Kettering he can call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

Can CyberKnife or TrueBeam be used to treat tumors in the colon? Can it be used safely in the elderly?

Roe, thank you for reaching out. Stereotactic radiosurgery (the technology used by TrueBeam and Cyberknife) can be used to treat colon cancer. As always, only a radiation oncologist who knows the details of the individual case can say for sure whether such treatment is feasible and appropriate.

If you would like to make an appointment with a physician at Memorial Sloan Kettering to discuss treatment options, please call Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

Can this type of procedure be used on osteosarcoma? Thank you.

Thank you for reaching out. Stereotactic radiation therapy could be an option for someone with osteosarcoma, but an expert would need to evaluate you in order to confirm that. For information about making an appointment with an MSK doctor, go to: http://www.mskcc.org/cancer-care/appointment. We wish you the best, and thanks again for reaching out.

I know other centers (UT, Southwestern Medicical Center and UCLA) are using this approach for kidney tumors in the IVC. Do you treat patients with IVC tumors?

Dee, according to Dr. Wu, we can use stereotactic radiosurgery to treat tumors in almost any location, but for a situation like this, one of our radiation oncologists would have to review your particular case to determine whether it is feasible and beneficial. If you’d like to make an appointment for a consultation, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

Does Dr Wu or others at MSKCC use Varian to treat prostate cancer.

With UPSC and/frontline treatment, then metastases in 6 months to lymphnodes, can cyberknife or Trubeam be used? My wife has 3 sub-centimeter paratracheal & subcarinal lymphnode involvements,

David, we’re sorry to hear about your wife’s diagnosis. According to Dr. Wu, stereotactic radiosurgery is not generally used on cancer that has metastasized to the lymph nodes. Thank you for your comment.

My uncle has been diagnosed with Cancer of the prostrate. His gleason scores was 9 and PSA 89. The doctors have recommended Hormonal therapy, followed by 3 session of Cyberknife and then IMGT/IGRT treatment.
His cancer is stage 3 and spread to the seminal vesicles and lymph nodes. But primarily is only in the pelvic, prostrate region and not spread anywhere else (bones, organs etc)
In such a situation is Cyberknife required? Most of the research online says, cyberknife works mostly in early stage and less aggressive forms of cancer
Please shed some light on this.
Thanks, Much appreciated !