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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Kundan, thank you for reaching out. Memorial Sloan Kettering does not actually use Cyberknife but uses the same technology, called stereotactic radiosurgery. Decisions about the best therapy and best technology are based on each individual case, and we suggest your uncle consult with his physician on questions such as this.

If he would like to make an appointment with one of our physicians for a more-personalized assessment and recommendation, please have him call our Physician Referral Service at 800-525-2225.

He 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…

Does Sloan Kettering use Cyberknife in treating moderately aggressive (Gleason 4+3) Prostate Cancer in 2 sites? How effective is Cyberknife with Prostate Cancer compared with Robotic R.P. and Brachytherapy?

Thank you for reaching out. Memorial Sloan Kettering does not actually use Cyberknife but uses devices employing the same technology, called stereotactic radiosurgery. Unfortunately, it is not possible to comment on the effectiveness of a treatment for an individual case, which is affected by a large number of factors.

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.

Does Dr. Wu perform cyber knife on pituitary
tumor regrowth

Kathy, thank you for reaching out. 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. Stereotactic radiation therapy is used for pituitary tumor regrowth, but an expert would need to evaluate the patient in order to confirm that. For information about making an appointment with an MSK doctor, go to: http://www.mskcc.org/cancer-care/appointment.

I have metastatic prostate cancer and am currently receiving hormone and chemotherapy. Might this device be helpful after my chemo is finished?

Thank you for reaching out. Memorial Sloan Kettering does not actually use Cyberknife but uses devices employing the same technology, called stereotactic radiosurgery. Unfortunately, it is not possible to comment on the effectiveness of a treatment for an individual case, which is affected by a large number of factors.

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 have a schwannoma Tumor of size 4.8 * 5.4 * 4.2. Which Radio surgery is good for this tumor (cyber knife OR True Beam)

Thank you for your question. We suggest you consult with your physician about the best treatment option, including whether stereotactic radiosurgery (using CyberKnife or TrueBeam) would be appropriate, as we are not able to answer personal medical questions. (Every individual case is affected by a large number of factors.)

If you would like to make an appointment with a Memorial Sloan Kettering physician for a consultation, please call our Physician Referral Service at
800-525-2225 or go https://www.mskcc.org/experience/become-patient/appointment

Hi, How do we compare two options of radical robotic prostetectomy vs cyberknife in a prostate cancer patient with gleason 6 and PSA 7.5.Thanks

Azim, thank you for reaching out. We suggest you consult with your medical team about your best treatment option, as every individual case is affected but many factors. 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 https://www.mskcc.org/experience/become-patient/appointment

Thanks for your comment.

my friend had a grow back of a benign pituitary tumor, but doctor could not remove all, since some grew on optic nerve, my friend does not
want any more loss of vision, she is considering
either proton beam therapy or cyberknife,,,,,can not give any idea of which might be better and with shorter treatments so she will not go blind thank you

Carol, we’re sorry to hear your friend is going through this. MSK has a team of experts who specialized in pituitary tumors. If your friend would like to make an appointment for a consultation, she can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. Because we are not able to answer medical questions on our blog, this would be the best way for her to get the information she needs. Thank you for your comment.

I have small cell carcinoma of the bladder that has recently metastasized in the liver. Is the cyber knife procedure a possible option for me?

Rich, thank you for reaching out. Yes, Cyberknife (or the Varian TrueBeam device used at MSK) is commonly used to treat liver metastases. But the appropriate treatment for any individual case is a personalized decision to be made in consultation with a radiation oncologist.

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 https://www.mskcc.org/experience/become-patient/appointment

Thanks for your comment.

Hi,
My brother has stage 4 metastatic colon cancer that has spread to various areas of the peritoneum but no other organs to our knowledge. I understand that it is case by case, but can you tell me if radiosurgery is generally ideal for this type of situation? Or used to treat tumors in the colon and stomach?

Felicia, thank you for reaching out. Radiosurgery is not generally used for peritoneal metastases especially if they are multiple. Radiosurgery is also generally not used for tumors directly in the colon or stomach.

If your brother would like to make an appointment with a Memorial Sloan Kettering physician for a consultation, please call our Physician Referral Service at
800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment

In addition, he can learn more about the treatment of colon cancer at MSK here:

https://www.mskcc.org/cancer-care/types/colon

What are the statistics for new growths emerging after successful removal of malignant non-metastatic growths in the lungs?

Dear Ellen, we sent your inquiry to Dr. Wu and he responded:
“After surgery (if this is what you are referring to), it is certainly possible for tumors to regrow in or near the same area. The chance of this happening depends on many factors including the size, type, and location of tumor; and the quality and type of surgery performed. Your surgeon or oncologist may be able to provide statistics depending on the exact situation.”
Thank you for reaching out to us.

I am 74 years old. 28 months ago I underwent Da Vinci radical prostatectomy. Now my PSA is 0.21. what salvage therapy is best for me, IMRT or CyberKnife ? Thanks for your comment.

Alan, thank you for your comment. We recommend you speak with your physician about your treatment options as every individual case if affected by many factors and we are unable to answer personal medical questions.

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 https://www.mskcc.org/experience/become-patient/appointment
Thanks for your comment.

In addition, you can learn more about treatment for prostate cancer at Memorial Sloan Kettering here:

https://www.mskcc.org/cancer-care/types/prostate/treatment

IMRT after tonsillectomy for SCC, how does one minimise sore tongue, gums at MSKCC? Tongue blocks? Wearing the gum trays for fluoride during IMRT? How may weeks of treatment for t2 n0 is usual with Varian machine?

Dear Fifi, according to our treatment guide for squamous cell carcinoma (https://www.mskcc.org/cancer-care/types/squamous-cell-carcinoma/diagnos…) radiation is usually delivered in small doses over a period of three to four weeks. However, it’s best to check with your oncologist with questions regarding the specific treatment regimen recommended for you.

You may also be interested in reading through our patient education materials for people receiving radiation therapy. If you scroll down to pages 30-33, you’ll see information about managing mouth changes that may occur as a result of radiation therapy to the head and neck: https://www.mskcc.org/pdf/cancer-care/patient-education/radiation-thera….

We hope this information is helpful. Thank you for reaching out to us.

My father has a tumor that is 5cm by 5cm impinging and blocking the bile duct mostly intrahepatic and close to the vena cava so in our local hospital deemed inoperable and currently working with an catheter. Generally speaking, would this technology find some applications in bile duct cancer treatment if the facts of the case fit?

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

“Stereotactic Body Radiotherapy (SBRT) can be utilized for bile duct cancer and other tumors arising in or near the liver, but not in all circumstances as it depends on the exact size and location of the tumor, among other factors. As usual, I would recommend consultation with an oncologist to determine whether SBRT or other types of radiation might be possible in your father’s case.”

If your father would like to make an appointment for a consultation with one of our specialists, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

What is the difference between proton beam radiation and the high dose radiation done by Dr. Josh yamada at MSKCC for sacral chordomas

Thank you for your question. Proton therapy means that the radiation is being delivered in the form of protons, a different type of subatomic particle. Dr. Yamada performs stereotactic radiosurgery using x-ray (also known as photon) radiation, which provides durable and consistent tumor control for chordomas.

You learn more about proton therapy here:

https://www.mskcc.org/blog/proton-therapy-better-way-destroy-tumors

My family and I just found out my father has pancreatic cancer (4.5mm) his liver has failed and his whole body is yellow. He's not in any pain and he's acting as if nothing is wrong. He was just recently released from the hospital. He has to go back to do Endoscopy this Tuesday. I would like to know if he's qualified for Cyberknife or nanoknife. Is it covered by medicare or other insurance. We are starting him on a strict healthy diet. Exercise daily.

Michael, thank you for reaching out. Thank you for reaching out. Unfortunately, it is not possible to determine if someone is a good candidate for this type of therapy without a full medical consultation. We suggest your father consult with his physician, or if he 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 https://www.mskcc.org/experience/become-patient/appointment

To learn more about how Memorial Sloan­ Kettering treats pancreatic cancer, you can go to https://www.mskcc.org/cancer-care/types/pancreatic

For questions about pancreatic cancer treatment, you also can call the National Cancer Institute’s Cancer Information Service at 800­4CANCER (800­422­6237). 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.

Dr. Wu's article mentions that SKM's stereotactic radiation procedure employs CT scans. I have two questions concerning the CT scans:
1. Is contrast media used for the CT scans?
2. If the patient were allergic to contrast media would that preclude use of SKM's stereotactic radiation procedure?

Hi Yanni, we sent your questions to Dr. Wu and he replied as follows:

1. Contrast media is sometimes used for the simulation (the planning session) in preparation for SBRT, but is not used during the actual treatments.
2. Not necessarily. Some cases for SBRT don’t require use of contrast media for the simulation, and even if it is necessary, it is often possible to prescribe medication to prevent an allergic reaction to contrast.

Thank you for your questions.

my wife was just diagnosed with Pancreatic Cancer, we understand the size is small 1.7CM we need to make a decision immediately before it increases in size. we have an appointment on Sept 6th at the hospital where it was diagnosed, can we be seen the next day at any Sloan Kettering facility.i will follow this with a call
Thank You
Sheldon Rothstein

How do outcomes with Cyberknife compare with Tomotherapy for prostate cancer ?

Victor, thank you for reaching out. We consulted with Dr. Marisa Kollmeier, who responds:

“Cyberknife® is a brand name for a radiation treatment machine that delivers targeted high dose radiation treatment. Similar capabilities exist on other radiation treatment machines as well. Tomotherapy® is also a brand name for a radiation treatment machine that uses imaging for targeting and delivery of radiation on a continuously moving arc. There are similar technologies that exist on other machines as well.

There is no clear data that the outcomes using one brand name device over another is beneficial.

Depending on the location and type of a tumor, one or more of these techniques may be incorporated into radiation treatment at MSKCC although this may not be appropriate technology for all patients.”

My Mother-in-law is metastatic colon cancer patient and having metastasis in lungs and liver. Cyberknife will work for this kind of patients?

Jayaraman, thank you for your question. This type of treatment is frequently used to treat metastatic lesions in the lungs and other organs. Usually it is only recommended when there are a limited number of lesions (~3 or less), and the lesions are relatively small (~5cm or less), but it is always on a case-by-case basis.

To make an appointment at Memorial Sloan Kettering, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information.

is the amount of radiation used harmful to the rest of the body as in normal radiation for cancer ? i have heard that people get very sick from the radiation treatments using the standard old type of radiation treatment.

Dear John, stereotactic body radiation therapy (SBRT), delivers (through Cyberknife and other similar systems) extremely precise, very intense doses of radiation to cancer cells while minimizing damage to healthy tissue. You can learn more about this treatment here: https://www.mskcc.org/cancer-care/treatments/cancer-treatments/radiatio….

You can learn more about this and other forms of radiation therapy, along with the possible side effects and how to manage them, here: https://www.mskcc.org/cancer-care/patient-education/radiation-therapy.

We hope this is helpful and appreciate your reaching out to us.

How successful is cyberknife in cases of prostate cancer, that has not spread but is a Gleason 8?
How many treatments would be necessary and are there any side affects?

Dear Doug, every man’s disease and treatment plan is unique, so it’s best for you to arrange for an in person consultation to discuss the most appropriate treatment recommendations for you.

While we do not offer Cyberknife at MSK, we do offer stereotactic body radiation therapy for men with prostate cancer (a form of radiosurgery called SHARP), which you can read more about here: https://www.mskcc.org/blog/treating-prostate-missile-delivery-high-dose….

If you are interested in making an appointment, please contact our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

Which radiation machine would you use for Prostate Cancer

Dear Stuart, external-beam radiation therapy (EBRT) involves aiming radiation directly at your prostate from outside your body using a device called a linear accelerator. At Memorial Sloan Kettering, we use three primary types of EBRT to treat men with prostate cancer: image-guided, intensity-modulated radiation therapy; stereotactic radiosurgery; and proton therapy. To learn more about these approaches, please visit https://www.mskcc.org/cancer-care/types/prostate/treatment/radiation-th….

If you would like to make an appointment with one of our specialists to discuss possible treatment options, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

I have 3/4 prostate cancer

Which is better proton therapy or stereotactic

which is more precise and delivers less collateral damage

are there any studies

Bill, thank you for reaching out. Unfortunately, it is not possible to recommend the best therapy for an individual case, because a large number of factors is involved. If you would like to make an appointment with a Memorial Sloan Ketttering Physician for a consultation, you can call our Physician Referral Service at
800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment
Thanks for your comment.

Good evening my name is jack miranda i recently had ct done and what was found was a complex cystic mass in the body and uncinate process of the pancreas size 4.3 by 3.2....a more ill defined and ominous hypodense lesion 3.0 x3.0 found in the body of the pancreas the mass appears to encase the splenic artery!! Splenic vein not visualized and maybe occluded!!! Biopsy to be done this tuesday!!! Questions are 1- can both these situations be benign??? I have no pain no jaundice i have lost abount 12 pounds in 5 months!!!! There are no areas but the pancreas effected!!!! 2nd question if there is no cancer would the splenic artery have to be taken care of and if so could it be operated on!!! With or without cancer????

Dear Jack, we’re sorry to hear that you’re going through this. Unfortunately, we are not able to respond to individual medical questions on our blog. If you’d like to arrange for a consultation with one of our doctors, you can call 800-525-2225 during regular business hours or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

Hi. I have heard that radiation therapy is not very effective in metastatic urothelial carcinoma. Can you please tell me if this is also true in SBRT? How does SBRT differ from conventional radiation

Megha, thank you for your question. We consulted with MSK radiation oncologist Marisa Kollmeier, who responds,:

“Stereotactic body radiotherapy (SBRT) is the precise delivery of high radiation doses to discrete tumor sites. It is highly effective for the majority of tumor types, including urothelial carcinoma.”

Is this treatment effective in treating early stage breast carcinomas?