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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Badar, thank you for reaching out. Memorial Sloan Kettering does not actually use Cyberknife but uses devices employing the same technology, called Stereotactic Body Radiation Therapy (SBRT).This treatment destroys tumors with extremely precise, very intense doses of radiation while minimizing damage to healthy tissue.

We consulted with radiation oncologist Marsha Reyngold about the use of SBRT for early-stage breast cancer and she responds:

The role for this technology in the treatment of early stage breast cancer remains unclear and needs to be better defined. Although this technology can allow us to improve our targeting accuracy, the bigger question in breast cancer treatment is, “What is the area at risk of harboring residual cells after surgery?” The most conservative approach is to assume that after the tumor is taken out, the entire remaining breast tissue is at some risk of harboring residual cancer cells.That’s why the standard treatment is to cover the entire breast. In that case, when the target of radiation is large, the precision of targeting is relatively unimportant because it would not make a significant difference in the amount of normal tissue exposed. . However, we think that in many cases treating the area immediately surrounding the cavity where the tumor was, can be sufficient. We call that Partial Breast Irradiation, and it is still considered experimental, as we are waiting to see long-term results of clinical trials that compare this approach to the standard approach of treating the whole breast. In select cases when partial breast irradiation is performed, the intended target is smaller than when the whole breast is treated. In those cases, improved accuracy raditation therapy delivery, such as that offered by SBRT technology, would make a difference in terms of decreasing exposure to normal organs.

In summary, aspects of SBRT technology—such as using an image right before each treatment to verify perfect alignment— are being actively incorporated into radiation therapy for early stage breast cancers. However, “true” SBRT consisting of 5 or fewer fractions is very experimental and should only be done in the context of a clinical trial or in very select cases because the efficacy has not been fully evaluated.

Hi, my father has had a recurrence in retro peritoneal paraaortic lymph node post GE Junction and stomach cancer treatment. He is being recommended for CyberKnife treatment. How does this compare with VMAT/3DCRT techniques?

Shuchita, thank you for your question. Cyberknife,VMAT and 3DCRT are different from each other, and evaluating pros and cons of different radiation techniques for this situation requires individualized consultation. We suggest your father speak with a physician about the best option.

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

I've had 30 courses of radiation for a rectal tumor---can the cyber knife radiation still be employed to further shrink or eliminate the remainder?

Andrew, thank you for reaching out. Generally, CyberKnife or other stereotactic body radiation therapy techniques are not used to treat residual rectal tumor after a full course of standard radiotherapy.

I am 57 years old and have early stage Prostate cancer. 2 biopsies over 2 years have found 4 x Gleeson 6 tumours. (1 tumour 2 years ago and a different 3 on the last biopsy 3 months ago). I am deciding between SRT and brachytherapy. The latter seems to work by killing the entire prostate (a shotgun) where the SRT is more a rifle to me. BUT SRT seems to have lower side effects..correct ?
How do you know you have hit all the tumours with SRT is what worries me?

Dear John, we’re sorry to hear about your diagnosis. Imaging is a very important part of SRT. We use the latest imaging technology to make sure we know exactly where the tumors are located, so that we can be sure to reach them. Thank you for your comment, and best wishes to you.

Hello, My wife has a codman 3000 hepatic pump and we want to know if it needs to be removed if she is going to have the cyberknife procedure on her 2cm liver mass.

Dear Anthony, this is something your wife should discuss with her healthcare team. Thank you for your comment, and best wishes to you.

do they use varian for stage 1 vocal cord lesion removal ,,,,i had laser surgery for one side of vocal chord at yale smillow was to be scheduled for other side in 6 weeks ,,,,doctor suggested radiation at sloan and will probably refer me to a doctor their....just wondering where i have read they were using cyberknife to treat vocal chord cancers....

Dear Sal, we sent your question to Nancy Lee, one of our experts in radiation therapy for head and neck cancers, and she said that stereotactic radiosurgery is not used for cancer of the vocal cords. The types of radiation therapy that are used are IMRT and proton therapy. If you are interested in making an appointment you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment, and best wishes to you.

How effective is your radiation treatment on the prostrate?

My 52 y,o. daughter was just diagnosed with mesothelioma in her abdominal peritoneum.
Is the cyber knife helpful in this kind of cancer?
The cancer is small the size of peas but numerous. All in one place together. She had a PET scan.

Dear Martha, we’re very sorry to hear about your daughter’s diagnosis. We sent your question to Dr. Wu, and he said he’s not aware of stereotactic radiosurgery being used to treat peritoneal mesothelioma. You can learn more about how MSK treats mesothelioma here: https://www.mskcc.org/cancer-care/types/mesothelioma/treatment

If your daughter would like to come to MSK for a consultation, she 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, and best wishes to you and your family.

Sorry , not sure if this went through to you before.
My diagnosis : Right temporal tumor. excision and totaly removed Chordoid meningioma (WHO grade II) on Nov 9, 2017 and recommended to start IMRT low grade radioation on Dec 6, 2017 ((30 sessions) to get rid of any agressive cells left behind in the surgery done at Cornell Weill. I feel my old healthy self again and am wondering if MSK has more sofisticated equipment to deal with a succesfull outcome with short and long term side effects from the radiation treatments?

So assuming a finding of prostate cancer (3x3 gleason), is MSK a viable option. While Dr. Wu does not specialize in the prostate, would you have other well trained doctors in this area. Also, while Cyberknife uses and robot, is it true that MSK does not?

Marc, thank you for reaching out. Our radiation oncologists sometimes use stereotactic radiosurgery to treat prostate cancer, although every individual medical case is unique. 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 mother had a breast cancer and she was treated with the chemo, then surgery and then radiation. But after, 5 months the cells are again growing. Is cyberknife could help her????

We’re sorry to hear that your mother’s cancer has returned after treatment. To learn more about MSK’s approach to treating breast cancer with radiation therapy, you can go to this link: https://www.mskcc.org/cancer-care/types/breast/treatment/radiation-ther…

If your mother is interested in coming to MSK for a consultation, she 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, and best wishes to you.

Hi
I have stage4 colon cancer colon liver resection loads of different chemo. Last one irinitican exubertex Bad side effects. Multiple lesions in lungs being treated at upenn. Can cyber knife help me

Dear Dorothy, we’re sorry to hear you’re going through this. If you would like to arrange a consultation with an expert at MSK, 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, and best wishes to you.

Is cyberknife treatment appropriate for Ewing Sarcoma in the Pelvis. The doctor has recommended only radiation and no surgery to avoid physical limitations after surgery though surgery is possible, but it would leave back a limp.He mentions radiation is as good as surgery and results in similar outcomes. Please guide me if cyberknife is better than IMRT for Ewing Sarcoma in pelvis(right iliac bone)

I have just had a Radical Prostatectomy which had a Gleason 9 score.
Bones clear, Nodes clear but evidence of minor area of capsule escape. Recommended 30 standard radiation trtmts. Would Cyberknife procedure be better or easier? Thanks

Unfortunately we are not able to make individual treatment recommendations on our blog. If you would like to arrange an consultation with one of our prostate cancer experts to discuss this, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information or to request an appointment online. Thank you for your comment, and best wishes to you.

I look forward to meeting with and working with Dr. Wu. I have been diagnosed with an adenocarcinoma in the anus. I understand this is an unusual presentation. At MSK, do you see this situation often? So looking forward to the treatment that will eradicate this cancer!

Dear Sammi, we’re sorry to hear about your diagnosis. Dr. Wu should be able to answer all of your questions when you meet with him. Thank you for your comment, and best wishes to you.

Is cyberknife an alternative to the surgical removal of prostate cancer?

I have a re surfaced hip with a Chromium Cobalt cap on the right femoral head. Can this procedure be used in my situation?

Dear Wayne, to learn more about this, please call our Patient Access Service at 800-525-2225. Thank you for your comment and best wishes to you

Got Neuroma on the right side!

91 years old!

What Can we do for cyberknive in South Suburb of Chicago !?

Who has latest updateet equipment !?

Alfred in New Lenox Ill

Dear Alfred, we are not able to answer individual medical questions on our blog. If you are interested in receiving treatment in the Chicago area, we recommend that you consult the list of National Cancer Institute-designated cancer centers to find a doctor close to you. You can find a list here: https://www.cancer.gov/research/nci-role/cancer-centers

Thank you for your comment and best wishes to you.

I'm curious about the prospects of using SBRT (when surgery is not an option) as an approach when other metastasis cancer does not exist outside a secondary location (lungs for example) as opposed to chemotherapy. Is it true that SBRT Tru Beam will miss harboring residual cancer cells and not offer the potential for an Abscopal effect found with other high dosages of radiation therapy?

Dear Abigail, if you’d like to arrange a consultation to discuss whether this approach would be an option, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

With prostrate cancer, when would CyberKnife not be a good option?

Dear David, if you would like to speak with someone about the potential benefits and drawbacks of different types of radiation therapy, you can make an appointment with one of our doctors online or call 800-525-2225. Thank you for your comment and best wishes to you.

Recently diagnosed with Prostate cancer. If Proton treatments take 6 - 8 weeks, what is length of treatment for your MSK Precise and are the results comparable?

Dear Jeffrey, we’re sorry to hear about your diagnosis. If you are interested in arranging a consultation to learn about your treatment options at MSK, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

My husband had radiation nine years ago for rectal cancer along with surgery. Is he a candidate to get cyberknife radiation for prostate cancer

Dear Rose, we’re sorry to hear about your husband’s diagnosis. We recommend that he discuss treatment options with a doctor who is familiar with his situation, full diagnosis, and medical history. If he is interested in arranging a consultation with a doctor at MSK, he can make an appointment online or call 800-525-2225 during regular business hours. Thank you for your comment and best wishes to both of you.

I underwent successful Robotic assisted LAR in Nov 2017 for Ca. recto sigmoid. Followed by 5 cycles of FOLFOX. Further 6 cycles of chemo with CAPIRI+Bevacizumab for multiple lung metastases nodules.
Latest CT scan in JUL 2019 shows presence of 4 nodules in left lung and one in right lung, largest of 1.7x2.1x1.6 cm FDG avid SUVmax 4.7. Others FDG non-avid.
Whether SBRT/CYBER-KNIFE/PROTON is beneficial for treatment, and if yes, which one?

Dear Kamal, we’re sorry to hear that your cancer has spread. If you’d like to arrange a consultation with someone at MSK to learn about your treatment options, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

I have an abominal liposarcoma. it is 11cmx 11cmx 7. the sarcoma piece is only 2cm by 2 cm. why are they recommending a ery involved and complicarted surgery instead of this theerapy?

Dear Stanley, because every patient is different, we are not able to answer individual medical questions on our blog. If you’re interested in arranging a consultation with one of our sarcoma experts, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

I have a tumor on/in fron of pituitary. I've have it surgically removed twice but it grows back since in its location the surgeon cannot remove it completely. Is cyberknife an option.

May i ask what is the estimated cost of CyberKnife treatment for ACC?