CyberKnife
With CyberKnife, patients have the opportunity to undergo a non-invasive, effective treatment with minimal impact on their quality of life.
Lucia Graziosi, sales manager
ARE YOU A HEALTHCARE PROFESSIONAL?
The following content is intended for healthcare professionals as it concerns products categorised as medical devices that must be used or operated by professionals in the medical/healthcare sector.
N.B.: Pursuant to and for the purposes of Art. 76 of Italian Presidential Decree (DPR) 445/2000, aware of the liability and the civil and criminal repercussions for false declarations and/or for the preparation or use of false documents, as well as in the event of the production of documents containing information that no longer corresponds to the truth, I confirm that I am a HEALTHCARE PROFESSIONAL.
System Operation
The robotic arm moves the linear accelerator in space around the patient. It generates a high number of radiation beams with different orientations in a non-coplanar 3D geometry. The treatment occurs along a predefined path in space and is divided into points, called “nodes,” where the robot can stop to allow the Linac to deliver the beam.
The image-guided system enables monitoring of the target position throughout the entire treatment and corrects the beam direction for any detected displacement, whether continuous over time or not. The imaging system consists of two X-ray tubes installed on the ceiling and two corresponding high-resolution detectors placed on the floor. This configuration allows for continuous monitoring of the patient’s and target’s position during the entire treatment, guiding the robot to direct the treatment beams so they hit the target with extreme accuracy.
The Collimation System
The Collimation System
The CyberKnife system is equipped with three different beam collimation systems. The collimators allow for the adjustment of the shape and size of the treatment beam.
-
Fixed Collimators
These have a circular cross-section to treat localized lesions, including very small ones. -
Variable Diameter Iris Collimator
This replicates the twelve openings of the fixed collimators. It allows the use of different fields during treatment without the need to change the collimator. -
Multileaf Collimator
For the treatment of larger lesions, reducing the treatment time.
Radiosurgery Treatment with CyberKnife
The CyberKnife system is particularly suitable for targets that move with respiration. The treatment is delivered during the patient’s normal breathing cycle, without the need for the patient to hold their breath (as required with the breath-holding technique).
With CyberKnife, the beam continuously follows the target’s movement in real-time (not just when the target is in a certain area, as with the gating technique) and instantly adapts to variations in the respiratory pattern (this is known as dynamic tracking).
Before the treatment begins, a dynamic correlation model is created between the external movement of the body surface and the internal movement of the target. The internal target movement is detected by the imaging system using one of the tracking algorithms (fiducial tracking or XsightLung tracking), while the external movement is detected with optical LEDs applied externally to the patient’s chest. These LEDs are identified by an infrared camera, which tracks their position in real time.
The model is continuously updated throughout the treatment to ensure that the beam delivery is based on the patient’s current respiratory pattern.
Distinctive Features of the Technology
CyberKnife is a radiotherapy system equipped with a robot that moves the linear accelerator with six degrees of freedom around the patient.
Thanks to its imaging system and robot, it allows for tracking the movements of the target throughout the entire treatment, resulting in sub-millimeter accuracy. This enables the delivery of high doses to the target while sparing healthy tissues and reducing the number of treatment sessions. The significant benefit for the patient is the reduction in hospital visits for therapy, along with the associated cost savings for both the patient and the National Health Service (NHS).
The Synchrony respiratory tracking system is the only one that allows for continuous tracking of the target and delivery of the beams while the patient breathes freely (no breath holding) and without interrupting beam delivery (no gating) throughout the entire treatment, maintaining sub-millimeter accuracy (24, 25, 26, 27, 28).
Clinical benefits
-
It offers more effective treatments in terms of dose distribution and gradient while safeguarding organs at risk.
-
Thanks to its sub-millimeter precision, it allows for the delivery of high doses to the target while preserving healthy tissues.
Benefits for the patient
-
It allows for hypofractionated treatments (from 1 to 5 treatment sessions), providing the significant advantage of reducing hospital visits for therapy, with consequent cost benefits for both the patient and the National Health Service.
-
The patient can continue to maintain their daily routines, with minimal impact on their social life, particularly because the therapy is completed within a maximum of one week.
-
Thanks to the image-guided system, invasive patient immobilization systems are not necessary.
Clinical specialisms and areas of application
In the intracranial field, experience is well established in the treatment of brain metastases (2, 3, 4, 5, 6) and malignant tumors, as well as benign tumors such as meningiomas (7, 8, 9, 10, 11), acoustic neuromas (12, 13, 14), pituitary adenomas (15), functional disorders like trigeminal neuralgia (16, 17), and arteriovenous malformations (18).
The CyberKnife treatment is also applicable in the treatment of oropharyngeal tumors (19, 20), re-treatment of head and neck tumors (21), bone metastases, and benign and malignant spinal lesions (22, 23).
Excellent results have been achieved for central lung tumors near sensitive structures (29) and near the chest wall (30), as well as for inoperable peripheral lung tumors (31, 32, 33). Non-small cell primary lung tumors (34, 37, 38) and lung metastases (35, 38) are also treated.
Stereotactic radiotherapy with CyberKnife is chosen as an alternative to surgery or when surgery is not feasible; additionally, CyberKnife is used to treat recurrences of adenocarcinomas and squamous cell carcinomas previously treated with conventional radiotherapy.
The CyberKnife treatment is effective for low-risk and intermediate-risk prostate tumors (39, 40, 41), as well as for recurrences of localized prostate cancer previously irradiated with conventional radiotherapy (42, 43). Primary liver tumors and liver metastases (44, 45, 46, 47, 48, 49, 50, 51, 52, 53) are treated, as well as malignant pancreatic metastases and pancreatic tumors near the stomach and duodenum (54, 55, 56).
Regarding breast cancer, the protocols for Stereotactic Partial Breast Irradiation and Accelerated Partial Breast Irradiation (57, 58, 59, 60) are increasingly being applied for post-surgical radiation treatment. Additionally, there are initial studies on adjuvant treatment with CyberKnife in a single fraction before surgical intervention (61).
During the ESTRO 2021 Congress held in Madrid, Dr. Alison Tree (Consultant Clinical Oncologist at the Royal Marsden NHS Foundation Trust in London) presented the latest results of the PACE-B clinical trial (Prostate Advances in Comparative Evidence). Comparing various stereotactic radiotherapy techniques with hypofractionated treatments for prostate cancer, it was observed that CyberKnife is superior to other techniques in reducing the incidence of late Grade 2 toxicity and bladder toxicity.
VOLO™ Optimization Software
VOLO™ uses GPU technology to optimize the treatment plan, allowing the creation of a treatment plan in just a few seconds (reducing the treatment planning time by 90%). Thanks to more efficient plan optimization, the treatment time has been reduced by 50%.
PreciseRTX® Retreatment Option
The planning system allows for the import of previously delivered treatment plans from any linear accelerator; the contours and dose distributions of the old plan are deformed onto the new CT scan, enabling the summation of the old plan with the new plan.
22/10/2024
about care, who is speaking today? Dott.ssa Zerella
La Dott.ssa Maria Alessia Zerella, Radioterapista presso la Divisione di Radioterapia all’IEO Istituto Europeo di Oncologia, ci condivide un innovativo studio di ricerca, il CRYSTAL trial; come il sistema per radiochirurgia e radioterapia stereotassica CyberKnife ...
01/08/2024
CyberKnifeS7all’ARNAS G. Brotzu a Cagliari
CyberKnifeS7, sistema per la radiochirurgia e radioterapia stereotassica, è arrivato all’ARNAS G. Brotzu a Cagliari, la radioterapia oncologica più grande della Sardegna. Cosa succede quando arriva una tecnologia così innovativa? Vediamo in questo video i primi mo...
01/08/2024
CyberKnife: intervista al Dott. Raffaele Barbara, A.O. Brotzu
Intervista al Dott. Raffaele Barbara, Direttore S.C. Radioterapia Oncologica, A.O. Brotzu “Con l’arrivo CyberKnife all’Arnas Brotzu i pazienti sardi potranno essere sottoposti alle più moderne tecniche radiochirurgiche senza dovere migrare nei poli onc...
01/02/2023
Cyberknife, il braccio robotico che blocca la crescita dei tumori
Nel reparto di neurochirurgia dell’ULSS 8 di Vicenza, si taglia il traguardo dei 20 anni di attività del sistema robotico CyberKnife per la radiochirurgia e radioterapia stereotassica. Intervista al dott. Umberto Fornezza.
09/06/2022
Quando viene utilizzato CyberKnife e per quali patologie?
A Medicina 33, il quotidiano di medicina del Tg2, la voce di un paziente che ha beneficiato di CyberKnife e del Prof. Giuseppe Sanguinetti, Dir. Unità Oncologica dell’Istituto Nazionale Tumori Regina Elena di Roma (IRE).
25/06/2020
#andratuttobene con… la tecnologia CyberKnife
Intervista al Prof. Stefano Maria Magrini, Direttore della U.O. di Radioterapia degli Spedali Civili di Brescia
- Adler JR, Cox RS. Preliminary clinical experience with the Cyber-Knife: image guided stereotactic radiosurgery. Radiosurgery 1995;1:316-26
- WowraB. et al. J. Neurooncol. 2009; 94: 69-77
- MuacevicA. et al. J. Neurooncol. 2010; 97: 267-274
- Shultz et al. Int. J. Radiat. Oncol. Biol. Phys. 2015; 92: 993-999
- Mengue L. et al. Brain metastases treated with hypofractionated stereotactic radiotherapy: 8 years experience after Cyberknife installation
- Hiroshi K. et al. Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study
- Colombo F. et al. Neurosurgery. 2009; 64: A7-13
- Conti A. et al. Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma: a German and Italian pooled cohort analysis
- Manabe Y. et al. CyberKnife Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy As First-line Treatments for Imaging-diagnosed Intracranial Meningiomas
- Oermann E. et al. Five fraction image-guided radiosurgery for primary and recurrent meningiomas
- Yazici O. et al. Intracranial meningioma: Experience with stereotactic radiotherapy
- Jumeauet al. Tumori. 2016; 102: 569-573
- HansasutaA. et al. Neurosurgery. 2011; 69: 1200-1209
- CasentiniL. et al. J. Neurosurg. 2015; 122: 818-824
- KilloryB.D. et al Neurosurgery. 2009; 64: A19-25
- Romanelli P, Conti A, Bianchi L, Bergantin A, Martinotti A, Beltramo G, Image-Guided Robotic Radiosurgery for Trigeminal Neuralgia. Neurosurgery 2017 Dic
- Conti A. et al. Factors affecting outcome in frameless non-isocentric stereotactic radiosurgery for trigeminal neuralgia: a multicentric cohort study
- Colombo F. et al. Early results of CyberKnife radiosurgery for arteriovenous malformations
- Al-Mamganiet al. Stereotactic body radiotherapy: a promising treatment option for the boost of oropharyngealcancers not suitable for brachytherapy: a single-institutional experience. Red Journal 2012;82:1494-1500
- Al-MamganiA et al. A prospective evaluation of patient-reported quality-of-life after (chemo)radiation for oropharyngeal cancer: which patients are at risk of significant quality-of-life deterioration? RadiotherOncol. 2013 Mar;106(3):359-63.
- Vargo J et al. Prospective evaluation of PR-QoL outcomes following SBRT +cetuximab for locally recurrent, previously irradiated H&N cancer RadiotherOncol 2012
- Pontoriero A. et al. Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost in Patients With Spinal Metastases
- Conti A. et al. Decision Making in Patients With Metastatic Spine. The Role of Minimally Invasive Treatment Modalities
- MuacevicA. et. al. TCRT. 2007; 6(4): 321-328. https://doi.org/10.1177/153303460700600409
- Sumida I. et al. J. App. Clin. Med. Phys. 2016; 17(2): 74-84. http://doi.org/10.1120/jacmp.v17i2.5914
- Hoogeman Mischa et al. Int. J. Radiat. Oncol. Biol. Phys. 2009; 74(1): 297-303
- Nioutsikouet al. Med. Phys. 2008; 35(4): 1232-1240
- Seppenwooldeet al. Med. Phys. 2007; 34(7): 1774-2784
- Nuyttens J.J. et al. Radiotherapy and Oncology. 2012; 102: 383-387
- Podder T. et al. Future oncology. 2014; 10(15): 2311-2317
- Brown W.T. et al. Clin. Oncol. (R. Coll. Radiol.). 2009; 21: 623-631
- Snider J.W. et al. Front. Oncol. 2012; 2: 63. https://doi.org/10.3389/fonc.2012.00063
- Lischalk J.W. et al. J. Radiat. Oncol. 2016; 5: 379-387
- Van der Voort van Zyp NC, Prevost JB, Hoogeman MS et al. Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: clinical outcome. Radiother Oncol 2009; 91(3):296-300
- Brown WT, Wu X, Fowler JF et al. Lung metastases treated by Cyberknife image-guided robotic stereotactic radiosurgery at 41months. South Med J 2008; 101(4):376-382
- Lischalk J. et al. Stereotactic body radiotherapy (SBRT) for high-risk central pulmonary metastases
- Sumodhee et al. Long term efficacy and toxicity after stereotactic ablative reirradiation in locally relapsed stage III non-small cell lung cancer
- Repka M. et al. Five-fraction SBRT for ultra-central NSCLC in-field recurrences following high-dose conventional radiation
- Meier R, et al. Int J Radiat Oncol Biol Phys. 2016; 96(2): S33-S34 Prospective evaluation of CyberKnife System stereotactic radiosurgery for low and intermediate risk prostate cancer: Homogenous Dose Distribution
- Fuller DB, et. al. J Clin Oncol. 2017; 35(6S) Prospective evaluation of CyberKnife System stereotactic radiosurgery for low and intermediate risk prostate cancer: Emulating HDR brachytherapy dosimetry
- Katz A. et al. Stereotactic Body Radiotherapy for Low-Risk Prostate Cancer: A Ten-Year Analysis
- Robotic Stereotactic Retreatment for Biochemical Control in Previously Irradiated Patients Affected by Recurrent Prostate Cancer. Loi M, Di Cataldo V, Simontacchi G, Detti B, Bonomo P, Masi L, Desideri I, Greto D, Francolini G, Carfora V, Pezzulla D, Perna M, Carta GA, Livi L.
- Olivier J. et al. Stereotactic Re-irradiation for Local Recurrence in the Prostatic Bed After Prostatectomy: Preliminary Results
- Anderson EM, Koong A, Yang G et al. Phase I dose escalation study of stereotactic radiosurgery for liver malignancies (poster presentation). Proceedings of the ASCO 2007 Gastrointestinal Cancers Symposium Orlando, Florida, USA, 19-21 January 2007
- Choi BO, Jang HS, Kang KM et al. Fractionated stereotactic radiotherapy in patients with primary hepatocellular carcinoma. Jpn J Clin Oncol 2006; 36:154-158
- Tse RV, Hawkins M, Lockwood G et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 2008; 26(4):657-664
- Robotic radiosurgery treatment in liver tumors: Early experience from an Indian center. Dutta D, Krishnamoorthy S, Sudahar H, Muthukumaran M, Ramkumar T, Govindraj J
- Yuan Z. et al. OncoTargets and Therapy. 2014; 7: 915-923.
- Mahadevan A. et al. Radiat. Oncol. 2018; 13(1)
- Andratschka N. et al. BMC Cancer. 2018; 18(1)
- Yuan Z. et al. OncoTargets and Therapy. 2013; 6: 1527-1532
- Inhat P. et al. Stereotactic body radiotherapy using the CyberKnife® system in the treatment of patients with liver metastases: state of the art
- Sun J. et al. Repeated CyberKnife stereotactic body radiation therapy in hepatocellular carcinoma
- Mahadevan A. et al. Int. J. Radiat. Oncol. Biol. Phys. 2010; 78: 735-742
- Mahadevan A. et al. Int. J. Radiat. Oncol. Biol. Phys. 2011; 81(4): 615-622
- Goldsmith C. Stereotactic ablative radiotherapy (SABR) as primary, adjuvant, consolidation and retreatment option in pancreatic cancer: scope for dose escalation and lessons for toxicity
- Rahimi A. et al. Int. J. Radiat. Oncol. Biol. Phys. 2017; 98(1): 196-205 https://doi.org/10.1016/j.ijrobp.2017.01.020
- Vermeulen S. et al. Frontier in Oncology. 2011; 1: 43 https://doi.org/10.3389/fonc.2011.0004
- Vermeulen S. and Haas J.A. Translational Cancer Research. 2014; 3(4)
- Lozza, Fariselli et al. Partial breast irradiation with CyberKnife after breast conserving surgery: a pilot study in early breast cancer
- Di Cataldo, Francolini, Livi Robotic preoperative breast radiotherapy: tracking uncertainties and dosimetric implications
For more information write us
"*" indicates required fields