What is CyberKnife®?

The CyberKnife® is a state-of-the-art, radiotherapy equipment for robotic radiosurgery that allows radiation oncologists to treat pathologies painlessly, without the need for an operation.

CyberKnife® uses pencil beams of radiation which can be directed at any part of the body, from any direction with the help of a robotic arm. The system tracks the tumour’s position, detects any movement of the tumour or patient, and automatically corrects its positioning. It then targets the tumour with multiple beams of high-energy radiation, destroying abnormal tissue without damaging surrounding areas.

The treatment is so accurate that it’s now possible to treat tumours previously thought to be inoperable. Although the results of treatment do not always show immediately, in most cases, the procedure will initially stop the growth of tumours, before gradually reducing their size. As there is no open surgery, the risk complications normally associated with an operation are eliminated, as is the need for a long recovery time. This makes treatment suitable even for those who are not well enough to cope with surgery. Most patients leave the hospital the same day.

​

How does the CyberKnife®system work?

CyberKnife® gives patients new hopes for treatment of tumours previously diagnosed as inoperable or untreatable. As mentioned earlier, the CyberKnife® uses pencil beams of radiation that can be directed at any part of the body from any direction, via a robotic arm. The vast array of different angles/trajectories from which pencil beams of radiation converge upon the tumour lead to a high cumulative dose of radiation dose at the convergence point (the target/tumour), and yet a very fast ‘fall-off’ of dose towards the periphery of the carefully mapped target. The surrounding normal tissues/organs only receive a small fraction of the high central dose of therapy.

A pair of X-ray cameras is able to obtain frequent pictures of the patient during the treatment session. The computer uses this information to target the radiation beam with sub-millimeter accuracy.

The use of the robot in the CyberKnife® System is vital in delivering radiation beams accurately whilst monitoring patient’s movement during the treatment. Any change in the position of the patient is detected by the cameras and then the robot adjusts its position to allow re-targeting of the linear accelerator before delivering the radiation beam. Use of the robot ensures that there is no need to manually reposition the patient during treatment as a result of movement, thereby slowing down the treatment process.

​

Whilst the tumour may be destroyed by an efficiently high dose of radiation therapy, conventional radiotherapy cannot usually deliver the required dose on a tumour without also delivering a high dose of radiation on the surrounding organs. CyberKnife® often overcomes this problem by its capability to reach the target area with pinpoint accuracy.

CyberKnife® system consists of an advanced lightweight linear accelerator (LINAC) – this device is used to produce high energy ‘tumour’ beams of radiation.

There is a robot that can make the linear accelerator point from a wide variety of angles. It’s this centralized computer controlled movement of the system that’s also called as the ’Brain’ of the machine.

​

How is the CyberKnife® system different from other radiation delivery systems?

Standard stereotactic radiosurgery techniques rely on a rigid frame fixed to the patient’s skull for head immobilization. There are other systems for extra-cranial Stereotactic Radiation. These systems are most often uncomfortable. If the target moves with the breathing of the patient, they often require breath holding techniques, which may be difficult for some patients. Frame-based systems mean there are limited angles that the radiation can be delivered through.

The CyberKnife® System offers maneuverability and versatility that other systems cannot offer, therefore now making it possible to treat tumours anywhere in the body, especially the brain, spine, liver, lung, pancreas and prostate. The combination of image guidance cameras and the very latest computer technology ensures that the CyberKnife® System is able to overcome the limitations of older frame-based radiosurgery systems, such as the Gamma Knife and LINAC based X-Knife.

​

What is CyberKnife® with Synchrony?

The Synchrony system is an additional, enhanced system that works alongside the CyberKnife® System. According to Accuray (the manufacturer of CyberKnife®), the Synchrony system is the first technology in the world capable of delivering radiosurgery to tumours affected by the respiratory cycle. This includes tumours of the lungs, liver, kidney and pancreas.

Synchrony uses a complex system of cameras, motion tracking software, fibre-optic sensing technology, infrared emitters and a special tight-fitting elastic patient garment. As a patient undergoes CyberKnife® treatment the synchrony system continually identifies patient breathing movement in conjunction with the internally placed fiducial markers and then updates the treatment delivery of the radiation beams. It means that the CyberKnife® system is always able to track the tumour in real time, thus allowing maximum radiation delivery and minimum risk of damage to surrounding healthy tissue.

The majority of CyberKnife®  centres around the world use Synchrony technology in conjunction with the CyberKnife®  robot. Centres which only treat intracranial tumours do not need respiratory tracking and therefore may use CyberKnife® without the Synchrony system.

Benefits of CyberKnife®

• Alternative to conventional open surgery

• Pain-free

• Non-invasive

• Can be generally done as an Out-Patient procedure

• No anesthetic required

• No recovery time

• No blood loss

• Lesions/tumours that have previously had the maximum dose of standard radiation can be treated

• Lower risks than with conventional surgery

• Treatment of lesions/tumours previously inoperable by surgery or standard radiation

• Can often achieve comparable or better outcomes than conventional surgery

• The ability to give stronger, more accurate doses of radiation directly to the tumour means that the number of treatment doses can be shortened.

• The risk of radiation damage to normal surrounding healthy tissues is minimized greatly

• Increased patient comfort due to the elimination of the invasive head frame

• Immediate return to normal activity.

​

​

CyberKnife® indications

• Lesions adjacent to radiosensitive structures

• Complex-shaped lesions

• Previously irradiated lesions precluding further external beam irradiation

• Recurrent surgical lesions after surgery

• Lesions requiring difficult surgical approaches

• Patients who are too frail for surgery or refuse surgery

​

​

What are the conditions that CyberKnife® can treat?

All patients considered for radiotherapy are potential candidates for CyberKnife® also. Research is still going on all the other conditions that can be considered for CyberKnife® treatment. However the most common conditions treatable are:

• Astrocytoma

• Glioma

• Glioblastoma multiforme

• Oligodendroglioma

​

Other Conditions:

• Brain metastases: Radiosurgery may be equal to surgery for single metastases and better for multiple metastases. Advanced imaging allows CyberKnife® to treat those that are widely dispersed.

• Spinal tumours: CyberKnife® is regularly used to treat spinal metastases. It may also serve as a treatment for many primary spinal tumours.

• SKULL BASE

  • Meningioma

  • Parasellar Meningioma

  • Pituitary Adenoma

  • Schwannoma

• HEAD & NECK

  • Nasopharynx tumours

  • Misc. Skull Base tumours

  • Recurrent Cancers

• LUNG / THORACIC

  • Primary, Metastatic or Recurrent Cancer

• LIVER

  • Primary & Metastatic Cancer

• PANCREAS

  • Primary or Recurrent Cancer

• MELANOMA

  • Primary, Metastatic or Recurrent Cancer

• INTRACRANIAL

  • Acoustic Neuroma

  • Trigeminal Neuralgia

  • Astrocytomas

  • Hemangioblastomas

  • Craniopharyngiomas

  • Metastasis

  • AVM

• SPINE

  • Benign tumours (chordomas, neurofibromas etc).

  • Primary, Metastatic or Recurrent Cancer of the spinal cord

  • Benign tumours of the bony spine

• KIDNEY

  • Primary or Recurrent Cancer

• PROSTATE

  • Primary or Recurrent Cancer

• RECURRENT DISEASE

  • Brain, Skeleton, & Soft Tissue

  • Pituitary adenoma

CyberKnife’s® staged treatments may help avoid the risk of visual loss and other side effects associated with single-session radiosurgery. Its superior conformance minimizes irradiation of normal tissue, including the optic chiasm and hypothalamus.

• Hemangioblastoma: CyberKnife® noninvasively ablates the tumour nodule, usually in one session, even in hard-to-reach areas. This is especially beneficial for Von Hippel Lindau disease patients who can become disabled by multiple surgeries.

• Skull base tumours: The proximity of these tumours to vital nerve and vascular structures makes them surgically problematic.

• Chordoma: While chordomas are relatively radioresistant and close to vital structures, they were frequently labeled as untreatable. Superior conformance and staged sessions permit higher doses therefore. CyberKnife® should be considered as a primary treatment option, the treatment of choice by now.

• Meningioma: For smaller meningiomas, radiosurgery is an ideal therapy. CyberKnife® is especially safe for meningiomas adjacent to critical structures because it can be delivered in fractions.

• Neurofibroma & schwannoma: While these tumours’ resistance to radiation makes conventional radiotherapy an option only when surgery is not, CyberKnife’s® conformance makes it an effective alternative to radiation therapy and surgery for selected patients.

• Acoustic neuroma: Studies show that CyberKnife® treatment in stages offers the highest rates ever achieved for hearing and facial-nerve preservation.

• Intracranial AVMs: With CyberKnife®, we can treat locations that can’t be safely approached with microsurgery or endovascular therapy. Selected AVMs have an 80% chance of disappearing after a single treatment session. CyberKnife® can also be used in conjunction with other therapies to remove remnants.

• Spinal AVMs: CyberKnife® is the first and the only system to offer radiosurgical treatment of spinal AVMs .It provides the same or even more accuracy and success as for intracranial AVMs.

• Trigeminal neuralgia: Unlike invasive therapies and conventional radiotherapy, CyberKnife® is painless, frameless, less risky and therefore more easily repeated to treat recurrence. It can be used in functional Neurology like Trigeminal neuralgia.

Why Choose Apollo Healthcare?

Established by Dr Prathap C Reddy in 1983, Apollo Healthcare has a robust presence across the healthcare ecosystem. From routine wellness & preventive health care to innovative life-saving treatments and diagnostic services, Apollo Hospitals has touched more than 120 million lives from over 120 countries, offering the best clinical outcomes.

• 7,000+ Healing HandsLargest network of the world’s finest and brightest medical experts who provide compassionate care using outstanding expertise and advanced technology.

• 4,000+ PharmaciesApollo Pharmacy is India’s first, largest and most trusted branded pharmacy network, with over 4000 plus outlets covering the entire nation

• Most Advanced H