Cyberknife Clinical Data for Neurosurgeons

Stereotactic radiosurgery is nothing new in neurosurgery. In fact, radiosurgery has long been the domain of neurosurgeons (and radiation oncologists) because of its singular usefulness in the treatment of intracranial lesions.

At CyberKnife of Southern California at Vista, we’re innovating how you treat intracranial tumors and AVMs with stereotactic radiosurgery. During CyberKnife® treatment, imaging cameras determine the actual location of the lesion. Each time the robotic arm repositions to deliver another fraction of the ablative dose, CyberKnife recalculates the true position of the target. The result is unsurpassed, submillimeter accuracy. And because there is no need for the stereotactic frame that Gamma Knife® requires, overall treatment time is reduced, anesthesia is unnecessary and the process is painless and comfortable. Also, without the frame, treatment can be delivered in fractions (up to five sessions), if necessary, to spare surrounding healthy tissue.

Yet, CyberKnife goes beyond intracranial lesions. Because highly accurate stereotaxy is achieved without a frame, your ability to treat radiosurgically now includes tumors and lesions of the spine. And at CyberKnife of Southern California at Vista, we use the very latest CyberKnife hardware and software, including the world’s first next-generation linear accelerator. In other words, we give you the power to treat more patients with improved accuracy and in less time and with less patient risk and discomfort than is possible with Gamma Knife.

CLINICAL INDICATIONS for CyberKnife.

With CyberKnife, the range of tumors treatable with stereotactic radiosurgical ablation has increased... and now includes extracranial lesions. Here are the clinical indications for which you can give your patients state-of-the-art treatment...

• Astrocytoma, glioma, glioblastoma multiforme, oligodendroglioma – CyberKnife offers superior conformance to tumor shape, which is important for future treatment for recurrence. CyberKnife can also irradiate the tumor bed to delay recurrence.

• 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 tumors – CyberKnife is regularly used to treat spinal metastases. It may also serve as primary or follow-up treatment for meningioma, schwannoma, neurofibroma, hemangioblastoma, chondrosarcoma, chordoma, giant cell tumor, myeloma, lymphoma, osteosarcoma, Ewing sarcoma, aneurismal bone cysts and ependymoma.

• 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 tumor nodule, usually in one session, even in hard-to-reach areas. This is especially beneficial for von Hippel Lindau patients who can become disabled by multiple surgeries.

• Skull base tumors – The proximity of these tumors to vital nerve and vascular structures makes them surgically problematic. Risk of injury, infection and residual tumor growth make CyberKnife a leading treatment.

• Chordoma – While chordomas are radioresistant and close to vital structures, superior conformance and staged sessions permit higher doses and repeat treatments. CyberKnife should be considered as an initial treatment option.

• 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 tumors’ 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.

• Trigeminal neuralgia – Unlike invasive therapies and conventional radiotherapy, CyberKnife is painless, frameless, less risky and therefore more easily repeated to treat recurrence.

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

• Spinal AVMs – CyberKnife is the first system to offer radiosurgical treatment of spinal AVMs... and provides the same accuracy and success as for intracranial AVMs.

Brain Tumors:

• Staged stereotactic irradiation for acoustic neuroma. Chang et al. 2005 . Stanford researchers show that fractionated treatment using the CyberKnife System for acoustic neuromas may improve hearing preservation.

• Visual field preservation after multisession CyberKnife radiosurgery for perioptic lesions. Adler, et al. 2006. Stanford University researchers used the CyberKnife System to obtain high rates of tumor control for tumors near (less than 2 mm from) the optic apparatus; over 90% of patients treated maintained or improved their vision.

• Stereotactic radiosurgery using CT cisternography and non-isocentric planning for the treatment of trigeminal neuralgia. Lim et al. 2006. Researchers from Stanford University used the CyberKnife System to treat trigeminal neuralgia.  Ninety percent of patients treated rated their pain control as excellent with limited facial numbness at 10 months follow-up.

• Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Soltys, et al. 2007. Researchers from Stanford University used the CyberKnife System for adjuvant treatment of brain metastases by targeting post-resection cavities. They obtained a 79% local control rate at 12 months, which compares favorably to historic whole brain radiation treatment results.

• A volumetric study of CyberKnife hypofractionated stereotactic radiotherapy as salvage for progressive malignant brain tumors: initial experience. Giller et al. 2007.  Researchers from Baylor University Medical Center used the CyberKnife System to perform fractionated stereotactic radiosurgery on lesions that are difficult to treat in a single fraction approach.

• Survival following CyberKnife radiosurgery and hypofractionated radiotherapy for newly diagnosed glioblastoma multiforme. Lipani et al. 2008. Researchers from Stanford University performed CyberKnife System treatment on 20 GBM patients after tumor resection. The overall median survival was 16 months, which compares favorably to post-surgical external beam radiation therapy.

Spine:

• CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life. Degen, et al. 2005. Georgetown University Researchers performed CyberKnife System radiosurgery on patients with both benign and malignant spinal tumors. The results show pain relief and maintenance of quality of life after the treatment.

• CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Dodd et al. 2006. Stanford University researchers determined that benign lesions located on the spinal cord can be treated safely and effectively with the CyberKnife System.

• Multisession CyberKnife radiosurgery for intramedullary spinal cord arteriovenous malformations. Sinclair et al. 2006. Stanford University researchers used the CyberKnife System to treat spinal cord AVMs with fractionated stereotactic radiosurgery.

• CyberKnife radiosurgery for breast cancer spine metastases: a matched-pair analysis. Gagnon et al. 2007. Georgetown University researchers performed a comparison of external beam radiation therapy to CyberKnife System stereotactic radiosurgery for breast cancer metastasis to the spine.  Outcomes were statistically comparable, even though most of the patients treated with the CyberKnife System had previously undergone external beam radiation therapy.

• Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Gerszten et al. 2007. Researchers from the University of Pittsburgh Medical Center performed the largest published study on spinal radiosurgery. Their results show that single fraction CyberKnife System radiosurgery is safe and effective both as a primary treatment modality and as salvage treatment for spinal tumors.