More than 300,000 people worldwide are diagnosed with malignant brain tumours every year. Yet the mortality rate from this group of diseases remains high in many parts of the world. The main problem is the sensitive location of the neoplasms, which often cannot be completely removed by surgery, as with other cancers. Brain metastases are also a dangerous problem for many cancer patients. In this article, we will discuss one of the most effective modern methods of dealing with brain tumours – Cyberknife.
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What is a Cyberknife and how does it work?
The Cyberknife is a type of stereotactic radiosurgery that is based on radiation therapy. In other words, this technique uses an external radiation device to destroy diseased tissue. However, unlike classical radiotherapy, the Cyberknife concentrates on an area the size of a pen tip, allowing doctors to achieve millimetre-level accuracy not available with many other treatment methods.
This procedure uses the CyberKnife medical robot that circles the patient and irradiates the tumour at different angles. A detailed treatment plan is downloaded into it, which the robot follows and automatically performs the procedure. The location of the tumour is tracked in real-time, and the CyberKnife can adapt to millimetric movements like breathing.
Although the method is called the CyberKnife, the treatment is done without any incisions. This name comes from the fact that this treatment is carried out with surgical precision which is not possible with standard radiation therapy.
In its nearly thirty-year history, CyberKnife has proven its effectiveness and safety in the treatment of many diseases, including brain tumours. It provides excellent clinical results in treating a wide range of neoplasms in a small number of sessions.
The principle of Cyberknife is the destructive effect of X-rays on tumour cells, which makes them stop growing and dividing. Unlike radiation therapy, this treatment does not involve neighbouring healthy tissue.
In addition, the Cyberknife can be used to shrink a tumour by cutting off the blood supply to it. It uses a medical beam to “cauterize” the vessel that feeds the tumour, thickening its walls and interrupting the blood flow. The tumour “starves” due to the lack of oxygen and nutrients, and gradually disintegrates. This method can be used to treat both malignant and benign masses.
CyberKnife treatment works well with other methods of fighting cancer – neurosurgery, chemotherapy, targeted therapy, and immunotherapy. The method can be prescribed to patients who have previously undergone brain irradiation or radiosurgical treatment of tumours, including the CyberKnife itself.
CyberKnife is used in the treatment of patients for whom surgery is contraindicated. It is recognized as safe for patients of all ages, including children.
Advantages of the CyberKnife in treating brain tumours:
The precision of the method makes it possible to irradiate only the tumour, practically not affecting the adjacent healthy brain tissue. This avoids many of the side effects typical of classical neurosurgery and radiotherapy, including cognitive defects (decreased memory, attention, and ability to solve problems).
The CyberKnife machine has an advanced system that automatically adapts to the patient’s breathing. This makes the positioning and immobilization phase much easier. It requires no additional attachment other than a mask that fixes the position of the head relative to the equipment.
The procedure is non-invasive – it requires no incisions or cranial trepanation.
Ability to remove tumours regardless of their location, even in cases where surgery is not possible due to the proximity of important parts of the brain.
No need to interrupt courses of chemotherapy or immunotherapy.
Better tumour control and overall health compared to radiation therapy.
A short course of treatment – on average, patients need to complete 1-5 sessions in 1-2 weeks.
Shorter rehabilitation period – most patients can go home immediately after treatment.
The method allows one to maintain quality of life and comfort, often – the ability to work.
Find out if CyberKnife treatment is right for you
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For what diagnoses is the CyberKnife used?
The CyberKnife system can be used for the treatment of:
Malignant primary brain tumours;
Benign primary brain tumours;
Brain metastases (up to 4 neoplasms);
Adenomas of the pituitary gland;
Neuralgia of the trigeminal nerve.
In addition to the above, CyberKnife can also be used to treat other diseases – spinal cord tumours, head and neck cancer, eye cancer, and prostate cancer.
Only an experienced oncologist will be able to recommend the best method of treatment after he or she has looked at the results of previous examinations. Many factors influence the decision – not only the type of tumour but also its size, location, growth rate, the patient’s well-being, etc. In most cases, if the doctor cannot recommend the CyberKnife, other radiosurgery options remain available to the patient – in particular, the TrueBeam and Gamma Knife.
A significant advantage of the method is that it can be effective in treating brain metastases that are considered to be resistant to radiation therapy – such as melanoma or kidney cancer.
The CyberKnife System can be used to remove tumours located in areas that are difficult to operate on without compromising important functions such as motor control, touch, hearing, and vision.
68% of tumours found in the brain are benign. However, they may still require treatment if they disrupt organ function and cause dangerous or unpleasant symptoms.
How to prepare for the procedure and how does it work?
Before treatment, each case is reviewed by a tumour board, which analyzes the diagnostic results and comes to a general agreement on whether radiosurgery is appropriate or not. Most foreign clinics request MRI brain scans no older than 4 weeks, translated into English or the national language.
You can get an answer from the hospital you are interested in more quickly by applying for help from the international MediGlobus platform. Send us your test results and we will contact hospitals and arrange a consultation with an oncologist as soon as possible.
For each patient who comes to the clinic for CyberKnife treatment of a brain tumour, an individual treatment plan is made. For this purpose, a board of oncologists convene, which usually includes a neurosurgeon, a radiation oncologist and a radiologist. Sometimes, representatives of other specialities may be invited, such as a pediatric oncologist for treating children. The doctors put together an individual treatment plan for the patient based on the results of the diagnosis. It includes the necessary number and duration of sessions, as well as the amount of radiation exposure. A single procedure is usually sufficient to remove a small tumour. If there are several neoplasms or they are located near important structures, 3-5 sessions are needed.
The patient will be informed about the tactics of treatment, preparation for radiosurgery, and possible side effects and get answers to all their questions about CyberKnife cancer treatment.
The next step is to prepare the patient for radiosurgery. CT and MRI scans of the brain are mandatory to obtain fresh images of the operated area.
An individual thermoplastic mask is also made for each patient. It will hold their head in the correct position during radiosurgery and serve as an additional guarantee of radiation accuracy.
During the actual procedure, the patient will have to lie still while the machine circles around him/her, irradiating the tumour from different angles. The treatment is completely painless and does not cause any discomfort. Some clinics may put on light music to make it easier for the patient to relax.
The radiosurgery procedure lasts an average of 60-90 minutes. The patient can go home immediately after the procedure.
After the planned course of treatment, the patient will consult with an oncologist and receive:
Conclusion of the treatment;
Recommendations for the first three months after treatment;
Information on possible side effects of radiosurgery and what to do if they occur.
To monitor the brain tumour after CyberKnife radiosurgery, you will need to have repeat MRI scans every 6 months.
Effectiveness of CyberKnife treatment for brain tumours
Various studies show 85-95% efficacy in the treatment of brain tumours with the CyberKnife method, including metastases.
Today, CyberKnife is considered a reliable method of removing benign and malignant brain tumours, even when primary cancer (located elsewhere in the body) is poorly amenable to oncotherapy. This procedure can significantly reduce or destroy the tumour in most cases, and improve the patient’s quality of life.
The specific success rate of a patient’s treatment in each case is difficult to predict. It depends on several factors:
Diagnosis (type of cancer);
Number of tumours;
Age of the patient;
His or her general state of health.
The effect of CyberKnife treatment often takes time. Reduction or complete disappearance of the tumour can be expected within 3-6 months after radiosurgery.
Recovery from treatment and side effects
Compared to other methods of treating brain tumours – neurosurgery, chemotherapy, radiation therapy – the recovery period after CyberKnife radiosurgery is shorter and easier for patients to tolerate. The quality of life of patients in most cases is not reduced.
Due to the nature of the procedure, CyberKnife usually causes fewer and milder side effects than standard radiotherapy. It has virtually no adverse effects on most patients. However, like any other radiation treatment, CyberKnife has some potential risks. These vary from patient to patient depending on the type and location of the tumour, the treatment dose, and the overall health of the patient. In most cases, they go away on their own after a month, but if specific symptoms cause severe discomfort, you can ask your treating oncologist for medication. The most common side effects include:
nausea and vomiting,
intense hair loss.
Leading CyberKnife Treatment Centers
CyberKnife is one of the most accurate and safe methods of treating brain tumours. In 85-95% of cases, the tumour shrinks significantly or disappears completely.
Compared to radiation therapy and neurosurgery, CyberKnife treatment of brain tumours is associated with fewer side effects. Patients can usually go home immediately after the procedure.
Tumour shrinkage or complete disappearance can be expected within 3-6 months after radiosurgery.
A single session may be sufficient to remove a small tumour. Most patients are treated with 3 to 5 procedures over several weeks.
Leading foreign clinics which receive patients for CyberKnife tumour treatment are Liv Ulus (Turkey), Quiron Madrid (Spain), Severance (Korea) and Ichilov (Israel).
For a quick appointment for CyberKnife treatment abroad, please contact the MediGlobus coordinating physicians. We provide free assistance in selecting clinics and making travel arrangements.
- 1. CyberKnife therapy of 24 multiple brain metastases from lung cancer: A case report
- 2. CyberKnife Stereotactic Radiosurgery in brain metastases: A report from Latin America with literature review