Advantages of CyberKnife Radio Surgery over other Radio Surgery Methods - World’s Best Advanced Technology in India

CyberKnife® is the only FDA approved completely Robotic Stereotactic Radiosurgery System available in the world that targets and destroys small and previously inaccessible tumors or lesions anywhere the body. As a non-invasive “operation”, CyberKnife has proven to be an effective alternative to surgery or conventional radiation for treating vascular abnormalities, tumors, functional disorders, and cancers with sub-millimeter accuracy. CyberKnife gives renewed hope and the possibility of a better quality of life, especially for patients with tumors previously diagnosed as inoperable, and for those who have already received the maximum amount of radiation through other treatment methods.  CyberKnife uses advanced robotics and computer guidance to deliver precise radiation beams to treat tumors anywhere in the body…even those previously thought untreatable with other radiosurgery systems.A computer program evaluates the unique shape and location of the tumor to determine the orientation of each of the 1,200 or more beams of radiation that will target the tumor. Each tumor generally requires one to five treatments, each lasting 45 to 90 minutes. Cyberknife is the world's first and only robotic radiosurgery system which treats tumours anywhere in the body without any surgery. Though it is called Radiosurgery or Cyberknife- No knife is used for incision and no surgery is performed to treat the tumours. A new hope for patients who have inoperable or surgically complex tumors, or who may be looking for a non-surgical option.Cyberknife radiosurgery is a non –invasive, high-energy radiation treatment that delivers very precise beams of radiation from many angles outside the body. The accuracy of Cyberknife is so precise that radiation can be 'matched' to the shape of small complex tumors, even those located near critical organs. This ability allows Cyberknife to treat many lesions including some considered inoperable or untreatable with surgery. Conditions Cyberknife® Can Treat The CyberKnife Robotic Radiosurgery System treats both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney.It provides a pain-free, non-surgical treatment to the patients with complex tumours which are un operable or too risky to be operated and to the patients who are looking for an alternative to surgery. To date, more than 100,000 patients have been successfully treated and more than 150 systems are installed worldwide. Benefits in India CyberKnife is so precise and accurate that radiation beams can treat small, complex tumors near critical structures such as hearing and vision nerves:  Surgical-like outcomes, without surgery Painless outpatient procedure…no head frames Does not carry the risks and complications associated with conventional surgery FDA approved to treat tumors and lesions throughout the body No anesthesia No recovery time…immediate return to normal activity Cyberknife® Indications Lesions adjacent to radiosensitive structures Complex-shaped lesions Previously irradiated lesions precluding further external beam irradiation Recurrent lesions after surgery Lesions requiring difficult surgical approaches Patients who are too frail for surgery or refuse surgery Radiosurgery Versus  Radiotherapy in India Radiosurgery is a form of radiotherapy. Both deliver radiation but use different means and doses to minimize the risk of radiation damage to healthy tissue. Standard radiotherapy delivers small daily doses of radiation in multiple treatment sessions over several weeks. Radiosurgery delivers radiation in single high doses that conform closely to the tumor shape, and fall off sharply at the edge of the tumor. Treatments can typically be done in a single session. For some patients with large tumors, the target is divided into smaller targets, each of which is treated with high doses in separate daily sessions. Stereotactic radiosurgery was once limited to brain tumors, but today it may be used to treat other diseases and conditions, including : -  Astrocytoma, Glioma, Glioblastoma Multiforme, Oligodendroglioma : - CyberKnife offers superior conformance to tumour shape, which is important especially for recurrence after surgery and conventional radiotherapy. CyberKnife can also irradiate the tumour bed to delay or prevent 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 Tumours : - CyberKnife® is regularly used to treat spinal metastases. It may also serve as a treatment for many primary spinal tumours. Pituitary Adenoma : - CyberKnife's® staged treatments may help to avoid or minimize 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® non-invasively treats 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. Meningioma :- For smaller meningiomas, radiosurgery is an ideally non-invasive 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 besides effective control of the tumour-growth. 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 though it may take some time. 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

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Minimally-Invasive Radiofrequency Ablation in India - Effective Treatment for Small Tumors

Radiofrequency ablation (RFA):

A minimally invasive treatment called radiofrequency ablation (RFA), one of several types of ablation therapy, may be an alternative when surgery for certain types of cancer is not a good option. Guided by imaging techniques, the doctor inserts a thin needle through the skin and into the tumor. High-frequency electrical energy delivered through this needle heats and destroys the tumor. Months after the procedure, dead cells turn into a harmless scar.

RFA can be used to treat certain types of cancers in the liver, bone, kidney, lung and other locations, destroying cancer cells while preserving surrounding healthy cells. Whether you are a good candidate for RFA depends on several issues, such as the size and location of your tumor.

 Radiofrequency ablation (RFA) is a minimally invasive alternative to surgery if you are not a good surgical candidate, have recurrent or multiple small tumors, or do not benefit from conventional therapies. RFA can also be used before or after surgery or in combination with radiation therapy and chemotherapy. Your doctor will determine whether RFA is the most appropriate treatment for you.

Advantages of RFA include:

·         Effective treatment for small tumors

·         Minimally invasive with no skin incision

·         Minimal risk

·         Few complications

·         Typically little or no pain

·         Minimal hospital stay

·         Can be repeated if new cancer appears

Types of cancer treated with RFA :

·         Liver cancer. RFA can be effective for cancer that starts in the liver and for some types of cancer that have spread to the liver, such as colon cancer.

·         Kidney cancer. For select people, RFA may be considered for small kidney tumors.

·         Lung cancer. For select people who have lung cancer tumors that are limited in size and number, RFA may be a nonsurgical alternative.

·         Bone cancer. RFA may be used to try to control severe pain caused by bone cancer that's limited to one or two sites, rather than to cure bone cancer.

Procedure:

The procedure is performed with patient under conscious sedation (a state of consciousness achieved through medication where the patient can bear unpleasant procedure while maintaining cardiorespiratory function. It is now called as procedural sedation) using drugs like midazolam, fentanyl and meperidine. These drugs are introduced into the body intravenously.

The instruments that are used for this procedure include image guiding technique like ultrasound, MRI or CT scan, a radiofrequency generator to produce radiofrequency waves, straight needles and straight hollow needles with retractable electrodes, insulating wires and earthing pads, and an endoscope in case of a laparoscopic procedure is done. The ablation procedure is performed by a specifically trained interventional radiologist in an operation theatre or a radiology room. The patient is connected to a monitor where his pulse, respiratory rate and blood pressure are monitored continuously throughout the procedure. In case the patient is sedated under general anesthesia, a tube is inserted down the wind pipe and connected externally to an artificial breathing unit (ventilator). The area where the needles are to be inserted is sterilized and draped. The grounding pads are attached to the back or thigh of the patient. The needles can be introduced into the patient’s body surgically, percutaneously or through endoscope.

 In the percutaneous method the surgeon makes small punctures in the skin of the abdomen through which the needle probes are inserted. The probe is guided towards the site of tumor using the image guiding option of US, MRI or CT scan or microscopic camera. Once the needle is inside the target tissue, radiofrequency energy is generated by the generator that passes between the needle probes and grounding pads. This creates a large amount of ionic vibration around the needle which in turn produces a lot of heat. This large amount of heat destroys the cancer cells and closes the nearby feeding blood vessels, ensuring no nutrition to the tumor cells. The dead cells shrink away and are replaced by scar tissue. If the tumor is large or located at multiple places in the same organ, the needles are removed and replaced into the various tumor sites for complete destruction of the cancer. This helps to prevent recurrence to a large extent. After the procedure the needles are pulled out and pressure is put at the entry site to prevent any bleeding. The skin is covered with a simple dressing. No sutures are required.

Outcome:

The outcome of this procedure is very encouraging especially for persons with large tumor who are not in a position to withstand the stresses of conventional surgery. Single ablation requires around 10-30 minutes and in case of multiple ablations the procedure takes 1-3 hours. The patient is kept in the recovery room till the effect of sedation wears away. He is then permitted to go home. Very few patients experience any pain at the site of needle entry. This pain goes away in a week’s time and the person is then able to resume his daily activities.

Benefits:

1.      Radiofrequency ablation can be an effective treatment for primary liver cancer and for cancers that have spread to the liver in those patients whose liver tumors are unsuitable for surgical resection.

2.      The success rate for completely eliminating small liver tumors is greater than 85 percent.

3.      Treatment-related serious complications are rare and discomfort, pain and muscle weakness is minimal. This reduces the hospital stay.

4.      Radiofrequency ablation may be used repeatedly to treat recurrent liver tumors.

5.      The percutaneous method of radiofrequency ablation, in which electrodes are inserted through the skin, is minimally invasive, produces few complications, and does not require hospital admission.

6.      RFA is a relatively quick procedure and recovery is rapid so that chemotherapy may be resumed almost immediately in patients who need it.

7.      Radiofrequency ablation is less expensive than other treatment options.

8.      It does not require general anaesthesia.

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