Radiosurgery and How Cyberknife is Different from Other Systems - Cyber Knife Radio surgery in India

Radiosurgery and How Cyberknife is Different from Other Systems

Although Radiosurgery has been used for over 30 years to treat both cancerous and benign tumors and growths, Cyberknife is a very new concept and different than its counterparts. Radiosurgery does not remove the tumors, rather it uses high doses of radiation to destroy the tumor cells and stop the growth of active cells. Multiple beams of radiation produced by a linear accelerator are directed at the abnormal growth within the body.

Various radiosurgery systems are available, the most most widely used being the Gamma Knife and modified linear accelerators. Cyberknife's distinction advantage over the other options is its precision, which enables physicians to maximize the amount of radiation that reaches the tumor or abnormal growth while minimizing exposure to healthy tissue and organs.

Cyberknife Treatment Procedures

Cyber knife treatment works in mainly two ways. In the first methodology, lightweight radiation delivery equipment is inserted on a multi-jointed robotic arm, so that it can be easily reach tumors in any part of the body. In the second method, the technique uses image guidance system, which allows the Cyberknife therapy to track and allocate the tumor.

CyberKnife uses image guidance and robotics to maintain a high degree of precision and is particularly useful for tumors that are close to critical structures.

The biggest advantages which the Cyber knife treatment offers are that no anesthesia is required, no hospitalization and no cuts or incisions at all. This means that there is no recovery time and everyday activities can be resumed immediately. Also, the treatment is undertaken in 1 to 6 sessions, which can be performed on either the same day or different days, as per the patient's convenience.

What does Cyber knife Surgery Treat?

The Cyberknife system has FDA clearance for treatment of tumors in any location of the body. Cyberknife surgery is administered for both cancerous and benign tumors. All stages, from I until IV (metastases) can be treated. Following are treated using Cyberknife system:

• Cancers involving the brain
• Lung cancers
• Pancreatic cancers
• Metastatic liver cancers
• Cancers involving the spine
• Benign brain tumors
• Malformations of blood vessels within the brain
• Trigeminal neuralgia
• Metastatic orbital tumors, orbital lymphomas and orbital inflammations (tumors or inflammations around the eye)

Cyberknife Treatment Cannot be Used

For tumors or metastases bigger than 3-4 cms., in which case they are treated via a similar radiotheraphy called IMRT( or Intensity Modulated Radiotherapy), which is not as precise as Cyberknife but the results are good if the tumors are not solid.

Common Conditions Treatable By CyberKnife 

Radiosurgery

• 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

Benefits of Cyberknife Surgery

Cyber knife treatment of Cancer is an extirely new approach and offers many advantages over other methods. It is a noninvasive alternative for patients who are not ideally suited for or are unable to undergo traditional surgery. The benefits include:

• No anesthesia
• No pain
• No incisions
• No bleeding
• Immediate return to normal routine
• Completely frameless
• No hospitalization
• Minimal radiation exposure to healthy tissues and organs
• Even if tumors have received the maximum allowed dosage of radiation, they can still be treated.

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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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