Los Angeles Brain Cancer Treatment Center
Pasadena CyberKnife brain cancer treatments are typically performed on an outpatient basis over a period of one to five days, requiring no overnight hospital stays and without the requirement of the rigid head-frame that is screwed to the patients skull, as is with the Gamma Knife. Most patients experience minimal to no side effects with a quick recovery time.
Cyberknife Stereotactic Radiosurgery For Brain Cancer
The CyberKnife® Radiosurgery System was cleared by the U.S. Food and Drug Administration in 1999 to treat tumors in the head and base of the skull. Despite its name, the CyberKnife Radiosurgery is not a surgical procedure. In fact, Cyberknife treatment is completely non-invasive.
The CyberKnife System delivers high doses of pin-point, sub-millimeter accurate radiation directly to brain tumors. The CyberKnife System offers patients a non-invasive alternative to brain cancer surgery, and can be used for brain tumors that are considered inoperable because of their location in the head, for those patients who cannot undergo brain cancer surgery due to their poor medical condition, or who refuse surgery.
The CyberKnife System also can treat benign, or non-cancerous, tumors and other conditions, such as trigeminal neuralgia and arterial venous malformations (AVMs).
CyberKnife Treatment Advantages
One of the primary advantages of the CyberKnife system for brain cancer radiation treatment is that it eliminates the need for an uncomfortable stereotactic frame to still the head while radiation for brain cancer is administered. Instead, the CyberKnife system takes X-rays of the patients’ head in real time, using the patient’s bone structure as a reference to pinpoint the tumor’s location.
Before you undergo brain cancer radiation treatment with the CyberKnife system, technicians will create a soft mesh mask that’s customized to your unique facial structure. The mask will help you keep your head still during your radiation treatment for brain cancer. It is non-invasive and comfortable to wear. An initial CT scan, taken while you’re wearing the mask, will help your treatment team identify the shape, size and location of your tumor.
The planning stage of your radiation therapy for brain cancer may require a variety of imaging tests. Data from MRIs, CT scans and PET scans will help the CyberKnife System’s software identify the area that should be targeted with radiation and how much radiation should be used. The data will also help the CyberKnife System identify areas that should receive little or no radiation.
No Overnight Stays
CyberKnife treatment typically requires one to five sessions. You can return home after each session; there are no overnight stays required. Wear comfortable clothes and ask your treatment team about bringing music to listen to during your sessions.
The treatment itself is painless. You’ll lie on the treatment table wearing your customized face mask. The CyberKnife System’s computerized robot will move around your body to deliver radiation from the best angles. Just relax and remain still while the CyberKnife System and your treatment team do their work.
Resume Your Normal Life Right Away
Most patients experience few or no side effects from CyberKnife brain cancer radiation therapy. If you do experience side effects, they will likely be minimal and go away in a week or two. If necessary, your doctor will prescribe medication to ease any side effects you may experience. Most patients can return to their normal activities immediately following treatment.
Clinical evidence shows most patients respond well to CyberKnife radiation treatment for brain cancer. After treatment, your doctor will monitor your progress through a series of follow-up CT or PET-CT scans.
CyberKnife® and Brain Cancer, Los Angeles, CA
How Are Brain Tumors Treated?
How Are Brain Tumors Treated?
The treatment of brain tumors often requires combinations of several types of treatments to effectively fight the disease.
Combined and Sequential Therapy
Treatment plans for patients must be individualized to provide the optimal outcomes and reduce potential side effects based on each patients diagnosis; this takes into account the patient’s type of tumor, location of the tumor, size of the tumor, extent of tumor involvement of brain structures and other medical conditions the patient may have, all of which impact on the decisions leading to a final treatment plan for a patient. The final treatment plans for brain tumors commonly involve multiple treatment methods and procedures including radiosurgery, surgery, chemotherapy and fractionated radiation therapy. Which treatment techniques and the sequence of the multiple treatment methods recommended for each patient will be determined by your team of physicians after evaluating all of a patient’s test results.
During the last 25 to 30 years, radiosurgery has emerged as an alternative to surgery. Unlike conventional radiation therapy, during which small doses of radiation are delivered over 7 to 9 weeks, radiosurgery can treat a tumor in one to five sessions by delivering a high dose of radiation with surgical, sub-millimeter accuracy.
During radiosurgery, hundreds of narrow radiation beams are delivered from different angles, all intersecting at the tumor. This treatment allows the tumor to be attacked by a high dose of radiation without damaging surrounding sensitive brain tissue. To be effective and safe, radiosurgery must be accurate.
Two Radiosurgery devices stand out as the most precise treatment option:
To achieve this accuracy, some radiosurgery devices, such as the Gamma Knife®, require a rigid stereotactic frame be affixed to a patient’s head so the system can pinpoint the exact location of a tumor. These frames are screwed into a patient’s skull after local anesthesia is given. Many patients find these frames to be uncomfortable and painful. In addition, if multiple treatment sessions are required, the patient may have to be hospitalized with the frame in place for several days until the treatment is complete.
*Gamma Knife treatments are limited to the brain and some of the newer Gamma Knife models can treat skull based tumors as well. Gamma Knife is not capable of treating Spine tumors or tumors or other tumors in the body.
First developed and approved for the treatment of cancers and other conditions of the Brain and Spine, the CyberKnife Robotic Radiosurgery System, improve on other radiosurgery techniques by eliminating the need for stereotactic frames.
CyberKnife’s unique robotic design and highly sophisticated software means that tumors are treated non-invasively, (no stereotactic frames). The CyberKnife relies on very advanced real-time tumor imaging throughout treatment to verify the CyberKnife is on target before each and every beam is delivered. As a result, the CyberKnife System enables doctors to achieve a high level of accuracy (less than 1MM) in a non-invasive manner and allows patients to be treated on an outpatient basis in 1 treatment or 2 to 5 treatments, once per day.
For patients with multiple lesions of the brain, CyberKnife radiosurgery is another safer, more precise and more comfortable option compared to fractionated radiation therapy to part or all of the brain.
*CyberKnife treatments are also used as a combined treatment with surgery, other forms of radiation therapy, chemotherapy and more.
For solitary tumors that are not near the brain’s most critical structures, such as those involved in vision or regulation of breathing, the most common treatment option is surgery, in which the tumor is cut out through surgery. Surgery is used for primary brain tumors, such as a GBM, as well as solitary brain metastases and benign tumors. Surgery is often followed by whole brain radiation therapy or partial brain radiation techniques to eliminate any microscopic bits of the tumor. In some cases, malignant brain tumors can be treated in combination with chemotherapy for greater effect.
Fractionated Radiation Therapy
If the patient suffers from multiple tumors, typically more than 10, as is often the case with metastatic brain cancer, treatment is often whole brain radiation therapy. Whole brain radiation treatment typically requires 10-20 sessions over two to four weeks and is used to treat the entire brain, including both the tumor(s) and normal tissue. The normal brain tissue is less susceptible to small daily doses of radiation as compared to tumor cells, so the extended courses of whole brain radiation therapy result in minimal toxicity of normal brain cells for the patient.
Chemotherapy medication is delivered orally or through an IV. It affects both normal tissue and the cancer cells, so patients may experience side effects, such as nausea and vomiting, infections, fatigue and weight loss. Chemotherapy is typically given to a patient in combination with other types of brain cancer treatment. For example, it may be given during and after fractionated brain radiation therapy to target both the tumor cells in the brain as well as the tumor cells outside the brain that may be present, particularly for metastatic tumors arising from primary tumors in other parts of the body.
How does the Cyberknife system treat Brain Tumors?
How does the Cyberknife system treat Brain Tumors?
The CyberKnife Robotic Radiosurgery System improves on other radiosurgery techniques by eliminating the need for stereotactic head frames to be attached to a patient’s head with screws or bolts. As a result, the CyberKnife System enables doctors to achieve a high level of sub-millimeter accuracy in a non-invasive manner and allows patients to be treated on an outpatient basis.
The CyberKnife System’s unique robotic design coupled with highly sophisticated software can pinpoint a tumor’s exact location in real time using three dimensional X-ray images taken during the brain tumor treatment. Cyberknife destroys the brain tumor with surgical accuracy, without the need for needles, cutting, anesthesia or surgery, hence called Radiosurgery.
The CyberKnife System has a strong record of proven clinical effectiveness. It is used either on a stand–alone basis or in combination with other brain cancer treatments, such as chemotherapy, surgery or fractionated brain radiation therapy.
The CyberKnife Treatment Process
The CyberKnife Treatment Process
CyberKnife brain cancer treatments involve a team approach, in which several specialists participate. The team may include:
- Radiation Oncologist
- Medical Physicist
- Radiation Therapist
- Clinical Care Nurse Coordinator
Once the team is in place, preparations begin for the CyberKnife treatment. Generally there are three steps involved:
- 1. Set up and imaging
- 2. Treatment planning
- 3. CyberKnife treatment
Unlike other radiosurgery systems – such as the Gamma Knife – the CyberKnife System does not require patients to be fitted with a rigid and invasive head frame. In the set-up stage, the radiation therapist will create a soft mesh mask that is custom-fitted to the patient’s face. This comfortable and non-invasive mask helps the patient keep his or her head and neck immobile during treatment. While wearing the mask, a CT scan will be performed. The CT data will be fused with other image data sets such as MRIs or PET scans. These fused images sets will then will be used by the CyberKnife team to determine the exact size, shape and location of the tumor.
An MRI, PET scan or angiogram also may be necessary to fully visualize the tumor and nearby anatomy. Once the imaging is done, the face mask will be removed and stored until the CyberKnife treatment begins. Then a medical physicist and the patient’s radiation oncologist use the data to custom-design the patient’s treatment plan. The patient does not need to be present for the treatment planning.
After the brain cancer treatment plan is developed, the patient will return to the CyberKnife Center for treatment. The Radiation Oncologist may choose to deliver the treatment in one session, or stage it over two to five days. All brain cancer treatments are completed within five days. For most patients, the CyberKnife treatment is a completely pain-free experience. Patients dress comfortably in their own clothes and, depending on the treatment center, they may be allowed to bring music to listen to during the treatment. Patients also may want to bring something to read while they wait, and have a friend or family member with them to provide support before and after treatment.
When it is time for treatment, the patient lies on the table while their custom-fitted face mask is secured into place. The CyberKnife System’s computer-controlled robot will move around the patient’s body to the various locations from which it will deliver radiation to the tumor. Nothing will be required of the patient during the treatment, except to relax and lie as still as possible.
Once the CyberKnife treatment is complete, most patients quickly return to their daily routines with little interruption in their normal activities. If the treatment is being delivered in stages, the patient will need to return for additional treatments over the next several days, as recommended by their Radiation Oncologist. Side effects vary from patient to patient. Generally some patients experience minimal side effects from CyberKnife treatments, and these often go away within a week or two. Prior to treatment, the Radiation Oncologist will discuss with the patient all possible side effects they may experience. The Radiation Oncologist also may prescribe medication designed to control any side effects should they occur.
After completing CyberKnife radiosurgery treatment, it is important that the patient schedule and attend follow-up appointments. They also must keep in mind that their tumor will not suddenly disappear. Response to treatment varies from patient to patient. Clinical experience has shown that most patients respond very well to CyberKnife treatments. As follow-up, Radiation Oncologists will monitor the outcome in the months and years following a patient’s treatment, often using either CT scans and/or PET-CT scans.
Brain Cancers and Tumor Information
What is Brain Cancer?
Brain cancer is an abnormal growth of cells in the brain, which result in a collection of cells called a brain tumor. There are two general types of brain cancer: primary brain cancer and brain metastasis.
1.Primary brain cancer – a normal brain cell (glial cell) becomes malignant and is called a glioma.
* Each year more than 35,000 people are told that they have a tumor that started in the brain (primary tumors).
2.Brain metastases are defined as cancer that started elsewhere in the body (such as lung, breast, or colon) and spread to the brain through the blood stream or other body fluid.
*25 – 50% of patients with advanced cancer may develop brain metastases, with the most common sites lung (50%), breast (15%), melanoma, renal and colon (6%).
Brain Tumor Symptoms and Grades
Brain Tumor Symptoms
Depending on the location of the tumor patients will have different side effects. Most common symptoms of brain tumors include:
- Changes in vision, hearing or speech
- Memory loss or inability to concentrate
- Changes in mood or personality
- Twitching, seizures, muscle jerks or convulsions
- Weakness, numbness or tingling in arms or legs
Brain Tumor Grades
Tumor grade corresponds to the aggressiveness of the tumor. Higher grade tumors tend to grow faster, have an aggressive course, and more likely to be malignant.
Physicians assign a grade to a tumor by the way the cells look under a microscope:
- Grade I – The tumor is benign. The cells look nearly like normal brain cells. This grade is the least aggressive.
- Grade II – The tumor is malignant. The cells look less normal but they, generally, are slow growing cells
- Grade III – The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing (anaplastic).
- Grade IV – The malignant tissue has cells that look most abnormal and tend to grow quickly.
Primary Brain Tumor Types and Treatments
Primary Brain Tumors
Primary brain tumors are tumors that start in the brain and did not migrate from another area in the body.
Primary brain tumors can be either benign or malignant.
Benign brain tumors tend to grow slowly and do not contain cancer cells so they cannot metastasize; however, sometimes they can press on other sensitive areas of the brain, cause serious health problems and be life threatening. Since benign tumors usually have a clearly defined edge, they can usually be removed and usually do not grow back. Some benign tumors can transform and become malignant over time. Malignant brain tumors (brain cancer) are more serious and are a threat to life. They are likely to grow rapidly and crowd or invade nearby brain tissue. Cancer cells from malignant brain tumors although not common may break away and spread (metastasize) to other areas of the brain, the body or to the spinal cord.
Types of Primary Brain Tumors
This type of tumor arises from star-shaped glial cells called astrocytes and most often occur in the cerebrum. Astrocytoma tumors do not usually spread outside the brain or spinal cord and usually will not affect other organs. Astrocytomas are the most common glioma and often have clearly defined outlines on diagnostic images. They sometimes have diffuse zones of infiltration (e.g. low-grade astrocytoma, anaplastic astrocytoma, glioblastoma) that can arise in any location in the central nervous system (CNS), but they can have a tendency to progress to more advanced grades.
GlioBlastoma Multiforme (GBM)
The most common form of astrocytoma and it is the most malignant. Primary GBM grow, then spread to other parts of the brain very quickly. They can become very large before symptoms occur, which often begin abruptly with seizures. Surgical removal is the mainstay of treatment for this type of aggressive tumor if it can be done without unacceptable neurologic injury. Since GBM is extremely infiltrative, complete surgical removal is impossible.
*Radiation therapy and stereotactic radiosurgery is usually used in addition to surgery and can double the median survival of patients compared to supportive care alone.
A tumor arises in the meninges, which are three thin layers of tissue surrounding the brain and spinal cord. This type of tumor is usually benign, but can be malignant, and generally is a slow growing tumor. Meningiomas can happen at any age, even to children, but most frequently arise in older women. Meningiomas may not require immediate treatment and can be observed with MRI scans. If the patient has symptoms or the tumor is in a critical area treatment is usually recommended.
*Patients are often treated with surgical resection, stereotactic radiosurgery, and radiation therapy.
This is a rare, slow-growing tumor that occurs in the cells that make up the fatty substance that covers and protects nerve cells in the brain and spinal cord. It is sometimes referred to as an oligodendrogilial tumor. Oligodendroglioma can occur in adults and children, and the average age of diagnosis is 35. *These tumors are often treated with surgical resection, radiation therapy, stereotactic radiosurgery and will often respond well to chemotherapy as well.
Acoustic Neuroma (Vestibular Schwannoma)
A slow growing almost always benign tumor that arises from the cells that cover the vestibular cochlear nerve. This tumor presents with hearing loss, balance problems, or ringing in the ears (tinnitus). The tumor is located on the nerve connected to the hearing. While surgical resection has great tumor control rates it can lead to hearing loss, facial numbness, or facial weakness.
*Multiple studies show outstanding tumor control rates with stereotactic radiosurgery with a far reduced risk of side effects.
Paraganglioma (Glomus Jugularis or chemodectomas)
These tumors are rare, most often benign tumors most commonly affecting the base of skull and neck region.
*These tumors are often treated with surgical resection, radiation therapy, or stereotactic radiosurgery.
While this tumor can be seen in adults it is often in diagnosed in children and teenagers and is the most common malignant brain tumor in childhood. Disease can often times involve the spinal cord, therefore treatment is often directed to the brain and spinal cord. Although less frequent, this tumor can spread throughout the body.
*This tumor is often treated with a combination of surgery, radiation, and chemotherapy and less often stereotactic radiosurgery
Ependymoma – This tumor forms from cells lining the ependymal lining of ventricular system of the brain and spinal cord. This tumor is also often seen in children.
*Surgical resection is often followed by radiation or stereotactic radiosurgery.
These tumors are almost always benign. The pituitary is located in the sella turcica which is near the optic nerve and optic chiasm. Tumors that progress in this location can lead to loss of vision. These tumors can make hormones in excess that can lead to symptoms. In many instances these tumors may not require treatment and in some instances can be treated with medication.
*Often times patients will require surgical resection, radiation therapy, stereotactic radiosurgery or a combination of treatments.
These tumors are rare and most commonly behave as benign tumors. They are often found in young adults but can be seen in children and the elderly. They usually form in the ventricles and often present with hydrocephalus.
*Most patients will be treated with surgery and radiation therapy or stereotactic radiosurgery.
Treatment Options Comparison
|CyberKnife||Gamma Knife||Tomotherapy||Conventional Radiation Therapy|
|Total Targeting Accuracy||< 1 Millimeter||< 1 Millimeter||3-20 Millimeters||5-20 Millimeters|
|Head-Frame Requirements||Never||Required for all Treatments||Required in most Treatments||Required|
|Number of Treatments||Flexible
(1 to 5)
*See Clinical Studies
|Limited to 1||Flexible||Flexible|
|Moving Tumor Targeting||Yes||No||No||No|
|Real-time Imaging for Target Verification between each radiation beam delivery||Yes||No||No||No|
|Dedicated Radiosurgery Technology||Yes||Yes||No||No|
|Applications||Brain & Spine
|Brain||Full Body||Full Body|
Learn more about CyberKnife® and Brain Cancer
Brain Tumor Treatment: CyberKnife Patient Education
Cyberknife Benefits explained by Surgeons
Patient Testimonial: Acoustic Neuroma
Patient Testimonial: Trigeminal Neuralgia
For more information on CyberKnife’s ability to treat Brain Tumors, check out our Case Studies.