CyberKnife Radiation Therapy
Case Studies

Learn about the science behind CyberKnife.

CyberKnife Case Studies For Brain Cancers & Tumors
CASE STUDY: Cyberknife Treatment of Trigeminal Neuralgia

CONCLUSION: Optimized nonisocentric CyberKnife parameters for TN treatment resulted in high rates of pain relief and a more acceptable incidence of facial numbness than reported previously.

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CASE STUDY: CyberKnife Treatment of Brain Metastases of Malignant Melanoma and Renal Cell Carcinoma

CONCLUSION: CyberKnife radiosurgery provided excellent local control with acceptable toxicity in patients with melanoma or renal cell brain metastases.

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CASE STUDY: Cyberknife Staged Treatment of Acoustic Neuroma

CONCLUSION: Although still preliminary, these results indicate that improved tumor dose homogeneity and a staged treatment regimen may improve hearing preservation in acoustic neuroma patients undergoing stereotactic radiosurgery.

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CASE STUDY: Cyberknife of the Post-operative resection cavity of Brain Metastases

CONCLUSION: Adjuvant SRS targeting the resection cavity of brain metastases results in excellent local control and allows WBRT to be avoided in a majority of patients. A 2-mm margin around the resection cavity improved local control without increasing toxicity compared with our prior technique with no margin.

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CASE STUDY: Comparing Cyberknife (Frameless Treatment) vs. Gamma Knife (requiring a stereotactic frame to be screwed to the patients skull) – CyberKnife stereotactic radiosurgery in the treatment of patients with trigeminal neuralgia.

CONCLUSION: Effectiveness and safety of SRS using CyberKnife system is comparable with framed SRS.

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CyberKnife Case Studies For Head & Neck Tumors

CASE STUDY: Cyberknife Treatment of Recurrent Squamous Cell Cancers of the Head & Neck

CONCLUSION: Stereotactic body radiotherapy seems to be feasible, well-tolerated, and a potential alternative to surgery or external beam radiation. Stereotactic body radiotherapy may be a more convenient and effective form of reirradiation given the relatively short time required for delivery of the scheduled treatment fractions.

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CASE STUDY: Treatment Techniques comparison regarding dysphagia-related quality of life in cancer of the oropharynx and nasopharynx.

CONCLUSION: Most dysphagia problems were observed in the base of tongue tumors. For OP cancer, boosting with IMRT resulted in more dysphagia as opposed to BT or SRT/CBK. For NPC patients, in contrast to the first booster dose (46-70 Gy), no additional increase of dysphagia by the second boost was observed.

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CyberKnife Case Studies For Prostate Cancer
CASE STUDY: Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer.

CONCLUSION: Significant late bladder and rectal toxicities from SBRT for prostate cancer are infrequent. PSA relapse-free survival compares favorably with other definitive treatments. The current evidence supports consideration of stereotactic body radiotherapy among the therapeutic options for localized prostate cancer.

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CASE STUDY: Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years.

CONCLUSION: In this large series with long-term follow-up, we found excellent biochemical control rates and low and acceptable toxicity, outcomes consistent with those reported for from high dose rate brachytherapy (HDR BT). Provided that measures are taken to account for prostate motion, SBRT’s distinct advantages over HDR BT include its noninvasiveness and delivery to patients without anesthesia or hospitalization.

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CASE STUDY: Stereotactic body radiotherapy as boost for organ-confined prostate cancer.

CONCLUSION: Three-year actuarial biochemical control rates were 89.5% and 77.7% for intermediate- and high-risk patients, respectively. SBRT boost for prostate cancer treatment is safe and feasible with minimal acute toxicity. At 33 months late toxicity and biochemical control are promising. Long-term durability of these findings remains to be established.

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CASE STUDY: Stereotactic body radiotherapy as monotherapy or post-external beam radiotherapy boost for prostate cancer: technique, early toxicity, and PSA response.

CONCLUSION: Early results with SBRT monotherapy and post-EBRT boost for PCa demonstrate acceptable PSA response and minimal toxicity. PSA nadir with SBRT boost appears comparable to those achieved with HDR brachytherapy boost.

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CASE STUDY: Cost-effectiveness analysis of SBRT versus IMRT: an emerging initial radiation treatment option for organ-confined prostate cancer.

CONCLUSION: Compared with IMRT, SBRT for low to intermediate-risk prostate cancer has great potential cost savings for our healthcare system payers and may improve access to radiation, increase patient convenience, and boost quality of life for patients. Our model suggests that the incremental cost-effectiveness ratio of IMRT compared with SBRT is highly sensitive to quality-of life outcomes, which should be adequately and comparably measured in current and future prostate SBRT studies.

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CASE STUDY: Less Is More: Will Hypo-fractionated Radiotherapy Negatively Affect Cancer Centers or Be a Godsend in the New Health Care Environment?

CONCLUSION: Aneja et al have articulated a convincing argument for the use of hypofractionated radiotherapy regimens in the treatment of prostate cancer. Longer follow-up of efficacy and toxicity is needed to confirm equal endpoints compared with more conventional fractionation regimens. However, hypofractionated radiotherapy could be a solution for newly formed ACOs, should the recent health care legislation be upheld by the Supreme Court.

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CASE STUDY: SBRT instead of IMRT could reduce cost of prostate treatment.

CONCLUSION: Defining the factors that comprise cost-effectiveness as cost, efficacy, and quality of life, the authors calculated that patients treated with either modality had a mean quality-adjusted life year score of 7.9. However, the mean cost of treatment for SBRT was $22,152, compared with $35,431 for IMRT. More widespread adoption of SBRT for this type of prostate cancer patient could have a profound economic impact from both societal and individual patient perspectives, the group concluded.

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CASE STUDY: Intermediate-risk patients with organ-confined prostate cancer have high cancer-free survival rate after stereotactic body radiation therapy.

CONCLUSION: Results demonstrate that three years after SBRT treatment, 99 percent of patients were cancer-free, with only one patient experiencing cancer recurrence. There were no reports of acute grade 3 to 5 toxicity.

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CASE STUDY: INTRAFRACTIONAL MOTION OF THE PROSTATE DURING HYPOFRACTIONATED RADIOTHERAPY (Cyberknife).

CONCLUSION: Our study shows the importance of real-time image guidance and motion-compensation techniques such as the robotic linear accelerator used in CyberKnife during hypofractionated prostate radiation treatment. Given the magnitude and random nature of prostate motion as well as recent technical advancements in various related fields, real-time monitoring of prostate position to compensate for the motion should be part of future prostate radiation therapy to ensure adequate dose coverage of the target while maintaining adequate sparing of adjacent structures.

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CyberKnife Case Studies For Spine Tumors
CASE STUDY: Cyberknife Radiosurgery for Spine Metastases

CONCLUSION: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.

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CASE STUDY: SBRT reirridation of Spinal Metastases

CONCLUSION: Reirradiation for progressive spinal metastases with stereotactic body radiotherapy results in good local control and limited toxicity. Initial surgery should be considered for tumors within 5 mm of the spinal cord. Radiation dose should be tailored for tumors near or invading the psoas muscle secondary to observed risk of lumbar plexopathy.

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CASE STUDY: Cyberknife Stereotactic Radiosurgery of Spinal Tumors for pain control and quality of life.

CONCLUSION: CyberKnife radiosurgery improves pain control and maintains QOL in patients treated for spinal tumors. Early adverse events are infrequent and minor. The authors await long-term follow-up data to determine late complications and tumor control rates.

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CASE STUDY: CyberKnife radiosurgery for benign intradural extramedullary spinal tumors.

CONCLUSION: Although more patients studied over an even longer follow-up period are needed to determine the long-term efficacy of spinal radiosurgery for benign extra-axial neoplasms, short-term clinical benefits were observed in this prospective analysis. The present study demonstrates that CyberKnife radiosurgical ablation of such tumors is technically feasible and associated with low morbidity.

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CyberKnife Case Studies For Lung Tumors
CASE STUDY: Case Study: Cyberknife for Stage I Lung Cancer at 36 Months.

CONCLUSION: The results indicate that the delivery of precisely targeted ablative radiation doses with surgical precision to limited treatment volumes of lung tumors in a hypofractionated fashion is feasible and safe. Image-guided robotic stereotactic radiosurgery of lung tumors with CyberKnife(R) achieves excellent rates of local disease control with limited toxicity to surrounding tissues and, in many cases, might be curative for patients for whom surgery is not an option.

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CASE STUDY: Outcomes of four dimension stereotactic body radiotherapy (SBRT) for centrally located lung tumors.

CONCLUSION: SBRT of central lung lesions can be safely delivered, with promising early tumor control in patients many of whom have severe comorbid conditions.

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CASE STUDY: Cyberknife with Tumor Tracking an effective treatment for high-risk surgical patients with Stage I non-small cell lung cancer.

CONCLUSION: CyberKnife is an effective treatment approach for stage I NSCLC that is similar to wedge resection, eradicating tumors with 1-2 cm margins in order to preserve lung function. Prospective randomized trials comparing CyberKnife with wedge resection are necessary to confirm equivalence.

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CASE STUDY: Radical stereotactic radiosurgery with real-time tumor motion tracking in the treatment of small peripheral lung tumors.

CONCLUSION: Radical stereotactic radiosurgery with real-time tumor motion tracking is a promising well-tolerated treatment option for small peripheral lung tumors.

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CASE STUDY: Fractionated Stereotactic Body Radiation Therapy in the Treatment of Primary, Recurrent, and Metastatic Lung Tumors: The Role of Positron Emission Tomography/Computed Tomography–Based Treatment Planning.

CONCLUSION: Stereotactic body radiation therapy with CyberKnife is an effective treatment for patients with medically inoperable recurrent or metastatic lung cancer. Positron emission tomography/CT is valuable in staging, planning, and evaluating treatment response and might predict long-term outcome.

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CASE STUDY: Role of 4D Stereotactic Radiotherapy with the CyberKnife® System in the Treatment of Lung Cancer.

CONCLUSION: 4-D SBRT with the CyberKnife system thus provide a major therapeutic advance in the management of lung lesions. While minimising exposure to the surrounding normal tissue or adjacent vital structure, it achieves high levels of local disease control with limited toxicity. In many cases, it might be curative or at least beneficial for patients in whom surgery is not an option. Its practical advantages include a short treatment course as well as preservation of physical and emotional quality of life during and after treatment.

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CASE STUDY: STEREOTACTIC BODY RADIOTHERAPY (SBRT) FOR OPERABLE STAGE I NON–SMALL-CELL LUNG CANCER: CAN SBRT BE COMPARABLE TO SURGERY?

CONCLUSION: Stereotactic body radiotherapy is safe and promising as a radical treatment for operable Stage I NSCLC. The survival rate for SBRT is potentially comparable to that for surgery.

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CASE STUDY: Multi-Institutional Phase I/II Trial of Stereotactic Body Radiation Therapy for Lung Metastases

CONCLUSION: This multi-institutional phase I/II trial demonstrates that high-dose SBRT is safe and effective for the treatment of patients with one to three lung metastases.

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CASE STUDY: Stereotactic body radiation therapy for inoperable early stage lung cancer.

CONCLUSION: Patients with inoperable non-small cell lung cancer who received stereotactic body radiation therapy had a survival rate of 55.8% at 3 years, high rates of local tumor control, and moderate treatment-related morbidity.

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CASE STUDY: Review and uses of stereotactic body radiation therapy for oligometastases.

CONCLUSION: Stereotactic body radiation therapy (SBRT) is a novel treatment modality in radiation oncology that delivers a very high dose of radiation to the tumor target with high precision using single or a small number of fractions. SBRT is the result of technological advances in patient and tumor immobilization, image guidance, and treatment planning and delivery. A number of studies, both retrospective and prospective, showed promising results in terms of local tumor control and, in a limited subset of patients, of survival.

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CASE STUDY: Stereotactic body radiation therapy in centrally and superiorly located stage I or isolated recurrent non-small-cell lung cancer.

CONCLUSION: Image-guided SBRT using 50 Gy delivered in four fractions is feasible and resulted in excellent local control.

*Cyberknife is the only Image-guided SBRT dedicated robotic system that detects and tracks tumors in motion maintaining submillimeter accuracy, sparing healthy tissues, resulting in less to no side effects.

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CyberKnife Case Studies For Pancreas Tumors
CASE STUDY: Phase I Study of Stereotactic Radiosurgery treatment of patients with locally advanced Pancreatic Cancer.

CONCLUSION: It is feasible to deliver stereotactic radiosurgery to patients with locally advanced pancreatic cancer.

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CASE STUDY: SBRT is non-inferior to standard chemo-radiation for locally advanced, non-metastatic pancreas cancer: A meta-analysis of published data.

CONCLUSION: Meta-analysis of published reports of SBRT for locally advanced, non-metastatic pancreatic adenocarcinoma using reconstructed individual patient survival data suggests this therapy is not inferior to standard chemoradiation therapy.

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CyberKnife Case Studies For Liver Tumors

CASE STUDY: DOSE PLANNING IN STEREOTACTIC RADIOTHERAPY OF LIVER TUMORS USING 18-FLUORODEOXYGALACTOSE AND PET/CT-SCANNING.

CONCLUSION: Preliminary results show that dose planning for SBRT based on 18FDGal PET/CT scanning in patients with liver tumors
is feasible. Dose planning for radiotherapy in general and for SBRT in particular may in the future be based on combined physiological and anatomical
imaging rather than anatomical imaging alone.

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CASE STUDY: Cyberknife Robotic Radiosurgery or Percutaneous Radiofrequency Ablation for salvage treatment of colorectal liver metastases.

CONCLUSION: Stereotactic radiation therapy is an evolving modality to treat otherwise unresectable liver metastases. In this analysis, two local therapies: 1) single session robotic radiosurgery (RRS) and 2) percutaneous radiofrequency ablation (RFA) were compared in a total of 60 heavily pretreated colorectal cancer patients.

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CASE STUDY: Cyberknife Stereotactic Body Radiotherapy for heavily pretreated Liver Metastases and Liver Tumors.

CONCLUSION: CyberKnife SBRT is an effective modality with good local control and low morbidity for metastatic disease to the liver or for primary liver tumors which are unresectable or medically inoperable.
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CASE STUDY: STEREOTACTIC BODY RADIOTHERAPY (SBRT) FOR LIVER METASTASES FROM COLORECTAL CANCER.

CONCLUSION: In this group of highly pretreated and poor risk patients, SBRT for liver metastases offered promising outcome with a median survival of
22 months. Patients treated after 2004 had a better survival than patients treated in the years before. Although the systemic treatment has changed, we believe that this is also a result of improved patient selection and treatment. SBRT should be part of the treatment of colorectal liver metastases, even in poor risk patients.

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CyberKnife Case Studies For Cervical Cancer
CASE STUDY: Robotic radiosurgery: emulating brachytherapy in patients with locally advanced cervical carcinoma. Technique, feasibility and acute toxicity.

CONCLUSION: CyberKnife robotic radiosurgery in patients with cervical cancer provides excellent target coverage with steep dose gradients toward normal tissues and safe DVH parameters for bladder, rectum and sigmoid. Acute toxicity was mild. Longer follow-up is needed to evaluate the oncological benefit.

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CyberKnife Case Studies For Breast Cancer
CASE STUDY: Accelerated Partial Breast Irradiation: Using the CyberKnife as the Radiation Delivery Platform in the Treatment of Early Breast Cancer.

CONCLUSION: Our experience suggests that the CyberKnife is a suitable non-invasive radiation platform for delivering APBI with achievable normal tissue constraints. Although the clinical outcomes for this retrospective analysis are promising, the follow-up is too limited and the number of treated patients is too small to permit firm conclusions. Patient selection for APBI using the CyberKnife continues at our center and others worldwide including a recently opened dose escalating Phase I trial at the University of Texas Southwestern Medical Center (Timmerman, 2010). The next 3–5years will provide additional evidence for local control and cosmetic outcomes in selected subgroups of patients with early breast cancer.

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