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CyberKnife: review of first 1,000 cases at a dedicated therapy center

  • Review Article
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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

The development of the CyberKnife technology, a combination of image guidance and industrial robotics, led to a paradigm shift in radiosurgery.

Materials and methods

The CyberKnife Robotic Radiosurgery System consists of a 6-MV compact LINAC mounted on a computer-controlled robotic manipulator capable of 6 degrees of freedom, with a dedicated image-guidance system which acquires X-ray images during treatment. Apart from standard neurosurgical indications (i.e., acoustic neurinomas, meningiomas, brain metastases, etc.) radiosurgical applications are currently evolving to include extracranial indications such as tumors of the spine, pancreas, lung, and liver. We reviewed the indications and outcomes in the first 1,000 patients treated in the CyberKnife Center Munich. Single-dose treatment was chosen because published clinical studies have demonstrated high efficacy and low morbidity for intracranial and spinal tumors. A recent development in radiosurgery is breathing-triggered real-time correction for respiratory motion of tumors, which makes it possible to apply radiosurgical doses to moving targets. CyberKnife treatment is designed to be delivered on an outpatient basis, mostly consisting of a single treatment session lasting between 60 and 90 min. High quality imaging is of utmost importance for successful radiosurgical applications. For example, high-field MRI, multislice CT’s, PET and PET-CT imaging data must be integrated in the planning phase for optimal target definition.

Results

A total of 750 patients with brain tumors were treated at the CyberKnife Center Munich in cooperation with the Department of Neurosurgery of the University Munich. A total of 285 patients with brain metastases received 339 treatments for 780 brain metastases. The first 55 spinal tumor patients were analyzed and have a mean follow-up of 14 months (out of 200 spinal tumor patients treated at our facility). Efficacy was high and complications minimal for all patient groups.

Conclusion

CyberKnife radiosurgery technology may be used as a primary treatment modality or in multidisciplinary cancer therapy. Patient selection, high quality diagnostic imaging and consideration of alternative modes of therapy are key issues in optimizing the benefits of CyberKnife treatment.

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Authors and Affiliations

  1. European CyberKnife Center Munich, Max-Lebsche-Platz 31, 81377, Munich, Germany

    Alexander Muacevic & Berndt Wowra

  2. Institute of Clinical Radiology, University Hospital of Munich, Munich, Germany

    Maximilian Reiser

Authors
  1. Alexander Muacevic
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  2. Berndt Wowra
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  3. Maximilian Reiser
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Correspondence to Alexander Muacevic.

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Muacevic, A., Wowra, B. & Reiser, M. CyberKnife: review of first 1,000 cases at a dedicated therapy center. Int J CARS 3, 447–456 (2008). https://doi.org/10.1007/s11548-008-0246-1

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  • DOI: https://doi.org/10.1007/s11548-008-0246-1

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