CyberKnife
Radioterapia y Radiocirugía
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Presentación
“[…] the same radiobiologic principles [as SRS] could and should be clinically applicable to targets in the spine, chest or abdomen with comparable success.”
"[...] los mismos principios radiobiológicos (tales como en SRS) podrían y deberían ser aplicables clínicamente a la columna, pecho o abdomen con éxito semejante."
Información general
Primer y único sistema robótico de radiocirugía con precisión submilimétrica para tratamientos en cualquier parte del cuerpo, brindando seguimiento en tiempo real del tumor y sincronización con la respiración del paciente.
CyberKnife® es una alternativa no invasiva, indolora y no quirúrgica para tratar tumores en todo el cuerpo. De esta forma, se evita que el organismo reciba altas dosis de radiación que suelen dañar gran cantidad de tejido sano circundante al tumor.
Es ideal para pacientes que no desean someterse a una cirugía con tumores inoperables o quirúrgicamente complejos.
Su avanzado software permite el seguimiento de tumores en movimiento, especialmente los localizados en los pulmones, y disminuye la radiación que reciben los tejidos sanos a niveles mínimos.
Permite que los haces de radiación puedan llegar al tumor desde más de 1200 posiciones diferentes, concentrando la radiación sobre el objetivo, mejorando la experiencia del usuario y del paciente.
- El CyberKnife® ofrece más opciones de tratamiento, proporcionando una nueva esperanza a los pacientes con tumores inoperables o a aquellos que rechazan la cirugía.
- Efectúa un seguimiento continuo de la posición del tumor, detecta la localización de los mismos y corrige el movimiento del tumor y del paciente a lo largo del tratamiento.
- Administra una dosis alta de radiación con precisión submilimétrica, minimizando el daño al tejido sano circundante.
- Este tratamiento es indoloro y no requiere la utilización de anestesia, eliminando eficazmente el riesgo de complicaciones tales como infecciones, hemorragia y otros efectos colaterales de la cirugía tradicional.
- Menor tiempo de recuperación en comparación con la cirugía abierta tradicional, ya que se realiza de forma ambulatoria.
- En el caso de los tratamientos intracraneales, los pacientes reciben la radiación de forma cómoda, gracias a la ausencia de un marco estereotáxico, y por lo tanto sin dolor.
- El paciente puede recibir su tratamiento en un número de sesiones que oscila entre 1 y 5.
- Seguimiento continuo del tumor
Los tumores suelen moverse durante la aplicación del tratamiento con radioterapia. Aún estando el paciente inmovilizado, movimientos imperceptibles como el de la respiración o, en el caso de tumores en la próstata, el movimiento de la misma, pueden ocasionar variaciones en la posición del tumor durante la administración de la radiación, generando que el tejido sano circundante sea irradiado. El CyberKnife® posee un software que facilita el seguimiento continuo del tumor, la detección automática del movimiento, y la corrección de la posición del brazo robótico, readecuando la dirección del haz de radiación sin tener que interrumpir el tratamiento o reposicionar al paciente. No es necesaria la colocación de fiduciales ni marco estereotáxico.
- Tratamiento no coplanar
A diferencia de los aceleradores lineales (LINAC) convencionales que entregan tratamientos coplanares, el CyberKnife®, gracias a su manipulador robótico, permite realizar tratamientos no coplanares. Los haces de radiación son entregados desde diferentes planos, pudiendo atacar al tumor desde distintos ángulos.
- Flexibilidad para entregar haces no isocéntricos de radiación
CyberKnife® es el único sistema capaz de ofrecer tratamientos isocéntricos y no isocéntricos, proporcionando tratamientos más conformados a lesiones con formas irregulares, preservando el tejido sano circundante.
- Sistema de seguimiento fiducial
Permite realizar el seguimiento de tumores extracraneales a través del seguimiento de marcadores fiduciales implantados. - Sistema de seguimiento XSight® Spine
Permite realizar un seguimiento preciso y automático de todas las regiones de la columna vertebral, desde la primera cervical hasta la sacra. - Sistema de seguimiento XSight® Lung
Se utiliza en conjunto con el XSight® Spine para llevar a cabo la alineación del paciente. Durante el tratamiento es posible utilizarlo con el sistema Synchrony® para realizar un seguimiento de los movimientos del tumor debido a los patrones de respiración del paciente. - Sistema de seguimiento respiratorio Synchrony®
Se utiliza para supervisar la respiración del paciente y regular la posición del LINAC, de modo que coincida con el movimiento respiratorio del tumor. - Sistema adaptable de adquisición de imágenes in Tempo™
Se ha diseñado especialmente para representar los tipos de movimientos que se encuentra en general al administrar radiación a la próstata. - Multiplan MD Suite
Permite a los usuarios realizar una preparación previa a la planificación y una revisión posterior a la planificación de los planes de tratamiento. Proporciona acceso a los datos del registro del paciente desde la base de datos del sistema CyberKnife® para permitir la carga remota de estudios de imágenes y tareas de planificación para uso del médico. - Sistema de posicionamiento de pacientes RoboCouch®
Es una camilla robótica controlada por una computadora para posicionar a los pacientes mediante un manipulador con 6 grados de libertad. - Cambiador robótico del colimador XChange®
Es un sistema controlado por computadora para intercambiar automáticamente los colimadores en el manipulador del sistema, tanto antes como durante el tratamiento.
Tratamientos
- Antes del procedimiento:
El paciente se realiza una tomografía computarizada de alta resolución, para determinar el tamaño, forma y la localización del tumor.
La tomografía es digitalizada y transferida a la estación de trabajo del sistema CyberKnife®, donde se planificará el tratamiento.
A continuación, un médico calificado utiliza el software CyberKnife® para generar un plan de tratamiento. El plan se utiliza para dirigir la dosis de radiación deseada al tumor, limitando la exposición de los tejidos sanos circundantes a la radiación. - Una vez en el centro de atención:
El paciente se posiciona cómodamente en la camilla de tratamiento.
El CyberKnife® se mueve lentamente alrededor del paciente para administrar la radiación hacia el tumor desde las distintas posiciones.
Cada sesión de tratamiento tiene una duración de entre 30 y 90 minutos, dependiendo del tipo de tumor a tratar.
Los tumores que se mueven con la respiración suelen generar mucha incertidumbre con respecto a la precisión del tratamiento. El Synchrony Respiratory Tracking System permite detectar dinámicamente los tumores que se mueven con la respiración, posibilitando un tratamiento continuo mientras que el paciente respira normalmente. De esta manera se evitan las técnicas de compensación para movimientos respiratorios.
La próstata puede moverse de manera impredecible más de 5mm en solo 30 segundos. El CyberKnife®, con su guía visual continua, permite brindar al paciente tratamientos precisos y seguros en la próstata, evitando afectar órganos críticos como el recto, la vejiga y la uretra.
Es el único sistema capaz de administrar a la próstata, de forma no invasiva, dosis equivalentes a HDR con precisión submilimétrica. La posibilidad de realizar tratamientos no coplanares permite aumentar la dosis con un control preciso.
El CyberKnife® es el primer y único sistema que puede realizar radiocirugía en todo el sistema nervioso central, extendiéndose a todos los niveles de la columna, desde las cervicales hasta las sacras, sin la necesidad de utilizar marco estereotáxico o fiduciales.
Permite tratar lesiones benignas, malignas, vasculares e intracraneales funcionales, y periféricas extremas, con una preservación de la visión y de la audición ampliamente mejorada.
El CyberKnife® ha revolucionado la radiocirugía intracraneal sin marco estereotáxico, siendo el único sistema con guía visual continua durante la administración de la radiación, que detecta constantemente el movimiento intracraneal, y corrige automáticamente el posicionamiento del manipulador robótico para seguir emitiendo radiación con exactitud.
La columna vertebral puede moverse hasta 4mm durante un tratamiento de 15 minutos, aunque el paciente se encuentre inmovilizado. Mientras que los sistemas de IGRT (Radioterapia Guiada por Imágenes) no tienen en cuenta estas variaciones y son limitados por la rotación del gantry, el sistema CyberKnife® proporciona exactitud y precisión durante todo el tratamiento.
Preguntas frecuentes
El sistema cuenta con un sistema de colimación del haz de radiación de apertura variable Iris Collimator y un sistema de intercambiador robótico de colimadores Xchange, los campos de irradiación tienen un tamaño de 5,7.5,10,12.5,15,20,25,30,35,40,50 y 60 mm de diámetro a una distancia fuente superficie de 80 cm.
El valor del sistema se socializa mediante la emisión de un presupuesto oficial en el marco de una reunión, típicamente con valor característico correspondiente al de un sistema que realice radiocirugía con intensidad modulada y con guía de imágenes.
El CyberKnife es el primer y único sistema que puede realizar radiocirugía en todo el sistema nervioso central, extendiéndose a todos los niveles de la columna, desde las cervicales hasta las sacras, sin la necesidad de utilizar marco estereotáxico o fiduciales.
Permite tratar lesiones benignas, malignas, vasculares e intracraneales funcionales, y periféricas extremas, con una preservación de la visión y de la audición ampliamente mejorada.
El CyberKnife es el único sistema en el mundo que realiza radiocirugía robótica tanto intracraneal como extracraneal. Las siguientes patologías son tratadas en cientos de centros con el sistema CyberKnife:
- Cabeza y cuello
- Pulmón
- Mama
- Hígado
- Páncreas
- Próstata
- Columna
- Tumores benignos
- Tumores malignos, metástasis cerebrales, neuroblastomas gliomas
- Malformaciones Arteriocerebrales
- Patología funcional como neuralgia del trigémino y trastornos del movimiento
El servicio técnico es prestado de forma local por los ingenieros de DeLeC Científica altamente capacitados por Accuray, adicionalmente se cuenta con el respaldo de asistencia remota y presencia de ingenieros de fábrica según la necesidad y complejidad del aspecto técnico a tratar.
La estadística indica que a diciembre del 2010 fueron tratados a nivel mundial más de 100,000 pacientes.
Equipos instalados en Latinoamérica
- Fundación Arturo López Pérez – Santiago de Chile, Chile.
- Instituto Neurológico de Colombia – Medellín, Colombia
- Christus Muguerza Hospital – México
- UMAE Hospital de Oncología Centro Médico Nacional Siglo XXI – IMS – México
- Hospital Domingo Luciani – Caracas, Venezuela
- Hospital Perez Carreno – Caracas, Venezuela
- HIMA San Pablo – Caguas, Puerto Rico
Brochures
Folleto
Sistema overview
Technical specifications cyberknife m6 series
Serie cyberknife m6
Posibilidades inigualadas con cyberknife
Treatment delivery
Respiratory motion solutions
Non small cell lung cancer
Lung radiosurgery
Lung treatment comparison
Prostate solutions
Prostate radiosurgery
Prostate treatment comparison
Spine radiosurgery
Intracranial radiosurgery
Publicaciones Científicas
Long-term outcomes after radiosurgery for glomus jugulare tumors
Radiosurgery is an effective and safe treatment modality for GJT. Patients having 1 CN involvement before radiosurgery show a higher risk of lack of improvement of symptoms.
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Dosimetric investigation of accelerated partial breast irradiation (APBI) using CyberKnife
The dosimetric feasibility of APBI using CyberKnife was investigated in this retrospective study. All the dosimetric parameters strictly met the guidelines from the NSABP B39/RTOG 0413 protocol.
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On the beam direction search space in computerized non-coplanar beam angle optimization for IMRT—prostate SBRT
Virtual hdrsm cyberknife treatment for localized prostatic Carcinoma
It is possible to construct CK SBRT plans that closely recapitulate HDR dosimetry and deliver the plans noninvasively.
Dosimetric comparison of Linac-based (BrainLAB) and robotic radiosurgery (CyberKnife) stereotactic system plans for acoustic schwannoma
Comparison of intracavitary brachytherapy and stereotactic body radiotherapy dose distribution for cervical cancer
SBRT plans achieved better target coverage and better dose distributions to critical organs except bone marrow compared with HDR brachytherapy plans in patients with locally advanced cervical cancer.
Intrafractional motion of the prostate during Hypofractionated radiotherapy
With proper monitoring and intervention during treatment, the prostate shifts observed among patients can be kept within the tracking range of the CyberKnife. On average, a sampling rate of 40 sec between consecutive X-rays is acceptable to ensure submillimeter tracking.
On the beam direction search space in computerized non-coplanar beam angle optimization for IMRT—prostate SBRT
For prostate SBRT, IMRT plans generated with all four investigated non-coplanar search spaces had clearly improved organ at risk (OAR) sparing compared to the coplanar (CP) search space, especially for the rectum which was the most important OAR in this study.
Technical Description, Phantom Accuracy, and Clinical Feasibility for Single-session Lung Radiosurgery
The latest development of image-guided respiratory real-time tumor tracking for robotic lung radiosurgery is a technically safe and stable procedure. The tracking error is well below 1 mm and the overall shape of the dose profile is not affected by target motion and/or phase shift between fiducial and optical marker motion.
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Advances in fiducial-free image-guidance for spinal radiosurgery with CyberKnife – a phantom study
Enhanced Xsight spine tracking further improves CyberKnife image guidance for spinal targets. Submillimeter translational accuracy and a more robust and accurate detection of the spine orientation raises the level of precision achievable in fiducial-free radiosurgery. Refe rences
Performance evaluation of a CyberKnife R G4 image-guided robotic stereotactic radiosurgery system
Clinical accuracy of the respiratory tumortracking system of the Cyberknife
Analyses of the log files of real clinical cases have shown that the geometric error caused by respiratory motion is substantially reduced by the application of respiratory motion tracking.
CyberKnife Radiosurgery for Prostate Cancer
Although long-term follow-up is necessary to further validate CyberKnife SBRT for prostate cancer, much can be learned from the available data. Thus far, the local control rates for all risk groups have been highly promising and the low PSA values at 2-3 years are highly suggestive of a potent biological effect of a total dose of 35 to 36.25 Gy delivered in 5 fractions.
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Health-Related Quality of Life After Stereotactic Body Radiation Therapy for Localized Prostate Cancer
Long-term outcome demonstrates that prostate SBRT is well tolerated and has little lasting impact on health-related QOL. A transient and modest decline in urinary and bowel QOL during the first few months after SBRT quickly recovers to baseline levels.
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Stereotactic body radiotherapy for localized prostate cancer
PSA relapse-free survival rates after SBRT compare very favorably with other definitive treatments for low and intermediate risk groups. The data for high risk patients is very encouraging but requires longer follow-up at this time.
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Stereotactic body radiation therapy boost in locallyadvanced Pancreatic cancer
Our findings indicate that a SBRT boost provides a safe means of increasing radiation dose. Based on the results of this study, we recommend that a well controlled Phase II study be conducted on locally advanced pancreatic cancer.
Induction gemcitabine and stereotactic body radiotherapy for Locallyadvanced nonmetastatic pancreas cancer
For patients with locally advanced pancreas cancer, this strategy uses local therapy for those who are most likely to benefit from it and spares those patients with early metastatic progression from treatment.
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Outcome of four-dimensional stereotactic radiotherapy for centrally located lung tumors
Four-dimensional lung tumor tracking is feasible for central tumors. The local tumor control rate was 76% at two years. Local tumor control was better in patients with early stage lung cancer compared to patients with metastasis.
Image-guided robotic stereotactic body radiation therapy for Liver metastases
Image-guided robotic stereotactic body radiation therapy is feasible, safe, and effective, with encouraging local control. It provides a strong alternative for patients who cannot undergo surgery.
Long-Term Outcomes of Stereotactic Body Radiation Therapy in the Treatment of Hepatocellular Cancer as a Bridge to Transplantation
Stereotactic Radiotherapy of Hepatocellular Carcinoma: Preliminary Results
Our results suggest promising therapeutic efficacy and good clinical tolerance to CyberKnife SRT treatment for HCC patients not eligible for other treatment modalities.
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Stereotactic radiosurgery of the postoperative resection cavity For brain metastases
Quality of radiosurgery for single brain metastases with respect to treatment technology
With a matched-pair analysis we for the first time were able to prove that identical quality of clinical results in a key indication of RS, namely single brain metastases, can be J Neurooncol 123 achieved with the GK and the CK. Furthermore we could show that the radiosurgical dose can be better tailored to the target with the CK than with the GK.
Nonisocentric radiosurgical rhizotomy for trigeminal neuralgia
Compared with previous reports that describe the clinical outcome after nonisocentric radiosurgical rhizotomy in patients with TN, the present investigation demonstrates both high rates of pain relief and an acceptable incidence of facial numbness.
Single-session and multisession CyberKnife radiosurgery for spine metastases
Single-session and MS SRS is safe and effective in treating spinal metastases. Over the 1st year, pain control was superior with SS treatment compared with MS treatment. There was no statistically significant difference in toxicity between treatment groups.
Radiosurgery for Spinal Metastases
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.
Treatment of spinal tumors using Cyberknife fractionated stereotactic radiosurgery
CyberKnife stereotactic radiosurgery is a safe and effective modality in the treatment of patients with spinal tumors. CyberKnife offers durable pain relief and maintenance of quality of life with a very favorable side effect profile.
CyberKnife Radiosurgery in Neurosurgical Practice
CyberKnife radiosurgery represents a significant advance over the very successful Gamma Knife radiosurgical treatment platform.
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The CyberKnife® Robotic Radiosurgery System in 2010
The CyberKnife in Clinical Use: Current Roles, Future Expectations
Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years
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.
Stereotactic body Radiotherapy as monotherapy or post–external beam radiotherapy boost for prostate cancer
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.
Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer
Hypofractionated SBRT can be delivered quickly and effectively in patients with nonmetastatic, locally advanced, unresectable pancreatic cancer with acceptable side effects and minimal interference with gemcitabine chemotherapy.
Comparison of planned dose distributions calculated by Monte Carlo and ray-trace algorithms for the treatment of lung tumors with CyberKnife
We establish that changing the treatment plan calculation algorithm from EPL to MC can produce large differences in target and critical organs’ dose coverage. The observed discrepancies are larger for plans using smaller collimator sizes and have strong dependency on the anatomical relationship of target-critical structures.
Application of Robotic Stereotactic Radiotherapy to Peripheral Stage I Non-small Cell Lung Cancer with Curative Intent
In this small cohort of patients with stage I peripheral NSCLC, robotic stereotactic radiotherapy seems to be a safe and obviously superior alternative to conventionally fractionated radiotherapy, with results that may be approaching those obtained with lobectomy without the associated morbidity.
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Image-Guided Robotic Stereotactic Radiation Therapy with Fiducial-Free Tumor Tracking for Lung Cancer
Lung SBRT with fiducial-free tumor tracking is both feasible and effective. Local control rate is similar to what so far has been reported in other studies that have used markers for tumor tracking. Toxicity was lower as there was no fiducial implantation, thereby preventing cases of pneumothorax normally associated with this procedure.
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Cyberknife Stereotactic Body Radiation Therapy for Nonresectable Tumors of the Liver: Preliminary Results
CyberKnife radiosurgery is a safe and effective local treatment option for unresectable primary and secondary liver tumors. In the multidisciplinary management of malignant maladies of the liver, SBRT adds to our armamentarium of local treatment modalities as complementary or salvage therapy.
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Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Prognostic Factors of Local Control, Overall Survival, and Toxicity
SBRT affords good local tumor control and higher overall survival rates than other historical controls (best supportive care or sorafenib). High aFP levels were associated with lesser local control, but a higher treatment dose improved local control.
Prospective evaluation of patient-reported quality-of-life outcomes following SBRT ± cetuximab for head and neck cancer
Especially for patients surviving >1-year, improved tumor control associated with SBRT re-irradiation may mitigate decreased PR-QoL resulting from rSCCHN. These improvements in PR-QoL are magnified throughout the duration of clinical follow-up and transcend all measured domains in a validated PR-QoL assessment tool.
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A prospective evaluation of patient-reported quality-of-life after (chemo) radiation for oropharyngeal cancer
The current study presents the results of prospective QoLassessment after (chemo)radiation for OPC using the EORTC QLQC30, and QLQ-H&N35-questionnaires. Statistically significant and clinically relevant deterioration was seen on QLQ-H&N35 dry mouth and sticky saliva.
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Excellent local control with stereotactic radiotherapy boost after external beam radiotherapy in patients with nasopharyngeal carcinoma
Stereotactic radiotherapy boost after EBRT provides excellent local control for patients with NPC. Improved target delineation and dose homogeneity of radiation delivery for both EBRT and SRT is important to avoid long term complications. Better systemic therapies for distant control are needed.
Accelerated partial breast irradiation:using the CyberKnife as the radiation delivery platform in the treatment of early breast cancer
Our experience suggests that the CyberKnife is a suitable non- invasive radiation platform for delivering APBI with achievable normal tissue constraints. Al though the clinical out comes for this etrospective analysis are promising, the follow up is too limited and the number of treated patients is toosmalltopermitfirm conclusions.
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CyberKnife boost for patients with cervical cancer unable to undergo brachytherapy
This paper is the among the first to report on using robotic SBRT in patients with real-time motion tracking for the treat ment of locally advanced cervical cancer in patients who are un able to under go brachytherapy. These preliminary results suggest that CyberKnife robotic SBRT is a safe and effective modality in the treatment of cervix cancer for those patients unable to undergo brachytherapy.
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Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer
In summary, we report here on the complete results of the first dose-escalation trial of SBRT for breast tumors. This protocol has a neoadjuvant breast-conserving chemoradiation approach for patients who are initially not suitable candidates for breastconserving surgery. With only 1 DLT reported, this study successfully demonstrated that SBRT could be safely combined with NACT.
Multisession Stereotactic Radiosurgery for Vestibular Schwannomas: Single-Institution Experience With 383 Cases
Multisession SRS with 18 Gy in 3 sessions results in excellent tumor control. The hearing preservation and nonauditory complication rates presented here are promising and comparable to those in other published series. Although hearing preservation rates are improved compared with earlier, higher-dose regimens, research is needed to further optimize the functional outcomes in our patients.
CyberKnife radiosurgery for benign meningiomas: short-term results in 199 patients
The introduction of the CyberKnife extended the indication to 63 patients (30%) who could not have been treated by single-session radiosurgical techniques. The procedure proved to be safe. Clinical improvement seems to be more frequently observed with the CyberKnife than in our previous linear accelerator experience.
Early results of CyberKnife radiosurgery for arteriovenous malformations
In the near future, using a combination of automatic contouring of an AVM nidus on 3D rotational angiography, automatic contouring of the critical structures on fMR imaging, and inverse treatment planning with dosevolume optimization, radiosurgery for AVMs could become the first completely automated operative technique.
CyberKnife Radiosurgery for Brain Metastases
The CyberKnife has been established as a modern non- invasive technology for intraand extracranial radiosurgery. Its full- body applicability is not at the expense of inferior intracranial treatment quality. The treatment results in brain metastases are in line with the published literature on frame- based technologies.
Clinical Results of Cyberknife® Radiosurgery for Spinal Metastases
Primary treatment of spinal metastasis has been external beam radiotherapy. Recent advance of technology enables radiosurgery to be extended to extracranial lesions. The purpose of this study was to determine the clinical effectiveness and safety of stereotactic radiosurgery using Cyberknife in spinal metastasis.
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Dose fall-off during the treatment of thoracic spine metastasis with CyberKnife stereotactic body radiation therapy (SBRT)
CyberKnife stereotactic body radiation therapy (SBRT) is becoming increasingly used for cancer treatment and, to maximize its clinical application, it is important to define the dosimetric characteristics, optimal dose, and fractionation regimens. The aim of this study was to evaluate the dose fall-off in two fractionated regimens of CyberKnife SBRT during the treatment of thoracic spinal metastasis.
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