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CyberKnife, TomoTherapy and MR-Guided Linear Accelerators
Published in W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald, Handbook of Radiotherapy Physics, 2021
Thomas Lacornerie, Albert Lisbona, Andrew W. Beavis
The CyberKnife is a fully robotised, image-guided system that allows a target to be located and tracked in three-dimensional (3D) space and irradiated with multiple non-coplanar beams. The fixed frame that was originally used to define the cartesian coordinates for stereotactic radiotherapy (see Section 40.3) is replaced by image guidance, which allows frameless intra- and extra-cranial stereotactic radiotherapy. The CyberKnife meets the criteria of stereotactic radiotherapy: tight margins and steep dose gradients. Tight margins are obtained because of the accurate alignment of the beams associated with the imaging system and the ability to adapt the beam direction to the volume, even with breathing motion. Steep dose gradients are obtained in all directions with multiple non-coplanar beams.
CyberKnife and ZAP-X Dosimetry
Published in Arash Darafsheh, Radiation Therapy Dosimetry: A Practical Handbook, 2021
Sonja Dieterich, Georg Weidlich, Christoph Fuerweger
The CyberKnife TPS currently requires the measurement of tissue-phantom ratios (TPRs) as input. With a regular size water tank, these measurements can be very time consuming, because the robot has to be moved manually for each measurement depth. For earlier CyberKnife versions, this was usually achieved by entering the treatment room. For M6, the Kuka teach pendant can be connected to the robot controller in the equipment room and routed to the control area, which allows for moving the robot from outside the treatment room but requires careful monitoring of the robot using in-room cameras to avoid collision. There is a third, unsupported option applicable to all CyberKnife versions, which uses service tools to move the robot from the delivery console.
Handling Regions and Volumes of Interest in Radiotherapy
Published in Pavel Dvorak, Clinical Radiotherapy Physics with MATLAB®, 2018
Table 6.4 illustrates examples of the method applied on ten clinical target volumes treated among three CyberKnife centers. The table demonstrates significant normal tissue sparing when applying the optimum fiducials combination together with the optimum anisotropic margin in order to expand the target volume contoured at EBH phase to also cover associated parts of the target contoured at the complementary breathing phase (IBH) while tracking selected fiducials. Note two important aspects: tumor-fiducial(s) bound deformation during breathing (addressed here) is not the only uncertainty associated with the tracking, and, intra-observer variation in contouring is included in the method (possibly an advantage rather than the opposite).
Cerebral gliomas: Treatment, prognosis and palliative alternatives
Published in Progress in Palliative Care, 2018
Dharam Persaud-Sharma, Joseph Burns, Marien Govea, Sanaz Kashan
Treatment options are patient specific and depend on the severity of the presentation. Gliomas are very aggressive tumors and require intensive treatment to prolong life. Depending on the clinical scenario, a physician can utilize a multitude of therapeutic options including Cyberknife©, surgical excision, radiation, Gamma Knife or proton therapy to eradicate the tumor.1 External beam radiotherapy or internal chemotherapy may be used as a primary or adjuvant therapy to improve the prognosis. Since 2004, targeted chemotherapy has continued to play an increasing role in the treatment of these cancers.10 One of the main challenges is that even with utilizing the most advanced treatments available; patients can often experience tumor regrowth or significant iatrogenic neurological impairment. This ultimately challenges the patient’s long-term prognosis, and impairs the quality of life. Post-therapeutic quality of life values remain of essential importance when discussing treatment options in patients with brain malignancies with a poor or limited prognosis, yet there are few resources available to guide such discussion. In this paper, we aim to compare and contrast two treatment approaches for gliomas: surgery and radiotherapy. We also attempt to address the central ethical considerations when deliberating the most appropriate therapeutic methods. Lastly, we aim to lay a foundational model to encourage patient-physician discourse of pertinent palliative and hospice-care topics to guide physicians and patient dialogue with regard to quality of life.
Cyberknife radiosurgery on the brainstem metastases of non-small cell lung cancer
Published in International Journal of Neuroscience, 2021
Guanghai Mei, Xiaoxia Liu, Kun Song, Yizheng Lv, Ming Xu, Hongzhi Xu, Enmin Wang
The Cyberknife technique provides the precise distribution of a high dose of radiation in 1–5 fractions. A steep dose gradient allows the protection of surrounding radiosensitive normal structures, and thus, it minimizes early as well as later-stage toxicities of the treatment. Furthermore, the Cyberknife system integrates the high precision and advantages of fractionating treatment, which is crucial in the optimal management of tumors located in the brainstem. In the current study, all but one lesion were effectively controlled by the CKRS, which was consistent with a review by Patil et al., who reported that WBRT plus SRS yielded better local tumor control (HR 0.27; 95%CI 0.14–0.52) and improved KPS performance status although it was not associated with longer survival [16].
Daily dose to organs at risk predicts acute toxicity in pancreatic stereotactic radiotherapy
Published in Acta Oncologica, 2020
Mauro Loi, Alba Magallon-Baro, Mustafa Suker, Casper Van Eijck, Mischa Hoogeman, Joost J. Nuyttens
Detailed description of the system and clinical application for daily dose evaluation has been previously reported [12,14]. In summary, in our institution, a treatment platform integrating a CyberKnife with a CT scanner on-rail allows to perform daily imaging before irradiation. According to the LAPC-1 protocol, for the first three fractions of the treatment, an end-expiration CT scan with IV contrast was acquired in treatment position and was used for comparison. Daily CT scans were matched offline to the planning CT by applying a rigid registration based on spine match followed by a fiducials match correction, which was used to overlay the planned dose distribution on the daily CT after OAR delineation according to RTOG recommendations, as previously described [12,14].