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Q. Tell us about CyberKnife
Ans. CyberKnife is a revolutionary radiation therapy delivery system. It is a highly precise, image guided radiation therapy delivery system capable of taking care of the motion during treatment (�Intra-fraction�). CyberKnife can treat tumours in almost any part of the body, deliver high dose of radiation precisely to the target and deliver minimal dose to the adjacent normal tissue, hence have minimal toxicity. Total treatment duration is only few days (usually 5 days), whereas it is usually 6 to 7 weeks in conventional radiation therapy treatment.
Q. What is the speciality of CyberKnife?
Ans. The major speciality of CyberKnife treatment is the high precision of treatment, real time image guided therapy, minimal acute toxicity and CyberKnife can deliver high dose of radiation in short time (Hypofractionated radiation therapy).
Q. How it is different from standard radiation therapy treatment?
Ans. The dose delivery in CyberKnife is with �dose painting� method which is highly precise and deliver high dose to target while minimal dose to adjacent structures. CyberKnife is the only radiation therapy delivery system that takes care of tumour movement during treatment with �real time tumour tracking�. CyberKnife has the unique and effective tumour tracking system (Synergy). CyberKnife has the sub-millimeter accuracy in treatment delivery which no other system has.
Q. What are the common indications of CyberKnife?
Ans. Though most of the tumours in any part of the body can be treated with CyberKnife, usual indications are 1) lung, prostate, pancreas, liver, gall-bladder cancer, 2) benign/ low grade brain tumours and recurrent/ residual high grade brain tumours, 3) brain, liver, bone and lung metastasis, 4) recurrent or residual tumours especially in head & neck region, 5) boost treatment combined with IMRT.
Q. All tumours can be treated with CyberKnife?
Ans. Though tumour size is not the contraindication for CyberKnife treatment, but usually high dose treatment is done in relatively small volume disease. Post-operative adjuvant radiation therapy and prophylactic radiation therapy are not the usual indications of CyberKnife.
Q. What are the clinical data about CyberKnife?
Ans. CyberKnife is approved by FDA in 2001 for both intracranial and extra-cranial disease. In initial few years there was slow progress in clinical data and when most of the academic centres throughout the world accepted this new concept of radiation therapy delivery system, there was a rapid surge in academic publications. There are more than 400 publications in last 5 years and in 2009 there was more than 100 peer reviewed publications. There is long term (5 year) data in prostate cancer, randomized data in early lung cancer, more than 600 patient data with bone metastasis treated with CyberKnife, promising short-term data about pancreas caner. At present date, there are prospective data for all indications of CyberKnife from across the world.
Q. Say about ongoing clinical trials about CyberKnife?
Ans. There are more than 30 clinical trials registered in www.clinicaltrials.gov.in . Majority of the trials are in extra-cranial sites (prostate, lung, pancreas, kidney, metastatic disease). Apart from these trials there are many ongoing institutional clinical and dosimetric studies. MD Anderson Cancer Centre has started a multi-centric randomized study in early lung cancer treated with either CyberKnife or surgery. Apollo Speciality Hospital is one of the centre involved in this study.
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