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Stereotactic radiosurgery - CyberKnife

Definition

Stereotactic radiosurgery (SRS) is a form of radiation therapy that focuses high-power energy on a small area of the body. Despite its name, radiosurgery is a treatment, not a surgical procedure. Incisions (cuts) are not made on your body.

More than one system is used to perform radiosurgery. This article is about radiosurgery using CyberKnife.

Alternative Names

Stereotactic radiotherapy; SRT; Stereotactic body radiotherapy; SBRT; Fractionated stereotactic radiotherapy; SRS

Description

During treatment you lie on a table, which slides into a machine that delivers radiation.

• A robotic arm controlled by a computer moves around you. It focuses radiation exactly on the area being treated.
• You are not put to sleep. The treatment does not cause pain.

The nurses and doctors can see you on cameras. They can hear you and talk with you on microphones.

Each treatment takes about 30 minutes to 2 hours. Some patients receive more than one treatment session, but usually no more than five sessions.

Why the Procedure Is Performed

SRS targets and treats an abnormal area without damaging nearby healthy tissue. SRS is more likely to be recommended for patients who are at high risk of surgery. These patients include the elderly or those who are very ill.

CyberKnife is often used to slow the growth of small, deep brain tumors that are hard to remove during surgery that involves incisions.

Tumors of the brain and nervous system that can be treated using CyberKnife include:

• Cancer that has spread (metastisized) to the brain from another part of the body
• A slow-growing tumor of the nerve that connects the ear to the brain (acoustic neuroma)
• Pituitary tumors
• Spinal cord tumors

Other cancers that can be treated include:

• Breast
• Kidney
• Liver
• Lung
• Pancreas
• Prostate
• A type of skin cancer (melanoma) that involves the eye

Other medical problems treated with CyberKnife are:

• Blood vessel problems such as arteriovenous malformations
• Parkinson disease
• Severe tremors (shaking)
• Some types of epilepsy
• Trigeminal neuralgia (severe nerve pain of the face) 

Risks

SRS may damage tissue around the area being treated. As compared to other types of radiation therapy, CyberKnife treatment is much less likely to damage nearby healthy tissue.

Brain swelling may occur in people who receive treatment to the brain. Swelling usually goes away without treatment. But some people may need medicines to control this swelling. In rare cases, surgery with incisions (open surgery) is needed to treat the brain swelling caused by the radiation.

Before the Procedure

Before the treatment, you will have MRI or CT scans. These images help your doctor determine the specific treatment area.

The day before your procedure:

• Do not use any hair creams or hair spray if CyberKnife surgery involves your brain.
• Do not eat or drink anything after midnight unless told otherwise by your doctor.

The day of your procedure:

• Wear comfortable clothing.
• Bring your regular prescription medicines with you to the hospital.
• Do not wear jewelry, makeup, nail polish, or a wig or hairpiece.
• You will be asked to remove contact lenses, eyeglasses, and dentures.
• You will change into a hospital gown.
• An intravenous (lV) line will be placed into your arm to deliver contrast material, medicines, and fluids.

After the Procedure

Often, you can go home about 1 hour after the treatment. Arrange ahead of time for someone to drive you home. You can go back to your regular activities the next day if there are no complications such as swelling. If you have complications, you may need to stay in the hospital overnight for monitoring.

Outlook (Prognosis)

The effects of CyberKnife treatment may take weeks or months to be seen. Prognosis depends on the condition being treated. Your health care provider will likely monitor your progress using imaging tests such as MRI and CT scans.

References

Chang EF, Quigg M, Oh MC, et al. Epilepsy Radiosurgery Study Group. Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy. Neurology. 2010;74:165-172.

Ewend MG, Morris DE, Carey LA, et al. Guidelines for the initial management of metastatic brain tumors: role of surgery, radiosurgery, and radiation therapy. J Natl Compr Canc Netw. 2008;6:505-513.

Suh JH. Stereotactic radiosurgery for the management of brain metastases. N Engl J Med. 2010;362:1119-1127.

Welling DB, Packer MD. Stereotactic radiation treatment of benign tumors of the cranial basae. In: Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 179.

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