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The Cyberknife is the world's first and only system which can treat tumors, ensuring a sub-millimetre accuracy and also the only system available today to treat tumours in any part of the body with the same precision.

The cyberknife is a breakthrough product that expands the potential of precision radio surgery to every part of the body. Cyberknife treatment is a painless outpatient procedure that involves no stereotactic frame being fixed to the skull or body. There is no blood loss either. Both the benefits are highly desired by patients who receive these treatments.

Linear Accelerator V/s Cyberknife

So what is it that sets the cyberknife aside from the conventional linear accelerator? Linear accelerator (Linac) has undergone many changes over the last four decades or so. Currently, available Linacs apart from being able to produce multiple energy X-ray and electron beams also possess Multi Leaf Collimators (MLC) and Micro Multi Leaf Collimators (mMLC) which help in shaping the X-ray beam to conform to the shape of the tumour, thereby sparing normal tissues from unnecessary radiation. These collimators have also played a role in Intensity Modulated Radiotherapy (IMRT) where dose intensification and dose modulation is possible as the X-ray beam passes through the body. This results in delivering high doses to the tumour and reducing doses to normal tissues which come in the path of the X-ray beam.

Now you have Rapid Arc technology which reduces the treatment time of one sitting. hybrid systems have also been developed now. These linear Accelerators incorporate advanced imaging techniques within the therapy machine. However, one has to understand the limitations of this series of equipment. During every sitting of radiation, the Linac acquires an image through an in-built CT scanner. This image is fused with a pre-treatment reference image. When the matching of fusion nears perfection, the machine goes into the 'On' mode. The catch here is that one has to assume that the target is not moving during the treatment session. This is where the Cyberknife's intelligent robotics comes into play. The image acquisition is also very sophisticated. The Cyberknife is able to track even a moving tumour and deliver radiation from many angles. Conventional Linacs have a limit to the number of gantry angles from which radiation can be delivered. The Cyberknife has no limit whatsoever. A single treatment session may, for example, use even 100 to 200 beams to treat a tumour. All this is accomplished without the need for a frame to be fixed and most treatments are completed in one to five sittings.

Futuristic Technology

The Cyberknife uses technology that is truly futuristic. With it we have now entered a new frontier in cancer treatment as well as in the treatment of certain benign tumours and functional radiosurgery. Collectively, all these treatments fall into a new field of radiotherapy called Stereotactic Body Radiotherapy (SBRT) hitherto not possible with existing radiation equipment.

SBRT can now be offered as a viable alternative to surgery in the following clinical situations:

• Primary Liver Cancer (Hepatocellular carcinoma or HCC)

• Lung Cancer

• Spine

SBRT is also being practiced as a treatment for prostate cancer, renal cell carcinoma of the kidney and for pancreatic cancers.

• Functional Radiosurgery

• Vascular Malformations (AVM's)

• Benign tumours in the Brain

• Glioblastomas

• Metastases (Secondaries) in the Brain

The advantages of the Cyberknife's frameless feature are:

• One can perform more than one surgical stage (sitting or fraction) in certain clinical situations where multiple stages are desired to achieve a better tumour response or for normal tissue sparing reasons.

• Patients find the treatment very comfortable. There is no anesthesia required, no frame being fixed to the skull thereby leading to a totally pain free outpatient procedure.

• Infants and young children can now be treated with the Cyberknife.

• The Cyberknife is the world's first and only system which can treat tumors ensuring a sub- millimetre accuracy and also the only system available today to treat tumours in any part of the body with the same precision.

• Because of its precise real time image guided robotic feedback, the Cyberknife can also perform radiosurgery treatments on tissues and tumours that move with respiratory motion with similar targeting accuracy.

So, how is the Cyberknife system different from other radiation delivery systems available today? Apart from the fact that no stereotactic frame is required to be fixed on the patient, breath holding which is difficult for some patients has also been dispensed with. In effect, even if the target moves with breathing, this machine tracks, detects and delivers radiation from many angles due to its maneuverability and versatility. The combination of image guidance cameras and the latest computer technology ensures that the Cyberknife System is able to overcome the limitations of older frame-based radiosurgery systems such as the gamma knife And Linac based X-knife.

A few words about the synchrony system are a must. This is the first technology in the world capable of delivering radiosurgery to tumours affected by the respiratory cycle. It uses a complex system of cameras, motion tracking software, fibre-optic sensing technology, infra-red emitters and a special tight fitting elastic patient garment.

A word about the X-Sight spine tracking system. This technology which is now part of most Cyberknife systems has enabled tracking of the spinal column without the need for fiducial markers to be implanted into the vertebrae.

Source: Express Healthcare