CyberKnife ® robotic radiosurgery system : first in the UK
New medical technology available to patients of HCA hospitals in London - February 2009.
When would patients need to be treated by a CyberKnife ®?
The CyberKnife system offers new hope to patients who have inoperable or surgically complex tumours, or who may be looking for an alternative to surgery for treating many small tumours and a few other select medical disorders. Unlike other radiosurgery systems, which are primarily used for head cancers, the CyberKnife can deliver radiosurgery to any part of the body.
Indications
Cancer tumours of the brain, spine, lung, liver, pancreas, kidney and prostate.
Description
It is a compact linear accelerator (used to direct high doses of radiation to a target) mounted onto a robotic arm, designed to treat tumours anywhere in the body.
What does radiotherapy with a CyberKnife ® involve?
The CyberKnife system delivers multiple beams of high-dose radiation to tumours with sub-millimetre accuracy, minimizing damage to surrounding healthy tissue. It is able to continuously track, detect and correct for tumour and patient movement throughout the treatment.
Safety
Because of its extreme precision, the radiation doses used for treatment are calculated to be safe and effective.
How is it administered?
The patient lies on a moveable treatment table and the robotic arm moves around them.
Average duration of treatment
Treatments can be delivered in single or multiple sessions (typically two to five), at the patient's convenience. Each session generally ranges from 30 to 90 minutes depending on the dosage and the complexity of the tumour.
Supporting evidence
An estimated 40,000+ patients have been treated with the CyberKnife system worldwide.
What it's replacing/is it additional?
It can be used for patients that wouldn't have previously been considered for radiotherapy. For brain tumours, the CyberKnife system is an alternative option to the Gamma Knife.
Benefits
The CyberKnife is non-invasive and is a pain-free alternative to surgery with minimal side effects. Treatment can be given as an outpatient procedure with little or no recovery time and the patient can immediately return to normal activities. The CyberKnife is able to target multiple tumours at different locations during a single treatment. It is able to non-invasively detect and correct for tumour and patient movement throughout the treatment. This results in minimal damage to surrounding tissue and eliminates the need for tracking implants or invasive head or body frames to stabilize patients as typically used with conventional radiosurgery systems.
FDA status and CE mark
Accuray received FDA clearance to introduce enhancements to the CyberKnife system for the treatment of tumours anywhere in the body in 2001, and in 2002 in Europe.
For more information
www.accuray.com
When would a patient be treated with a Gamma Knife?
The Gamma Knife is used to treat patients with certain brain conditions.
Indications
Tumours, vascular abnormalities and functional targets within the brain.
Description
The Gamma Knife is minimally invasive radiosurgical technology.
How does it work?
A head frame is used to ensure utmost accuracy and stillness of the head whilst multiple radiation beams converge on the target treatment area. The level of accuracy is better than 0.5mm allowing a large therapeutic dose to be delivered to the target treatment area whilst sparing surrounding healthy brain tissue
Safety
Treatment is safe due to its accuracy. Also, the unwanted radiation dose to the rest of the body is up to 100 times less than that of competing technologies.
Average duration of treatment
Treatment is performed on a single day. Sometimes patients require overnight admission to the neurosurgical unit after treatment, but many are treated as day cases. Because of this, Gamma Knife treatment is cheaper than surgery.
Supporting evidence
There is a proven track record. Almost 500,000 patients have been treated worldwide and thousands of peer-reviewed scientific articles have been published 1,2,3.
What it's replacing/is it additional?
Gamma Knife treatment is an addition to standard microsurgery and other radiosurgical techniques.
Benefits
- Few post-treatment complications and rapid recovery. Most patients return to normal activity, even work, within one to three days.
- Better treatment outcomes for AVMs and acoustic neuromas than with microsurgery. For other pathologies in selected cases outcomes are at least as good as, if not better than, conventional neurosurgery and radiotherapy.
- Treatment is precise and only requires a single session.
NICE status
The Gamma Knife is approved by NICE for stereotactic radiosurgery for trigeminal neuralgia (IPG 085).
For more information
The Gamma Knife Centre
154 Harley Street
020 7486 6969
info@radiosurgery.co.uk
www.radiosurgery.co.uk
References
1. Régis J. et al., Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg. 2006 Jun;104(6):913-24.
2. Hasegawa T, et al., Brain metastases treated with radiosurgery alone: an alternative to whole brain radiotherapy? Neurosurgery. 2003 Jun;52(6):1318- 26; discussion 1326.
3. Mathieu D, et al., Stereotactic radiosurgery for vestibular schwannomas in patients with neurofibromatosis type 2: an analysis of tumor control, complications, and hearing preservation rates. Neurosurgery. 2007
When would patients need to be treated with the da Vinci surgical system?
For minimally invasive general surgery procedures. It's beneficial for use in tricky and delicate areas where there are a lot of nerves and vessels to be avoided such as the prostate.
Indications
All general surgery. It can be used to treat conditions as diverse as obesity and heart disease. It is most commonly used to remove parts of the prostate to treat prostate cancer.
Description
A computer-enhanced minimally invasive surgical system consisting of three components: vision system, surgical cart and surgeon console. It enables the surgeon to perform minimally invasive work with minimal movement whilst having a close-up and clearer 3-D view of the nerves, blood vessels and muscles.
How does it work?
The surgeon is seated at a control console across the room from the patient, viewing magnified 3-D images from a tiny video camera and manipulating the robot with joystick-like hand and foot controls. The surgery tools mimic the surgeon's hand and wrist movements at the console, enabling the surgeon to make minute and precise movements for complex surgery in tiny entry incisions as small as 1-2cm.
Safety
Robotic surgery can be performed safely with excellent results. (1)
Average duration of treatment
Two to three hours, dependent on surgery type.
Supporting evidence
There are many clinical studies which support the effectiveness of the da Vinci surgical system.
What it's replacing/is it additional?
It's an alternative tool to both traditional open surgery and conventional laparoscopy (minimally invasive surgery).
Benefits
Less damage to the surrounding tissue, nerves and vessels of the area being operated on, resulting in less pain, discomfort, blood loss and scarring, a shorter hospital stay and a quicker return to normal activities.
FDA status
The da Vinci Surgical System is FDA-approved for both laparoscopic and general surgery procedures.
NICE status
The da Vinci Surgical System has been approved by NICE for use as an alternative to laparoscopic surgery.
For more information
www.davincisurgery.com
References
1) Robotic Surgical Training in an American Institution. W. Randolph Chitwood, et al., Ann Surg. 2001 October;234(4):475-486.
When would a patient receive a PET.CT scan?
PET.CT scans are used to locate cancer cells within the body prior to any treatment recommendation.
Indications
Tumour detection for a variety of cancers including: lung, colorectal, head and neck, ovarian, cervical, melanoma, lymphoma, breast and oesophageal.
Description
A full body scan which uses the two imaging tools, Positron Emission Tomography (PET) and Computerized Tomography (CT), at the same time to respectively detect active cancerous cells, and determine these tumours’ location, size and shape.
How does it work?
The patient is injected with a radioactive tracer (similar to sugar) which is taken up by any metabolic hotspots, often indicating actively growing cancer cells which have a much higher metabolic rate than other organs or tumours. These cells are then shown up by the PET scan. At the same time, the CT scan takes a series of cross-sectional x-rays to produce a highly accurate image of the body’s internal structures.
Safety
There is a small amount of radiation involved in the procedure but the benefits of this combined modality outweigh any risks.
Average duration of treatment
One hour for the tracer to be absorbed by the cells, followed by a scan lasting about 30 minutes.
Supporting evidence
Clinical trials show that a PET.CT scan provides a more complete picture and is more accurate than PET and CT scans alone1,2.
What it's replacing/is it additional?
The PET.CT is an additional new technology, combining two diagnosis tools.
Benefits
It enables early diagnosis and very accurate localization of the tumour(s), enabling precise treatment without the need for undergoing any unnecessary invasive diagnostic or other procedures. It also enables the physician to monitor the progress of any treatment programme.
FDA status
18FDG, the most commonly used isotope tracer used in PET.CT scanning, received FDA approval in 2005.
NICE approval
In 2005 NICE guidelines were published stating that lung cancer patients should have access to PET.CT scanning for staging the disease.
For more information
The Imaging Centre
The Harley Street Clinic
020 7935 7700
info@hcahealthcare.co.uk
References
1. Branstetter BF, 4th: Radiology, May 2005; 235 (2): 580-6
2. Hricak, H., M.D., Memorial Sloan Kettering Cancer Centre, (2002, January 15)
The contents of these pages are to be used for information purposes only and are not intended for use by clinicians or other. Individual patient needs, such as the type and duration of treatment, are a clinical decision and will vary depending on the patient's response and tolerability to a treatment or procedure. A patient should always ask their GP or specialist if treatment is appropriate for their condition.
