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; CyberKnife; CyberKnife radiosurgery; Non-invasive neurosurgery; Brain tumor - CyberKnife; Brain cancer - CyberKnife; Brain metastases - CyberKnife; Parkinson - CyberKnife; Epilepsy - CyberKnife; Tremor - CyberKnife

  • Description
    • During treatment:

      • You won't need to be put to sleep. The treatment does not cause pain.
      • You lie on a table that 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.
      • The doctors and nurses are in another room. They can see you on cameras and hear you and talk with you on microphones.

      Each treatment takes about 30 minutes to 2 hours. You may receive more than one treatment session, but usually no more than 5 sessions.

  • Why the Procedure Is Performed
    • SRS targets and treats an abnormal area. This minimizes damage to nearby healthy tissue. SRS is more likely to be recommended for people who are too high risk for conventional surgery. This may be due to age or other health problems. SRS may be recommended because the area to be treated is too close to vital structures inside the body.

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

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

      • Cancer that has spread (metastasized) 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:

  • 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 clothes.
      • 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.

      Follow instructions for how to care for yourself at home.

  • 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
    • Accuray Incorporated. CyberKnife robotic radiosurgery system patient brochure. 2012. Accessed August 19, 2015.

      Romanelli P, Morris DE, Adler JR Jr, Ewend MG. Image-guided robotic radiosurgery. In: Winn RH, ed. Youmans Neurological Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 257.

      Welling DB, Spear SA, Packer MD. Stereotactic radiation treatment of benign tumors of the cranial base. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 179.