CyberKnife Treatment in India
What is CyberKnife?
CyberKnife does not refer to any type of knife, as it’s a robotic radiosurgery system that is capable of providing high-dose radiation to tumours anywhere in the body with the accuracy of a sub-millimetre. This technology was developed by Accuray Incorporated and is a groundbreaking discovery in the field of radiation oncology.
CyberKnife, unlike traditional radiation therapy equipment, utilises a compact linear accelerator that is mounted to a robotic arm and that delivers high-energy radiation beams from multiple angles, making it able to reach deep tumours which cannot be reached by standard radiation therapy.
The CyberKnife Treatment has many modern technologies:
- A compact linear accelerator that creates a high-energy radiation beam
- Sophisticated imaging systems that track the tumour’s position at all times
- Software that controls all systems during treatment
How it is different than traditional radiation therapy
The intent of traditional radiation therapy and CyberKnife is the same, which is to destroy cancer cells using high-energy radiation to treat tumours; however, there are several important differences between CyberKnife and conventional radiation therapy as listed below:
Precision and Accuracy:
- CyberKnife delivers radiation with sub-mm accuracy (under 1 mm), with conventional radiation therapy being fractionated and tentatively accurate to within millimetres.
- This precision allows for larger doses of radiation to be delivered and limited exposure to healthy tissue.
Treatment Delivery Method:
- Conventional radiation therapy is meant to deliver radiation typically at fixed angles from a limited number of beams.
- A robotic arm that can deliver hundreds of beams from almost any angle around the patient delivers the CyberKnife.
Treatment Duration:
- Total treatment time in conventional radiation therapy can be up to 2 months.
- Typically, 5 sessions depending on the tumour location and type.
Motion Management:
- Conventional radiation therapy usually requires patients to hold their breath or some way manage their motion.
- During treatment, the patient may breathe properly through CyberKnife’s motion management technology, which continuously monitors the tumour’s movement and modifies the radiation output.
What Conditions Can It Treat?
CyberKnife was originally developed for tumours of the brain, but it has since expanded its use to treat many other conditions throughout the body.
Brain Tumors
CyberKnife is particularly good at treating tumours in the brain, including:
- Primary brain tumours
- Brain tumours that have metastasised (spread from other regions of the body to the brain)
Lung Cancer
CyberKnife helps assess tumour movement from breathing and can therefore be particularly useful for treating lung cancer.
- Early-stage non-small cell lung cancer
- Metastatic lung tumours
- Recurrent lung tumours
Liver and Prostate Tumours
CyberKnife has been effective for treating the following types of tumours:
Liver Tumours:
- Primary liver tumours (hepatocellular carcinoma)
- Metastatic liver tumours
- Liver tumours that are unresectable
Prostate Tumours:
- Early-stage prostate cancer
- Recurrent prostate cancer
- Cases of prostate cancer in patients who are not candidates for surgery
Spine Lesions
- Primary spine tumours
- Metastatic spinal tumours
- Benign spinal tumours
- Spinal arteriovenous malformations
How Does CyberKnife Work?
Robotic system targets tumours with high precision
- The High-tech technology at the CyberKnife system enables the AI arm to move in upto six different directions.
Conventional radiation equipment
- The straight accelerator is mounted by the robot with sub-millimetre
The targeting process involves:
- Making a thorough three-dimensional map of the tumour and its surroundings
- Calculating optimal beam angles and intensities
- Real-time tracking of tumour location during treatment
No surgery or hospitalisation needed
- Unlike traditional cancer surgeries, CyberKnife treatment is:
- Completely non-invasive – no cuts, incisions, or surgical tools are used
- Conducted without general anaesthesia
- Not requiring recovery from surgical trauma
Real-time imaging as part of the treatment
Another advantage that CyberKnife has over other radiation therapy systems is its imaging capabilities:
- X-ray cameras record images during each treatment fraction.
- For moving tumours, such as those in the lung that shift with breathing, the system uses Synchrony. Respiratory Tracking to correlate the chest’s external movement with the target tumour’s internal movement.
What to expect during treatment
Preparation and scanning
Before CyberKnife treatment starts, there are several preparatory steps a patient will go through:
- Initial visit: During this visit, the radiation oncologist will investigate the patient’s medical history, previous treatment, and the current disease state.
- High-resolution imaging: Sometimes, CT, MRI, and PET scans create detailed images of the tumour and surrounding anatomical structures.
- Treatment planning: A team of medical professionals will then utilise the images obtained during the imaging stage to develop a customised treatment plan (the radiation oncologist, medical physicist, and dosimetrist).
- Fiducial placement: Fiducials are small gold markers either placed within the tumour burden or in the corresponding anatomy nearby. Fiducials can help track the target tumour’s position (not required for all treatments).
- Custom immobilisation devices: An immobilisation device may include a soft mesh mask or body mould to facilitate consistent body position, depending on the treatment protocol.
The planning process usually takes about one to two weeks to complete. During this time, the treatment team:
- Exactly defines tumour boundaries
- Identifies critical structures to be spared
- Determines radiation dose
Number of sessions and fractionation
The number of CyberKnife therapy sessions varies depending on:
- Type and location of the tumour
- Size of the tumour
- Nearness to sensitive tissues
- Overall health of the patient
- History of previous radiation treatments
In general:
- Most treatments are done under five sessions
- Most brain tumours are treated within one to three sessions
- Lung, liver, and prostate tumours usually require three to five treatments
Duration of sessions
CyberKnife is a shorter, softer, and less frequent session than normal radiation therapy.
- Sessions take approximately 30–90 minutes
- The actual radiation time is typically 15–45 minutes
- The rest of that time is spent positioning the patient and imaging
During the session, patients:
- Are typically lying comfortably on the treatment table
- Are awake and alert during the entire process
- Can breathe normally and make small movements (the system compensates for it)
Benefits of CyberKnife
No pain or incisions.
CyberKnife treatment has tremendous comfort benefits:
- The procedure will be completely painless during delivery
- There are no cuts or incisions or needles (except for maybe fiducial implantations before treatment)
- There is no surgical pain or complications when recovering afterwards
- There is no risk of infection at the surgical site
- There is no anaesthesia administered
Unlike the surgical procedure, the CyberKnife treatment:
- Is delivered to the patient while they are wide awake
- Requires no sedation or general anaesthetic
- Reduces the risk and side effects associated with anaesthesia
- There is no post-anaesthetic “recovery time”
Quicker recoveries
Since CyberKnife treatment is non-invasive, it has numerous recovery benefits:
- All but a few patients resume their normal activities after treatment
- No time is needed to heal from surgical wounds
- There is minimal downtime between sessions
- No need for hospital stays
- Fewer complications during recovery
- Decreased need for pain pills
Are There Any Risks?
CyberKnife is generally well-tolerated; however, patients should be aware of potential side effects:
Mild Fatigue
- This was the most common side effect patients reported.
- Usually starts during the actual treatment or soon afterwards
- Will usually resolve within a few days to weeks, once all of the treatments are completed
- Mild fatigue can generally be controlled with just proper rest and nutrition
Temporary swelling
- Can occur in or around the treated area
- Typically peaks 1–2 weeks after treatment
- Typically resolves slowly in the following weeks
- May require corticosteroids to treat, if needed
Rare radiation effects
Less common potential side effects include:
- Radiation necrosis: Rarely, radiation causes the death of normal tissues adjacent to the treatment area
- Skin changes: Redness or irritation on the skin
- Effect site-specific: Depending on where the location was treated, other rare effects may include:
- Brain: headache, some dizziness, and rarely seizures
- Lung: there can be mild lung tissue inflammation (Pneumonitis)
- Liver: infrequently, normal liver tissue inflammation
- Prostate: temporary urinary and/or bowel changes
- Spine: the possibility of rare nerve irritation
Most of the listed rare effects can be temporary and managed accordingly. For appropriate candidates, the benefits generally exceed the risks.
Best hospitals for CyberKnife treatment in India
India has become a global destination for high-quality treatment for several cancer diagnoses, and many premier institutions now offer CyberKnife technology:
- Apollo Hospitals: Multiple locations across India with dedicated teams experienced in radiation oncology.
- Fortis Hospitals: The best-in-their-class CyberKnife facilities seamlessly integrated in a whole imaging and treatment cancer care hospital.
- HCG (Healthcare Global Enterprises): A specialist cancer hospital network with advanced radiosurgery technology.
- Max Healthcare: Equipped with the latest CyberKnife technology and a multi-disciplinary approach.
- Manipal Hospitals: A cancer care centre with a CyberKnife experienced team, with hospitals based in major cities in India.
In India, facilities with a CyberKnife usually offer the features below:
- Advanced generations of CyberKnife VSI or M6 systems
- Diagnostic imaging that includes CT, MRI, PET-CT and associated treatment planning
- Quality assurance programs conforming to international standards
- Focus on patient wellbeing, which includes patient and family comfort and convenience
- Telemedicine services are needed for follow-up (when required)
- Research and participation in clinical trials
Many of these centres also have an affiliation with international cancer treatment institutions, and many international clinical trials and research programs.
