CyberKnife Real-Time Image-Guided Radiosurgery Treats Spinal Tumors

Laurie Barclay, MD

April 29, 2003

April 29, 2003 -- The CyberKnife Real-Time Image-Guided Radiosurgery system is safe and effective for spinal tumors not amenable to an open operative approach, according to an oral presentation at the American Association of Neurological Surgeons annual meeting in San Diego, California. This system is useful even in previously irradiated regions.

"The purposes of the study were to compare conventional frame-based radiosurgery with frameless image-guided stereotactic radiosurgery and to evaluate the safety and efficacy of the systems," presenter Peter Gerszten, MD, MPH, from the University of Pittsburgh Medical Center in Pennsylvania, says in a news release. "The image-guided treatment system is a logical advance of the current state-of-the-art radiation therapy, and proving new technologies safe and effective is a critical step for clinical adoption."

The CyberKnife consists of a lightweight computer-controlled linear accelerator mounted on a robotic arm. Before treatment, which usually lasts one to two hours, small bone fiducials are implanted near the tumor. X-ray cameras allow real-time computed tomographic imaging that tracks patient movement and delivers the treatment dose to within 1 mm of the target.

By minimizing irradiation of the surrounding healthy tissue, this targeted method could potentially decrease complications. The investigators suggest that it may be useful in surgical lesions not amenable to open surgery, in medically inoperable patients, in previously irradiated lesions, or as an adjunct to surgery.

"Image-guided stereotactic radiosurgery for spinal tumors is a safe and feasible treatment option and introduces the opportunity for irradiation to be completed in a single day," Dr. Gerszten says.

In this study, 50 patients had CyberKnife treatment of 67 spinal tumors, of which 12 were benign and 55 metastatic, including 31 tumors previously irradiated with maximal spinal cord doses. Location was cervical in 27, thoracic in 22, lumbar in 14, and sacral in four tumors. Overall pain decreased in all patients who were symptomatic prior to treatment.

"This study proves that spinal stereotactic radiosurgery using a frameless image-guided system is now both feasible and safe," says Dr. Gerszten. "The major benefits of radiosurgical removal of spinal cord tumors are noninvasive short treatment times in an outpatient setting, with both rapid recovery and symptomatic response."

AANS Annual Meeting: Abstract 730. Presented April 28, 2003.

Reviewed by Gary D. Vogin, MD

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