What
is CyberKnife® Radiosurgery?
CyberKnife®
radiosurgery is a high precision, pain-free, robot guided radiation
treatment which in certain cases can be an alternative to invasive surgery.
Multiple high
energy beams are focussed on a target within the body where they become
effective and destroy the tumour. One single beam cannot cause damage,
but bundling of all beams in the target leads to destruction of the
tumour tissue without harming the adjacent healthy tissue.
Some treatments
offered by CyberKnife® are not otherwise available by radiotherapy.
Other treatments may be conducted more quickly, more conveniently, or
more economically with CyberKnife® than by alternative methods.
In some cases a single CyberKnife® treatment may take the place
of a four-week course of conventional radiotherapy.
CyberKnife®
offers pain-free, outpatient "surgery", with no need for uncomfortable
fixings to secure the patient in position, no anesthesia and no surgical
incisions. There is no inpatient hospital stay and no time is required
for recovery or rehabilitation.
Introducing
the European CyberKnife® Centre
CyberKnife®
is made by Accuray Inc in the USA and there are CyberKnife® centres
across the USA, with a number in Asia and Europe. As yet there are none
in the UK or Eire but the European CyberKnife® Centre in Munich
(Europäisches CyberKnife® Zentrum München or ECZM) takes
patients from many countries.
ECZM offers
modern, state-of-the art facilities and was named as the leading CyberKnife®
Centre in the world for treatment of tumours in the central nervous
system at the annual Cyberknife® Users meeting in San Diego in January
2006.
Medilux Healthcare
Limited is proud to have been appointed as the sole Representative in
the UK and Eire for ECZM. We handle all initial enquiries from patients,
doctors, hospitals and health insurers, providing information on the
range of treatments available, the relevant costs and the procedures
and time scale for obtaining treatment.
We provide information
of a general nature but we do not give medical advice on specific cases.
Where it is felt
that these may be suitable for CyberKnife® treatment and the patient
or doctor wishes to pursue their enquiry further we introduce them to
the relevant doctor at ECZM and all clinical decisions, diagnosis and
treatment are conducted entirely by ECZM or under their supervision
in Munich.
Professional
Presentations
For Medical
Professionals we offer formal presentations with the opportunity to
meet ECZM personnel and we arrange places at on-site practical seminars
in Munich. See below for details. If you would like to be notified of
the next presentation please e-mail us with your contact details and
let us know if you have any special area of interest.
What
are the principal treatments offered by ECZM, the European CyberKnife®
Centre, Munich?
Head Region
- Acoustic
neuroma
- Meningeoma
- Other
Neuromas
- Metastases
- Gliomas
(selected cases)
- AVM
(arterio-venous malformations)
- Trigeminal
neuralgia
- Haemangioblastomas
- Jugular
foramen tumours
ECZM has recently installed the new Siemens Emotion 16 detector CT
which enables very fast scanning times (30 seconds for a brain scan).
Spine
- Metastases
- Neuromas
- Meningeomas
- MPNST
(malignant peripheral nerve sheath tumours)
- Haemangioblastomas
- Tumour
pain
Spine lesions are treated with
the brand new Xsight software package, which enables a treatment without
the need to place invasive fiducials for spinal tracking. ECZM is
currently the only CyberKnife® Centre in Europe operating this
software.
Body
- Lung
metastases (single)
- Lung
cancer (Stage I)
Body lesions are
treated with the Synchrony (breath triggered robot movement) system. Note:
these treatments are more complex than brain and spine treatments and
patients are carefully selected for suitability. Preparatory procedures
are required one week before CyberKnife® can be used and these are
conducted in the adjacent University Hospital.
When conventional radiotherapy
has been insufficient
CyberkKnife®
treatments can sometimes be performed for patients after conventional
therapy when the tumour could not be controlled. This is an important
advantage because traditionally there was no other option for these patients.

Why travel to
Munich for treatment?
Cancer therapy
is a difficult time for patients but CyberKnife® radiosurgery eases
this considerably. ECZM goes further however, by incorporating the latest
software to make treatments even easier, faster and more comfortable.
Treatment is provided in clean, pleasant and modern premises and the
patient is in full communication with English-speaking doctors throughout
the treatment.
Everything is
done to make the patient feel more relaxed and confident and there are
set price treatment packages to relieve financial uncertainty.
ECZM offers
a complete service including hotel bookings and transfers from and to
Munich Airport. CyberKnife® treatments are painless, mostly very
short and require no recovery time so the stay need not be expensive.
There are direct scheduled flights to Munich from Birmingham, Bristol,
Cork, Dublin, Glasgow, London (City, Gatwick, Heathrow and Stansted)
and Manchester and Munich is also a popular destination for charter
flights and city breaks.
Useful
Links
Hotels and tourism in Bavaria
www.bayern.by
Airlines and flights to and from Munich www.munich-airport.de
Payment of treatment
costs via EEC 112 - for United Kingdom patients click
here for Government website and details
Payment of treatment costs via EEC 112 - for Ireland patients
click
here for Government website and details
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How
do I obtain more information?
Medilux Healthcare Limited
is Sole Representative of the European CyberKnife® Centre for
the UK and Eire. Patients, doctors or health insurers should contact
Medilux Healthcare Limited for further information, including advice
in general terms whether CyberKnife® is likely to be of assistance
for a stated condition, procedures for obtaining treatment at the
European CyberKnife® Centre (ECZM) and indications of cost.
For treatment please request our Patient Assessment Form by
sending an email to
cyberknife@mediluxhealth.net
This contains further technical details,
information on submitting scans, medical questionnaire and practical
guidance on travel to/from ECZM in Munich. Consultants should request
this for each patient as it is updated regularly to advise the
latest requirements and treatment possibilities as new medical software
is introduced.
NOTE: The
European CyberKnife® Centre (ECZM) is in great demand as a global
centre of excellence for brain and spinal tumours. Scanning facilities
and medical software are upgraded periodically, offering new or improved
treatments. As Sole Representatives for the UK and Ireland we are
therefore instructed to screen all initial enquiries and to advise
on information required by ECZM to consider each case. Please understand
that this enables the Consultants to work efficiently and ensures
prompt and fair treatment for all patients in need.
Patients
or doctors should request our Patient Assessment Form. This will
be supplied by e-mail, with more detailed information on CyberKnife®
treatments as well as practical guidance on visiting ECZM. We can
also advise patients, doctors or health insurers in general terms
whether CyberKnife® is likely to be of assistance for a stated
condition and give an indication of cost. The Timelines Group and
ECZM are committed to the prompt handling of enquiries and once
ECZM accepts a case treatment is usually offered within two weeks.
Medilux Healthcare Limited does not examine or diagnose patients,
nor can we commit ECZM to any diagnosis, outcome or costing or enter
into any formal or informal agreement on ECZMs behalf. We
will not enter into contractual arrangements with any party regarding
their or their patients treatment at the ECZM, nor will we
be in any way liable for the success, failure or other outcome of
such treatment.
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O
v e r v i e w
CyberKnife®
radiosurgery in certain cases can be an alternative or adjunct to open
surgery and standard radiation treatment lasting several weeks.
The therapeutic
possibilities of the innovative CyberKnife® technology far exceeds
other treatment modalities available to date.
Image guided
precision robotics
The innovation
of the CyberKinfe® system is the technical integration of two components:
- A particularly
lightweight and compact high precision radiation source that is mounted
on a robot arm. All regions in the body can be reached with high accuracy
and lesions safely destroyed. The system is much more flexible than
the other technologies in use today.
- A computer
assisted image guidance system allows the surgeon to track the lesion
throughout the treatment and correct for small patient movements.
Actual treatment
takes approximately one hour.
Benefits
of treatment for patients
- no
incisions
- no
pain
- no
head frame
- no
anesthesia
- no
hospitalisation
- no
recovery time
P
r e c i s e - c o n t r o l l e d - p a i n f
r e e
Brain
and spinal cord tumours are destroyed safely and effectively.
There
is no pain or stress caused by fixation of an invasive sterotactic frame,
anaesthesia or an open surgical procedure. Treatment is on an outpatient
basis.
CyberKnife®
technology
How CyberKnife® works. The CyberKnife®
system is a novel, revolutionary achievement in the medical field - it
combines two modern advancements in medical high technology:
1. Precision robotics. The
first innovation consists of a particularly lightweight and compact
radiation device mounted on a robotic arm. The precision robot - which
is also used in the automobile industry - can move freely in 6 planes.
Thus all body parts can be accessed without problems for an optimal
treatment. The system is clearly more flexible in handling and hence
more effective than conventional systems.
2. Image
guidance system. The second innovation consists of a
computer assisted image guidance targeting system. With this technology
the CyberKnife® can target the tumour throughout the treatment and
smaller patient movements can be compensated for. Thus it is no longer
necessary to fix the head of the patient in a frame, to immobilize the
body or to administer anaesthesia, as is required for conventional systems.
Treatment
advantages The
newly developed design of the CyberKnife® system enables treatments
not only in the area of the brain but also throughout the spine and spinal
cord or in other parts of the body. In such a way also lesions in very
sensitive body parts can be eliminated while minimising impact on the
surrounding healthy tissue.
Pain free surgery The
newly developed CyberKnife® technology offers pain-free, outpatient
"surgery". There are no complications from fixations, no anesthesia,
no surgical incisions. No inpatient hospital stay is required, also no
subsequent cure or rehabilitation time.
High quality of life High
quality of life during and after the treatment. The outpatient CyberKnife®
treatment does not lead to limitations in normal daily life. Immediately
after the treatment the usual activities can be resumed. 
Treatment
Example
This example shows
a 46 years old female patient harbouring an intramedullary breast cancer
metastasis at the level of C2 (left image). She was experiencing a life
threatening disease with the beginning of complete paralysis. The patient
was treated by a 1 hour single session radiosurgical CyberKnife® procedure.
4 weeks after
CyberKnife® treatment the tumour was no longer visible any more (right
image). The patient had a good quality of life and walked out of the outpatient
department on her own feet.

Medical
experience The CyberKnife®
system is based on radiosurgical principles which have been in clinical
use for 30 years. Thousands of patients world wide have already been
treated successfully with the CyberKnife® technology. A great
number of scientific studies have also been published in international
medical journals.
Indications of treatment
Generally, tumours in all parts of the body with a positive
indication for radiosurgical therapy can be treated with the CyberKnife®.
The latest
in medical high technology allows it to treat even very irregularly
shaped tumours in the area of critical brain regions such as the visual
or auditive nerve, without damage to these sensitive brain areas.
Such possibility
to provide focussed treatment of tumour tissue while sparing the surrounding
structures also allows for an effective treatment of brain lesions
in various areas difficult to access by surgery, such as for example
the brain stem or skull base.
Treatment
Process
The treatment process consists of several components: a first
interview, the imaging, the treatment planning,
the actual precision radiation, and routine follow-up examination.
Preparation work
For lesions located in the brain, an individual head rest
is moulded. This keeps the head still during the treatment as much
as possible.
Imaging For
each treatment computed tomographic (CT) and MR examinations are required.
The CT scan is acquired in the CyberKnife® Centre itself. Depending
on the individual constellation of the disease, this examination can
take place immediately before or one day prior to the actual treatment.
Existing MR images may also be transferred via CD for the treatment
planning.
Treatment Planning
The CT and MRI data are logged onto a computer so that
the attending physicians and specialised medical physicists can plan
and simulate the number, intensity and direction of the beams which
the robot will deliver to the target. During this planning phase the
patient does not need to be present.
Gentle treatment Treatment
is performed in the centres very modern practice rooms in an outpatient
setting. On the day of treatment no special measures have to be taken.
Have breakfast as usual and take any medicine, if applicable. An companion
for your personal support is welcome. If desired, your favourite music
CD can be played during the treatment.
Positioning
At
the beginning of the treatment the patient is requested to lay down
on the treatment table and if necessary the previously- moulded head
rest is in place. Anaesthesia is not necessary since the treatment
is entirely pain free.
Precision
radiation
During
the treatment the patient should lie as still as possible, small movements
however are tolerated. The patient is observed with video cameras
by the treating physicians and can get into contact at any time with
the attending doctor via microphone.
Duration and Termination
of treatment Normally only one treatment session is required
which lasts from between 45 minutes to 90 minutes depending on the
indication. Immediately after the treatment the patient can leave
the CyberKnife® Centre and resume usual daily activities.
In rare cases
it may be necessary to split the radiation dose over several sessions.
In such cases the patient will be requested to return for the remaining
treatment sessions. Treatment will commence on a Monday run for either
three or five consecutive days.
Follow-up examinations
After each medical intervention a follow up examination is recommended
after 4 to 6 months in your home country.
T
h e E u r o p e a n C y b e r K n i f e® T
r a i n i n g C e n t r e
has been designed as a training centre for
interested colleagues from all over Europe. There will be regular training
courses for smaller groups essentially comprising neurosurgeons, radiation
therapists, medical physicists and medical technical assistants (MTA's).
To this effect
modern conference rooms have been created with provision of all audiovisual
equipment from where the treatment process can be observed via video cameras
and details of the treatment can be discussed with the attending physicians.
Please contact Timelines Group for details.
R
o y a l S o c i e t y o f M e d i
c i n e, L o n d o n
In addition with the support of the UK and
Eire representatives, Medilux Healthcare Limited, a series of presentations
are being prepared for 2006/2007. Please enquire for dates and further
details.
s.warren@mediluxhealth.net
D
O W N L O A D S
To
view VIDEOS of the history and CyberKnife in action please follow
this link
All
downloadable files are in Portable Document Format [pdf] and will require
Adobe Reader® to be installed on your computer to open these files.
If you find that the reader programme is not already installed on your
computer you may download the reader for FREE from the following official
download site 
Medilux Healthcare
Limited - CyberKnife Radiosurgery Introduction.
Illustrated overview of the technology,
mode of action and treatment examples [2 pages] Click the icon to begin
your download. . . 
Medilux Healthcare
Limited - CyberKnife Radiosurgery Complete Guide for Patients and Their
Doctors.
Four page document outlining the
following important questions and answers: How do I obtain treatment?
Details of how the outpatient treatment is carried out and what will happen
when you arrive at the clinic. Details of training seminar for doctors
both at the clinic as well as here in London, England. Click
the icon to begin your download. . . 
Medilux Healthcare
Limited - CyberKnife Radiosurgery - Detailed Travel Information for Patients,
Family and Friends to The European CyberKnife in Munich, Germany.
Listing of airports and carriers throughout the UK along with details
of rail connections as well as suitable accommodation in Paris, France,
should you wish to break up your journey when travelling by rail. Click
the icon to begin your download. . .
CyberKnife
- Radiosurgery Details
(more information on CyberKnife® and on specific treatments). Check
for the latest updates as these are issued and further treatment sections
are added.
Acoustic Neuroma
Arteriovenous Malformations [AVM]
Brain Metastasis
Glioma
Hemangioblastomas
Lung Cancer
Meningiomas
Pancreatic Cancer
Pituitary Adenoma
Prostate Cancer
Spinal Tumour
Trigeminal Neuralgia
What
is Radiosurgery and how is it different from radiotherapy?
Stereotactic radiosurgery (SRS)
combines the principles of stereotaxy, or 3-D target localization, with
multiple cross-fired beams from a high-energy radiation source to precisely
irradiate an abnormal (oftentimes cancerous) lesion within a patient's
body. This technique allows maximally aggressive dosing of the target,
while normal surrounding tissue receives lower, non-injurious doses
of radiation. The ideal objective is the ablation or destruction of
the targeted area without damaging any normal tissue outside of the
defined target area.
Stereotactic radiosurgery differs from conventional radiotherapy in
several ways. The efficacy of radiotherapy depends primarily on the
greater sensitivity of tumour cells to radiation relative to normal
brain tissue. With all forms of standard radiotherapy, the spatial accuracy
with which the treatment is focused on the tumour is a secondary concern;
normal tissues are protected by administering the radiation dose over
multiple sessions (fractions) daily for a period of a few to several
weeks. In contrast, radiosurgery, by its very definition, requires much
greater targeting accuracy. With SRS, normal tissues are protected by
both selectively targeting only the abnormal lesion, and using cross-firing
techniques to minimize the exposure of the adjacent anatomy. Since highly
destructive doses of radiation are used, any normal structures (such
as nerves or sensitive areas of the brain) within the targeted volume
are subject to damage as well.
Typically, SRS is administered in one to five daily fractions over consecutive
days. Nearly all SRS is given on an outpatient basis without the need
for anaesthesia. Treatment is usually well tolerated, and only very
rarely interferes with a patient's quality of life. Stereotactic radiosurgery
has been used for more than 30 years to treat benign and malignant tumours,
vascular malformations, and other disorders of the brain with minimal
invasiveness. To date, more than 200,000 patients have been treated
worldwide with radiosurgery. The success of SRS is based, to a large
extent, on the use of a multidisciplinary approach, which requires close
interaction between surgeons, radiation oncologists, medical oncologists,
physicists, diagnostic radiologists, technicians, and nurses. This specialized
team is responsible for the selection of appropriate patients for SRS,
treatment delivery, and long-term follow-up.
What
are the differences between the common radiosurgery technologies?
Several SRS systems are available
for the treatment of patients. The most widely used SRS devices include:
cobalt-sourced systems (Gamma Knife), modified linear accelerators,
and the CyberKnife. All of these devices, if properly operated, are
capable of delivering the desired radiation dose to a designated target.
However, for certain clinical situations, there can be important differences
between these devices, which for some patients may have a significant
impact on clinical outcome.
Cobalt-Sourced
Systems (Gamma Knife)
The first radiosurgical device
was conceived and developed in the 1950s by Professor Lars Leksell at
the Karolinska Institute in Stockholm, Sweden. His work culminated in
the development of the Gamma Knife (Elekta Inc), which was used to treat
patients beginning in 1968. This device is capable of precisely irradiating
small intracranial [glossary term] (inside the skull) target with gamma
ray photons. The treated lesion is targeted and the patient's head immobilized
(held completely still) through the use of an external metal frame attached
to the skull by four screws. A large helmet-shaped device with 201 separate,
fixed "holes" or ports allows the radiation emitted by discrete
(separate) radioactive cobalt-60 sources to enter the patient's head
in small beams that converge on the designated target. The Gamma Knife
is designed to treat intracranial targets only. Advantages of the Gamma
Knife include:
1. Over 30 years of clinical use with a large number of studies published
in the medical literature
2. Targeting precision within 2 mm
1. Multiple targets in the brain are easily treated during a single
treatment session Disadvantages of the Gamma Knife include: The basic
design limits use to the brain only
2. The procedure for radiation targeting requires the placement of a
somewhat painful stereotactic head frame
3. It can be difficult to treat patients with lesions located in certain
areas (e.g. the periphery) of the brain
4. It cannot be used for staged radiosurgery (delivering the radiation
dose in more than one fraction or treatment session); staged radiosurgery
can be particularly beneficial for larger tumours or lesions located
near nerves and other sensitive structures
Modified Linear Accelerator Systems
An alternative to the Gamma Knife
was developed in the mid 1980s and utilized the conventional linear
accelerators (linac) that are commonplace in most large hospitals. By
combining a series of small modifications to the radiation delivery
mechanism of the linac with specialized planning software, it is possible
to do many types of brain radiosurgery. There are both dedicated and
non-dedicated linac-based radiosurgery devices. Dedicated linac systems
are used solely for radiosurgery treatment. In contrast, non-dedicated
systems are the daily workhorses for conventional radiation therapy
departments which can also be temporarily modified to perform radiosurgery.
Compared to the latter multi-purpose linacs, dedicated systems tend
to be more carefully calibrated for spatial accuracy and optimised for
radiosurgical efficiency. Unlike the radioactive cobalt-based Gamma
Knife, linac-based systems use X-ray beams generated from a linear accelerator.
As a result, these devices do not require or generate any radioactive
material. When treating brain tumours with linac radiosurgery, a metal
head frame is attached to the patient's skull and used to precisely
target the radiation beam. Common brand names for modified linacs include
X-Knife (Radionics Inc). Advantages of Multi-Purpose Linac Radiosurgical
Systems include:
1. More commonplace technology in hospitals
Disadvantages of Multi-Purpose Linac Radiosurgical Systems include:
1. Less accurate
2. Less efficient than dedicated systems, which results in longer treatment
time
3. Frame-based targeting only works for brain lesions
Shaped Beam Systems
The recent development of IMRT
or Intensity Modulated Radiation Therapy has added another dimension
to multi-fraction radiation therapy. These linac-based technologies
use computer-controlled "beam-shaping" to do a better job
of conforming the radiation dose to the shape of the tumour or other
lesion. This form of advanced radiation therapy can be utilized at virtually
any location in the body.
IMRT technology enables a mechanical device (called a multi-leaf collimator)
that is typically attached to most modern medical linear accelerators,
to dynamically reshape the outlines and intensity of the radiation field
during cancer treatment. When combined with sophisticated planning software,
IMRT fits the dose of radiation to a target much better than conventional
radiation therapy, and thereby minimizes the volume of surrounding normal
tissue that is injured by treatment. While it appears that IMRT may
produce fewer side effects than conventional radiation therapy, IMRT
is not as spatially precise as radiosurgery. Because of this imprecision,
a full course of IMRT treatment is typically administered over multiple
treatment sessions (typically 20-30+). Common brand names include X-Knife
(Radionics) and Novalis (Brain Lab). Advantages of Shaped-Beam systems
include:
1. The capacity to treat most regions of the body with IMRT
2. When coupled to an invasive stereotactic frame, precision targeting
for brain tumours that approaches, but does not equal, that of the Gamma
Knife or CyberKnife.
3. The capacity to more accurately target extracranial (non-brain) tumours
than standard radiation therapy
4. An ability to deliver fractionated intracranial or extracranial treatment
Disadvantages of the Shaped Beam systems include:
1. The need for an invasive head frame (similar to the Gamma Knife)
to assure treatment accuracy when used for brain radiosurgery (single
fraction)
2. Less treatment accuracy when multiple fractions are used to treat
areas of the brain where the use of an invasive head frame is impractical
3. A significantly lesser degree of targeting accuracy when treating
extracranial tumours compared to brain radiosurgery
4. Treatment accuracy is degraded further when the target moves during
radiation delivery from either natural breathing or patient movement
CyberKnife System
The CyberKnife System is an SRS
system utilizing contemporary technology that is designed to be the
most accurate and flexible tool available for aggressive therapeutic
irradiation. The CyberKnife was designed to address the limitations
of frame-based SRS systems and expands the application of radiosurgery
to sites outside of the head. It is the only system to incorporate a
miniature linear accelerator mounted on a flexible, robotic arm.
An image-guidance system that can track target location during treatment
also enables the CyberKnife to offer superior targeting accuracy without
the need for the invasive head frame. While Gamma Knife and linac-based
systems can perform radiosurgery in the brain, true radiosurgery for
areas outside of the brain is difficult if not impossible to perform
with these systems.
For more detailed information on the CyberKnife, see CyberKnife
Overview.
Advantages of the CyberKnife
include:
1. No invasive head frame or other rigid immobilization
device is required
2. The ability to perform radiosurgery (1-5 fractions) on targets
throughout the body, not just the brain
3. Precise targeting (within 1 mm) of selected lesions in the
brain and body
4. A unique ability to provide real time monitoring of the
treated target throughout treatment using an advanced image-guidance
system
5. A unique ability to correct during treatment for limited
target motion (e.g. due to small patient movements)
6. The capacity to easily perform staged radiosurgery
Disadvantages of the CyberKnife include:
1. The need for placement of very small markers
(fiducials) via a needle for the treatment of targets outside of the
head
2. Compared to other radiosurgical devices, treatment takes
longer when multiple tumours are ablated during the same treatment
session.
Because the CyberKnife system is so accurate
as well as versatile and painless, it is often the radiosurgical procedure
of choice from a patient's perspective.
PRIVACY
STATEMENT
Medilux
Healthcare Limited is a specialised marketing company. We promote devices
on the basis of the Manufacturers' representations as to quality and efficacy
and where possible we provide additional information as to the conditions
which may benefit from their use but we do not guarantee that they will
be suitable or effective for all purchasers. We do not examine or diagnose
patients or recommend treatments and where we promote medical services
this is on an information-only basis. Patients contract directly with
these providers and all clinical decisions are made by them alone.
(c)
Medilux Healthcare Limited. 2003 - 2008. All rights reserved
VAT No 887 9818 33 Comp Reg 5925249 Webmaster
- Steven Warren s.warren@mediluxhealth.net..
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