Cyberknife

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The currently most modern Cyberknife device M6 and InCise MLC (Multileaf Collimator), European Cyberknife Center Munich-Großhadern, Germany (as of 2015)

Cyberknife is the name of the US manufacturer Accuray for its robotic linear accelerator for radiosurgery (and teletherapy ), which was developed at Stanford University . According to the manufacturer, 234 Cyberknife systems had been installed worldwide by 2010. There are eleven systems in Germany (as of November 2015). Over 100,000 treatments have already been carried out worldwide with the Cyberknife system.

construction

Cyberknife at St. Mary's Hospital in Michigan

A linear accelerator serves as the radiation source . This is operated at 9.3 GHz, which corresponds to a comparatively high operating frequency which, compared to other radiation therapy devices, allows a more compact design. The length of the jet pipe is 50 cm with a weight of 150 kg. The accelerated electrons hit a cooled tungsten braking target, generating photons with a nominal energy of 6 MeV; this energy corresponds to a dose drop in body tissue to 80% at a depth of 6.7 cm. ( see also : depth dose curve ) The beam is widened by a scattering cone to field sizes of 5–60 mm. The nominal dose rate is 6 Gy / min at a reference distance  of 80 cm. The linear accelerator is mounted on a conventional 6-axis industrial robot . The positioning accuracy of the robot is specified by the manufacturer as 0.2 mm. A second robotic arm carries the patient table.

The system is continuously updated during therapy. The location system consists of two X-ray systems and an image processing computer. The axes of the two X-ray tubes are perpendicular to each other and intersect in the center of the target area. The system thus provides a stereoscopic image. This image is compared with reconstructed images from the planning computed tomography . The positions of prominent bony structures or implanted gold markers must match. Displacements and rotations with respect to the reference position are sent to the robot as correction values. In radiosurgical applications, you can do without the usual invasive fixation using a frame screwed to the patient.

The irradiation planning software takes into account the special radiation geometry and uses an inverse algorithm (based on so-called linear programming as an optimization method) with ray tracing processes or Monte Carlo simulations . The duration of the treatment is - depending on the complexity of the target volume - between 30 and 120 minutes.

Treatment spectrum

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In scientific studies, the effectiveness of the method has been proven in the following diseases:

History of Cyberknife Technology

In 1951 Lars Leksell , professor of neurosurgery at the Swedish Karolinska Institute, developed what they called radiosurgery together with the physicist Börje Larsson at the University of Uppsala . In 1968 they installed the first prototype of the Gamma Knife in Stockholm. In 1972 Leksell founded the Elekta Instruments company , which from then on produced the Gamma Knife devices. In 1987, after returning from Sweden, where he had worked at Leksell, John Adler developed the first Cyberknife at Stanford University in California, USA. In 1990 the Accuray company was founded in California to produce and further develop these devices. In 1999 the American FDA approved the treatment of brain and cranial tumors in the United States. In 2000, approval was extended to include tumors throughout the body. In 2002, the Cyberknife system was also approved in Europe for the treatment of tumors throughout the body. In 2005, the FDA approved synchrony respiratory tracking . This made it possible to calculate the patient's movements or certain organs (e.g. lungs) in advance during treatment. With the synchrony method, the movement of the target volume is determined using a correlation method. External marks (infrared LEDs) are attached to the patient's skin surface. In addition, the position of implanted gold landmarks is calculated at fixed time intervals using an X-ray method. The two sensors (X-ray camera and infrared position tracking) are time-synchronized by time stamps (hence the name Synchrony method), and a model of the movement correlation between external and internal landmarks is calculated. Prediction can also compensate for the latency of the robot movement (and imaging).

Locations in Germany and Switzerland

Switzerland:

See also

literature

  • JR Adler, SD Chang, MJ Murphy, J. Doty, P. Geis, SL Hancock: The Cyberknife: a frameless robotic system for radiosurgery. In: Stereotactic and Functional Neurosurgery . Volume 69, Numbers 1-4, Pt 2, 1997, pp. 124-128, ISSN  1011-6125 . PMID 9711744 .
  • Achim Schweikard, Hiroya Shiomi, John Adler: Respiration tracking in radiosurgery. In: Medical physics. 31.10, 2004, pp. 2738-2741. ISSN  1478-596X . doi: 10.1002 / rcs.38 . PMID 17518375 . (Review)
  • W. Hara, SG Soltys, IC Gibbs: CyberKnife robotic radiosurgery system for tumor treatment. In: Expert Review of Anticancer Therapy . Volume 7, Number 11, November 2007, pp. 1507-1515, ISSN  1744-8328 . doi: 10.1586 / 14737140.7.11.1507 . PMID 18020920 . (Review).
  • A. Muacevic, M. Staehler, C. Drexler, B. Wowra, M. Reiser, JC Tonn: Technical description, phantom accuracy, and clinical feasibility for fiducial-free frameless real-time image-guided spinal radiosurgery. In: Journal of Neurosurgery: Spine . Volume 5, Number 4, October 2006, pp. 303-312, ISSN  1547-5654 . doi: 10.3171 / spi.2006.5.4.303 . PMID 17048766 .
  • A. Muacevic, M. Nentwich, B. Wowra, S. Staerk, A. Kampik, U. Schaller: Development of a streamlined, non-invasive robotic radiosurgery method for treatment of uveal melanoma. In: Technology in cancer research & treatment. Volume 7, Number 5, October 2008, pp. 369-374, ISSN  1533-0346 . PMID 18783286 .
  • B. Wowra, A. Muacevic, S. Zausinger, JC Tonn: Radiosurgery for spinal malignant tumors. In: Deutsches Ärzteblatt international. Volume 106, Number 7, February 2009, pp. 106-112, ISSN  1866-0452 . doi: 10.3238 / arztebl.2009.0106 . PMID 19562022 . PMC 269624 (free full text). (Review).
  • W. Kilby, JR Dooley, G. Kuduvalli, S. Sayeh, CR Maurer: The CyberKnife Robotic Radiosurgery System in 2010. In: Technology in cancer research & treatment. Volume 9, Number 5, October 2010, pp. 433-452, ISSN  1533-0338 . PMID 20815415 . (Review).
  • Joanne N. Davis, Clinton Medbery, Sanjeev Sharma, John Pablo, Frank Kimsey, David Perry, Alexander Muacevic, Anand Mahadevan: Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch® patient registry . In: Radiation Oncology . 10, 2015, p. 113. DOI: 10.1186 / s13014-015-0417-5

Web links

Individual evidence

  1. ↑ SD Sharma: Quality of high-energy X-ray radiotherapy beams: Issues of adequacy of routine experimental verification. In: Journal of Medical Physics. 33, 2008, p. 1, doi: 10.4103 / 0971-6203.39416 .
  2. ^ SC Sharma, JT Ott, JB Williams, D. Dickow: Commissioning and acceptance testing of a CyberKnife linear accelerator . In: Journal of applied clinical medical physics / American College of Medical Physics. Volume 8, Number 3, 2007, p. 2473, ISSN  1526-9914 . PMID 17712305 .
  3. ↑ A. Schweikard, M. Bodduluri, JR Adler: Planning for camera-guided robotic radiosurgery. In: IEEE Transactions on Robotics and Automation. 14, pp. 951-962, doi: 10.1109 / 70.736778 .
  4. ↑ Kirsten Eibl-Lindner, Christoph Fürweger, Martina Nentwich, Paula Foerster, Berndt Wowra, Ulrich Schaller, Alexander Muacevic: Robotic radiosurgery for the treatment of medium and large uveal melanoma . In: Melanoma Research . tape 26 , no. 1 , February 2016, p. 51-57 , doi : 10.1097 / CMR.0000000000000199 ( lww.com [accessed August 19, 2016]).
  5. ↑ Berndt Wowra, Alexander Muacevic, Christoph Fürweger, Christian Schichor, Jörg-Christian Tonn: Therapeutic profile of single-fraction radiosurgery of vestibular schwannoma: unrelated malignancy predicts tumor control . In: Neuro-Oncology . tape 14 , no. 7 , July 1, 2012, ISSN  1522-8517 , p. 902-909 , doi : 10.1093 / neuonc / nos085 , PMID 22561798 , PMC 3379795 (free full text) - ( oxfordjournals.org [accessed August 19, 2016]).
  6. ^ Or Cohen-Inbar, Cheng-chia Lee, Jason P. Sheehan: The Contemporary Role of Stereotactic Radiosurgery in the Treatment of Meningiomas . In: Neurosurgery Clinics of North America (=  Meningiomas ). tape 27 , no. 2 , April 1, 2016, p. 215-228 , doi : 10.1016 / j.nec.2015.11.006 ( sciencedirect.com [accessed August 19, 2016]).
  7. ↑ Ken Somekawa, Masayuki Yamatani, Satoshi Endo, Kiminori Fuse, Akiyoshi Sato: Prospects of CyberKnife stereotactic radiation therapy for cerebral vascular malformations and functional diseases . In: Brain and Nerve = Shinkei Kenkyū No Shinpo . tape 63 , no. 3 , March 1, 2011, ISSN  1881-6096 , p. 217-222 , PMID 21386122 .
  8. ↑ Berndt Wowra, Alexander Muacevic, Jörg-Christian Tonn: CyberKnife radiosurgery for brain metastases . In: Progress in Neurological Surgery . tape 25 , January 1, 2012, ISSN  1662-3924 , p. 201-209 , doi : 10.1159 / 000331193 , PMID 22236681 .
  9. ↑ Markus Heide: Radiation therapy for brain metastases: The trend is towards stereotactic radiosurgery instead of whole-brain radiation. In: www.dgn.org. Retrieved August 19, 2016 .
  10. ↑ Joanne N. Davis, Clinton Medbery, Sanjeev Sharma, John Pablo, Frank Kimsey: Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch (®) patient registry . In: Radiation Oncology (London, England) . tape 10 , January 1, 2015, ISSN  1748-717X , p. 113 , doi : 10.1186 / s13014-015-0417-5 , PMID 25975848 , PMC 4443630 (free full text).
  11. ↑ M. Schoenberg, A. Khandoga, S. Stintzing, C. Trumm, TS Schiergens, M. Angele, M. Op den Winkel, J. Werner, A. Muacevic, M. Rentsch: CyberKnife Radiosurgery - Value as an Adjunct to Surgical Treatment of HCC? In: Cureus . tape 8 , no. 4 , April 28, 2016 ( cureus.com [accessed September 6, 2016]).
  12. ↑ Sebastian Stintzing, Ralf-Thorsten Hoffmann, Volker Heinemann, Markus Kufeld, Markus Rentsch, Alexander Muacevic: Radiosurgery of liver tumors: value of robotic radiosurgical device to treat liver tumors . In: Annals of Surgical Oncology . tape 17 , no. 11 , November 1, 2010, ISSN  1534-4681 , p. 2877-2883 , doi : 10.1245 / s10434-010-1187-9 , PMID 20574773 .
  13. ↑ Christopher R. King, Debra Freeman, Irving Kaplan, Donald Fuller, Giampaolo Bolzicco: Stereotactic body radiotherapy for localized prostate cancer: pooled analysis from a multi-institutional consortium of prospective phase II trials . In: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology . tape 109 , no. 2 , November 1, 2013, ISSN  1879-0887 , p. 217-221 , doi : 10.1016 / j.radonc.2013.08.030 , PMID 24060175 .
  14. ↑ Debra Freeman, Gregg Dickerson, Mark Perman: Multi-institutional registry for prostate cancer radiosurgery: a prospective observational clinical trial . In: Frontiers in Oncology . tape 4 , January 1, 2014, ISSN  2234-943X , p. 369 , doi : 10.3389 / fonc.2014.00369 , PMID 25657929 , PMC 4302811 (free full text).
  15. ^ M. Staehler, M. Bader, B. Schlenker, J. Casuscelli, A. Karl, A. Roosen, CG Stief, A. Bex, B. Wowra, A. Muacevic: Single fraction radiosurgery for the treatment of renal tumors . In: The Journal of Urology . tape 193 , no. 3 , March 1, 2015, ISSN  1527-3792 , p. 771-775 , doi : 10.1016 / j.juro.2014.08.044 , PMID 25132240 .
  16. ↑ Shankar Siva, Rodney J. Ellis, Lee Ponsky, Bin S. Teh, Anand Mahadevan, Alexander Muacevic, Michael Staehler, Hiroshi Onishi, Peter Wersall, Takuma Nomiya, Simon S. Lo: Consensus statement from the International Radiosurgery Oncology Consortium for Kidney for primary renal cell carcinoma . Future Medicine, London March 2016, p. 637-645 ( futuremedicine.com ).
  17. ↑ A. Schweikard, G. Glosser, M. Bodduluri, MJ Murphy, JR Adler: Robotic motion compensation for respiratory movement during radiosurgery. In: Computer aided surgery. Volume 5, Number 4, 2000, pp. 263-277, ISSN  1092-9088 . doi : 10.1002 / 1097-0150 (2000) 5: 4 <263 :: AID-IGS5> 3.0.CO; 2-2 . PMID 11029159 .
  18. ^ A. Schweikard, H. Shiomi, J. Adler: Respiration tracking in radiosurgery. In: Med Phys. 31, 2004, pp. 2738-2741. PMID 15543778 .
  19. ↑ Floris Ernst, Alexander Schlaefer, Sonja Dieterich, Achim Schweikard: A Fast Lane Approach to LMS prediction of respiratory motion signals. In: Biomedical Signal Processing and Control. 3, 2008, pp. 291-299, doi: 10.1016 / j.bspc.2008.06.001 .