The CyberKnife^® System is cleared by the FDA to treat tumors and lesions anywhere in the body. With revolutionary precision, CyberKnife is able to spare healthy tissue while destroying the tumor with highly targeted radiation.

Malignant Tumors

• Primary (e.g., astrocytomas, carcinomas, gliomas, lung, pancreas)
• Metastases (brain and bony)

Benign Tumors

• Acoustic neuromas
• Craniopharyngioma
• Hemangioblastoma
• Schwannomas
• Meningiomas
• Pituitary adenomas

Vascular Malformations

• Arteriovenous malformations (AVM’s)
• Cavernous malformations

Functional Disorders

• Trigeminal neuralgia

Extracranial Tumors and Lesions

• Base of skull
• Neck
• Cervical spine
• Thoracic spine
• Lumbar spine
• Pancreas
• Liver
• Lungs
• Prostate
• Other lesions, tumors, and conditions anywhere in the body when radiation treatment is indicated

To better understand how CyberKnife^® works, it is helpful to understand the technology of radiosurgery. 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 (often-times cancerous) lesion within a patient’s body. The ideal objective is the destruction of the targeted area without damaging any normal tissue outside of the defined target area.

Radiosurgery and conventional radiotherapy are often confused.

Stereotactic radiosurgery differs from conventional radiotherapy in several ways. Because radiotherapy does not achieve the same level of accuracy, 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 utilizes highly destructive doses of radiation administered in one to five (1-5) daily fractions.

The key to the success of SRS is its ability to precisely target the tumor, firing these high dose beams from multiple angles to avoid sensitive structures (nerves, sensitive areas of the brain, etc.) even as the tumor moves (due to patient movement, breathing, etc.). Prior to CyberKnife, the accuracy of SRS relied on the use of a rigid metal frame fixed to a patient’s skull, immobilizing the head to prohibit movement and minimize damage to the surrounding healthy tissue. This procedure is very effective, but has considerable drawbacks, including the fact that treatment is restricted to only the head.

The CyberKnife radiosurgery system takes this procedure to the next level, eliminating the need for a head frame and allowing CyberKnife to treat tumors anywhere in the body. Perhaps more importantly, CyberKnife is uniquely capable of providing real time monitoring of the target throughout treatment using an advanced image-guidance system, and is able to detect and correct during treatment for some target motion (e.g. due to small patient movements, breathing, coughing).

Stereotactic radiosurgery has been used for more than 30 years to treat benign and malignant tumors, vascular malformations, and other disorders of the brain with minimal invasiveness.

Safe delivery of these radiosurgical high doses require a different treatment delivery technique than the conventional radiotherapy devices. Would you rather treatment with 4 high dose treatments for a chance to cure, control growth, or get pain relief vs. 40 lower dose treatments over several weeks?

CyberKnife provides the means to get the highest dose of radiation to the target with continual detection and correction throughout treatments with no pain, no incision, and little to no recovery time or side effects – allowing you to get back to your life.

How does the CyberKnife treatment work?

CyberKnife^® treatment is a radiosurgical procedure that utilizes a linear accelerator to generate radiation beams precisely targeted at the site of the tumor or other area of concern.

After treatment, when will my tumor or lesion disappear?

The effects of radiosurgery occur gradually over a period of time. The time frame may range from days, months or even years depending on the medical condition targeted. Some tumors resolve more slowly than others and may or may not eventually disappear completely, while others simply stop growing and present no further biologic activity. After CyberKnife treatments patients typically have periodic follow-up imaging examinations, such as CT, MRI or PET studies, as deemed appropriate by their medical team, to assess their progress. Laboratory tests may also be ordered.

How can I determine if CyberKnife is a treatment option for me or my patient?

CyberKnife Center of Louisiana conducts regularly scheduled Cyberknife-specific case conferences, as well as, participation in bi-monthly oncology “tumor board” conferences in which a multidisciplinary team of physicians review the unique history and conditions of each patient before delivering a medical opinion. A patient and/or a physician who provides our CyberKnife Center Nurse with a patient’s demographics, insurance, history & physical, past treatment records, medication list, a pathology report and the applicable imaging (CT, MRI, or PET scans – preferably on CD) will receive a complimentary opinion by the next business day following the case conference.

With a signed consent for release of medical records from the patient, our CyberKnife nurse may request records and images for a patient from other healthcare providers for the purposes of a review. Most opinions are given within the next business day following the case conference. In some cases, additional information may be requested prior to giving an opinion. To expedite a review, a patient’s documentation may be faxed to the Cyberknife nurse, and the related diagnostic images may be mailed to the Center at the following mailing address:

155 Hospital Dr., Ste. 102, Lafayette, LA 70503

Note: Healthcare providers may call our Center to schedule a courier to pick up records & images from local healthcare providers. For delivery of out-of-town patient images, ask about our next day account mail service.

How many procedures have been performed using the CyberKnife^® Robotic Radiosurgery System?

The FDA-approved CyberKnife System has been used to treat over 50,000 patients worldwide. More than half of these patients are treated for conditions outside of the brain/head.

How much does a Cyberknife treatment cost?

Medicare, Medicaid and most managed care plans cover stereotactic radiosurgery (SRS) – the term that most payors recognize. Each patient will have a different cost due to the unique treatment plan involved for each diagnosis and the patient’s insurance plan/coverage. Some payors require precertification and clinical information prior to a patient’s pretreatment set up.

The Cyberknife Center staff pre-certify each patient’s setup, scan and treatment and notify the patient when the payor has given authorization or if there are any concerns or extended delays. Patients are also highly encouraged to contact their health insurance company prior to their pretreatment set up appointment to inquire about coverage and expected costs. If you consulted with a radiation oncologist and a CyberKnife-trained surgeon, then each of these physician consults/visits are separate from your treatment costs.

Any patient who desires more information on the hospital’s specific charges and out-of-pocket costs, may request an appointment with one of our financial counselors in the hospital’s business office to discuss this in detail. Any questions about your surgeon or radiation oncologist charges should be addressed with the physician’s office manager.

How does Intensity Modulated Radiation Therapy (IMRT) differ from robotic radiosurgery and the CyberKnife System?

IMRT, Intensity Modulated Radiation Therapy, is a form of radiation therapy incorporating multi-leaf collimators on standard gantry-based linac delivery systems to better “shape” the radiation beams to the lesion volume. This is generally accepted as an improvement over conventional radiation therapy (XRT) systems, however it is still limited by many of the same constraints as conventional radiation therapy.

IMRT differs from CyberKnife radiosurgery in several fundamental ways:

• Accuracy — IMRT systems register target location only at the beginning of a treatment and cannot localize and automatically compensate for a moving target during the actual treatment. The CyberKnife System combines image guidance and computer-controlled robotics to continuously track, detect and automatically correct for tumor and patient movement throughout the treatment, providing far greater accuracy when compared to an IMRT system and other systems.
• Fractionation — Due to the large error margin and the need to minimize damage to the surrounding healthy tissue, IMRT cannot deliver high doses of radiation (8-25 Gy per fraction). As a result, a higher number of treatment fractions (20-30 sessions) are delivered at a lower radiation dose (typically 2 Gy per fraction). Because the CyberKnife System is able to target and treat lesions more precisely, radiation doses can be increased and the number of fractions can be reduced to five or less.
• Flexibility — Compared to gantry-based IMRT, IGRT (Image Guided Radiation Therapy) and conventional radiosurgery systems, the CyberKnife System allows for greater flexibility. The robotic arm can be positioned in almost any orientation, providing maximum treatment delivery options compared to the constrained geometry of the gantry-based systems. The flexibility of the CyberKnife System helps the clinician to easily execute complex treatment plans, including those for non-symmetrical, complex-shaped lesions in difficult-to-reach locations. Less maneuverable systems make it difficult to achieve the same level of conformality and accuracy.

What can I expect during a Cyberknife treatment?

Request a DVD copy of a patient education video to learn more about specific treatment processes from CyberKnife Center of Louisiana.

What is stereotactic radiosurgery?

Stereotactic radiosurgery is a non-surgical, non-invasive and painless treatment in which high doses of focused radiation beams are delivered from multiple locations outside the body to destroy a tumor or lesion within the body. This procedure does not remove the tumor or lesion. Instead, it destroys tumor cells or stops the growth of active tissue.

What is Synchrony?

Unlike lesions of the brain and spine, tumors in and near the lung move with breathing. One way to treat these moving tumors is to have patients hold their breath when the radiation beam is on to minimize large movements of the tumor and reduce unwanted irradiation of surrounding healthy tissue. However, breath-holding can be difficult for some patients, requires larger treatment margins around the tumor, and prolongs treatment time.

The Synchrony System is an enhancement that works together with the CyberKnife System to deliver dynamic radiosurgery—the ability to irradiate a tumor or other target while it is moving. The advantage of the Synchrony System is that patients can breathe normally throughout treatment while the CyberKnife robot actively compensates for the breathing motion during irradiation – this allows extremely accurate radiation delivery without the need for breath holding. Treatment is thus more comfortable for patients and significantly faster. The Synchrony System is used in conjunction with the CyberKnife to treat patients with tumors and lesions in areas of the body such as the lung, liver, kidney and pancreas.

What is the average treatment time for the CyberKnife system?

The treatment time per session ranges from 30 to 120 minutes depending on the dose delivered, the complexity of the tumor shape and the location. Physicians may elect to treat a patient with a single treatment or 2-5 treatments or fractions.

Will my hair fall out or will my skin burn after CyberKnife treatment?

The radiation delivered by the CyberKnife is so focused on a specific target that it is highly unlikely that hair loss or skin burn will occur. In the event that a treated lesion is very close to the scalp or skin though, the adjacent hair or skin may be affected. If so affected, this hair or skin will typically recover over time.

All medical procedures, including CyberKnife treatment, have potential side effects and associated risks, and every patient will be individually evaluated and counseled in detail before a final plan of treatment is made. Any and all questions by the patient and their family will be answered before we proceed with treatment.

Small gold seeds, called fiducials, are implanted near a soft tissue tumor to act as a marker to define the lesion(s) position with sub-millimeter precision. They are usually not necessary for brain or spine lesions.

If fiducial placement is required, keep in mind the following:

• Some medications such as aspirin, ibuprofen or Plavix will need to be held for one week prior. Others should be held for only 48 hours prior to the exam. Be sure to review all prescribed and over-the-counter medications with the CyberKnife nurse prior to your exam date.
• In most scenarios, fiducial placement is done as an outpatient service in the Radiology Department and you are able to return home in 4 to 8 hours.
• The physicians will prescribe the best fiducial placement for you and the CyberKnife center staff will make all the arrangements.
• Depending on the exact fiducial placement procedure used, the patient may not be able to eat or drink for up to 6-12 hours prior to the fiducial placement procedure.
• A designated driver will be needed to drive the patient home.
• There may be slight discomfort after the procedure

Fiducial placement is potentially required about one week prior to treatment for the following conditions:

Head and neck and soft tissue lesions
Typically anesthesia is required to place 3-6 fiducials by a surgeon or percutaneously by a radiologist under CT guidance.

Lung lesions
CT- guided lung fiducials may result in a complication known as pneumothorax – air trapped in the space between the lung and the chest wall – also referred to as “collapsed lung”. This complication occurs in about 1/3 of the patients. If a pneumothorax occurs, it may be minor, requiring no further treatment, or it may require a chest tube to remove this air pocket and re-expand the lung, potentially resulting in admission to the hospital overnight. Other fiducial placement methods such as placing them through a scope that passes through the bronchus or esophagus may be used.

Liver, pancreatic, retroperitoneal and kidney lesions
Placement in these instances is usually done under CT guidance in the Radiology Department or if surgical exploration is done, then fiducial placement may be done by the surgeon directly.

Prostate cancer
Prostate fiducials will typically be placed under ultrasound guidance, either by the urologist or by the radiation oncologist.

Spine lesions
Your physician will prescribe whether the small screws are necessary to mark the condition. Not all spine lesions require them.

Your pre-treatment set up and imaging will follow the above fiducial placement about one week after fiducial placement to allow the fiducials to settle into a stable position. If spinal fiducials are used, then treatment planning and your scheduled treatment days may occur sooner. You will be contacted throughout the steps in the process to schedule your appointment dates and times.

Once your medical history and imaging studies have been reviewed by the multidisciplinary team at a weekly case conference, and you are determined an appropriate candidate for CyberKnife treatment, you will be notified and scheduled for the next steps in the treatment process as outlined below.

Step 1: Initial Consultation

During the initial consultation, the patient will meet with several members of our highly trained staff, including the radiation oncologist, the CyberKnife coordinator, the radiation therapist, and/or a surgical specialist if needed. At this time, the procedure, treatment objectives and risks and benefits will be explained in depth; questions are welcomed and encouraged.

Step 2: Patient Treatment Preparation

Soft Tissue Fiducial Placement (not required for all cases):
The CyberKnife is a completely frameless treatment system, which often utilizes bony structures in the body as landmarks to track tumor location. For some tumors or lesions, however, tiny gold seeds, called fiducials, may be implanted to accurately guide the radiation beams. These are typically used to mark tumors in the chest, the abdomen, pelvis or other soft tissue areas. If fiducial placement is needed, the CyberKnife Center will typically coordinate this procedure with an interventional radiologist in the Lafayette General Radiology Department or a surgeon.

Making a Mask or Body Immobilizer
In addition, either a plastic “mesh” mask (used with brain, head or neck tumors) or a comfortable foam body mold will be made to help minimize movement during treatment. This simple and painless process is done in the CyberKnife Center. The patient will then undergo imaging (CT, MRI, PET, etc.) with the mask or the body mold.

Imaging: CT Scan, MRI, PET scan, CT cisternogram / myelogram

One or more of the imaging tests outlined below may be prescribed in order to provide the most detailed map possible of your treatment area. When you are consulting with your radiation oncologist, you will be informed of which imaging out of those listed below is needed to plan for your treatment.

Computed Tomography (CT) uses x-rays to capture extremely detailed cross-sectional images of your body, called slices. The image slices allow physicians to view internal organs, tissue, bones, and blood vessels at various angles.

What to expect:

• You will be asked to remove all jewelry, hairpins, eyeglasses, hearing aids and dentures. For abdominal exams, you should refrain from eating and /or drinking after midnight prior to your exam date.
• Let the technologist know if you have had allergic reactions to a contrast medium, iodine, or shellfish, or if you have asthma. Also inform the radiologic team if you have diabetes or take medication.
• If contrast medium is used, it will be given either intravenously or by mouth to coat the gastrointestinal tract. Most people tolerate the contrast medium without any problems and merely feel flushed for a moment.
• Though the images are acquired in a few seconds, the entire exam takes about 15-30 minutes – longer if contrast medium is used.

Magnetic Resonance Imaging (MRI) uses a huge magnet and radio waves to create a high resolution image of body tissues. The open design facilitates ease and comfort for each patient.

What to expect:

• Let the technologist know if you have a pacemaker; other imaging will be substituted.
• No special preparation is usually needed prior to your MRI. Eat normally and take medications as usual, unless your doctor or the CyberKnife nurse instructs you otherwise.
• You will be asked to remove your eyeglasses, watch, jewelry, credit cards, dentures, hearing aids and any other metallic objects that you are carrying.
• Generally, you lie on your back. A lightweight surface coil may be placed over the part of the body to be scanned. The exam itself usually takes 15-30 minutes.

Positive Emission Tomography (PET)/CT detects changes in cells in internal organs and living tissue, diagnosing the presence of disease at the molecular level. The CT pinpoints exact location with fine structural detail of the anatomy. For the PET you will be injected with a drug that contains a dose of radiation to localize the disease.

What to expect:

• For six (6) hours before your test, do not eat or drink (except water), do not even chew gum. Your last meal should be high in protein and low in carbohydrates. No caffeine or exercise 24 hours before the test.
• Take medication as prescribed, but if taken with food try to eat a few soda crackers only four to eight hours prior to your exam. If you have diabetes, call the CyberKnife nurse at least 48 hours prior to your appointment.
• Most people receive the radiopharmaceutical (called FDG) intravenously, a procedure that is usually painless. You will then rest quietly for about 60-90 minutes to allow the FDG to distribute throughout your body. The scan itself will take approximately 2 hours.

Myelography is a type of radiographic exam of the spinal cord by the use of contrast medium injected into the space around the spinal cord and the nerves, visualization using fluoroscopy and a series of x-rays. A cisternogram is a similar exam of the cerebral (brain) spinal fluid. Both tests will show soft tissues that regular x-ray and other imaging may not show in order to develop your individualized CyberKnife treatment plan.

What to expect:

• Some medications such as aspirin, ibuprofen or Plavix will need to be held for one week prior. Others should be held for only 48 hours prior to the exam. Be sure to review all prescribed and over-the-counter medications with the CyberKnife nurse prior to your exam date.
• You will need to abstain from eating after midnight on the night before the imaging appointment. You may drink clear liquids (clear broth, tea, clear juice, coffee w/out dairy products) up to the time of your examination. You are encouraged to drink 2- 3 glasses of fluid prior to the test.
• On the morning of your imaging, you should take a bath/shower and dress in comfortable clothing and leave all jewelry (metal) at home.
• Before going to the radiology department, you will be asked to empty your bladder and you may be given a prescribed medication that may make you drowsy or your mouth dry.
• You will be taken to the X-ray area via stretcher. Your family should wait in the waiting room. You will be placed on your abdomen on an X-ray table and the radiologist will explain the treatment to you. The radiologist will then anesthetize (numb) the part of your spine where the needle will be inserted. With the needle, he/she will inject the dye into the spinal canal. The X-ray table may be tilted at one point so that the dye moves to the part of your spine to be x-rayed. The procedure may take about one hour. After the procedure, you will be watched for several hours with your head elevated before going home. Further instructions will be given to you upon discharge.

Step 3: Treatment Planning

The CyberKnife physician(s) and the medical physicist will use the high-resolution imaging conducted above to identify the exact size, shape and location of the tumor, along with the surrounding health tissues to be avoided. The imaging data is downloaded to the CyberKnife treatment planning computer where physicians use advanced software to customize the number, intensity and direction of radiation beams the robot will send to the target. This may take a few days depending upon the complexity. The patient is not present during this step. When the planning is complete, a date and time for treatment(s) will be scheduled.

Step 4: CyberKnife Treatment

When you are preparing for your first treatment, you may want to enlist the help of a close friend, family member or driver should you require sedation for treatment. Wear comfortable clothes and avoid wearing jewelry. A blanket will be provided for warmth if needed.

CyberKnife treatment will be given once or up to 5 times depending on your unique situation. When the treatment begins, the patient lies flat on the treatment couch while the imaging system acquires the first set of x-rays. The treatment table then moves to the correct position for accurate alignment with the robotic arm. The robotic arm then moves around the patient to deliver the radiation beams—often greater than 100 times. This process takes anywhere from 45 to 130 minutes; so patients need to prepare to lie still for this time frame. Plan on spending two hours at the center on the first day of treatment to allow for variability, though if more than one treatment is given, this time will be more firm after the first treatment.

There are cameras in the treatment room so the CyberKnife team can monitor the entire process, and a microphone allows the patient to communicate directly with the radiation therapist at all times. The entire process is painless, but if the patient becomes uncomfortable during treatment, the patient should tell the radiation therapist.

f the treatment plan calls for more than one treatment session, the radiation therapists will schedule all appointment times with you.

Follow Up

Upon your last treatment, you will be given a follow up appointment with your CyberKnife physician to monitor your progress along with follow up imaging prior to this appointment. While waiting for your results, remain positive and resume activity as usual. If you experience any discomfort immediately after treatment, call CyberKnife Center of Louisiana (337) 289-8070 and speak with the nurse.

We want to know how your doing, so please forward your follow-up office visit notes and any new imaging reports to us by fax at (337) 289-8071. A signed consent form to release this information may be requested from the imaging center and/or the physicians’ offices, especially if you request these to be faxed one year after your CyberKnife treatment.

Targeting tumors that move with respiration:

CyberKnife^® Robotic Radiosurgery System

• Beams move in real-time with 3D target motion
• Dose delivered continuously throughout the breathing cycle

Conventional Radiotherapy Systems

• Limited system mobility requires the beam to repeatedly turn on and off as the target moves through fixed crosshairs.

Ring Gantry Radiotherapy Systems

• Delivers high-doses of radiation to the entire envelope of target-motion – encompassing both healthy and cancerous tissues.