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Liver and pancreatic tumors

Liver and pancreas tumor treatment with CyberKnife

Welcome to the CyberKnife patient education video. During the next few minutes we hope to help you better understand how the CyberKnife Robotic Radiosurgery System and the Synchrony Respiratory Tracking System are used to treat liver and pancreas tumors.

We believe that the more a patient – and their family and friends – know about the steps involved in the CyberKnife treatment, the more comfortable everyone will be with the procedure.

The CyberKnife System is one of the most advanced stereotactic radiosurgery systems in use today. It relies on robotics and sophisticated image guidance technologies to attack tumors with extreme precision. The flexibility of the robotic arm enables your doctor to deliver multiple beams of high-dose radiation directly to your tumor from almost any angle while minimizing damage to surrounding healthy tissue and critical structures.

The challenge that doctors face with treating tumors in the abdominal region is that tumors in this area move as you breathe. Unlike traditional radiation therapy, Accuray's Synchrony Respiratory Tracking System was designed to overcome this challenge. It allows you to breathe normally during the course of your CyberKnife treatment. The robot follows the tumor as it moves, delivers radiation to the tumor and avoids spreading radiation to the surrounding healthy tissue. As a result, your treatment is more comfortable, radiation is delivered more accurately and treatments can be completed in a shorter period of time.

Your treatment involves a team approach, in which several specialists participate. Once the team is in place, you will begin preparation for the CyberKnife Treatment.

As part of your diagnosis, your doctors will have identified the location and size of your tumor. To allow the CyberKnife to better identify your liver or pancreas tumor, small markers are placed within the tumor or the surrounding tissue to help the CyberKnife see the tumor clearly. 

You will be scheduled for a short outpatient procedure in which three to five tiny gold seeds – called fiducial markers – are inserted into the tumor or the tissue around the tumor. These markers may be placed by putting a small needle through the abdomen guided by the help of a CT scan or an ultrasound. Alternatively, a camera might be passed through your mouth into your stomach and small intestine, allowing additional visual access to the tumor. 

After insertion of the fiducials, you must wait approximately one week before CyberKnife treatment planning can begin to ensure the fiducial movement has stabilized. 

During setup, a special custom-fit body cradle will be made. The cradle is made of a soft material that molds to your body and is created to make your treatment more comfortable and to ensure your body position is the same for each treatment session

You also will be fitted with a special vest, called a Synchrony vest. You will wear this comfortable vest during the CyberKnife treatment to allow the robot to correlate  your chest motion and breathing pattern with the tumor position.

While lying in the cradle, a CT scan will be performed to locate your tumor.  This CT data will be used by the CyberKnife team to determine the exact size, shape and location of your tumor. An MRI or PET scan also may be necessary to fully visualize the tumor and nearby anatomy. Once the imaging is done, you will remove your vest and it will be stored with your body cradle for use in your CyberKnife treatment.

During treatment planning, your relevant CT, MRI or PET scan data will be downloaded into the CyberKnife System’s treatment planning software. Your medical team will determine the size of the area being targeted by radiation, the radiation dose and will identify critical structures – such as your spinal cord or vital organs – where radiation should be minimized.

After your treatment plan is developed, you will return to the CyberKnife Center for treatment.  Your doctors may choose to deliver the treatment in one session, or stage it over several days. Typically, treatments are completed within five days.

For most patients, the CyberKnife treatment is a completely pain free experience. You can dress comfortably in street clothes and your Center may allow you to bring music to listen to during the treatment. 

When it is time for your treatment, you will be asked to put on your Synchrony vest and lie on the custom body cradle made during the set-up process.

When you are ready for treatment to begin, the location of your tumor will be tracked and detected continually as you breathe normally.  Your medical team will be watching you every step of the way as the CyberKnife “watches” your tumor, follows it as you breathe and safely delivers radiation to the tumor.  

The CyberKnife System’s computer-controlled robot will slowly move around your body to various locations from which it will deliver radiation to your tumor. At each position, the robot will stop. Then, special software will determine precisely where the radiation should be delivered by correlating your breathing motion with your tumor. 

You can expect each treatment session to last 30 to 90 minutes depending on your specific tumor. Nothing will be required of you during the treatment, except to relax and lie as still as possible. 

After completing your CyberKnife radiosurgery treatment, it is important to schedule and attend any follow up appointments. You must keep in mind that your tumor will not suddenly disappear.

Once treatment is complete, most patients quickly return to their daily routines with little interruption to their normal activities.  If your treatment is being delivered in stages, you will need to return for additional treatments over the next several days as determined by your doctors. 

Side effects vary from patient to patient but in general most patients experience minimal side effects from CyberKnife treatments that often go away within the first week or two after treatment. Your doctor will discuss all possible side effects you may experience prior to your treatment.

Additionally, your doctor may prescribe medication designed to control any side effects, such as nausea, should they occur.

Response to treatment varies from patient to patient. Clinical experience thus far has shown most patients respond very well to CyberKnife treatments. Your doctors will monitor the outcome in the months and years following your treatment, often using either CT scans, or PET-CT scans. 

Thank you for choosing the CyberKnife System and we hope that this video has addressed any questions you may have. Please consult with your doctors if you have any questions specific to your treatment.

Source: Leslie Nussbaum, MD,  PhD, neurosurgeon, co-medical director, Nasseff CyberKnife
Reviewed By: Leslie Nussbaum, MD,  PhD, neurosurgeon, co-medical director, Nasseff CyberKnife
First Published: 02/10/2015
Last Reviewed: 02/06/2015