The articles listed below support CyberKnife radiosurgery applications. Links to articles may be either full text or abstracts; if you want to read more of an article for which we could provide only an abstract, please contact the El Camino Hospital Health Library & Resource Center to arrange for free access to the full text.

Intracranial

Staged stereotactic irradiation for acoustic neuroma, Chang et al. 2005. Good hearing preservation when treatment is delivered in fractions.

Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Soltys, et al. 2007. CyberKnife radiosurgery is an efficient adjuvant treatment modality targeted at post resection cavities of intracranial tumors. It compares favorably to whole brain radiation treatment.

Visual field preservation after multisession CyberKnife radiosurgery for perioptic lesions. Adler, et al. 2006. CyberKnife radiosurgery resulted in high rates of tumor control in close proximity (less than 2mm) of optic apparatus with over 90% of patients maintaining or improving their vision.

CyberKnife radiosurgery in the treatment of complex skull base tumors: analysis of treatment planning parameters. Collins et al. 2006. Good conformality and homogeneity for oddly shaped lesions in the sensitive skull base region.

Spine

CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life. Degen, et al. 2005. CyberKnife radiosurgery can be safely performed in patients with both benign and malignant spinal tumors. The results show significant and durable pain relief and maintenance of quality of life after the treatment.

CyberKnife radiosurgery for breast cancer spine metastases: a matched-pair analysis. Gagnon et al. 2007. This is the only head-to-head comparison of EBRT with CyberKnife SRS for breast cancer metastasis to the spine. Outcomes were statistically comparable, despite the fact that most of the CyberKnife patients had undergone EBRT previously.

Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Gerszten et al. 2007: Largest published study on spinal radiosurgery in the literature. Shows that single fraction radiosurgery is safe and efficient both as a primary treatment modality as well as salvage treatment for spinal tumors

Lung

Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell lung cancer. Timmerman et al. 2003: High dose hypofractionated radiation can be delivered safely in medically inoperable patients with excellent local control.

Stereotactic Hypofractionated High-Does Irradiation for Stage I Non-small Cell Lung Carcinoma. Onishi et al. 2004 Effective dosing requires BED ≥ 100 Gy for better local control.

Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. Timmerman et al. 2006: High doses can be dangerous when delivered to central lesions. The use of extreme accuracy and altered fractionation may make it possible to deliver high doses to central lesions.

Radical stereotactic radiosurgery with real-time tumor motion tracking in the treatment of small peripheral lung tumors. Collins et al 2007. First methodical lung paper using 45-60 Gy in 3 fractions resulting in 83% local control and 84% overall survival at 12 months. Includes some metastatic lesions.

Accuracy of tumor motion compensation algorithm from a robotic respiratory tracking system: a simulation study. Seppenwoolde et al 2007: A simulation study using data from treatment of 8 lung cancer patients treated with respiratory gating. The continuous relationship of external and internal markers was used to establish the effect of the lower acquisition frequency of respiratory tracking using Synchrony. With the use of Synchrony, simulated treatment errors due to breathing motion were reduced largely and consistently for all patients.• Synchrony's linear model usually reduced error as well as the polynomial (nonlinear) model, but the polynomial model accounted better for anterior-posterior movement and movement in patients with hysteresis.• At least six X-ray images were necessary to obtain a consistent correlation between the internal and external movements using the linear model.• The polynomial model, however, required at least 10 X-ray images for consistency and 15 or more images to reach the level of consistency of the linear model.• The more frequently the model is updated the larger the size of the improvement became, because the overall residual error was smaller when the errors were corrected earlier.

Prostate

Virtual HDR CyberKnife treatment for localized prostatic carcinoma: dosimetry comparison with HDR brachytherapy and preliminary clinical observations. Fuller et al. 2008 CyberKnife can achieve HDR-like dose distributions with excellent conformality and sharp dose fall off.

New technologies for the radiotherapy of prostate cancer. A discussion of clinical treatment programs. Meyer et al. 2007 To achieve local control rates similar to surgery, dose needs to be at least 81 Gy.

Stereotactic Body Radiotherapy for Localized Prostate Cancer: Interim Results of a Prospective Phase II Clinical Trial. King et al: 2008. The radiobiology of prostate cancer favors a hypofractionated dose regimen. The early and late toxicity profile and PSA response for prostate SBRT are highly encouraging. Continued accrual and follow-up will be necessary to confirm durable biochemical control rates and low toxicity profile.

Stereotactic Body Radiotherapy: An Emerging Treatment Approach for Localized Prostate Cancer. Friedland et al: 2009. 100 patients treated with SBRT for early stage prostate cancer with median follow up of 24 months. Mean PSA value was .78 mg/ml. Acute side effects were mild and resolved shortly after treatment. One Grade 3 rectal complication reported. 82% of patients that were sexually potent prior to treatment maintained erectile function post treatment.

Pancreas

Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Koong et al. 2004. It is feasible to deliver stereotactic radiosurgery to patients with locally advanced pancreatic cancer. The recommended dose to achieve local control without significant acute gastrointestinal toxicity is 25 Gy.

Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. Koong et al. 2005. Concurrent IMRT and 5-FU followed by SRS in patients with locally advanced pancreatic cancer results in excellent local control, but does not improve overall survival and is associated with more toxicity than SRS, alone.

Gemcitabine Chemotherapy and Single-Fraction Stereotactic Body Radiotherapy for Locally Advanced Pancreatic Cancer. Schellenberg et al. 2008. Combining Gemcitabine chemotherapy with CyberKnife resulted in good local control but a significant rate of duodenal ulcers.

Liver

Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial. Herfarth et al. 2001. A phase I trial which delivered 14 to 26 Gy in a single fraction to 60 metastatic lesions. Actuarial local tumor control was 75%, 71%, and 67% at 6, 12, and 18 months, respectively. Local control was improved at higher doses. No serious complications were noted.

A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Schefter et al. 2005. Biologically potent doses of SBRT are well tolerated in patients with limited liver metastases. Results of this study form the basis for an ongoing Phase II SBRT study of 60 Gy over three fractions for liver metastases.

Phase I Study of Individualized Stereotactic Body Radiotherapy for Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma. Tse et al. 2008. Dose escalation study that delivered 24-54 Gy in 6 fractions to 41 patients with primary liver tumors. Local control was 65% at 1 year, with 50% of patients surviving at 1 year. Grade 3 changes in liver function indexes and platelet count were noted in 12 patients within 3 months of radiosurgery. Two late GI toxicities, one leading to death, were also obtained.