Lung Cancer Treatment

The challenge that physicians face in treating lung tumors is that the tumors move as the patient breathes.

Radiosurgery devices, such as the CyberKnife® Robotic Radiosurgery System, offer patients a new option for the treatment of lung cancer. Unlike traditional radiation therapy, the CyberKnife System precisely identifies the tumor location as the patient breathes normally during treatment. CyberKnife can be used to treat lung tumors noninvasively.

CyberKnife offers patients a non-invasive option for the treatment of lung cancer. Unlike traditional radiation therapy, the CyberKnife System precisely identifies the tumor location as the patient breathes normally during treatment. Douglas Gray, MD, discusses lung cancer treatment options and who would be a good candidate for CyberKnife.

Before a typical CyberKnife treatment

Lung cancer treatment with the CyberKnife System involves a team approach in which several specialists participate. The patient’s team may include:

• Surgeon
• Pulmonologist
• Radiation oncologist
• Interventional radiologist
• Medical physicist
• Radiation therapist
• Medical support staff

Once the team is in place, preparations begin for CyberKnife treatment.

The tumor will be located with the aid of the advanced technology of superDimension^TM Navigation System. Using a bronchoscope, a pulmonologist will place roughly four fiducials in and around the tumor to allow the CyberKnife to accurately treat the tumor as it moves with the patient's normal respiration. CyberKnife is the only radiation machine in the world capable of real-time tracking.

Before CyberKnife treatments begin, a special custom-fit body cradle is made. The cradle is made of a soft material that molds to the patient’s body and is designed to make treatment more comfortable and to ensure body position is the same for each treatment session. The patient is also fitted with a special vest, which is worn during treatment. The data generated using the vest allows the CyberKnife robot to correlate chest motion and breathing patterns with the tumor position, precisely following the tumor’s motion to deliver each beam of radiation. This ensures safe and accurate radiation delivery.

With the patient lying in the cradle, a CT scan is performed to locate the patient’s tumor. This CT data is used by the CyberKnife team to determine the exact size, shape and location of the tumor. An MRI or PET scan also may be necessary to fully visualize the tumor and nearby anatomy.

Treatment plan design

While the patient is carrying out his or her normal daily activities, a treatment plan is specifically designed by a medical physicist in conjunction with the patient’s physicians. During treatment planning, the CT, MRI and/or PET scan data is downloaded into the CyberKnife System’s treatment planning software. The medical team determines the area to be targeted by radiation and the radiation dose, and identifies critical structures such as the spinal cord or vital organs.

The CyberKnife System calculates the optimal radiation delivery plan to treat the lung tumor(s). Each patient’s unique treatment plan takes full advantage of the CyberKnife System’s extreme maneuverability, allowing for a safe and accurate lung cancer treatment. After the treatment plan is developed, the patient returns to the CyberKnife center for treatment, which is usually delivered in one to five outpatient sessions.

The treatment session

The CyberKnife treatment is a completely pain-free experience. Patients may dress comfortably in street clothes, and are free to bring music to listen to during the treatment. Patients also may want to bring something to read or listen to during any waiting time, and have a friend or family member accompany them to provide support before and after treatment.

At treatment time, the patient puts on the vest and lies on the custom body cradle. The radiation therapist ensures that the vest is properly adjusted and that the patient is positioned appropriately on the treatment couch.

As treatment begins, the location of the lung tumor is tracked and detected continuously as the patient breathes normally. The medical team monitors every step via closed-circuit TV as the CyberKnife tracks the patient’s lung tumor, and safely and precisely delivers radiation to it.

The CyberKnife System’s computer-controlled robot moves around the patient’s body to various locations from which it delivers radiation. At each position, the robot stops and special software determines precisely where the radiation should be delivered by correlating breathing motion with the tumor’s location. Nothing is required of the patient during treatment, except to relax and lie as still as possible.

After treatment

Once treatment is complete, most patients quickly return to their daily routines with little interruption of their normal activities. Most patients experience little to no side effects. Physicians will discuss all possible side effects with their patients prior to treatment. In addition, they may prescribe medication in order to reduce the risk of side effects or treat them if they occur.

After completing a CyberKnife radiosurgery treatment, it is important for patients to schedule and attend any follow-up appointments. Clinical experience thus far has shown that more than 90 percent of the time the tumor will not return to the same area. Physicians will monitor the outcome in the months and years following a patient’s treatment, often using CT scans or PET-CT scans.

*Source material drawn from www.cyberknife.com.  Please refer to that website for a complete listing of references used in the original information sections.

CyberKnife® is a registered trademark of Accuray Incorporated.

superDimeson^TM is a registered trademark of Covidien.