CyberKnife

Overview

CyberKnife (Accuray, Sunnyvale, CA) is a frameless robotic radiosurgery system that delivers stereotactic body radiation therapy using a lightweight linear accelerator mounted on a robotic arm, guided by real-time X-ray image tracking of implanted fiducial markers. It enables sub-millimetre targeting accuracy for extracranial tumours including pancreatic cancer, where respiratory motion management is critical.

Used by

• Used in the Polistina CyberKnife series for locally advanced pancreatic cancer (n=23, 30 Gy in 3 fractions with induction and adjuvant gemcitabine); achieved 50% 1-year local control with zero grade 2+ toxicities and 3 patients proceeding to resection (2 R0, 1 pathologic complete response). CyberKnife is the prototypical frameless SBRT delivery platform referenced throughout this SBRT review for pancreatic cancer. PMID:27826200

Notes

• Frameless robotic delivery guided by implanted fiducial marker tracking (X-ray–based real-time imaging).
• Synchrony respiratory tracking module compensates for tumour motion during beam delivery without breath-hold.
• Used in conjunction with endoscopic fiducial placement for pancreatic tumour targeting.
• Dose regimens in pancreatic cancer: typically 24–45 Gy in 3 fractions in the reviewed literature.

Sources

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