HealthCare Global Enterprises Ltd, The Specialist in Cancer Care, today organized a press conference on Robotic Whole Body Stereotactic Radio Surgery, (Cyberknife) and its benefits in the treatment of cancer.

HCG is one of the few hospitals in the world to treat more than 1000 patients with Cyberknife. Cancer patients have benefitted immensely, with this technology with better medical outcomes and quality of life.

Professor Ramesh S Bilimaga, Senior Consultant, Radiation Oncology & Medical Director, HCG, said, “The incidence of cancer is on the rise.With the advancements in technology, cancer treatment has become more precise. Robotic Whole Body Stereotactic Radio Surgery has revolutionized cancer treatment. The areas which were supposed to inoperable can be treated with Cyberknife. We are now able to target the disease with larger doses of radiation. Cyberknife tracks the organ motion in real time and directs radiation with sub millimeter precision at the tumor tissue. This is typically applicable in Brain Tumors, Prostate Cancer, Spine, Lungs, and Liver…etc where we effectively treat with better clinical outcomes and quality of life. Because of the high doses of radiation per sitting (Hypo Fractionation), in some cases the entire process of treatment can be completed in 8 to 10 days as opposed to 7 to 8 weeks with conventional treatments.”

He further adds, “We have patients who travel from various parts of Northern India and Lucknow. With increased awareness now we are seeing a trend where 60% of the cancers are diagnosed early.”

CyberKnife:

It is the world’s first non-invasive whole body robotic radiosurgery. CyberKnife offers patients new hope for the treatment of tumours and lesions, including ones that previously have been diagnosed as inoperable or untreatable with the existing technology. CyberKnife uses state-of-the-art real-time image guidance, similar to cruise missile technology, to precisely target tumours anywhere in the body with pinpoint accuracy and delivers high doses of radiation.

Advantages of CyberKnife:

 Non-invasive and pain-less
 Treats inoperable tumors
 Pin-point accuracy
 Significantly reduces treatment time
 Automatic movement tracking
 No need for invasive body or head frame
 Higher radiation dose possible
 Minimizes side effects

In an era of personalised medication, treatment of cancer is seeing improvisation by the day. After radiation surgery, radiotherapy, now it is the turn of the CyberKnife boost therapy to take cancer care a step ahead. Dr Kumar Swamy, senior radiation oncologist, HCG, speaks to DNA on cyberknife boost.

What are the recent advances in cancer care?
Until now the treatment of cancer was based on stage of the disease and a particular histological (that is based on study of biopsy tissue) type. Now we are beginning to understand that a same histological type responds differently in
different patients. Stage IV may get cured and stage I may come back, although probability of cure is much higher in the latter. For that matter, a good responding tumour has a tendency to stay in earlier stage for longer time making for the difference in survival for the different stages.

How does radiation therapy help?
Coming to radiation therapy, similar stage, similar size and similar histology responds differently in different patients. However, generally it is known that invisible cancer cells respond to radiotherapy best, a size up to 2-4 cms responds moderately and a size greater than 4 cms responds not to the level of expectation. We generally add chemotherapy along with radiation, in lesser dose, to improve the effect of radiation. Recently there is entry of biological agents and oral tablets called small molecules, which penetrate the cancer cells and sensitise them only to radiation damage. However, we are still far from a satisfactory strategy.

What is boost therapy and how does it work?
There are basically two types of cancer cells, group of them who respond to our treatment and a group who mange to survive our attack. The latter is termed as resistant cells and is responsible for recurrence of cancer.
In radiation therapy, to handle these resistant cells, long time practice has been to deliver higher dose to the visible portion of cancer. This technique is the boost therapy – i.e. boosting the basic dose with higher dose to the particular portion of cancer. This technique is also used when the disease comes back (recurrence) in the earlier radiation area. Recently, by studying various biological models, we understand that it is not only total dose, but also amount of dose per treatment that matters in killing cancer cells. That is how a new technique of radiation has emerged, known as radiosurgery.

How is radiosurgery different from radiotherapy?
In radiosurgery high dose of radiation per sitting is given, focused on tumour only, to cause ablation (that is laser like destruction), unlike in radiotherapy where smaller dose per session is given, killing some cells and hoping that subsequent doses will completely kill surviving cells. With the radiation, cancer can be eliminated and cure can happen.
However, in selected patients when this does not happen or when the disease comes back in the same area, radiosurgery is an option.

Why is the boost with cyberknife technology in cancer care considered to be so very valuable?
CyberKnife being the product of robotic technology is the only stereotactic machine, as of now, which tracks the tumour during the treatment and automatically corrects the patient position. This has several cascading benefits. Hence, the boost with the cyberknife is very valuable after conventional radiotherapy. It is also ideal technique to deliver good dose of radiation to the tumour, when it is large in size or if the tumour persists after radiotherapy or in cases of recurrence following earlier radiation.

Precision: With phenomenal jump in imaging and software technology, radiotherapy has seen unprecedented development in the last 10 years in it’s over 100 years of existence. This astonishing progress is probably not matched by any other field of medicine. The precision has made the radiotherapy far safer and effective in the treatment of cancer. For example earlier to 2000 one could not treat a prostate cancer with radiotherapy satisfactorily, but now radiotherapy and radiosurgery are now becoming the preferred modality of treatment. There are several non cancerous tumours and diseases that are being targeted by these developments also.

Robotics: The other exceptional development is the introduction of robotics in radiotherapy. With this the new technology of radiosurgery that was developing in the recent decades got a shot in the arm. Radiosurgery is a specialized technique of radiotherapy, where innumerable small beams get concentrated at a point, and is biologically acts uniquely in destroying the cancer cells that are resistant to conventional radiotherapy. CyberKnife is the outcome of fusion of imaging, most sophisticated tracking software and robotics. Cyberknife radiosurgery distinctly differs from the linear accelerator based radiosurgery by automatic robotic adjustment of the position of the cancer bringing it in line of the sharp radiation beam, which a human adjustment in a linear accelerator cannot do. This technically makes it more efficient in targeting the cancer and avoiding normal tissue.

Combination: Basis of the effective cancer treatment always has been combination of treatments combining the advantages of different types of treatment to give the best possible cure and least possible side effects. Classically surgery, radiation therapy and chemotherapy are combined such a way to overcome the disadvantage of one over the other. Similarly in radiation treatment, it is not the question whether one machine is better than the other but the answer is in effective combinations of different types of radiotherapy machines. In several situations best outcome is in combining radiotherapy and radiosurgery. Cyberknife being the dedicated and most effective radiosurgery machine plays a key role in supplementing the benefits of linear accelerator based radiotherapy. And with the rapid pace of advances in design of targeted drugs killing exclusively cancer cells without effecting the normal cells, robotic radiosurgery is going to play more and more vital role in cancer and other diseases.