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Donna G

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  • 4 weeks later...

CyberKnife or stereotatic radiosurgery was tried on lung tumors a few years ago with pretty good results. The Japanese, together with M.D. Anderson were looking into using it for stage I lung cancers in patients that are otherwise suitable candidates for surgery.

The bottom line is this, it is a new technology for lung masses. It may have a role in patients who are not surgical candidates, or perhaps someday for many patients that may even have resectable disease and good cardiopulmonary reserve.

Some thoracic surgeons, who are the experts in thoracic oncology, have learned to use it, evaluate its efficacy and have it in their armamentarium, so as not to loose patients to others that may use their new hammer inappropriately thinking that every tumor is a new nail.

Thoracic surgeons need to be poised as the gatekeepers for thoracic oncology patients for appropriate disease management.

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  • 1 month later...

Quality of radiosurgery for single brain metastases with respect to treatment technology: a matached-pair analysis.

Wowra B, Muacevic A, Tonn JC.

European CyberKnife Center Munich, Max Lebsche Platz 31, 81377, Munich, Germany, Berndt.Wowra@cyber-knife.net.

Objective: A comparison of treatment parameters and quality of clinical outcome in patients with single brain metastases treated with two different technologies for radiosurgery (Gamma Knife and CyberKnife).

Methods: Treatment parameters were statistically analyzed. Clinical outcome was assessed by matched-pair analysis based on the treatment device, differences in dose prescription, and the date of the treatment. Patients were matched according to their tumor size, age, gender, primary cancer, and Radiation Therapy Oncology Group score. Survival post-radiosurgery, local and distant tumor control, and complications were analyzed. Predictive factors were investigated.

Results: 423 single brain metastases were treated with Gamma Knife and 73 with CyberKnife. Tumor volumes were similar. The parameters minimum tumor dose, maximum tumor dose, prescription isodose volume, conformality index, homogeneity index, volume of tissue receiving a dose of 10 Gy or more were significantly larger in Gamma Knife group. Sixty-three patients were good matches. These showed the same pattern in parameters. Concerning the outcome analysis, only overall survival differed significantly between groups, twice as long with CyberKnife (P < 0.03). According to pooled data, dose was predictive of local failure, whole brain radiation therapy and chemotherapy were predictive of toxicity, the Radiation Therapy Oncology Group score was predictive of survival after radiosurgery, and date of treatment was predictive of overall survival. No factor predicted new brain metastases, including whole brain radiation therapy.

Conclusions: The most important result of this study was the finding that the obvious differences in treatment-related parameters between Gamma Knife and CyberKnife had no impact on the quality of the clinical outcome after radiosurgery. Survival time increased chronologically, presumably due to an intensified anti-cancer therapy in the more recent era of the CyberKnife treatments.

PMID: 19184641

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