PANCREATIC CANCER
Frequently Asked Questions
The CyberKnife System uses leading-edge robotics and advanced software technology, but it’s not new. The CyberKnife System has more than two decades of clinical proof and has been used to help thousands of patients with pancreatic cancer.
Studies support CyberKnife SBRT treatment as a safe, effective and convenient option with demonstrated clinical benefits for patients with advanced, medically inoperable pancreatic cancer and pancreatic cancer that has returned after primary treatment such as surgery or radiation:
- A clinical study evaluating 56 patients with locally advanced unresectable pancreatic cancer found that treatment with the combination of CyberKnife SBRT and chemotherapy resulted in excellent efficacy with acceptable toxicity. Use of the Synchrony® Real-Time Adaptive Technology during the CyberKnife treatment enabled continuous tracking of tumors as they moved with patients’ respiration and automatic adaptation of the radiation beam, minimizing dose to healthy tissue such as the stomach and duodenum that surround the tumor1.
- A study of 417 patients with advanced or medically inoperable pancreatic cancer found that stereotactic body radiation therapy delivered with the CyberKnife System is safe and effective for elderly patients and an alternative for those patients who are ineligible for surgery2.
- An analysis of 19 patients with unresectable pancreatic cancer found that CyberKnife SBRT is an effective local treatment option with acceptable rates of adverse events. Study authors noted, “In the multidisciplinary management of these tumors, SBRT adds to our armamentarium of local treatment modalities especially for non-operable patients"3.
- An analysis of 38 patients treated with CyberKnife SBRT and chemotherapy for locally advanced, inoperable pancreatic cancer indicates the combined treatment is feasible, generally well tolerated and convenient – CyberKnife treatments were administered in 5 sessions avoiding disruption to patients’ chemotherapy regimen4.
- An analysis of 30 patients with recurrent pancreas cancer after previous radiation therapy has been performed. Due to its focused targeting and avoidance of normal tissue CyberKnife proved to be a feasible, effective and tolerable treatment option5.
- A study of 59 patients evaluated the efficacy and safety of CyberKnife treatment for locally-advanced pancreatic cancer (LAPC). The authors concluded that, “excellent clinical efficacy was obtained after treatment of LAPC using CyberKnife, with minimal toxicity.” The majority of patients experienced good local control of their tumors. Local control of pancreatic tumors can improve pain control and reduce the risk of gastric or duodenal obstruction6.
The FDA provided clearance for the CyberKnife System in 2001 for the treatment of tumors anywhere in the body, including pancreatic cancers and metastases. The CyberKnife System is supported by years of published clinical follow-up with a large number of patients.
CyberKnife treatment is available at hundreds of locations worldwide.
Treatment with the CyberKnife System is a non-surgical, outpatient procedure that does not require incisions or general anesthesia. Most patients will not require hospitalization or a long recovery period. This makes CyberKnife treatment an excellent option for patients with medically inoperable pancreatic cancers.
The CyberKnife System was designed to deliver stereotactic body radiation therapy (SBRT), a treatment process that has proven to be effective in the treatment of pancreatic cancer. SBRT uses advanced techniques to deliver ultra-hypofractionated radiation therapy — very high doses of radiation are administered over several days. Treating in fewer sessions with higher individual doses per session is typical for SBRT and has proven to be an effective approach. This treatment process necessitates an extremely high degree of accuracy and precision.
The entire CyberKnife treatment is typically completed in as little as 5 sessions, compared to 20 to 30 sessions over 4 to 6 weeks with conventional radiation therapy. Because CyberKnife SBRT may be completed in as little as 5 sessions, it typically does not require interruption or delay of chemotherapy treatment, which is very often combined with radiation therapy.
Radiation therapy is a treatment that uses high-energy X-rays (photons) to kill and shrink the tumor or control the growth of tumors. Radiation therapy works by damaging cells, disabling them from growing and dividing. The goal of any radiation treatment is to destroy cancer cells while minimizing the side effects on healthy tissue. As imaging technologies have improved over the last several decades, radiation therapy has integrated those improvements to enhance dose delivery and minimize unwanted dose to healthy tissue.
Radiation may be recommended as an alternative to surgery or in addition to other therapies. There are several kinds of radiation therapy. The CyberKnife System delivers a type of radiation therapy known as stereotactic body radiation therapy (SBRT).
Stereotactic Body Radiation Therapy (SBRT) couples a high degree of targeting accuracy with very high doses of extremely precise, externally delivered radiation, thereby maximizing the cell-killing effect on the tumor(s) while minimizing radiation-related injury in adjacent normal tissues.
Because of the location and position of the pancreas — adjacent to numerous sensitive tissues and organs such as the stomach and duodenum — extreme precision is critical for any treatment method. CyberKnife SBRT enables treatment teams to deliver very high doses of radiation with continuous, sub-millimeter accuracy, while minimizing dose to surrounding healthy tissues. In addition, because CyberKnife SBRT may be completed in as little as 5 sessions, it typically does not require interruption to the chemotherapy cycle.
There are more options than ever for treating pancreatic cancer, and the right option depends on your specific tumor location, cancer type and cancer aggressiveness — as well as your health, age and lifestyle. CyberKnife SBRT may be an appropriate treatment option for a wide range of cancer types and patient situations. The best way to determine if CyberKnife treatment is right for you is to find a CyberKnife treatment location and make an appointment to discuss your specific details.
Despite the higher dose per session associated with SBRT, multiple studies have validated that CyberKnife SBRT is generally well tolerated with minimal side effects. The ability to deliver precise doses of radiation enables clinicians to minimize irradiation of the healthy tissues surrounding the tumor and the risk of side effects, which may lead to better quality of life for the patient both during and after treatment. Nonetheless, side effects can and do occur. Most radiation side effects are minimal and last only a short time. Most patients resume normal activity immediately after treatment sessions.
CyberKnife treatment is typically completed in as little as 5 sessions, compared to 20 to 30 sessions over 4 to 6 weeks with conventional radiation therapy.
Treatment sessions are non-invasive outpatient procedures, and no anesthesia is required. Most patients resume normal activity immediately after treatment sessions.
No anesthesia is required for CyberKnife treatment and treatment sessions are completed on an outpatient basis. Prior to the initiation of treatment, fiducials will need to be implanted within the pancreas through a short, minimally invasive outpatient procedure. This procedure would be performed under local anesthesia.
The CyberKnife System was designed to provide the clinical team with a powerful tool to effectively control pancreatic cancer while minimizing side effects and the impact of treatment on patients’ daily lives. The majority of patients can continue normal activity during and immediately following CyberKnife treatment. In some circumstances, complications may occur.
The majority of patients can continue normal activity during and immediately following CyberKnife treatment. In some circumstances, complications may occur.
The CyberKnife robot, guided by motion synchronization software, can deliver radiation from virtually any angle — allowing it to maintain sub-millimeter accuracy throughout treatment delivery. Greater precision helps minimize dose to surrounding healthy tissues, which can reduce the risk of many common side effects7, 8.
When you breathe, your diaphragm moves. This means that a pancreatic tumor will continuously move throughout the course of treatment delivery. In addition, anatomical shifts (such as those due to normal digestion) can cause the pancreas to shift slightly.
Failing to adapt and synchronize the delivery of radiation dose with tumor movement can result in decreased dose delivered to the target — and increased dose delivered to surrounding healthy tissues. This can impact the overall effectiveness of the treatment and can potentially increase the frequency and severity of side effects.
Unlike any other radiation treatment, the CyberKnife System uses the world’s only real-time motion synchronization technology to continually track that motion and adapt treatment delivery to maintain sub-millimeter accuracy. This helps to ensure the radiation dose is delivered to the target — maximizing treatment effectiveness while minimizing dose to surrounding tissues which can help reduce the incidence of side effects. And unlike other radiotherapy options, the CyberKnife System does not require uncomfortable patient restraints or breath-hold techniques; you can relax and breathe normally, with full confidence in the CyberKnife System’s synchronization capabilities.
Precisely delivering the prescribed radiation dose to the tumor is essential for optimizing cancer control. Additionally, precise dose delivery reduces irradiation of healthy tissues surrounding the target.
Because the pancreas is adjacent to several sensitive organs and tissues within the abdomen, precise delivery is critically important for reducing the incidence and severity of side effects and protecting quality of life both during and after treatment.
SBRT is a form of hypofractionated radiation therapy. Hypofractionation entails delivering a higher dose per fraction across fewer total fractions. Hypofractionated radiation therapy, such as CyberKnife SBRT, has been proven to deliver clinical outcomes as good as conventional fractionation — while dramatically reducing both the number of treatments and the total cost of care for both patients and payers.
The CyberKnife System, guided by motion synchronization software, continually tracks the motion of the abdominal organs caused by patient breathing, as well as the movement of the tumor itself, automatically adapting the radiation beam to make sure the beam stays precisely focused on the target. With its motion adaptive delivery technology, the CyberKnife System can treat pancreatic tumors with SBRT. SBRT uses advanced techniques to deliver a very high dose of radiation to the tumor, effectively treating the cancer while minimizing the dose on healthy tissue and organs, such as the intestine and stomach. The entire course of treatment is typically completed in as little as 5 sessions.
The use of CyberKnife SBRT is supported by extensive clinical evidence demonstrating the treatment can provide a convenient and effective option for patients with locally advanced and medically inoperable pancreatic cancer.
Because the precise targeting of the CyberKnife System significantly reduces irradiation of surrounding healthy tissues, patients treated with conventional radiotherapy systems may be candidates for re-irradiation with the CyberKnife System, in the event of recurrence. Each patient should consult his/her physician regarding his/her own specific case.
Most payers (government and private) should allow coverage for SBRT to treat pancreatic cancer subject to medical necessity. The CyberKnife center where the SBRT procedure will be performed will contact your insurance company to determine specific coverage criteria and any co-payments / co-insurance obligations.
If you live outside of the United States, typically the CyberKnife Center that you would choose for treatment can answer coverage questions.
Not every patient’s pancreatic cancer is effectively treated with SBRT. Talk to your physician about your best options and come to a joint decision.
References:
1 Shen ZT, Zhou H, Li AM, et al. “Clinical outcomes and prognostic factors of stereotactic body radiation therapy combined with gemcitabine plus capecitabine for locally advanced unresectable pancreatic cancer.” J Cancer Res Clin Oncol. 2020 Feb;146(2):417-428..This is not needed in addition, we can be consistent how to quote.
2 Zhu X, Li F, Ju X, et al. "Prognostic role of stereotactic body radiation therapy for elderly patients with advanced and medically inoperable pancreatic cancer." Cancer Med. 2017 Oct;6(10):2263-2270.
3 Goyal K, Einstein D, Ibarra RA, et al. “Stereotactic Body Radiation Therapy for Nonresectable Tumors of the Pancreas.” J Surg Res. 2012;174:319–325.
4 Gurka MK, Kim C, He R, et al. “Stereotactic Body Radiation Therapy (SBRT) combined with chemotherapy for unresected pancreatic adenocarcinoma.” Am J Clin. Oncol. 2017;40:152.
5 Dagoglu N, Callery M, Moser J, et al. Stereotactic Body Radiotherapy (SBRT) Reirradiation for Recurrent Pancreas Cancer. J Cancer.2016 Jan 10;7(3):283-8.
6 Song Y, Yuan Z, Li F, et al. “Analysis of clinical efficacy of CyberKnife® treatment for locally advanced pancreatic cancer.” OncoTargets Ther.2015;8:1427–1431.
7Drexler and Furweger. “Quality assurance of a robotic, image guided radiosurgery system.” WC 2009, IFMBE Proceedings 25/I, 492-495, 2009.
8 Kilby. W. et al. “The CyberKnife Robotic Radiosurgery system in 2010.” TCRT 2010;9(5):433-452.