Cyberknife Radiosurgery for Benign Meningiomas

Abstract

The introduction of the CyberKnife extended the indication to 63 patients (>30%) who could not have been treated by single-session radiosurgical techniques. The procedure proved to be safe. Clinical improvement seems to be more frequently observed with the CyberKnife than in our previous linear accelerator experience.

Update on Meningiomas

“…SRS has been especially useful to treat skull-based meningiomas, with data demonstrating 98% tumor control rates, 58% tumor reduction, and 39% reduction in cranial nerve deficits [123]. Cyberknife surgery, a form of SRS designed to be accurate and expand treatment sites outside the head, is another effective modality, particularly for skull-based lesions, with data demonstrating 18.8% tumor reduction and 77.5% tumor stabilization in a cohort of 191 patients with either symptomatic or growing tumors [124]. Spot-scanning proton beam radiotherapy is a sophisticated modality wherein the proton beam scatters within the tumor volume, sparing surrounding tissue, and can be applied to complicated tumor volumes.…”

The use of RapidArc volumetric-modulated arc therapy to deliver stereotactic radiosurgery and stereotactic body radiotherapy to intracranial and extracranial targets

“…Our data show that the dosimetric quality of 1-arc RapidArc, 2-arc RapidArc, and IMRT in terms of conformity, homogeneity, and OAR sparing are clinically similar for the treatment sites and targets investigated. To gain a broader perspective on our findings, we compared our brain SRS and SRT treatments conformity data, as measured by PCI (Table 4), with previously published conformity data with other stereotactic modalities, including GammaKnife, 13,14 CyberKnife, 15,16 Linac with mMLC, 17 IMRS/IMRT 18 , and helical tomotherapy. 18 This comparison shows that the dosimetric quality for RapidArc stereotactic treatments is clearly comparable with the values reported for these other well-established techniques.…”

Radiosurgery and Hypofractionated Stereotactic Irradiation with Photons or Protons for Tumours of the Skull Base

“…In a series of 157 patients treated with Cyberknife [27], 5-year control was 93.5%. Interestingly, local control in tumours bigger than 8 ml and/or situated close to critical structures and treated with two to five daily fractions was similar to that obtained in smaller meningiomas treated with single fraction SRS.…”

“…Only few studies report on the use of HSRT for skull base meningiomas [25][26][27]. In a series of 157 patients treated with Cyberknife [27], 5-year control was 93.5%.…”