What type of patients with lesions of the pancreas and spine are suitable candidates for treatment with the CyberKnife robotic radiosurgical system?

Abstract

Materials & methodsA systematic literature review was conducted to critically examine patient selection for patients undergoing stereotactic body radiotherapy (SBRT) to the spine and pancreas on the CyberKnife robotic radiosurgical system (CK). Online databases were searched and data was collected and ranked using a system from the Scottish Intercollegiate Guideline Network. The quality of the evidence analysed was insufficient to generate universal recommendations. However, the conclusions reached do help to demonstrate the safety and efficacy of CK treatment to both pancreatic and spinal patients.ResultsExcellent local control rates and minimal acute toxicity were reported within the spinal literature with uncertainties remaining with regard to the precise tolerance of the spinal cord and the reliability of current toxicity prediction methods. For pancreatic patients prognosis remains dismal due to the tendency for patients to present with advanced or inoperable disease. Combinations of CK SBRT and Gemcitabine chemotherapy are given though regimes vary and overall survival is not extended due to the rapid onset of distant metastases. New chemotherapy agents are required as well as better means of predicting response to treatment.ConclusionNo randomised controlled trials or meta-analyses were identified in the review and these are required in order to generate universal guidelines