Robotic radiosurgery advances in UK

NHS patients with surgically inoperable tumours will soon have access to a pioneering cancer treatment, previously provided only by private healthcare providers. The London Clinic and the Harley Street Clinic were the first UK hospitals to invest in this state-of-the-art technology. Now the Mount Vernon Cancer Centre, in London, has become the first National Health Service (NHS) hospital to acquire a Cyberknife robotic radiosurgery system, through the generosity of local benefactors. The robotic radiosurgery system purchased by the Mount Vernon Cancer Centre is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumours anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney. It is also used for some benign conditions such as trigeminal neuralgia. The centre will treat its first patient, using this technology, by the autumn of 2010, and expects to treat up to 50 patients in its first year of operation – rising to around 140 annually in succeeding years. One of the reasons for the interest in this technology is the fact that it offers a painless treatment option for patients suffering from tumours and other medical conditions that have previously been considered untreatable. It is extremely accurate; anaesthesia and hospitalisation are not required; and there is little or no recovery time. “The Cyberknife robot gives us the ability to deliver a high radiotherapy treatment dose to a cancer, while avoiding the surrounding normal tissues – the main treatment constraint when giving radiotherapy,” explained Dr Peter Ostler, consultant clinical oncologist and the Trust’s clinical chair for cancer services. “This exciting new approach offers many additional treatment possibilities that previously just did not exist. It means that we can treat some patients that would be very difficult to support through conventional means, as well as offering therapy to others that can be given over much shorter periods of time than is the case currently. Also those patients whose underlying condition means that they may be too unwell to undergo surgery may benefit from treatment with the Cyberknife.”

The technology

Using continual image guidance technology and computer controlled robotic mobility, the Cyberknife system automatically tracks, detects and corrects for tumour and patient movement in realtime throughout the treatment. This enables the system to deliver high-dose radiation with pinpoint precision, which minimises damage to surrounding healthy tissue and eliminates the need for invasive head or body stabilisation frames, which can be stressful and uncomfortable for patients. The robotic mobility of the system enables beams to be delivered from a very wide array of angles. By approaching the target from hundreds of different directions, the system “sculpts” delivered dose precisely to the unique contours of the target. The system also overcomes one of the most significant challenges in radiation treatment delivery – the management of respiratory motion. Rather than use suboptimal techniques such as gating or breath-holding, the Cyberknife system intelligently tracks respiratory motion in real-time and automatically adapts to any changes in the patient’s breathing pattern. As well eliminating the discomfort associated with traditional approaches, the Cyberknife treatments are completed in five or fewer outpatient visits – significantly shorter than the many weeks of visits often required with conventional radiation therapy. Moreover, patients can typically return to normal activities immediately after treatment. An added advantage of the system is that it can increase the throughput of patients. In the US, a radiosurgery centre in Philadelphia reported a 46% increase in patient capacity in the first year following installation.1