1. The Role of Cyberknife Stereotactic Body Radiation Therapy in the Treatment of Localized and Advanced Prostate Cancer
David M. Spellberg M.D., FACS
Naples Urology Associates, P.A.
Naples, Florida

2. TREATMENT OPTIONS WATCHFUL WAITING SURGERY RADIATION THERAPY PROTON
HIFU
CRYOTHERAPY
HORMONAL MANIPULATION
CHEMOTHERAPY
EXPERIMENTAL

3. COMPLICATIONS OF TREATMENT
INCONTINENCE
IMPOTENCE
EJACULATION DYSFUNCTION
BOWEL PROBLEMS
WORSENING OF OVERALL HEALTH

5. Radiation Options Convenience Invasive Toxicity Efficacy IMRT Low No
Mod
High
LDR
BrachyTx
Yes X 1
HDR
Yes X 2 CK
Very Low
TBD

6. PATIENT DRIVEN NON-INVASIVE MINIMAL SIDE EFFECTS
MINIMAL DISRUPTION OF LIFE
EFFICACY

7. SEQUENCE OF EVENTS PATHOLOGY REVIEW CT/BS REVIEW
DISCUSSION OF TREATMENT OPTIONS
FIDUCIAL PLACEMENT
CYBERKNIFE TREATMENT

8. CyberKnife Treatment Delivery
Patient lies comfortably on the couch while the CyberKnife robot moves, images and treats.
Treatments typically last 1 hour
Most patients require no sedation allowing them to depart at the completion of their treatment

11. Prostate comparison: axial & sagittal
40 and 25 mm colls
40 mm coll

12. CyberKnife Technology
Frameless Radiosurgery
Robotics
Image Guidance
Advanced Treatment Planning
What is the CyberKnife?
The CyberKnife is the next generation Radiosurgery system capable of treatment anywhere in the body
The CyberKnife is the only frameless, robotic, image guided during treatment radiation delivery device in the world

14. Prostate Radiosurgery
Precise control limits dose to the rectal wall and urethra
2 - 3 fractions applies to boost
4 – 5 fractions applies to monotherapy
Image courtesy of San Diego CyberKnife Center

15. Accuray Confidential

16. Challenges for Hybrid Systems Treating Prostate Cancer
5mm of motion
240 seconds of Beam on time

17. CyberKnife® Treatment of Prostate Cancer

18. Prostate comparison: urethra
40 and 25 mm colls
40 mm coll
18.7% vol at 90% dose
30.8% vol at 90% dose

19. Prostate comparison: bladder
40 mm coll
40 and 25 mm colls
12.2% vol at 60% dose
16.7% vol at 60% dose

20. Prostate comparison: rectum
40 and 25 mm colls
40 mm coll
11.2% vol at 60% dose
20.5% vol at 60% dose

21. Basic Demographics Ages 62 to 85 Stage cT1cNoMo to cT2bNoMo
All patients treated between 12/07/2004 and 12/31/2007
Total number of Patients = 213

22. Hormonal Therapy 186 Patients treated without Hormonal therapy
27 Patients treated with Neoadjuvant Hormonal Therapy

23. Histology Gleason grade 3 + 3 = 172 Patients

24. Prostate Volumes Range = 15.5cc to 109cc Mean initial volume = 45.7 cc
Median initial volume = 46.1 cc

25. Initial PSA’s Range = 1.1 to 17.2 ng/ml Mean initial PSA = 5.87 ng/ml
Median initial PSA = 5.75 ng/ml

26. Dose Calculations for Cyberknife Stereotactic Body Radiation Therapy
For CK, one can fractionate the therapy yet remain convenient and non-invasive for the patient
CK doses are most like HDR, since the dose/fraction, total doses and time factors are similar
SHARP trial from Virginia Mason Hospital with good results (33.5Gy/5fx)
Thus, since we have intermediate and long term results with HDR, CK appears to be a well founded treatment option