Frequently Asked Questions - Mercy Medical Center

Stereotactic radiosurgery is as non-invasive, non-surgical treatment in which high doses of focused radiation beams are delivered from multiple locations outside of the body to destroy a tumor or lesion within the body. The procedure has been used for more than 30 years, and over 200,000 patients have been treated worldwide. Radiosurgery does not remove the tumor or lesions. The radiation destroys tumor cells and stops the growth of active cells.

What is image-guided stereotactic radiosurgery?
The CyberKnife® system uses a distinctive radiosurgery device with a linear accelerator (Linac), which produces the radiation mounted on a robotic arm. Through the use of image guided cameras, CyberKnife® locates the position of the tumor. The Linac attached to the robotic arm is then used to deliver multiple beams of radiation while minimizing exposure to surrounding normal tissue. With sub-millimeter accuracy, CyberKnife® is used to treat vascular abnormalities, tumors, functional disorders and cancers of the body.

Is CyberKnife® safe?
CyberKnife®, because it is not really surgery, does not present the same problems as traditional surgery. Anesthesia is not necessary therefore there are no anesthetic after effects, and the risk of infection and hemorrhaging are minimized. CyberKnife® offers accurate precision within sub-millimeter distances and spares healthy tissue surrounding the targeted area. More than 35,000 people have received CyberKnife® treatments around the world. No mortality or morbidity data has been reported as a direct result of a CyberKnife® procedure.

How is CyberKnife® system different from other stereotactic radiosurgery systems?
CyberKnife® uses the combination of a robotic arm and Linac image guidance. Because of the flexibility of the robotic arm, the system is able to reach areas of the body that are unreachable by other radiosurgery systems.

Second, unlike other stereotactic radiosurgery treatments, CyberKnife® is able to locate the position of the tumor within the body without the use of an invasive stereotactic head frame. This means there are no pins screwed into your forehead.

Third, the CyberKnife® system compensates for patient movement during treatment, constantly ensuring accurate targeting. The matrix below provides comparisons in stereotactic radiosurgery systems:

	CyberKnife®	Gamma Knife®	Other Linac Systems (Elekta Synergy®, Novalis®, Varian Trilogy®, TomoTherapy®)
Radiosurgery Dedicated	Yes	Yes	No
Also Does “Conventional” Radiotherapy	No	No	Yes
Anatomic Area treatable with Radiosurgical Precision	Brain, Spine, Entire Body	Brain	Brain +/- other selected sites depending upon specific system
Rigid Brain or Body Frame Required for Radiosurgical Accuracy	No	Yes	Yes
Lesion Size Limitation	No	Yes	No
Capable of divided treatments to better preserve adjacent tissues	Yes	No	Yes
Continuously adapts to lesion motion caused by organ movement (real time lesion tracking)	Yes	N/A	No
Continuously adapts to lesion motion caused by breathing (real time respiratory tracking)	Yes	N/A	Varian Trilogy® uses respiratory gating but does not track with radiosurgical precision – Other systems do not adapt to breathing

What can I expect during a CyberKnife® treatment?
All CyberKnife® cases are unique. Factors like the patient’s medical condition, ambulatory status, pre-existing conditions, and present treatments are considered during the planning phase and help the doctors formulate an individualized treatment plan. For example, some patients receive a single session of CyberKnife®. Others receive up to 5 treatments. Patients at The CyberKnife® Radiosurgery Center of Iowa receive one-on-one education pre and post treatment so that they know what to expect during the process.

What types of conditions are considered for CyberKnife® treatment?
CyberKnife® treats intracranial (skull base) benign and malignant tumors, as well as spine tumors and lesions of the cervical, thoracic and lumbar regions.

Additionally, CyberKnife® is capable of full-body targeting for lung, liver, pancreas, kidney, laryngeal, nasopharyngeal, glossal, spine and skull. More than 35,000 cases have been treated worldwide. Research is ongoing at major medical centers as more specific indications for treatment are explored.

What are the benefits of CyberKnife®?
There are many benefits to a CyberKnife® procedure. It is non-invasive, does not require a headframe or painful immobilization device and it is able to reach areas of the body previously thought untreatable. It is ideally suited for those who are unable to undergo traditional surgery or who do not wish to risk surgery.

How much does a CyberKnife® procedure cost?
The CyberKnife® Radiosurgery Center of Iowa receives many patients who do not have health insurance coverage for CyberKnife® treatments. These patients are offered discounts which includes the treatment phases and the professional fees for the treating physicians through the Mercy charity care and financial assistance program. Treatments can cost 20 to 45 percent less than conventional surgery. All treatment plans are customized to meet the needs of a patient and his or her condition. Some patients can be treated in one session, while others may require multiple sessions. Some conditions require a Cat-Scan for planning, others require different or multiple images. Some conditions require fiducial placements, while others do not. Consequently, until a CyberKnife® trained physician evaluates a particular case the price cannot be determined.

Will my insurance pay for CyberKnife® treatments?
CyberKnife® treatments are not experimental and are covered by most insurance carriers. A CyberKnife® procedure at The CyberKnife® Radiosurgery Center of Iowa is cost effective as it is performed on an outpatient basis and does not require hospitalization, anesthesia or rehabilitation. Because CyberKnife® technology is new to our region some insurance companies may not be familiar with our services. We ask all of our patients to share with us their information early enough prior to their treatment so we can assist with obtaining pre-authorization and meet coverage requirements. Our billing staff is available to assist patients with any question they may have concerning their coverage and out of pocket requirement.

Who determines if CyberKnife® is an appropriate treatment?
Medical necessity can be determined by your physician or specialist after evaluating your condition. CyberKnife® is a unique modality, and as such, only a CyberKnife® trained physician can best determine if it is appropriate treatment for a particular condition. An experienced CyberKnife® physician can offer the best advice and discuss other treatment options with you and your family.

It is not uncommon for cases to be discussed with various physicians, including the patient’s primary doctor, before determining candidacy for CyberKnife® treatment.

Can the elderly be treated with cyberknife®?
Because CyberKnife® is less risky than traditional surgery it can be a suitable option for the elderly. Age is not a crucial factor in excluding patients from CyberKnife® treatments.

After treatment, when will my tumor or lesion disappear?
The effects of radiosurgery occur gradually and over a period of time. The timeframe can range from days, months or years depending on the medical condition targeted. Some tumors dissolve slower than others and eventually disappear. Others simply stop growing and present no further cell activity.

After treatments patients typically are asked to get periodic images (CAT Scan or MRI) of their tumor(s) so that their physician can monitor the effectiveness of the radiation.

What are the complications or side effects of CyberKnife® radiosurgery?
Complications with CyberKnife® are less prevalent than those found in other radiosurgery modalities or radiation treatments. Following some patients may experience headaches or feel nauseated or very tired. These symptoms are temporary and rarely the result of radiation, but simple nerves or fatigue due to lack of sleep. Uncommon complications may include skin reddening due to the face mesh or vomiting. Delayed symptoms may include local brain swelling in the treatment site, which can be addressed with appropriate medications prescribed by the doctor. Extremely rare complications may include vision loss or hearing loss depending on the diagnosis and condition being treated.

Will my hair fall out or will my skin burn after CyberKnife® treatment?
The radiation being delivered by CyberKnife® is so focused on a specific target that it is highly unlikely that hair loss or skin burn will occur. Typically, the radiation dose administered is not sufficient to cause permanent damage to the skin or hair follicles. In the event that an intracranial lesion being treated is close to the scalp a patch of hair may be effected. The hair will grow back. Patients receive instruction before and after treatment and have an opportunity to dialogue with members of the medical team so that they are aware of possible events specific to their case.

How many times can you receive a CyberKnife® treatment?
The frequency of treatments depend on where the tumor is located and what type of tumor is being treated. Most patients can receive multiple treatments or be re-treated with CyberKnife®.

Are all CyberKnife® Centers alike?
CyberKnife® is solely manufactured by Accuray®, Inc. and is patented for its unique image-guided system and robotic-arm delivery. CyberKnife® centers are usually either a part of a hospital, or in a free-standing center. As such centers usually have their own medical director(s) and staff. Some CyberKnife® programs may choose to only treat specific conditions.

Are there CyberKnife® patient organizations I can contact for more information?
There are a number of CyberKnife® resources available through the internet and sites such as Accuray and the CK Society will provide additional information regarding treatment and CyberKnife® system. There are patient organizations that can offer support and education to patients seeking more information on radiosurgery treatment. Specific to CyberKnife® is The CyberKnife® Patient Support Group, a non-profit organization established in July of 2001. The CyberKnife® Patient Support Group is dedicated to helping others by sharing the personal experiences of patients who have undergone a CyberKnife® procedure.

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