Dr Aditya Gupta, Director, Neurosurgery and Cyberknife Centre, Artemis Hospital

The occurrence of brain tumors in India is steadily rising. More and more cases of brain tumors are reported each year in our country among people of varied age groups. In 2020, brain tumor was ranked as the 10^th most common kind of tumor among Indians. While there is no specified known cause, age bracket or gender for brain tumors, there is still hope for patients – the medical fraternity has made several strides to treat brain tumor effectively with a reduced rate of morbidity and mortality.

Symptoms of such tumors pose a challenge in its early diagnosis and hence complications arise for surgical intervention. Only, once the patient have persistent symptoms and come for further investigation and hence the doctors’ advice not to ignore any such symptoms for better outcomes.

The International Association of Cancer Registries (IARC) reported that there are over 28,000 cases of brain tumors reported in India each year and more than 24,000 people reportedly die due to brain tumors annually. Every year 40,000 to 50,000 people are diagnosed with brain tumors, out of which 20% are children.

While there has been tremendous advancements made in the treatment modality of brain tumors, the latest CyberKnife radiosurgery system can be used as an alternative to surgery, or in conjunction with other treatments. With the advent of cyberknife, the procedure has played a significant role in the management both non-cancerous and cancerous brain tumors.

The technique that has been around in India for about 3-4 years has been mostly used to treat a range of cancerous and non cancerous/benign tumors in the body including the prostate, lung, liver, etc., is now being commonly used to kill tumors of brain and spine as well.

What is CyberKnife?

Basically, CyberKnife radiation surgery is the most advanced, non invasive radiation therapy tools available to treat especially non-cancerous as well as cancerous and other diseases with the help of precise beams of high-dose radiation. It is a no pain and a no risk day-care treatment wherein patients are discharged as soon as the session gets over and therefore, no hospitalisation is required. The treatment uses a sophisticated image guidance system to beam high doses of radiation directly to your tumor.

The CyberKnife radiation therapy has clinically proven success rates, however, it works the best for a tumors that’s upto 2-2.5 cm in size. However, in a few rare cases it is also used as an treatment option to cure brain tumors that either cannot be operated because of their location in the head, or the patients who cannot undergo brain tumor surgery due to their poor medical condition, etc. And, the success of the treatment largely depends and increases beyond 90% upon choosing the right patient.

The next generation of CyberKnife – M6 is highly precise when compared to the earlier ones used in India as this offers some of the exceptional features and delivers a maximum dose of radiation directly to the tumor from many different angles with sub-millimeter precision for the higher success rates. Also, the emitted focused beams of intense energy destroy cancer cells and shrink/control the growth of tumors. It further prevents the cancerous cells from multiplying. Infact, the objective of radiation therapy is to destroy the harmful cells while minimising damage to healthy cells.

Besides, the CyberKnife system automatically adjusts itself and tracks the tumor which aids in minimising radiation exposure to healthy organs and tissues. The CyberKnife radiation surgery offers multiple benefits compared to conventional radiation treatments and surgery.

Cyber Knife Vs conventional Gamma Knife 

For brain tumor patients, Gamma Knife treatment is not as convenient or comfortable, largely because Gamma Knife requires an invasive head frame be bolted into the skull. Besides, the entire treatment process; right from imaging to planning to treatment itself has to happen on the same day. Typically, the head frame is mounted to the patient’s skull in the morning, followed by imaging scans which take place. The patient has no choice but to wait in the hospital during the treatment planning process with the metal head frame bolted to their skull.

Compared to this, the CyberKnife is a non-invasive, real-time motion tracking technology for accurate delivery of high-dose radiation therapy. Instead of a bulky head frame, CyberKnife patients are provided with a soft, mesh mask during the treatment.

Moreover, treatment with CyberKnife is flexible; imaging is performed few days in advance, thereby leaving the neurosurgeon with enough time to design and finalise a customised treatment plan. Once the plan is set in place, the patient will return for a non-invasive, pain-free experience. Using advanced tumor-tracking technology, the CyberKnife system is able to either deliver one single high-dose treatment, or smaller doses (upto 5) over the course of two to five days. This approach limits side effects and enables most patients to return to their regular routine the same day. Additionally, clinical studies have shown that patients with certain cancerous and non-cancerous conditions in the brain, neck and spine have a better outcome with a lower dose of two to five fractionated radiation treatments than a single, large dose.

Nothing is required of patients during treatment with CyberKnife, except to relax and lie as still as possible. The treatment is usually completed in four to five treatment sessions, over a week’s time. The treatment through CyberKnife is cost effective and it is almost similar to the cost of other surgeries.