HJAR Nov/Dec 2021

42 NOV / DEC 2021 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN ONCOLOGY ONCOLOGY is an ever-evolving field. Thanks to research and advancements in technique and technology, we are able to continue hon- ing our skills and provide the most leading- edge care to our patients who need it most. One such technological advancement in radiation oncology was the creation of Cy- berKnife. First debuted in 1994, CyberKnife is a precision robotic radiation treatment machine designed for and dedicated to ste- reotactic radiosurgery (SRS) and stereotac- tic body radiation therapy (SBRT) treatment. With its robotic delivery system and built- in, real-time image tracking, this established technology provides extreme accuracy over a minimum number of treatment sessions without an invasive frame. Despite its name, CyberKnife treatment is completely noninvasive, like traditional radiation treatment. The unique method of radiation delivery and high level of precision is ideal for some of the more complicated and high-dose treatments, commonly known as “stereotactic” treatments. These shorter course treatments are the future of radiation oncology, either by themselves as a curative treatment or in combination with the grow- ing number of targeted chemotherapy and immunotherapy options. These treatments are highly effective and safe, using robotic delivery and precision to spare nearby nor- mal tissues. CyberKnife makes use of robotics technol- ogy and artificial intelligence, coupled with well-established radiation therapy tech- niques in order to provide the best treatment accuracy and efficiency. At the most basic level, the CyberKnife system is composed of a compact and lightweight linear accelerator linked to the arm of a precision robotic ma- nipulator. The robotic manipulator allows for independent targeting of lesions in all six di- mensions with sub-millimeter accuracy. The unsurpassed maneuverability of this system provides effective ablative treatments that are delivered safely and fast. Patient and lesionmotion has always been a challenge in radiotherapy. If a patient’s lesion was stationary, targeting the lesion would be a simple matter. However, especial- ly in the case of lung cancers, lesion motion induced by internal anatomic motion such as respiration complicate the process. Some lung lesions can move as much as 5 cm due to respiration. In traditional radiotherapy, this internal motion is often managed by includ- ing margins around the lesion along with the use of patient immobilization. Immobiliza- tion techniques are used to control and limit respiration, thereby reducing lesion motion. Other techniques for managing this motion have been to simply stop the treatment when the lesion deviates from the intended posi- tion, which prolongs the treatment. The CyberKnife tracking system, referred to as “Synchrony,” is designed to continu- ously compensate for internal anatomic and patient motion in real time. By doing this, it minimizes the need for excessive margins, the sometimes-uncomfortable motion-lim- iting devices or prolonged treatment times. The systemmonitors the patient closely prior Matthew E. Hardee, MD, PhD Radiation Oncologist CARTI, Inc. ROBOTIC PRECISION, Personalized Radiation Therapy