Phoenix Cyberknife and Radiation Oncology Center ©2011
Cyberknife VSI and Truebeam STx FAQs
Now Phoenix has the Newest Cyberknife equipment with the latest Technology & Software
01 | WHAT IS THE CYBERKNIFE SYSTEM?

The CyberKnife® Robotic Radiosurgery System is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the head, spine, lung, prostate, liver and pancreas. The treatment – which delivers beams of high dose radiation to tumors with extreme accuracy – offers new hope to patients worldwide.



Though its name may conjure images of scalpels and surgery, the CyberKnife treatment involves no cutting. In fact, the CyberKnife System is the world's first and only robotic radiosurgery system designed to treat tumors throughout the body non-invasively. It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery.



02 | WHAT CAN THE CYBERKNIFE SYSTEM TREAT?

The CyberKnife System is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the head, spine, lung, prostate, liver and pancreas. Below is a list of some, but not all intracranial (head and brain) tumors and lesions that can be treated by the CyberKnife System:

Acoustic neuroma
Anaplastic astrocytoma
Arteriovenous malformation (AVM)
Craniopharyngioma
DNET
Ependymoma
Gangliocytoma
Germinoma
Glioblastoma multiforme
Glioma
Glomus jugulare tumor
Hemangioblastoma
Meningioma
Neurocytoma
Neurofibroma
Neurofibromatosis
Oligodendroglioma
PNET
Pituitary adenoma
Schwannoma
Trigeminal neuralgia
Vestibular schwannom

Below is a list of some, but not all extracranial (head and brain) tumors and lesions that can be treated by the CyberKnife System:

Osteosarcoma
Nasopharyngeal carcinoma
Squamous cell carcinoma
Non-small cell lung cancer
Small-cell lung cancer
Pancreatic cancer
Hepatocellular carcinoma
Prostate cancer
Renal cell carcinoma
Colon cancer
Ovarian cancer
Uterine cancer
Arteriovenous malformation (AVM)




03 | HOW MANY PATIENTS HAVE BEEN TREATED WITH THE CYBERKNIFE SYSTEM?

As of July 2008 more than 50,000 patients have been treated worldwide by the CyberKnife System. More than half of those patients were treated with lesions or tumors outside of the brain and head.



04 | HOW IS CYBERKNIFE 'RADIOSURGERY' DIFFERNT FROM TRADITIONAL RADIATION THERAPY TREATMENT?

Traditional radiation therapy typically delivers radiation to a wide field of tissue in the body resulting in the treatment of both the tumor and a large amount of surrounding healthy tissue. This is necessary because traditional radiation therapy systems did not account for tumor motion and were therefore much less accurate. These wide radiation fields increased the possibility of damage to normal tissue, increasing the risk of side effects following the radiation treatment. To reduce the number of side effects, clinicians were forced to rethink the way traditional radiation therapy was delivered. As a result, the overall radiation dose was reduced and the number of treatments was divided into 30 to 40 sessions, delivered over a period of weeks.



Radiosurgery devices, such as the CyberKnife Robotic Radiosurgery System, were designed to deliver radiation with extreme accuracy, targeting the tumor with minimal damage to the surrounding healthy tissue. The accuracy of the CyberKnife System allows clinicians to deliver very high doses of radiation safely because the size of the radiation field is smaller and only includes the tumor and a small amount of surrounding tissue. This allows for less damage to surrounding healthy tissue and for clinicians to complete treatment in 1 to 5 days vs. the weeks it takes traditional radiation therapy.



05 | HOW DOES THE CYBERKNIFE SYSTEM DIFFER FROM OTHER RADIOSURGERY SYSTEMS?

Unprecedented Targeting Accuracy – Many tumors, even when their movement has been restricted, have been proven to move during treatment delivery. Using advanced robotic technology and the ability to track the tumors movement throughout the treatment, the CyberKnife System can deliver radiation with extreme accuracy while automatically correcting for tumor movement without interrupting the treatment or having to reposition the patient.

Unrivaled Conformality and Dose Gradient – Unconstrained by the clockwise / counterclockwise gantry rotations of conventional radiotherapy systems, the robotic mobility of the CyberKnife System enables it to treat from a variety of angles without clinician intervention or treatment interruption.

Unparalleled Healthy Tissue Sparing – Without the limitations of conventional respiratory gating and breath-holding techniques, the CyberKnife System delivers radiation beams that adjust in real-time with a patients breathing cycle. By dramatically reducing the planning margins to only that which are clinically relevant, the CyberKnife System's ability to minimize damage to the surrounding healthy tissue is unmatched.



06 | WHAT ARE THE DIFFERENT TREATMENT OPTIONS FOR TREATING CANCER OR BENIGN LESIONS?

The treatment options available vary according to the specific cancer and its location. In general, the treatments can be divided into the following categories:

A. Radiosurgery: Radiosurgery, also known as stereotactic radiosurgery, is a form of radiation and despite its name, is not surgery. It is designed to precisely destroy a tumor or lesion by delivering a very high dose of radiation to the tumor in 1 to 5 treatments over a treatment course of 1 to 5 days. Patients are not required to be hospitalized during treatment and the procedure is almost always performed on an outpatient basis.

B. Radiation therapy: Radiation therapy is a form of radiation that is usually delivered 5 days a week over a treatment course of 6 to 8 weeks. Radiation therapy, (as opposed to stereotactic radiosurgery), usually treats larger areas that include not only the tumor, but large amounts of healthy tissue, increasing the risk of possible complications. Patients are not required to be hospitalized during treatment and the procedure is almost always performed on an outpatient basis.

C. Brachytherapy: Brachytherapy is a specialized form of radiation therapy that requires the surgical placement of small radioactive sources in and around a tumor. The radioactive sources can be implanted either temporarily or permanently, depending on the nature of the source used. Low dose rate brachytherapy (LDR) delivers a prescribed dose over a longer period of time. Radioactive sources are usually implanted permanently. High dose rate brachytherapy (HDR) uses a different source type that delivers dose over a shorter period of time, therefore HDR sources are usually implanted temporarily. Brachytherapy has been used to treat a wide variety of cancers including prostate, breast, lung, head and neck cancers.

D. Cryoablation: With Cyroablation, which is also called cryotherapy, a probe is inserted through the skin and into the tumor to freeze the tumor and kill its cells. Placement of the probe requires an incision and can be performed either on an inpatient or outpatient basis depending on the tumor being treated.

E. High Intensity Focused Ultrasound (HIFU): HIFU uses a focused ultrasound beam to kill tissue containing cancer cells. It is not FDA approved in the United States, but has been used to treat prostate cancer in Europe.

F. Surgery: Surgery or surgical resection is an invasive procedure that requires an incision to remove or cut the tumor out of the body. Surgery can be performed on an inpatient or outpatient basis depending on the tumor being treated. Because of the invasiveness of some types of surgery, some patients may be excluded from receiving this type of treatment.



07 | WHAT ARE THE PATIENT BENEFITS OF TREATMENT WITH THE CYBERKNIFE SYSTEM?

The CyberKnife System is a non-invasive alternative to surgery for the treatment of tumors anywhere in the body. The treatment – which delivers high doses of radiation to tumors with extreme accuracy – offers new hope to patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery.

Patient benefits include:
· No incision
· No pain
· No anesthesia
· No hospitalization
· Little or no recovery time
· Immediate return to daily activities



08 | HAS THE CYBERKNIFE SYSTEM BEEN CLEARED BY THE FDA?

Yes, the Food and Drug Administration (FDA) cleared the CyberKnife System to treat tumors in the head, neck and upper spine in 1999 and tumors anywhere in the body in 2001.



09 | ARE CYBERKNIFE TREATMENTS COVERED BY PRIVATE INSURANCE COMPANIES AND MEDICARE?

While we cannot guarantee reimbursement from any third-party payer, data collected from US-based CyberKnife centers indicate that Medicare has covered the CyberKnife treatment, and over 100 unique commercial, private payers are reimbursing the related codes, and any or all portions of CyberKnife services. Patients should always consult with a physician in connection with any and all treatment options, and if required, obtain prior authorization from their insurance companies once a treatment option is determined.

Accuray, Inc., manufacturer of CyberKnife, offers assistance to those patients that may experience challenges with their insurance carriers.

If you need special assistance, please contact Accuray Patient Relations at 1.888.522.3740 ext 4301, 1.408.789.4301 or patientinfo@accuray.com.



10 | WHAT IS THE DIFFERENCE BETWEEN A LESION AND A TUMOR?

A lesion can refer to any focused abnormality in the body, such as a tumor, a blood clot, a cyst, an aneurysm or an inflammatory mass. A is an abnormal collection of cells that has grown due to a change in the cells. Tumors can be either malignant or benign and are a type of lesion.



11 | HOW IS CANCER "STAGED" AND WHAT DOES THIS MEAN?

Staging describes the extent or severity of an individual's cancer. Knowing the stage of the disease helps the physician plan treatment and estimate prognosis. Staging systems for cancer have evolved over time and continue to change as scientists learn more about cancer. There are many staging systems and some are specific to certain cancer types. The TNM staging system, for example, is used for lung cancer and is based on the extent of the tumor (T), its spread to lymph nodes (N) and its metastasis (spread to other parts of the body) (M). Most cancers can be described as stage 0, stage I, stage II, stage III or stage IV. Physical exams, imaging procedures, laboratory tests, pathology reports, and surgical reports provide information to determine the stage of each cancer.



12 | I AM CURRENTLY ON OR HAVE BEEN ON CHEMOTHERAPY.
    AM I ELIGIBLE FOR A CYBERKNIFE TREATMENT?


The CyberKnife System can treat patients that have either gone through chemotherapy or are currently undergoing chemotherapy. It is important for the patient to provide their physician with a complete medical history, so to the physician can prescribe the appropriate treatment course.



13 | HOW MUCH DOES A CYBERKNIFE TREATMENT COST?

During the consultation process, the CYBERKNIFE staff will tell the patient how much the CYBERKNIFE treatment costs.



14 | I HAVE HAD RADIATION OR PROTON THERAPY. AM I STILL ELIGIBLE FOR A CYBERKNIFE TREATMENT?

The CyberKnife System can treat patients that have either gone through radiation therapy or are currently undergoing radiation therapy. It is important for the patient to provide their physician with a complete medical history, so the physician can prescribe the appropriate treatment course.



15 | WHAT SIDE EFFECTS CAN I EXPECT AFTER A CYBERKNIFE TREATMENT?

Most patients experience minimal to no short-term side effects and often recover quickly. Depending on the treatment site, some patient's may experience different side effects such as mild fatigue or nausea. The CyberKnife physician will disclose all possible side effects prior to treatment.



16 | AFTER TREATMENT, WHEN WILL MY TUMOR OR LESION DISAPPEAR?

The effects of radiosurgery vary and may occur gradually and over time. The timeframe can range from days, months or years depending on the medical condition targeted. Some tumors may disappear slower than others or may simply stop growing and present no further cell activity. After treatment, patients typically are asked to get periodic images (CAT scan or MRI) of their tumor(s) and additional tests may be required, so the physician can monitor the effectiveness of the treatment.



17 | HOW MANY TIMES CAN I RECEIVE A CYBERKNIFE TREATMENT?

The frequency of treatments depends on where the tumor is located and what type of tumor is being treated. Most cases can receive multi-treatments or can be re-treated with the CyberKnife System.



18 | WHAT IS A LINEAR ACCELERATOR?

A linear accelerator or LINAC is a device that uses an extremely high voltage power supply to produce high energy radiation.







01 | WHAT IS THE VARIAN TRUEBEAM?

When you have been diagnosed with cancer, it is important to discuss with your healthcare team all available treatment options. One possible option is radiosurgery. This guide will give you a brief overview of a radiosurgery treatment technology using an advanced system called Novalis Trubeam STx with ExacTrac. You should discuss with your healthcare team whether treatment with the Novalis Trubeam STx with ExacTrac system is right for you. The Novalis Trubeam STx with ExacTrac system is a radiosurgery system that uses noninvasive tumor-destroying radiation to treat cancers throughout the body as it minimizes exposure to the surrounding healthy tissue. Developed by Varian Medical Systems, a world-leader in radiation oncology solutions, this powerful technology is precise, accurate and fast. In fact, most treatments only take minutes a day. And the Novalis Trubeam STx with ExacTrac system's advanced imaging and treatment modes allow doctors to tailor treatments specifically to a particular cancer.

     As you read this guide, we hope that you'll gain a better understanding of this new technology and how it may be able to help you. Again, your doctor will be your best resource going forward and will help determine if Novalis Trubeam STx with ExacTrac is right for you.



02 | WHAT IS RADIOSURGERY & HOW DOES IT WORK?

As technical as it is, the underlying idea of radiosurgery is really pretty simple: high-intensity beams of radiation are used with great precision (within 2mm) to destroy cancer cells. When you undergo a Novalis Trubeam STx with ExacTrac treatment, these beams damage cancerous cells while minimizing exposure to nearby healthy cells. When the cancerous cells are hit by the very precise beams, their ability to reproduce is compromised and they eventually die, causing the tumor to shrink. However, unlike cancer cells, normal cells have the ability to repair themselves. Advances in technology, like Novalis Trubeam STx with ExacTrac have provided innovative treatments for people with cancer. Stereotactic body radiotherapy (also known as SBRT) and stereotactic radiosurgery (SRS) are two of the most important of these treatments. Both use high doses of radiation targeted precisely to destroy tumors. SRS treatments are generally used for tumors in the brain and central nervous system while SBRT is often used for tumors in other parts of the body.

     It is important to know that radiosurgery, including Novalis Trubeam STx with ExacTrac radiosurgery, is not appropriate for all types of cancer. Actual treatment times may vary. Typical radio- surgery treatments can be delivered during one day or for a series of days depending on your particular case. Serious side effects are treatment site specific and can include diarrhea, nausea, swelling at the treatment site, lymphedema and secondary cancer. Talk to your doctor about what you can expect from your treatment and to find out if treatment with the Novalis Trubeam STx with ExacTrac system is right for you. .



03 | WHAT IS Novalis Trubeam STx with ExacTrac?

What Is Novalis Trubeam STx with ExacTrac? Novalis Trubeam STx with ExacTrac is an advanced radiosurgery system from Varian Medical Systems that delivers treatment with speed and accuracy.Novalis Trubeam STx with ExacTrac synchronizes a treatment beam system (that provides the beams of radiation for treatment) to an imaging system (that allows doctors to "see" the tumor they're treating). It also has very sophisticated respiratory monitoring systems that compensate for your breathing as it targets tumors in the thorax and abdomen.

    Because treatments are noninvasive, there is no incision or surgery with Novalis Trubeam STx with ExacTrac.The ability to deliver higher doses of radiation at great speed allows most treatments to be given in just minutes a day.



04 | WHAT IS Novalis Trubeam STx with ExacTrac TREATMENT?

A doctor may prescribe treatment with Novalis Trubeam STx with ExacTrac for many reasons. This technology gives medical professionals the tools to treat many different types of cancers and other medical conditions. Novalis Trubeam STx with ExacTrac is fast, with most treatments taking just a few minutes a day. A Novalis Trubeam STx with ExacTrac system can deliver treatments 2.4 to 4 times faster with a dose delivery rate of up to 2,400 monitor units per minute—double the output of most other radiosurgery systems. A radiosurgery treatment that typically takes 30 to 60 minutes can be completed in just 5 to 20 minutes. In addition to enabling for a more comfortable experience, as the patient spends less time on the treatment couch, faster treatments also allow for reduced chance of patient and tumor movement during treatment.

    The precision of the Novalis Trubeam STx with ExacTrac system is measured in increments of less than a millimeter. This accuracy is made possible by the system's sophisticated architecture, which choreographs imaging, patient positioning, motion management, beam shaping and dose delivery, performing quality checks every ten milliseconds throughout the entire treatment.

    TrueBeam imaging technology can produce the three-dimensional images used to fine-tune tumor targeting in 60% less time than previous Varian imaging technology. Additional functionality makes it possible to create images using 25% less X-ray dose. For lung and other tumors subject to respiratory motion, Novalis Trubeam STx with ExacTrac offers Gated RapidArc® radiotherapy, which makes it possible to monitor the patient's breathing and compensates for movement of the tumor while the dose is being delivered in a continuous rotation of the treatment machine.In addition to its impressive technical specifications, Novalis Trubeam STx with ExacTrac has also been designed to address patient comfort. It operates quietly and has built-in music capabilities so the patient can listen to music during their treatment. The therapist who operates the system can be in constant two-way communication with the patient. Plus the therapist can visually see the patient through three closed-circuit monitors.



05 | WHAT KIND OF RADIATION DOES Novalis Trubeam STx with ExacTrac USE?

The treatment beam is generated by a machine called a medical linear accelerator. This machine shapes beams of energy with varying intensities generated by the machine. The treatment beam can be aimed at a tumor from multiple angles to hit the target in a complete three-dimensional manner. In fact, Novalis Trubeam STx with ExacTrac's treatment beam can be delivered with submillimeter accuracy and varying intensity. The idea is to deliver the lowest dose possible to the surrounding healthy tissue, while still delivering the maximum dose to the tumor.



06 | DOES RADIOSURGERY EXPOSE PEOPLE TO RADIOACTIVE SUBSTANCES?

Many people, when they hear the word "radiation," think immediately of radioactive substances. However, no radioactive substances are involved in the creation of the beam by a medical linear accelerator. When a linear accelerator is switched "on," radiation is produced and aimed directly at cancer cells. Then, like a flashlight, when the system is switched off, radiation is no longer emitted by the system.




07 | WHAT HAPPENS WHEN A PERSON IS TREATED WITH RADIOSURGERY?

Radiosurgery treatment, including Novalis Trubeam STx with ExacTrac treatment, involves three basic steps: visualization of the tumor, the planning of the individual treatment and the delivery of the treatment. After their diagnosis, the medical physicist generates three-dimensional diagnostic images (usually CT or MRI) of the tumor and the area around it. They then use these images to specify the dose of radiation needed to treat the tumor. A radiation oncologist will work with a physicist to plan an individualized treatment. After this, individualized Novalis Trubeam STx with ExacTrac treatments can be delivered according to a schedule specific to the treatment plan.

    During a Novalis Trubeam STx with ExacTrac treatment, the linear accelerator can rotate around the patient to deliver the radiation. The radiation is shaped and reshaped as it is delivered from many different angles. Most treatments usually take only a few minutes a day.




08 | WHAT IS THE TREATMENT PREPARATION?

X-rays and/or CT scansmay be taken in preparation for planning the treatment. Following these scans, the treatment planning process can take severaldays. When the treatment plan is complete, Novalis Trubeam STx with ExacTrac radiosurgery treatments can begin.Most cases require a treatment preparation session. Specially molded devices that help the patient maintain the same position every day are sometimesdeveloped at this point. The patient's radiation oncologist may request to have the treatment area marked on their skin to assist in aligning theequipment with the target area.Treatment Delivery The first Novalis Trubeam STx with ExacTrac treatment session may sometimes be longer than subsequent ones so that additional images can be acquired to check the positioning of the tumor on the day of the treatment. This is at the discretion of the treatment team. In the treatment room, the medical team uses the marks on the patient's skin to locate the treatment area. Then the patient is positioned on a treatment table. Sometimes, specially molded devices are used to help the patient stay still and provide correct positioning.The radiation therapist can also use the machine's imaging technology to position the patient for a treatment that is accurate to less than amillimeter. This involves the use of high-resolution X-rays of the targeted area to verify positioning of the tumor before administering the treatment. The radiation therapist then leaves the treatment room before the machine is turned on. The machine rotates around the patient to deliver the radiation beams, which are shaped by a special attachment called a high-definition (HD) multileaf collimator. This HD device has 120 computer-controlled mechanical "leaves" or "fingers" that can move to create apertures of different shapes and sizes.




09 | WHO ARE THE PROFESSIONALS YOU MAY TYPICALLY ENCOUNTER?

1} The radiation oncologist is a doctor who has had special training in using radiation to treat diseases and prescribes the type and amount of treatment. The radiation oncologist may work closely with other doctors and the rest of the healthcare team.

2) A medical physicist participates in the planning process and ensures that the machines deliver the right dose of radiation.

3) A dosimetrist plans the treatment with the oncologist and the physicist.

4) A radiation therapy nurse provides nursing care and may help the patient learn about treatment or how to manage any side effects.

5) A radiation therapist positions the patient for treatment and operates the equipment that delivers the radiation.




10 | HOW LONG IS A COURSE OF TREATMENT ON A Novalis Trubeam STx with ExacTrac SYSTEM?

The delivery of a patient's treatments varies depending on the diagnosis, so ask the medical professional for information about their specific diagnosis. Generally, radiosurgery is completed in just one to five treatment sessions over a week or two.




11 | DOES A PERSON BECOME RADIOACTIVE AFTER TREATMENT?

External radiosurgery does not cause anyone's body to become radioactive. A patient need not avoid being with other people because of treatment. Even hugging, kissing, or having sexual relations with others poses no risk to them of radiation exposure. Side effects of radiosurgery most often are related to the area that is being treated.A patient should consult with their medical professional to discuss the specific diagnosis, prognosis and possible side effects* from treatment. Is a treatment on the Novalis Trubeam STx with ExacTrac system expensive? Treatment of cancer with radiation can be costly. It requires very complex equipment and the services of many healthcare professionals. The exact cost of the radiation therapy will depend on the type and number of treatments you need. Many health insurance policies cover charges for radiosurgery. It's a good idea to talk with the insurer or with the doctor's office staff or the hospital business office about their policy and how expected costs will be paid.

    What is unique about radiosurgery using Varian's Novalis Trubeam STx with ExacTrac system? The main advantages of Varian's Novalis Trubeam STx with ExacTrac are ease, precision and speed. Thanks to its unprecedented accuracy, the Novalis Trubeam STx with ExacTrac system can be used to treat some tumors in sensitive areas such as the brain, spine, lung, liver, pancreas and prostate.Treatments focus powerful radiation on the tumor while minimizing exposure of surrounding healthy tissues. Novalis Trubeam STx with ExacTrac was designed from its inception to seamlessly integrate sophisticated imaging and radiation delivery systems. What this means for patients is accuracy, speed and comfort.What it means for medical professionals is the ability to treat many different types of complex conditions.




12 | IS A TREATMENT ON THE Novalis Trubeam STx with ExacTrac EXPENSIVE?

Treatment of cancer Treatment of cancer with radiation can be costly. It requires very complex equipment and the services of many healthcare professionals. The exact cost of the radiation therapy will depend on the type and number of treatments you need.Many health insurance policies cover charges for radiosurgery. It's a good idea to talk with the insurer or with the doctor's office staff or the hospital business office about their policy and how expected costs will be paid.




13 | WHAT IS UNIQUE ABOUT RADIOSURGERY USING VARIANS Novalis Trubeam STx with ExacTrac??

The main advantages The main advantages of Varian's Novalis Trubeam STx with ExacTrac are ease, precision and speed. Thanks to its unprecedented accuracy, the Novalis Trubeam STx with ExacTrac system can be used to treat some tumors in sensitive areas such as the brain, spine, lung, liver, pancreas and prostate. Treatments focus powerful radiation on the tumor while minimizing exposure of surrounding healthy tissues. Novalis Trubeam STx with ExacTrac was designed from its inception to seamlessly integrate sophisticated imaging and radiation delivery systems. What this means for patients is accuracy, speed and comfort. What it means for medical professionals is the ability to treat many different types of complex conditions.

    *The *Novalis Trubeam STx with ExacTrac system may not be appropriate for all cancers. Serious side effects can occur, including fatigue and skin irritation. Treatment times may vary. Patients should ask their doctor if Novalis Trubeam STx with ExacTrac is right for their particular case.








Phoenix Cyberknife and Radiation Oncology Center ©2011