Current role of image-guided robotic radiosurgery (Cyberknife®) for prostate cancer treatment
Article first published online: 31 JAN 2013
© 2013 BJU International
Volume 111, Issue 5, pages 761–766, May 2013
How to Cite
Seisen, T., Drouin, S. J., Phé, V., Parra, J., Mozer, P., Bitker, M.-O., Cussenot, O. and Rouprêt, M. (2013), Current role of image-guided robotic radiosurgery (Cyberknife®) for prostate cancer treatment. BJU International, 111: 761–766. doi: 10.1111/bju.12000
- Issue published online: 12 APR 2013
- Article first published online: 31 JAN 2013
- stereotactic body radiation therapy;
- hypofractionated radiation therapy;
- prostate cancer
- To describe the most recent data from phase I and II clinical trials of stereotactic body radiation therapy (SBRT) using image-guided robotic radiosurgery, specifically the Cyberknife® (Accuracy Incorporated, Sunnyvale, CA, USA).
- To better determine thecurrent role of this type of radiosurgery in prostate cancer (PCa) management.
Materials and Methods
- Current clinical trials and relevant retrospective studies were identified from the literature, clinical trial databases, websites and conference abstracts.
- The indications, technical aspects, efficacy and toxicity of SBRT using the Cyberknife® system were summarized.
- The Cyberknife® system is an experimental treatment mostly used for localized PCa in stage cT1/T2a–b N0 M0 with a Gleason score ≤7 and PSA level ≤20 ng/mL. Hypofractionated radiation therapy was delivered in five fractions of 7–7.25 Gy for a total dose of 35–36.25 Gy.
- After treatment, the median PSA levelfell from 4.9–8.3 ng/mL to 0.1–1.6 ng/mL at a median follow-up of 4–60 months.
- The biochemical progression-free survival rates ranged from 78.3 to 100%.
- Acute and late toxicities were mostly grade 1/2 rectal or urinary complications. Few grade 3 and no grade 4 toxicities occurred during follow-up; however, erectile dysfunction and testes toxicity were also reported.
- The use of the Cyberknife® system is limited mainly by its pretreatment and maintenance costs.
- Despite encouraging preliminary results, longer-term follow-up and randomized controlled phase III clinical trials are necessary before the Cyberknife® system becomes a standard treatment method.