Gamma knife vs Cyber Knife

[allitinez]

Need some advise please.  I am status post right side AN 9 years ago (3 cm).  Recently found out its back, tiny 6 mm but its back.  Doctor at Columbia Presbyterian in NYC (original surgeon used 9 years ago) says gamma knife 1 day procedure and Doctor at Sloan Kettering says 5 week 5 days a week procedure with Cyber knife.  I work in the radiology field (I'm a CT tech).  Head neuro-radiologist says go with 1 day procedure.  Who's right?  I'm so confused!

[PaulW]

I had single session Cyberknife. It was very easy.
Radiotherapy is typically done over 25-30 sessions.
Thats not Cyberknife.


Cyberknife for Acoustic Neuromas is most commonly done in 3 sessions. That is mainly done to potentially improve your chance of hearing preservation.
As your hearing is probably already gone after surgery I can see no reason as to why you cant get single session Cyberknife.

Treatment day for me was

Arrive 9:45am for a 10:00am appointment
Cyberknife was ready and I was lying on the machine at 10:00am
Treatment time was 35 minutes, and it was all over by 10:45am

I spent the next 30 minutes talking to the neurosurgeon about post cyberknife follow up until I had run out of questions.

I walked out around 11:25..

It was very easy...
No head frame, no drugs.
Still have my hearing after 2.5 Years

[arizonajack]

I chose Gamma Knife after reading comparisons between Gamma Knife and Cyber Knife.

One of the things I recall was that Gamma Knife can be aimed accurately down to 1mm, more precise than Cyber Knife and, thus, appears a better choice for small tumors.

YMMV.

Do your research and pick what's best for you.

[PaulW]

The accuracy argument is an interesting one, and is probably more academic than practical.

One Machine gets its accuracy from the headframe and a very rigid machine.
the other gets it's accuracy from feedback mechanisms, and the 3D xrays it takes during the treatment to verify the location.
 
Here is a paper showing end to end accuracy of the Cyberknife is 0.45mm +/- 0.09mm
http://www.cureus.com/papers/The-Targeting-Accuracy-of-the-CyberKnife-as-Measured-with-EBT2-film-inside-a-Ball-Cube-II-film-Cassette-and-Head-Phantom/7

Both machines are very accurate.

Cyberknife has advantages for acoustic neuromas in providing a more homogenous dose, and the ability to fractionate the dose to possibly improve hearing preservation.

Interestingly both machines are producing surprisingly similar results.
So the jury is still out as to whether either of those things have any clinical significance.

Something worth noting is the New Cyberknife M6 FIM has the ability to shape the beam.
http://www.accuray.com/pressroom/press-releases/first-patient-treated-worldwide-new-cyberknife%C2%AE-m6%E2%84%A2-system

There will be advantages for people with larger and irregular shaped tumours with this technology.

[allitinez]

Thank you everyone.  Guess I should have made my title Gamma Knife vs. IMRT or 1 day treatment vs. 5 week.  As per the radiologist I work with the Gamma knife is more precise than the IMRT.  Obviously a 1 day treatment sounds better than 5 weeks 5 times a week, but....  I have a call in to Columbia Presbyterian, hopefully I'll get a call back tomorrow.  I also have an appt with Sloan Kettering on Wednesday.  I'm going to take in all the information and try to make an informed decision.  My difficulty is I trust the doctors at my job and know they wouldn't steer me wrong (neuro-radiologists at a very large practice) and I trust Sloan Kettering

[nftwoed]

Hi allitinez;

   Guess I'm in favor of GK. It's a little like 6, or 1/2 dozen. Oh, which? The experience and expertise of the Dr. is likely more important.

[allitinez]

I have made my decision.  I will be going with Gamma Knife at Columbia Presbyterian in New York City.  I will be using my original Neuro-Surgeon who performed the surgery on my 3 cm. AN 9 years ago.  He will be working hand in hand with the radio-oncologist.  Thanks for the advice everyone.

[Bonnie B.]

Let us know how you make out.

[MDemisay]

Dear Altinez,

Actually, there are advantages to both and disadvantages to both. You should weigh each by making a list for both and then you can decide on one or the other. I know this will take a little effort but it's worth it! When I did this, I naturally chose Gamma Knife because it was easier and I was done in one shot. It involves a heavy steel frame and piercing your skin above your eyes and slightly to the left of each eye. The scars took approximately 3 weeks to fade.

I explored Cyber Knife very cursorily, and was told that I would have to have a form fitting mask so that they could give me several days of treatment,

For me, simpler is easier.

I guess I was too chicken for a multi day, when it could be a one and done affair!

Mike

Good luck with whatever you choose!