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Brain Cancer & Tumor Treatment Options

Discover your brain cancer treatment options

Spokane CyberKnife brain cancer treatments are non-surgical and performed on an outpatient basis. Treatments are delivered with sub-millimeter accuracy once per day for up to five days and without the requirement of the rigid head-frame that is screwed to the patients skull, as is with the Gamma Knife. Most patients experience minimal to no side effects with a quick recovery time.

*Cyberknife and TrueBeam Brain Tumor treatments are covered by Medicare and most all insurances.

What Sets CyberKnife Apart?

CyberKnife Stereotactic Radiosurgery For Brain Tumors

The CyberKnife® Robotic Radiosurgery System was cleared by the U.S. Food and Drug Administration in 1999 to treat tumors in the head and base of the skull. Despite its name, the CyberKnife System is not a surgical procedure. In fact, there is no cutting involved. Instead, the CyberKnife System delivers high doses of pin-point, sub-millimeter accurate radiation directly to brain tumors. The CyberKnife System offers patients a non-invasive alternative to brain cancer surgery, and can be used for brain tumors that are considered inoperable because of their location in the head, for those patients who cannot undergo brain cancer surgery due to their poor medical condition, or who refuse surgery. The CyberKnife System also can treat benign, or non-cancerous, tumors and other conditions, such as:

Brain Conditions We Treat

Brain Conditions We Treat open

 CyberKnife vs. Gamma Knife

Cyberknife Comparisons to Gamma Knife open

There are several ways of performing stereotactic radiosurgery. Some types of stereotactic radiosurgery methods require a rigid, invasive metal head frame that is screwed into the skull to hold the head in place during treatment. However, such frame-based systems have numerous limitations, including:

Gamma Knife head-frame screwed to patients skull

In contrast to the standard frame-based radiosurgical instruments, the CyberKnife robotic radiosurgery system combines three features unique to any other system:

This combination enables the CyberKnife to overcome the limitations of older frame-based radiosurgery systems such as the Gamma Knife and LINAC.

Brain Tumor Treatment At Spokane CyberKnife

1. How Does The CyberKnife System Treat Brain Tumors open

The CyberKnife Robotic Radiosurgery System improves on other radiosurgery techniques by eliminating the need for stereotactic head frames to be attached to a patient’s head with screws or bolts. As a result, the CyberKnife System enables doctors to achieve a high level of sub-millimeter accuracy in a non-invasive manner and has a higher brain surgery recovery time. In fact, it allows patients to be treated on an outpatient basis. The CyberKnife System can pinpoint a tumor’s exact location in real time using  three dimensional X-ray images taken during the brain cancer treatment and ablate the tumor with surgical outcomes, yet without surgery, hence called Radiosurgery. 

 The CyberKnife System has a strong record of proven clinical effectiveness. It is used either on a stand–alone basis or in combination with other brain cancer treatments, such as chemotherapy, surgery or fractionated brain radiation therapy.

 CyberKnife brain cancer treatments involve a team approach, in which several specialists participate. The team may include:

Once the team is in place, preparations begin for the CyberKnife treatment. Generally there are three steps involved:

Unlike other radiosurgery systems – such as the Gamma Knife – the CyberKnife System does not require patients to be fitted with a rigid and invasive head frame. In the set-up stage, the radiation therapist will create a soft mesh mask that is custom-fitted to the patient’s face. This comfortable and non-invasive mask helps the patient keep his or her head and neck immobile during treatment. While wearing the mask, a CT scan will be performed. The CT data will be fused with other image data sets such as MRIs or PET scans.  Thes fused images sets will then will be used by the CyberKnife team to determine the exact size, shape and location of the tumor. 

An MRI, PET scan or angiogram also may be necessary to fully visualize the tumor and nearby anatomy. Once the imaging is done, the face mask will be removed and stored until the CyberKnife treatment begins. Then a medical physicist and the patient’s radiation oncologist use the data to custom-design the patient’s treatment plan. The patient does not need to be present for the treatment planning.

During the CyberKnife treatment planning phase, the CT, MRI and/or PET scan data will be downloaded into the CyberKnife System’s treatment planning software. The medical team will determine the size of the area that must be targeted by radiation and the radiation dose. They also will identify critical structures where radiation should be minimized. Using this information, the CyberKnife System calculates the optimal radiation delivery plan to treat the tumor. The treatment plan will take full advantage of the CyberKnife System’s extreme maneuverability, allowing for a safer and more accurate treatment.

After the brain cancer treatment plan is developed, the patient will return to the CyberKnife Center for treatment. The Radiation Oncologist may choose to deliver the treatment in one session, or stage it over two to five days. All, brain cancer treatments are completed within five days. For most patients, the CyberKnife treatment is a completely pain-free experience. Patients dress comfortably in their own clothes and, depending on the treatment center, they may be allowed to bring music to listen to during the treatment. Patients also may want to bring something to read while they wait, and have a friend or family member with them to provide support before and after treatment.

When it is time for treatment, the patient lies on the table and with their comfortable, custom fitted mesh mask. The CyberKnife System’s computer-controlled robot will move around the patient’s body to the various locations from which it will deliver radiation to the tumor. Nothing will be required of the patient during the treatment, except to relax and lie as still as possible.

Once the CyberKnife treatment is complete, most patients quickly return to their daily routines with little interruption in their normal activities. If the treatment is being delivered in stages, the patient will need to return for additional treatments over the next several days, as recommended by their Radiation Oncologist. Side effects vary from patient to patient. Generally some patients experience minimal side effects from CyberKnife treatments, and these often go away within a week or two. Prior to treatment, the Radiation Oncologist will discuss with the patient all possible side effects they may experience. The Radiation Oncologist also may prescribe medication designed to control any side effects should they occur.

After completing CyberKnife radiosurgery treatment, it is important that the patient schedule and attend follow-up appointments. They also must keep in mind that their tumor will not suddenly disappear. Response to treatment varies from patient to patient. Clinical experience has shown that most patients respond very well to CyberKnife treatments. As follow-up, Radiation Oncologists will monitor the outcome in the months and years following a patient’s treatment, often using either CT scans and/or PET-CT scans. 

2. How Does TrueBeam Treat Brain Tumors? open
 Spokane Cyberknife is pleased to announce the arrival of the new TrueBeam™ system to Spokane. TrueBeam™ is an advanced radiotherapy technology for treating cancers throughout the body. Spokane Cyberknife is the only center in the United States with not one, but the two most advanced Radiation Treatment Technologies in one center. Your Cancer Experts at Spokane Cyberknife work with your unique condition to personalize the most effective treatment plan, that at times involves multiple technologies and methodologies, and only Spokane Cyberknife can offer this with the Cyberknife M6 and Truebeam from one center.

Opening up treatment options for people with cancer, it targets tumors with accuracy measured in millimeters. With its power and flexibility, clinicians can develop treatments that are best suited for patients’ individual circumstances.

3. What is Radiosurgery? open
  What is Radiosurgery? 

Radiosurgery = Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT) 

Many cancers cannot be completely eradicated with traditional radiation therapy (RT) techniques; which is why it is important to look at all brain cancer treatment options available. The goal of radiation treatment has always been to maximize the delivery of radiation to tumors while minimizing the amount of radiation to normal tissue. The higher the radiation dose delivered to a tumor, the greater the chance of tumor destruction. Likewise, the lower the radiation dose delivered to surrounding normal tissue, the less destruction. Historically, the available technology, found at other centers, was unable to accurately deliver high dose radiation to a tumor without also affecting the surrounding tissue. To minimize the side effects of radiation for brain tumors and collateral damage to the surrounding tissues, radiation oncologists traditionally deliver radiation over many sessions, giving low doses each day over usually several weeks, (25 to 45 days). Following each fraction of radiation the normal tissue cells can recover better than many cancerous cells. Over many sessions, the hope is that more tumor cells die than normal tissue cells. Unfortunately, this strategy is often unsuccessful. 

With the development of SRS & SBRT, physicians are now able to deliver lethal (surgical) doses of radiation to a tumor with sub-millimeter (surgical) accuracy, in 1 to 5 treatments. This methodology maximizes the amount of radiation going directly to the target tissue (and thus maximizing tumor response rate) while minimizing the radiation exposure to surrounding tissue. This is evidenced in the studies that compare the clinical treatment volume (CTV) to the planning treatment volume (PTV). With SRS & SBRT, unlike RT, the CTV and PTV are more closely aligned, which means that SRS & SBRT is able to precisely deliver lethal doses of radiation to the target tissue. By minimizing the impact on healthy tissue, SRS & SBRT shortens patient recovery time and decreases complication rates. 

As technology has continued to evolve advancements have enabled physicians to apply SRS & SBRT to lesions in the body, as well as to lesions in the cranium, head, and neck. Procedures were originally performed on cranial tumors because the technology at the time required a frame, which can easily be screwed into the skull, as with the Gamma Knife. Attempts to develop body frames were cumbersome and unsuccessful. As a result, initially, no technological solution was available to accurately deliver lethal doses of radiation to tumors below the head without also destroying normal tissue. 

Then came CyberKnife, the first and only dedicated robotic, SRS & SBRT treatment technology. And for the first time we now have a technology that allows for real time tracking of a tumor regardless of where it is in the body. Physicians are now able to achieve sub-millimeter (.3MM) accuracy in the head, without the frame, by using the anatomical markings of the skull and taking advantage of the stable relationship between the skull and an intracranial tumor. In the same manner, we are now able to use the anatomical markings of the spine to treat spinal lesions. For other tumors in soft tissue throughout the body, we are able to track, in real time, small gold fiducials placed in the tumor to accurately deliver radiosurgical doses. 

Over the last 17 years, SRS & SBRT has case study data proving the clinical effectiveness in treating intra-cranial, extra-cranial neck, and body tumors. In many cases SRS & SBRT provides a clinically superior alternative to either surgery or traditional RT for head and body lesions. In some cases, SRS & SBRT is the only effective option. The SRS & SBRT approach allows for dose escalation, hypo-fractionation, and 

heterogeneity of dosage within the tumor volume, and improved conformality and accuracy. As a result, SRS & SBRT delivers unique benefits to the patient, including improved tumor response, higher cure rates, improved pain control, success against tumors that had been radio-resistant or had exceeded tolerance levels, reduction in organ damage, and improved tolerance. These unique benefits apply to tumors regardless of their location in the head/neck or body.

*Please see below for CyberKnife Case studies treating Brain Tumors

Brain Cancers and Tumor Information

A. What Is Brain Cancer? open
Brain cancer is an abnormal growth of cells in the brain, which result in a collection of cells called a brain tumor. If the abnormal cells were originally brain cells that started to grow uncontrollably, it is a primary brain tumor. If the abnormal cells originated in another part of the body, such as the lung or breast, and were carried to the brain by the blood or other body fluid, then it is considered a metastatic brain tumor. More than 18,000 cases of primary brain tumors1 and more than 170,000 brain metastases are diagnosed in United States each year.

Primary brain tumors

There are many types of primary brain tumors, including:

Each primary brain tumor is categorized based on the type of normal brain cell from which they originated and has its own unique characteristics and growth patterns. Gliomas account for 40 percent of all primary brain tumors and it is uncommon for them to spread from the brain to other parts of the body. The most aggressive type of Glioma is called Glioblastoma Multiforme- GBM.

 Metastatic brain tumors

The cells that form metastatic brain tumors travel to the brain from other parts of the body through the bloodstream, along nerves or within the fluid surrounding the spinal cord and brain. These cells most commonly originate in tumors within the lung, breast, skin or colon, and are deposited in the brain where they grow into a tumor.

Both primary and metastatic brain tumors can be very dangerous because they can compress sensitive brain tissue and nerves within the head, causing patients to experience symptoms such as vision loss, hearing loss, difficulties with balance, pain or seizures. As these tumors grow larger, they can be life-threatening because they disrupt critical parts of the brain that are responsible for breathing and other basic life functions. 

B. What Are Brain Tumor Symptoms and Grades? open

What Are Brain Tumor Symptoms and Grades?

Patients with brain tumors may have symptoms such as:

Because many of these symptoms are not unique to brain tumors, it is difficult to make a diagnosis without some type of imaging study. 

Diagnosis often involves visualization of the brain tumor by:

Once the diagnosis has been made, more tests may be necessary, sometimes including a biopsy, to identify the specific type of tumor and determine the proper treatment for the patient.

Tumor Grades

Tumor grade corresponds to the aggressiveness of the tumor. Higher grade tumors tend to grow faster, have an aggressive course, and more likely to be malignant.
 
Physicians assign a grade to a tumor by the way the cells look under a microscope:

C. Primary Tumor Types open

Types of Primary Brain Tumors 

Astrocytoma – This type of tumor arises from star-shaped glial cells called astrocytes and most often occur in the cerebrum. Astrocytoma tumors do not usually spread outside the brain or spinal cord and usually will not affect other organs. Astrocytomas are the most common glioma and are often have clearly defined outlines on diagnostic images. They sometimes have diffuse zones of infiltration (e.g. low-grade astrocytoma, anaplastic astrocytoma, glioblastoma) that can arise in any location in the central nervous system (CNS) but they can have a tendency to progress to more advanced grades.
 
Glioblastoma multiforme (Grade IV- GBM) the most common form of astrocytoma and it is the most malignant. Primary GBM grow, then spread to other parts of the brain very quickly. They can become very large before symptoms occur, which often begin abruptly with seizures. (mayo clinic.org) Surgical removal is the mainstay of treatment for this type of aggressive tumor if it can be done without unacceptable neurologic injury. Since GBM is extremely infiltrative, complete surgical removal is impossible. Radiation therapy and stereotactic radiosurgery is usually used in addition to surgery and can double the median survival of patients compared to supportive care alone. (mayoclinic.org)
 
Meningioma – A tumor arises in the meninges, which are three thin layers of tissue surrounding the brain and spinal cord. This type of tumor is usually benign, but can be malignant, and generally is a slow growing tumor. Meningiomas can happen at any age, even to children, but most frequently arise in older women. Meningiomas may not require immediate treatment and can be observed with MRI scans. . If the patient has symptoms or the tumor is in a critical area treatment is usually recommended. Patients are often treated with surgical resection, stereotactic radiosurgery, and radiation therapy.
 
Oligodendroglioma – This is a rare, slow-growing tumor that occurs in the cells that make up the fatty substance that covers and protects nerve cells in the brain and spinal cord. It is sometimes referred to as an oligodendrogilial tumor. Oligodendroglioma can occur in adults and children, and the average age of diagnosis is 35. These tumors are often treated with surgical resection, radiation therapy, stereotactic radiosurgery and will often respond well to chemotherapy as well.
 
Acoustic Neuroma (Vestibular Schwannoma) – A slow growing almost always benign tumor that arises from the cells that cover the vestibular cochlear nerve. This tumor presents with hearing loss, balance problems, or ringing in the ears (tinnitus). The tumor is located on the nerve connected to the hearing. While surgical resection has great tumor control rates it can lead to hearing loss, facial numbness, or facial weakness. Multiple studies show outstanding tumor control rates with stereotactic radiosurgery with a far reduced risk of side effects.
 
Paraganglioma (Glomus Jugularis or chemodectomas) These tumors are rare, most often benign tumors most commonly affecting the base of skull and neck region. These tumors are often treated with surgical resection, radiation therapy, or stereotactic radiosurgery.
 
Medulloblastoma – While this tumor can be seen in adults it is often in diagnosed in children and teenagers and is the most common malignant brain tumor in childhood. Disease can often times involve the spinal cord, therefore treatment is often directed to the brain and spinal cord. Although less frequent, this tumor can spread throughout the body. This tumor is often treated with a combination of surgery, radiation, and chemotherapy and less often stereotactic radiosurgery.
 
Ependymoma – This tumor forms from cells lining the ependymal lining of ventricular system of the brain and spinal cord. Surgical resection is often followed by radiation or stereotactic radiosurgery. This tumor is also often seen in children.
 
Pituitary Adenoma – These tumors are almost always benign. The pituitary is located in the sella turcica which is near the optic nerve and optic chiasm. Tumors that progress in this location can lead to loss of vision. These tumors can make hormones in excess that can lead to symptoms. In many instances these tumors may not require treatment and in some instances can be treated with medication. Often times patients will require surgical resection, radiation therapy, stereotactic radiosurgery or a combination of treatments.
 
Central Neurocytoma – These tumors are rare and most commonly behave as benign tumors. They are often found in young adults but can be seen in children and the elderly. They usually form in the ventricles and often present with hydrocephalus. Most patients will be treated with surgery and radiation therapy or stereotactic radiosurgery.

D. How Is Brain Cancer Treated? open

Brain Cancer Treatment Options

The treatment of brain tumors often requires combinations of several types of treatments to effectively fight the disease.

Radiosurgery:  (Also called Stereotactic Radiosurgery – SRS)

During the last 25 to 30 years, radiosurgery has emerged as an alternative to surgery.7-9 Unlike conventional radiation therapy, during which small doses of radiation are delivered over weeks and months, radiosurgery can treat a tumor in one to five sessions by delivering a high dose of radiation with surgical, sub-millimeter accuracy. During radiosurgery, hundreds of narrow radiation beams are delivered from different angles, all intersecting at the tumor. This treatment allows the tumor to be attacked by a high dose of radiation without damaging surrounding sensitive brain tissue. To be effective and safe, radiosurgery must be accurate. To achieve this accuracy, some radiosurgery devices, such as the Gamma Knife®, require a rigid stereotactic frame be affixed to a patient’s head so the system can pinpoint the exact location of a tumor.8 These frames are screwed into a patient’s skull after local anesthesia is given. Many patients find these frames to be uncomfortable and painful. In addition, if multiple treatment sessions are required, the patient may have to be hospitalized with the frame in place for several days until the treatment is complete.

The CyberKnife Robotic Radiosurgery System, improve on other radiosurgery techniques by eliminating the need for stereotactic frames. As a result, the CyberKnife System enables doctors to achieve a high level of accuracy in a non-invasive manner and allows patients to be treated on an outpatient basis in 1-5 daily treatments of 30-60 minutes each.10, 11

For patients with a limited number of tumors in their brain, typically less than 10, radiosurgery is another option compared to fractionated radiation therapy to part or all of the brain.

Surgery: 

For solitary tumors that are not near the brain’s most critical structures, such as those involved in vision or regulation of breathing, the most common treatment option is surgery, in which the tumor is cut out through surgery.5 Surgery is used for primary brain tumors, such as a GBM, as well as solitary brain metastases and benign tumors. Surgery is often followed by whole brain radiation therapy or partial brain radiation techniques to eliminate any microscopic bits of the tumor. In some cases, malignant brain tumors can be treated in combination with chemotherapy for greater effect. 

Fractionated radiation therapy: to part or all of the brain.

If the patient suffers from multiple tumors, typically more than 10, as is often the case with metastatic brain cancer, treatment is often whole brain radiation therapy. Whole brain radiation treatment typically requires 10-20 sessions over two to four weeks and is used to treat the entire brain, including both the tumor(s) and normal tissue. The normal brain tissue is less susceptible to small daily doses of radiation as compared to tumor cells, so the extended courses of whole brain radiation therapy result in minimal toxicity of normal brain cells for the patient.

Chemotherapy: 

Chemotherapy medication is delivered orally or through an IV. It affects both normal tissue and the cancer cells, so patients may experience side effects, such as nausea and vomiting, infections, fatigue and weight loss. Chemotherapy is typically given to a patient in combination with other types of brain cancer treatment.  For example, it may be given during and after fractionated brain radiation therapy to target both the tumor cells in the brain as well as the tumor cells outside the brain that may be present, particularly for metastatic tumors arising from primary tumors in other parts of the body .

Combined and Sequential Therapy:

Treatment plans for patients must be individualized to provide the optimal outcomes and reduce potential side effects based on each patients diagnosis; this takes into account the patient’s type of tumor, location of the tumor, size of the tumor, extent of tumor involvement of brain structures and other medical conditions the patient may have, all of which impact on the decisions leading to a final treatment plan for a patient.  The final treatment plans for brain tumors commonly involve multiple treatment methods and procedures including radiosurgery, surgery, chemotherapy and fractionated radiation therapy.  Which treatment techniques and the sequence of the multiple treatment methods recommended for each patient will be determined by your team of physicians after evaluating all of a patient’s test results.

Gamma Knife requires an invasive Head Frame screwed to the patient's skull. 

CyberKnife Comparison Chart - Why CyberKnife Is Leading Edge Technology

Brain – Head & Neck Technology Treatment ComparisonCyberKnifeGamma KnifeTomotherapyConventional Radiation Therapy

(IMRT - IGRT)
Targeted Accuracy< 1 Millimeter< 1 Millimeter3-20 Millimeters5-20 Millimeters
Invasive Head-FrameNeverRequired for all TreatmentsRequired in most TreatmentsRequired
Number of TreatmentsFlexible(1 to 5)

*See Clinical Studies

Limited to 1FlexibleFlexible
Motion ManagementYesNoNoNo
Real-time Imaging with auto correctionYesNoNoNo
Dedicated Radiosurgery TechnologyYesYesNoNo
ApplicationsBrain - Full Spine
& Body
Brain & Limited Cervical SpineFull BodyFull Body

Learn More About How Spokane CyberKnife Can Treat Brain Cancer

Cyberknife Patient Education – Brain Tumor Treatment

TrueBeam Patient Education – Brain Tumor Treatment

Acoustic Neuroma – Cyberknife Patient Testimonial

 

 

Cyberknife Explained by Neurosurgeons

CyberKnife Case Studies

 

Brain Metastasis Treatment  
A Cyberknife Case Study – Stanford University
 

Acoustic Neuroma Treatment 
A Cyberknife Case Study – Stanford University