Topic: An experience of cyberknife treatment in patients with advanced...

An experience of cyberknife treatment in patients with advanced pancreaticobilliary malignancy

http://www.ncbi.nlm.nih.gov/pubmed/22113043

Abstract

Background/Aims:

CyberKnifeTM stereotactic body radiotherapy (SBRT) has been thought as a promising treatment modality for inoperable or recurred pancreaticobiliary malignancies. But, clinical course of CyberKnifeTM treatment have not been established yet, so we report the experience of CyberKnifeTM treatment in 19 patients with recurred or advanced pancreaticobilliary malignancies.

Methods:

Between July 2008 and May 2009, 19 patients (gallbladder cancer 4, common bile duct cancer 5, and pancreatic cancer 10) with recurred (12) and advanced pancreaticobiliary cancer (7) underwent CyberKnifeTM treatment in Soonchunhyang University Hospital. Tumor size was evaluated at 1, 3, 6, 8 and every 3 months after SBRT.

Results:

The mean age was 60.2 years, and the mean size of target lesions was 28.1±1.30 mm. After CyberKnifeTM treatment, the average size of target lesions was decreased; 2.53±4.18 mm from months 0-1 in 19 patients, 2.47±4.7 mm from months 1-3 in 15 patients, 0.08±5.11 mm from months 3-6 in 12 patients. However, the average size of target lesions was increased 3.67±8.98 mm from months 6-8 in 6 patients. There were 2 cases of massive duodenal ulcer bleeding after CyberKnifeTM treatment, one of them expired due to ulcer bleeding. Also, other minor complications appeared such as 1 case of abdominal pain and 1 case of diarrhea.

Conclusions:

CyberKnifeTM treatment seems to be effective in local control of pancreaticobiliary cancer, but we experienced serious complications. Further prospective studies will be needed for the proper evaluation of role of CyberknifeTM treatment in patients with advanced pancreaticobiliary malignancies.

Re: An experience of cyberknife treatment in patients with advanced...

Eli, My husband was DX 6 years ago. He had an aborted Whipple then 3 weeks later
the real deal. After 3 years the CC returned where his deuodenum used to be. After 25 Rad treatments he was then able to bring the CC down under 7 cm and had Cyber Knife. Other than his becoming tired he had no side effects. The CC again returned to the same spot 2 years later and no more could be done. From our experience we thought it was unbelievable and I know things have been advancing just in the last couple of years. We felt it bought him another 2 years.  Are they considering CK for your wife?

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: An experience of cyberknife treatment in patients with advanced...

Hi Eli,
My husband also had Cyberknife for palliative treatment.  He did not experience any bad side effects and lived a little under a year and a half from when he was diagnosed at stage 4.  Cyberknife was the only "treatment" he would allow.  He did not want chemo for palliative as he felt being "sick" from the chemicals was counterproductive. 
Peace be,
Karen

Wishing all God's blessings!

Re: An experience of cyberknife treatment in patients with advanced...

Gosh, I just posted a link to an article. Look what I get in return. smile Thank you Lainy and Karen for your informative posts.

My wife had microscopically positive margins after Whipple. CyberKnife is not an option to deal with margins. She did a course of conventional 3D radiation with concurrent 5-FU. She is currently in remission. I hope she doesn't need CyberKnife... NEVER EVER.

But since we are on the subject...

Our radiation oncologist (who delivered the conventional 3D course) also happens to be the head of the CyberKnife program at our hospital. We asked him if CyberKnife is an option to deal with a possible recurrence. He said it depends on how aggressive it is. CyberKnife is not an option if (a) the patient relapses soon after resection, or/and (b) the recurrence happens in multiple spots. He explained that using CyberKnife in such a scenario is akin to Whack-A-Mole game. You hit one spot only to see another one pop right next to it. He said that CyberKnife can be a viable option if the patient stays in remission for a long time and then relapses just in one spot. Maybe two spots, I don't remember what exactly he said.

Re: An experience of cyberknife treatment in patients with advanced...

Yep. It will not be done if there are more than a couple of spots. When I look back, I would have done it the same way as it bought an extra 2 years. When Teddy had his Whipple he had clean margins all around. 4 different doctors said no to chemo/radiation but things may have certainly changed at least we hope that they are changing rapidly. You wife is working on her own Miracle and lets hope that it continues and why wouldn't it with a wonderful husband who is certainly the best advocate she could ever have!!!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.