› Forums › General Melanoma Community › Cyber knife on lung mets
- This topic has 18 replies, 4 voices, and was last updated 11 years, 8 months ago by
jkc.
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- June 11, 2014 at 10:38 am
Has anyone had cyber knife done on lung mets and a few lymph nodes. The disease load is low. We are out of other treatments. Where would you go?
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- June 11, 2014 at 1:24 pm
Yes, there is a "cyber knife" type treatment that can be done on the body. It is called SBRT (stereotactic body radiation therapy). I think that Janner's father had that done. But why do you say that you are "out of other treatments"? There are several FDA approved treatments available now plus dozens of clinical trials.
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- June 11, 2014 at 1:24 pm
Yes, there is a "cyber knife" type treatment that can be done on the body. It is called SBRT (stereotactic body radiation therapy). I think that Janner's father had that done. But why do you say that you are "out of other treatments"? There are several FDA approved treatments available now plus dozens of clinical trials.
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- June 11, 2014 at 1:24 pm
Yes, there is a "cyber knife" type treatment that can be done on the body. It is called SBRT (stereotactic body radiation therapy). I think that Janner's father had that done. But why do you say that you are "out of other treatments"? There are several FDA approved treatments available now plus dozens of clinical trials.
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- June 11, 2014 at 5:48 pm
Hello, I recently had radiation on a lung met (in February). It was not CyberKnife specifically, but stereotactic body radiotherapy (SBRT). Remember that CyberKnife is basically a brand name and technique for delivering stereotactic radiation; when it's done on the brain, it's called stereotactic radiosurgery (SRS) and elsewhere on the body it's SBRT. But whether SRS or SBRT or done on a CyberKnife system or something else, it's all the same radiation, only a matter of how the radiation field is planned and targeted. I mention this because I think it's important to not get hung up on the brand name as you're looking for a treatment center. I've had CyberKnife for a brain met, but SBRT on the lung met. There aren't a lot of CyberKnife machines out there; I live in the Philadelphia area, so there are a handful, but you don't necessarily have to travel far to specifically use a CyberKnife machine. SBRT can be done on a much more traditional linear accelerator and those are all over the place.I've written elsewhere here about radiation and melanoma with respect to several bone metastases I've had, but the same goes for lung mets, too, so I'm copying and pasting that part here:"Melanoma used to be considered to be “radio-resistive”, i.e. not responsive to radiation therapy. More recently however, it’s been found that melanoma will respond to radiation using fewer sessions at much higher fractions per session, but the same overall dose. Most people think of radiation as a daily treatment regimen over many weeks. For example, and your mileage may vary, a “traditional” dosing schedule might be 30 grays (Gy) given in 1-Gy fractions, every weekday for 6 weeks (5 days per week x 6 weeks x 1 gray per session). Melanoma is more likely to respond to the same 30-Gy, but instead every other weekday (Mon-Wed-Fri) for 5 sessions in 6-Gy fractions, or even something more aggressive like 3 sessions of 10-Gy fractions. And again, the actual machine used isn't really important, that's more marketing-speak for how the system targets the tumor. So my experience was that radiation therapy was much less disruptive over a shorter period of time than I was expecting. It was also painless, with the biggest side effect being some fatigue. For a couple of the bone mets I also had some hair loss on the skin and what appears to be long-term but mild skin discoloration. Fatigue was very mild for the bone mets and a little more (but manageable) for a lung met this past February."Whether CyberKnife or another SBRT system is best may depend on the size and location in the lung of the tumor. CyberKnife can track the movement and target a tumor on the fly during treatment, which can be important with the lung and movement of respiration. However, in order to provide the tracking, it often requires the surgical implantation of a small metal marker, about the size of a grain of rice, called a "fiducial". It's not a major procedure, usually performed by an interventional radiologist, but it isn't without risk either. In my case, my radiation oncologist originally considered CyberKnife, but then felt that she could deliver the same SBRT treatment using a traditional linear accelerator without needing to implant the fiducial. The tumor was small enough that the radiation field could encompass the area where my chest was rising and falling without damaging nearby tissues.This tumor was in the "mid-lobe" of my right lung, just above the diaphragm and not far from my heart. It showed up on a PET scan in October 2013. I had a follow-up CT six weeks later and it wasn't growing much. At my next PET in January, it was lighting a little brighter and had grown some. I didn't have much tumor burden elsewhere and it wasn't growing really fast, it could have gone either way to treat it then or wait, but we all agreed that it was a good opportunity to "knock it out" when there wasn't much else going on and before it became a bigger issue. We talked about surgery, too, but all of my doctors agreed that they could handle it with radiation without the greater risks associated with surgery. By the time we started radiation it was 13-mm. I had 5 sessions given about every other day over two weeks in February. My next regular PET was in April and by then it was already showing a very good response.Long story short, given the low tumor burden you also have, my experience was that radiation was a reasonable approach to the lung met and I don't have any regrets about it.-
- June 11, 2014 at 7:12 pm
Thank you very much for a very informative answer!
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- June 11, 2014 at 7:12 pm
Thank you very much for a very informative answer!
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- June 11, 2014 at 7:12 pm
Thank you very much for a very informative answer!
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- June 13, 2014 at 4:15 pm
To add to RJoeyB's informative post, CyberKnife is a brand name but there are differences between 'robotic' SBRT and conventional SBRT. RJoeyB cited one of the differences in the CyberKnife's ability to not only track tumor motion in the lung but ALSO automatically adjust the beam in real-time without operator intervention so that the beam is always locked on to the tumor during breathing. Both fiducial and fiducial-less tracking methods are available on CyberKnife.
Another difference is unlike traditional linear accelerators, the CyberKnife's robotic range of motion enables the radiation beam to treat the tumor in 3D rather than 2D. This increases the number of available angles the system can use to avoid healthy tissue and ensure the entire tumor is radiated.
Ultimately, the doctor should decide which SBRT method is best for their patient based on many factors as mentioned by RJoeyB.
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- June 13, 2014 at 5:08 pm
Thanks so much for the clarification, I struggle to offer too much or not enough information here (and usually err on the side of perhaps too much information 😉 With my particular lung tumor, the lesion itself was not sufficiently distinct for fiducial-less tracking, so yes, the SBRT I had on the "old-fashioned" linear accelerator was given in 2D. The machine rotated around me a full 360 degrees, but in a single plane, delivering the radiation beam from 7 different angles. I've had SBRT on five different bone mets in my leg using a very similar approach, the movement of respiration made the planning more complicated for my lung met, but, again for my particular tumor, didn't require the full robotic range of CyberKnife.
I also had CyberKnife as a follow-up to brain surgery to treat the "tumor bed" after excision of a 2.5-cm brain met, and the technology is amazing. I used to joke that the machine was bordering on creepy the way it moved around so fluidly and, especially when targeting my head, almost seemed to be "staring" at me the whole time. It reminded me of how Pixar brought their iconic desk lamp "Luxo Jr." to life and gave it character. But I digress…
Again, as we've both stated, an experienced radiation oncologist can choose and plan the best method based on all the variables of location, movement, size, surrounding tissues, etc. Until I did some of my own research, I was a little hung up on the branding of CyberKnife myself – it sounds very cutting-edge (and it is), so when my doctor initially mentioned using it again and later backed off, my gut reaction was that I wasn't getting something as good ("There's no way that old giant Kitchen-Aid mixer can work as well as that fancy robot from the future!" 😉
I also limited my original response to the lung met, but it sounds like the original poster has additional nodal involvement, in which case the CyberKnife system probably has the added advantage of possibly being able to more conveniently target those multiple tumors during each treatment session. Apologies for missing that aspect in my original response.
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- June 13, 2014 at 5:08 pm
Thanks so much for the clarification, I struggle to offer too much or not enough information here (and usually err on the side of perhaps too much information 😉 With my particular lung tumor, the lesion itself was not sufficiently distinct for fiducial-less tracking, so yes, the SBRT I had on the "old-fashioned" linear accelerator was given in 2D. The machine rotated around me a full 360 degrees, but in a single plane, delivering the radiation beam from 7 different angles. I've had SBRT on five different bone mets in my leg using a very similar approach, the movement of respiration made the planning more complicated for my lung met, but, again for my particular tumor, didn't require the full robotic range of CyberKnife.
I also had CyberKnife as a follow-up to brain surgery to treat the "tumor bed" after excision of a 2.5-cm brain met, and the technology is amazing. I used to joke that the machine was bordering on creepy the way it moved around so fluidly and, especially when targeting my head, almost seemed to be "staring" at me the whole time. It reminded me of how Pixar brought their iconic desk lamp "Luxo Jr." to life and gave it character. But I digress…
Again, as we've both stated, an experienced radiation oncologist can choose and plan the best method based on all the variables of location, movement, size, surrounding tissues, etc. Until I did some of my own research, I was a little hung up on the branding of CyberKnife myself – it sounds very cutting-edge (and it is), so when my doctor initially mentioned using it again and later backed off, my gut reaction was that I wasn't getting something as good ("There's no way that old giant Kitchen-Aid mixer can work as well as that fancy robot from the future!" 😉
I also limited my original response to the lung met, but it sounds like the original poster has additional nodal involvement, in which case the CyberKnife system probably has the added advantage of possibly being able to more conveniently target those multiple tumors during each treatment session. Apologies for missing that aspect in my original response.
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- June 13, 2014 at 5:08 pm
Thanks so much for the clarification, I struggle to offer too much or not enough information here (and usually err on the side of perhaps too much information 😉 With my particular lung tumor, the lesion itself was not sufficiently distinct for fiducial-less tracking, so yes, the SBRT I had on the "old-fashioned" linear accelerator was given in 2D. The machine rotated around me a full 360 degrees, but in a single plane, delivering the radiation beam from 7 different angles. I've had SBRT on five different bone mets in my leg using a very similar approach, the movement of respiration made the planning more complicated for my lung met, but, again for my particular tumor, didn't require the full robotic range of CyberKnife.
I also had CyberKnife as a follow-up to brain surgery to treat the "tumor bed" after excision of a 2.5-cm brain met, and the technology is amazing. I used to joke that the machine was bordering on creepy the way it moved around so fluidly and, especially when targeting my head, almost seemed to be "staring" at me the whole time. It reminded me of how Pixar brought their iconic desk lamp "Luxo Jr." to life and gave it character. But I digress…
Again, as we've both stated, an experienced radiation oncologist can choose and plan the best method based on all the variables of location, movement, size, surrounding tissues, etc. Until I did some of my own research, I was a little hung up on the branding of CyberKnife myself – it sounds very cutting-edge (and it is), so when my doctor initially mentioned using it again and later backed off, my gut reaction was that I wasn't getting something as good ("There's no way that old giant Kitchen-Aid mixer can work as well as that fancy robot from the future!" 😉
I also limited my original response to the lung met, but it sounds like the original poster has additional nodal involvement, in which case the CyberKnife system probably has the added advantage of possibly being able to more conveniently target those multiple tumors during each treatment session. Apologies for missing that aspect in my original response.
-
- June 13, 2014 at 4:15 pm
To add to RJoeyB's informative post, CyberKnife is a brand name but there are differences between 'robotic' SBRT and conventional SBRT. RJoeyB cited one of the differences in the CyberKnife's ability to not only track tumor motion in the lung but ALSO automatically adjust the beam in real-time without operator intervention so that the beam is always locked on to the tumor during breathing. Both fiducial and fiducial-less tracking methods are available on CyberKnife.
Another difference is unlike traditional linear accelerators, the CyberKnife's robotic range of motion enables the radiation beam to treat the tumor in 3D rather than 2D. This increases the number of available angles the system can use to avoid healthy tissue and ensure the entire tumor is radiated.
Ultimately, the doctor should decide which SBRT method is best for their patient based on many factors as mentioned by RJoeyB.
-
- June 13, 2014 at 4:15 pm
To add to RJoeyB's informative post, CyberKnife is a brand name but there are differences between 'robotic' SBRT and conventional SBRT. RJoeyB cited one of the differences in the CyberKnife's ability to not only track tumor motion in the lung but ALSO automatically adjust the beam in real-time without operator intervention so that the beam is always locked on to the tumor during breathing. Both fiducial and fiducial-less tracking methods are available on CyberKnife.
Another difference is unlike traditional linear accelerators, the CyberKnife's robotic range of motion enables the radiation beam to treat the tumor in 3D rather than 2D. This increases the number of available angles the system can use to avoid healthy tissue and ensure the entire tumor is radiated.
Ultimately, the doctor should decide which SBRT method is best for their patient based on many factors as mentioned by RJoeyB.
-
- June 11, 2014 at 5:48 pm
Hello, I recently had radiation on a lung met (in February). It was not CyberKnife specifically, but stereotactic body radiotherapy (SBRT). Remember that CyberKnife is basically a brand name and technique for delivering stereotactic radiation; when it's done on the brain, it's called stereotactic radiosurgery (SRS) and elsewhere on the body it's SBRT. But whether SRS or SBRT or done on a CyberKnife system or something else, it's all the same radiation, only a matter of how the radiation field is planned and targeted. I mention this because I think it's important to not get hung up on the brand name as you're looking for a treatment center. I've had CyberKnife for a brain met, but SBRT on the lung met. There aren't a lot of CyberKnife machines out there; I live in the Philadelphia area, so there are a handful, but you don't necessarily have to travel far to specifically use a CyberKnife machine. SBRT can be done on a much more traditional linear accelerator and those are all over the place.I've written elsewhere here about radiation and melanoma with respect to several bone metastases I've had, but the same goes for lung mets, too, so I'm copying and pasting that part here:"Melanoma used to be considered to be “radio-resistive”, i.e. not responsive to radiation therapy. More recently however, it’s been found that melanoma will respond to radiation using fewer sessions at much higher fractions per session, but the same overall dose. Most people think of radiation as a daily treatment regimen over many weeks. For example, and your mileage may vary, a “traditional” dosing schedule might be 30 grays (Gy) given in 1-Gy fractions, every weekday for 6 weeks (5 days per week x 6 weeks x 1 gray per session). Melanoma is more likely to respond to the same 30-Gy, but instead every other weekday (Mon-Wed-Fri) for 5 sessions in 6-Gy fractions, or even something more aggressive like 3 sessions of 10-Gy fractions. And again, the actual machine used isn't really important, that's more marketing-speak for how the system targets the tumor. So my experience was that radiation therapy was much less disruptive over a shorter period of time than I was expecting. It was also painless, with the biggest side effect being some fatigue. For a couple of the bone mets I also had some hair loss on the skin and what appears to be long-term but mild skin discoloration. Fatigue was very mild for the bone mets and a little more (but manageable) for a lung met this past February."Whether CyberKnife or another SBRT system is best may depend on the size and location in the lung of the tumor. CyberKnife can track the movement and target a tumor on the fly during treatment, which can be important with the lung and movement of respiration. However, in order to provide the tracking, it often requires the surgical implantation of a small metal marker, about the size of a grain of rice, called a "fiducial". It's not a major procedure, usually performed by an interventional radiologist, but it isn't without risk either. In my case, my radiation oncologist originally considered CyberKnife, but then felt that she could deliver the same SBRT treatment using a traditional linear accelerator without needing to implant the fiducial. The tumor was small enough that the radiation field could encompass the area where my chest was rising and falling without damaging nearby tissues.This tumor was in the "mid-lobe" of my right lung, just above the diaphragm and not far from my heart. It showed up on a PET scan in October 2013. I had a follow-up CT six weeks later and it wasn't growing much. At my next PET in January, it was lighting a little brighter and had grown some. I didn't have much tumor burden elsewhere and it wasn't growing really fast, it could have gone either way to treat it then or wait, but we all agreed that it was a good opportunity to "knock it out" when there wasn't much else going on and before it became a bigger issue. We talked about surgery, too, but all of my doctors agreed that they could handle it with radiation without the greater risks associated with surgery. By the time we started radiation it was 13-mm. I had 5 sessions given about every other day over two weeks in February. My next regular PET was in April and by then it was already showing a very good response.Long story short, given the low tumor burden you also have, my experience was that radiation was a reasonable approach to the lung met and I don't have any regrets about it. -
- June 11, 2014 at 5:48 pm
Hello, I recently had radiation on a lung met (in February). It was not CyberKnife specifically, but stereotactic body radiotherapy (SBRT). Remember that CyberKnife is basically a brand name and technique for delivering stereotactic radiation; when it's done on the brain, it's called stereotactic radiosurgery (SRS) and elsewhere on the body it's SBRT. But whether SRS or SBRT or done on a CyberKnife system or something else, it's all the same radiation, only a matter of how the radiation field is planned and targeted. I mention this because I think it's important to not get hung up on the brand name as you're looking for a treatment center. I've had CyberKnife for a brain met, but SBRT on the lung met. There aren't a lot of CyberKnife machines out there; I live in the Philadelphia area, so there are a handful, but you don't necessarily have to travel far to specifically use a CyberKnife machine. SBRT can be done on a much more traditional linear accelerator and those are all over the place.I've written elsewhere here about radiation and melanoma with respect to several bone metastases I've had, but the same goes for lung mets, too, so I'm copying and pasting that part here:"Melanoma used to be considered to be “radio-resistive”, i.e. not responsive to radiation therapy. More recently however, it’s been found that melanoma will respond to radiation using fewer sessions at much higher fractions per session, but the same overall dose. Most people think of radiation as a daily treatment regimen over many weeks. For example, and your mileage may vary, a “traditional” dosing schedule might be 30 grays (Gy) given in 1-Gy fractions, every weekday for 6 weeks (5 days per week x 6 weeks x 1 gray per session). Melanoma is more likely to respond to the same 30-Gy, but instead every other weekday (Mon-Wed-Fri) for 5 sessions in 6-Gy fractions, or even something more aggressive like 3 sessions of 10-Gy fractions. And again, the actual machine used isn't really important, that's more marketing-speak for how the system targets the tumor. So my experience was that radiation therapy was much less disruptive over a shorter period of time than I was expecting. It was also painless, with the biggest side effect being some fatigue. For a couple of the bone mets I also had some hair loss on the skin and what appears to be long-term but mild skin discoloration. Fatigue was very mild for the bone mets and a little more (but manageable) for a lung met this past February."Whether CyberKnife or another SBRT system is best may depend on the size and location in the lung of the tumor. CyberKnife can track the movement and target a tumor on the fly during treatment, which can be important with the lung and movement of respiration. However, in order to provide the tracking, it often requires the surgical implantation of a small metal marker, about the size of a grain of rice, called a "fiducial". It's not a major procedure, usually performed by an interventional radiologist, but it isn't without risk either. In my case, my radiation oncologist originally considered CyberKnife, but then felt that she could deliver the same SBRT treatment using a traditional linear accelerator without needing to implant the fiducial. The tumor was small enough that the radiation field could encompass the area where my chest was rising and falling without damaging nearby tissues.This tumor was in the "mid-lobe" of my right lung, just above the diaphragm and not far from my heart. It showed up on a PET scan in October 2013. I had a follow-up CT six weeks later and it wasn't growing much. At my next PET in January, it was lighting a little brighter and had grown some. I didn't have much tumor burden elsewhere and it wasn't growing really fast, it could have gone either way to treat it then or wait, but we all agreed that it was a good opportunity to "knock it out" when there wasn't much else going on and before it became a bigger issue. We talked about surgery, too, but all of my doctors agreed that they could handle it with radiation without the greater risks associated with surgery. By the time we started radiation it was 13-mm. I had 5 sessions given about every other day over two weeks in February. My next regular PET was in April and by then it was already showing a very good response.Long story short, given the low tumor burden you also have, my experience was that radiation was a reasonable approach to the lung met and I don't have any regrets about it.
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