The Radiation Oncology Department at Amrita Institute of Medical Sciences (AIMS), Kochi recently conducted Amrita Annual High Precision Radiation Therapy Workshop and CME on from June 30- July 2, 2017. The workshop focused on training in the use of the CyberKnife. The academic session included a live demonstration on the treatment of liver tumors. The classes were given by experts from top hospitals across the country. including Tata Memorial Hospital, Fortis Hospital and Apollo Hospital.

Liver cancer is a problem in Kerala and there is an assumption that the incidence is higher than the national average. Many of the patients have preserved functional status (good general condition), and there is a dilemma regarding their management. There is a need to explore newer treatment options in these ‘difficult to treat’ patients. Sometimes patients usually don’t have any suitable treatment options and are treated with chemotherapy. But there is a technical challenge in delivering a high dose to the liver tumor and sparing other parts of normal liver. With standard radiation therapy techniques there are higher side effects and lower response to treatment. Radiation therapy was never considered an option previously, even in inoperable or recurrent disease. There are only few systemic therapy options in hepatocellular carcinoma (Sorafinib).

AIMS has recently found a technique to deliver a high dose of radiation to the tumor safely. Radiosurgery is a precise radiation therapy delivery technique to deliver high dose radiation to the target while sparing the adjacent critical structures. Robotic Radiosurgery (CyberKnife) is a robot assisted ‘real time’ image guided radiation therapy delivery technique where high dose short course radiation therapy is delivered to the target sparing adjacent normal liver.

CyberKnife treatment does not need any margin, as there is real time tracking and the robot ‘chases’ the tumour during respiratory motion. Gold seeds called ‘fiducials’ are placed near the tumour and the machine has the capability to track the ‘fiducials’ during real time imaging and treatment. Hence, high dose radiation therapy is delivered precisely with robotic arm based linear accelerator to the moving target with real time tracking and real time imaging. Accuracy of treatment is very high (within 1 mm) and monitored by computer-assisted systems. “CyberKnife robotic radiosurgery is considered the most appropriate treatment option for fiducial guided liver cancer treatment. CyberKnife is considered an option in inoperable and recurrent liver cancers,” said Dr. Debnarayan Dutta, Senior Consultant & Head of the Department of Radiation Oncology, AIMS. Radiosurgery with CyberKnife is now considered a standard option in inoperable, recurrent/ progressive liver tumours. There are many prospective randomised trials conducted worldwide to find if CyberKnife can be an option even in smaller lesions as a non-invasive option in operable liver cancers. Early studies with smaller lesion have shown that CyberKnife is equally effective as surgery with lesser side effects.