Cyber Knife and Lung cancer

Portal Forums Radiation Oncology Radiation for Distant Metastases Cyber Knife and Lung cancer

This topic contains 6 replies, has 4 voices, and was last updated by Dr West Dr West 5 years ago.

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June 9, 2013 at 2:22 pm  #1257139    


Is there any limits in term of size and numbers of how many tumours and lesions can be treated with Cyberknife? Do they need to be in the same area or the distant one can be treated also.I have the knowledge,they shouldn’t be more that 3cm.

I have been a good candidate for Cyberknife three months ago,but now my tumours have grown and another two small metastases were found so Cyberknife is not an option any more. It was money issue I didn’t do it three months ago. I have no other option but to go for regular Radiotherapy which will be done on my left adrenal gland and couple of lymph nodes close by.The right side will be left untreated and eventually I have to have chemotherapy again which is my enemy because I am reacting very badly to any of them.

I wonder, will I have the chance to go for Cyberknife if my condition allow and how long after regular Radiotherapy(5 days-20GY), Cyberknife can be performed.
Can IMRT be done in combination with Cyberknife.

Any Input will greatly appreciated.

June 9, 2013 at 9:08 pm  #1257143    
Dr West
Dr West

The real issue is that focal radiation doesn’t make good sense as a treatment if there are many lesions. If there are multiple brain lesions, then whole brain radiation is the treatment approach that makes far more sense than treating many areas in the brain individually, since it’s extremely likely that more will follow. If there are multiple lesions outside of the brain, then systemic therapy is really the approach that is far more likely to be an effective approach than doing focal radiation on multiple separate lesions simultaneously.

The real issue is that when there are multiple lesions, the risks are from the disease you can’t see as well as the disease you can. You need to address a much broader area of risk of progression when there are multiple lesions, and cyberknife doesn’t do that.

-Dr. West

June 10, 2013 at 9:14 am  #1257152    


Thank you Dr.West,

Actually my primary lung cancer moved from my lungs to my abdominal area where most of the tumours are.

One of the Radiologist suggested IMRT or VMAT may be performed on the mediastinum and left adrenal and paraaortic regions and Cyberknife might be applied to the other lesions -seven all together.

The second Radiologist advised against that because of too much radiation and severe side effects. Two different opinions which is very confusing for me.


June 10, 2013 at 11:14 am  #1257158    
JimC Forum Moderator
JimC Forum Moderator


It’s not unusual to get differing opinions from doctors. Some radiation oncologists want to radiate anything they see, while others are better at considering the patient’s overall situation. As Dr. West said, once the cancer has progressed outside the chest, radiating it wherever it currently appears can be an exercise in futility, since that doesn’t address the unseen cancer cells elsewhere. That’s what systemic therapy (chemo) does – it treats the cancer wherever it may be.

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Mar 2010 progression, added Alimta, stable
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Oct 2010 large pericardial effusion, tamponade
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June 11, 2013 at 2:42 am  #1257173    


Thanks Jim for your input.

I do agree with you that with progressive disease the chances of controlling the cancer with focal radiotherapy might be exercise in futility and Chemotherapy might be a better option.I had very bad experience with different chemotherapy agents and spent lot of time in hospital because of severe side effects. Chemotherapy never brought me in to ‘remission’ . In that respect if I know that focal radiotherapy will not cause me that misery I will probably go for it because there is no guarantee how affective chemo will the past it just didn’t work.

I know its difficult to deal with advanced cancer and I am not living in delusion that some magic will come soon.There is no guarantee that one treatment or another will be efficient enough to slow my cancer,but if I have to choose between the two devil, I will prefer the one with less misery.

June 11, 2013 at 10:32 am  #1257180    
catdander forum moderator
catdander forum moderator

Hi Mariya, I don’t want to belabor the topic but I’m sure you’re understanding what Jim and Dr. West are saying. So I suppose I am belaboring the topic. There isn’t a balance in treatment outcomes between radiation and chemo. While there has been significant amounts of research on both in this situation, radiation hasn’t proved to lengthen life while chemo has.

The beauty of radiation in stage IV setting is that it can significantly reduce and often eliminate pain when pain becomes an issue. However there is only so much radiation treatment a body can take so it’s beneficial to keep radiation for times when it is needed for pain relief.

In other words it may be that you will do better to have no treatment than to have radiation treatment for stage IV nsclc to every met that comes up and wait to use radiation for those places that cause pain or blockage.

Here is a link to an in depth discussion on the idea of radiation in stage IV cancer situations.

With sincere hopes,
forum moderator

June 11, 2013 at 9:22 pm  #1257197    
Dr West
Dr West

My real concern is that radiation for a bunch of metastatic but asymtomatic lesions, focal radiation may do nothing more than appease our sense that we’re doing something — it may have no greater effect than just using Adobe Photoshop to erase the lesions from the images and pretend they aren’t there. I don’t know…but I’m concerned that this practice is just driven by our desire to just do things, whether they make sense or not, and the fact that it’s profitable doesn’t hurt. I don’t think this practice would be recommended if it were a loss leader for a cancer center.

-Dr. West

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