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CyberKnife Prostate Clinical Trial |
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Prostate HDR Brachytherapy versus Prostate CyberKnife: Practical Comparison
Donald B. Fuller, M.D., April 17, 2008
Prostate Abstract Summary
| Comparison |
HDR Brachytherapy |
CyberKnife |
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DOSE DELIVERY |
Radiobiological Power (Hypofractionation)
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Yes |
Yes |
May deliver identical radiation fractionation
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Yes |
Yes |
Dose molding matches cancer distribution
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Yes |
Yes |
Spares urethra from high dose\
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Yes |
Yes |
Able to curve dose around rectum
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Yes |
Yes |
Can modulate dose to spare nerves
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Yes |
Yes |
Typical Accuracy
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+/- 1 mm* |
+/- 1 mm** |
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| SPECIFIC PROCEDURAL ASPECTS |
Hospitalization
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Yes |
No |
Invasive
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Yes |
No |
Operating Room
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Yes |
No |
Pain Management
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Yes |
No |
Follow-up protocol after completion
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Comparable |
Comparable |
Pubic bones block HDR catheter placement
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Occasional |
Not a factor |
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| SIDE EFFECTS |
Organs affected
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Primarily urological |
Primarily urological |
Typical magnitude
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Mild to moderate |
Mild to moderate |
Erectile Preservation
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Favorable |
Favorable |
Complications
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Rare |
Rare |
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| OUTCOME ASSESSMENT |
PSA Response Year One
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Appears identical |
Appears identical |
PSA Response Intermediate-term (2-3 yr)
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Appears identical |
Appears identical |
PSA Response Long-term (>= 5 years)
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Durable |
Not defined yet |
* Potential source of error > 1 mm – HDR delivery catheter migration; prostate swelling
** Potential source of error > 1 mm – Prostate rotation and deformation
Summary: The radiation dose molding and delivery accuracy properties of HDR brachytherapy and CyberKnife radiosurgery are extremely similar. CyberKnife is more patient friendly in the short run. HDR brachytherapy has long-term documentation of durable efficacy, which CyberKnife presently lacks, due to the newness of the technology. Because of the capability of CyberKnife to effectively “clone” HDR brachytherapy radiation dose distribution and fractionation, there is an expectation that it will produce an identical long-term efficacy result compared with HDR brachytherapy, when used in comparably selected patients, pending confirmation by clinical trials.
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Written by Donald B. Fuller, M.D. – Radiation Oncologist
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