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Abstract: We present the results of two retrospective studies, one regarding reirradiation of spinal tumours and the second, concerning lung tumours. In the first case, primary or secondary tumours were located in or in contact with the vertebrae and spinal cord. The first irradiation has given a full dose to the spinal cord. In the second case, primary or secondary lung tumours have already been treated by irradiation alone or by radiochemotherapy. No grade 3 or 4 early toxicity has been found. Preliminary clinical results are encouraging. The use of CyberKnife® represents a major therapeutic advance in the management of irradiated spinal or lung lesions. The possibility of sparing organs at risk and increasing the dose in the tumour target volume are the main advantages. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: CyberKnife® (CK) allows stereotaxic irradiation for thoracic tumor thanks to a tracking system which potential is known for lung tumors. This technique has never been used to treat breast tumors but may have a real potential. Patients and method: In order to define the interest of treating breast tumors with CK, we have conducted a phase I study with a dose escalation, adding CK to neoadjuvant chemotherapy in view of allowing conservative treatment for patients that will not have surgery in first intent. Neoadjuvant chemotherapy includes six cures, including three of docetaxel and three of FEC. CK treatment is made during the second cure of chemotherapy. Two dose levels are delivered in three fractions: 19.5 and 22.5Gy. Surgery is performed six to eight weeks after the last cure. The primary objective is to define tolerance of stereotactic irradiation concomitant with neoadjuvant chemotherapy for breast tumors. Skin toxicity is the limiting criterion of the study. The secondary objectives are both histological response and quality of surgery. Here, we are presenting the preliminary results of the 2-dose level. This study participates in the French national grant called Programme hospitalier de recherche clinique (PHRC). Results: No skin toxicity of grade I or more have been find. Surgery was performed as conventional and there was no complication. Pathology exams found one complete response, one lymphangitis and one partial response. Conclusion: These preliminary results seem to be promising but need to be confirmed. We carry on the dose escalation study. [Copyright &y& Elsevier]

Abstract: In 2006, 3 sites have been selected by the Institut national of cancer (Lille, Nancy et Nice) to evaluate a radiotherapy robot, the CyberKnife®. This machine, able to track mobile tumours in real time, gives new possibilities in the field of extra cranial stereotactic radiotherapy. Functionalities and medico economical issues of the machine will be evaluated during 2 years on the 3 sites. [Copyright &y& Elsevier]

Abstract: Pituitary adenomas represent 10 to 20% of all primary brain tumours. The main classifications consider their size, micro- and macroadenomas, and their properties, secreting or non-functioning. These characteristics determine the choice of treatment, surgery and medical therapy on first line in many cases. Conventional radiotherapy, whose efficiency has been demonstrated, is indicated in the post-operative setting for lesions at high risk of relapse, recurrences, contra-indications to surgery and intolerance or resistance to medical therapies. Optimal target volume delineation is critical, owing to the proximity of organs at risk and a risk of late toxicity for these patients who have normal life expectancy. Technological, computering and imaging advances have led to conformal radiotherapy, intensity-modulated treatment and stereotaxy. These new techniques are reviewed through a recent literature search. Local control rates are high, although follow-up is still short. Indications for radiosurgery are restricted by the size of the lesions. Fractionated stereotactic radiotherapy potentially reduces late toxicity, but longer follow-up is necessary. [Copyright &y& Elsevier]

Abstract: Purpose: Stereotactic radiotherapy using the CyberKnife® has become a key treatment in the multidisciplinary management of secondary tumours, as well as primary benign or malignant tumours located within or adjacent to vertebral bodies and the spinal cord. The aim of this treatment is to improve local control and clinical response, including previously irradiated cases. Patients and methods: In this study, we present the first patients treated with CyberKnife® between December 2006 and December 2007 for spinal or paraspinal tumours. The primary aim was to assess the feasibility and tolerance of stereotactic radiotherapy using the CyberKnife®. Secondary aims were to establish the short-term local control, to calculate the local progression-free survival and overall survival. Clinical examination and imaging procedures were performed every three months. Response was assessed according to RECIST criteria. Results: During that period, 16 patients were treated with CyberKnife®. Thirteen patients had been pre-treated, three of whom had received spinal cord doses considered to be maximal. Three patients did not receive previous irradiation. The median age was 59 (36–74). The most frequent symptoms were pain (n = 8) and motor weakness (n = 4). The median dose was 30 Gy (16–50). The median number of fractions was 3 (1–5). No patient developed acute myelitis. Three patients developed acute reaction. Overall survival at 18 months was 72.4%, with a mean survival of 18.2 months (95% CI: 15.4–20.9). Local progression-free survival at 18 months was 58.4%, with a mean value of 16.9 months (95% CI: 13.6–20.2). Conclusion: The use of stereotactic radiotherapy with CyberKnife® represents a major progress in the management of paraspinal tumours. The main advantages are better sparing of the spinal cord and the possibility of increasing the dose to the tumour target volume. [Copyright &y& Elsevier]

Abstract: Purpose: High-dose robotic stereotactic irradiation can be achieved with high precision using the Cyberknife®M system equipped with the Synchrony® respiratory tracking device. Cyberknife® irradiation can overcome some limitations of conventional radiotherapy including errors due to breathing motion and patient setup. High dose levels are of interest for tumours that have shown a dose-response relationship including lung tumours. We reviewed the treatments and outcomes for the first French patients with lung tumours treated at the Cyberknife® centre of Nice. Patients and methods: Thirty four patients were treated between November 2006 and November 2007 at the Cyberknife® centre of Nice, Centre Lacassagne, France. Thirty had untreated primary lung cancer, 4 had colorectal metastasis to the lung. We evaluated the feasibility and reliability of fiducial placement, toxicity and early outcomes. Objective tumour response was assessed on thoracic CT scan every three months. Results: There was no grade 3–4 toxicity. Toxicity (11%) mainly consisted of grade 1–2 asthenia. Crude overall tumour response rate was 96% for all assessable patients and 91% at 3 and 6 months, respectively. The use of one fiducial ensured minimal toxicity (no grade III pneumothorax) while allowing reliable tumour tracking as shown by the low infield failure rate (no geographic miss). Diagnostic procedure was performed during fiducial placement when required. Conclusion: Early toxicity and tumour control rates from this population suggest that the use of a unique fiducial for a Cyberknife treatment was safe and effective for the treatment of selected primary and secondary lung tumours. This strategy is corroborated by similar control rates in the literature. Longer follow-up are awaited. [Copyright &y& Elsevier]