Adler et al. developed an Image-guided frameless radiosurgery system in 1992. The CyberKnife is a X-band linear accelerator mounted on a robot, and is used for stereotactic irradiation. The CyberKnife is equipped with two fluoroscopic cameras, which constitute the Image Processing System (IPS). The patient's location can be determined precisely by comparing the digitally reconstructed radiograms (DRR), prepared from CT scans, with the real-time fluoroscope images. According to the information of the patient's location, the robot chases the moving patient. Therefore, patients can be treated without an invasive frame. 
  In April 1998, a CyberKnife was installed at the Osaka University Hospital. We make it a rule at our hospital to perform a practice irradiation on the phantom before performing irradiation on each patient. The median total targeting error was 0.7 mm. 
From April 1998 to December 2000, 43 sites in 28 patients with metastatic brain tumors were treated. There were 19 males and 9 females with a median age of 62 years ranged from 50 to 73. During these periods we carefully performed a dose escalation study. We adopted the single session of 9-20 Gy for group A, 24-25 Gy for group B and 27-30 Gy for group C as a standard dose for stereotactic radiosurgery. 
There were 9 PR, one NC and 5 PD for group A, 3 CR, 7 PR, 2 NC for group B and 9 CR, 4 PR, 2 NC and one PD for group C. The median survival time was 4 months in group A, while it was 10 months for groups B and C. Dose escalation study using CyberKnife was feasible and effective for stereotactic radiosurgery for metastatic brain tumors. 
  From December 1998 to December 2000, 18 patients with head and neck tumors of 19 lesions were treated using CyberKnife. There were 12 males and 6 females with a median age of 60 years ranged from 18 to 81. Primary sites were 7 nasopharynx, 5 oropharynx, 3 intraoral cavity, 2 maxillary sinus, and one middle ear. Most patients underwent 15 Gy/3 fractions for boost therapy to previously untreated lesions and 39 Gy/3 fractions for re-irradiation for recurrent lesions. One-year progression free survival rates was 72%. There were no adverse effects so far. 
  The real time tracking system for CyberKnife has been realized with AccuTRack system using LED on the body surface and amorphous silicone detector system for metal marker inserted into the tissue in the vicinity of the tumor. This enables us to treat lung tumors that move with respiration. Tumors in the lower spine, pancreas, and lung have been treated with CyberKnife in the USA.
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