title: Experience of CyberKnife Robotic Radiosurgery in treating intra and extra-cranial tumours: A review of outcomes.
abstract: OBJECTIVE
  To determine the success rate and complication of CyberKnife Robotic Radiosurgery for treating intracranial and extra cranial tumours.
  
  
  METHODS
  The cross-sectional observational study was carried out at the Department of CyberKnife Robotic Radiosurgery at the Jinnah Postgraduate Medical Centre, Karachi, and reviewed data related to a year from December 2012 to December 2013. Patients referred from different hospitals within and outside Pakistan for stereotactic radiosurgery were included. The patients had benign tumours less than 7cm size, post-operative residual tumour and recurrent tumour with post-radiotherapy. Patients were followed up every three months with contrast magnetic resonance imaging. Radiosurgery was considered successful if patients improved clinically with radiologically stable disease or if there was interval reduction in the size of tumour. SPSS 17 was used for data analysis.
  
  
  RESULTS
  Initially, 260 patients were selected, but 9(3.5%) were lost, and the final sample size was 251(96.5%). Clinically successful outcome results were seen in 225(90%) patients, while 8(3%) showed no change in symptoms and 18(7%) patients' follow-up is awaited. Radiological improvement was noted in 218(87%); stable disease in 138(55%) and 80(32%) cases showed more than 30% reduction in size after 6-12 months of follow-up. Only 5(2%) cases showed subtle increase in size within 3-month interval due to post-radiation oedema. Acute transient post-radiation changes were seen in 25(10%) patients, sub-acute changes in 4(1.59%) and 1(0.3%) patient showed radionecrosis after 9-month interval.
  
  
  CONCLUSIONS
  Cyberknife was an effective, safe and successful treatment alternative to surgery in benign and malignant tumours with low risk of post-radiotherapy complication compared to conventional radiation.
authors.affiliation: Department of Radiology, CyberKnife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Nausheen
authors.affiliation: Department of Radiology, CyberKnife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Naveed
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Department of Radiology, CyberKnife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Aneeta Ghulam
authors.initials: AG
authors.lastname: Muhammad
authors.affiliation: Department of Radiology, CyberKnife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Kamran
authors.initials: K
authors.lastname: Saeed
authors.affiliation: Department of Radiology, CyberKnife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Tariq
authors.initials: T
authors.lastname: Mahmood
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010154:Pakistan; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012371:Robotics / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: CyberKnife Robotic Radiosurgery, tumours, Karachi.