Radiation Therapy: Intensity-Modulated Radiotherapy, Cyberknife, Gamma Knife, and Proton Beam

  • Lei Ren
  • Samuel Ryu
Reference work entry


Radiosurgery is a medical procedure of accurate targeting of a well-defined volume with radiation. It requires a decision-making based on the patient’s clinical presentation, medical status, and imaging studies. Practically, radiosurgery requires reliable patient positioning and immobilization, stereotactic target tumor localization, computerized radiation planning and calculation, and delivery of the designed radiation with rapid dose falloff outside the target. Recent advances of computer science, radiation delivery technology, and image guidance made it possible to apply the radiosurgery to the extracranial body sites as well as brain. The technology has been evolving rapidly. In this entry, the currently available radiosurgery equipments are described. It is helpful for the practitioners to understand the different design of the technology for radiosurgery for a better clinical application.


Proton Beam Bragg Peak High Radiation Dose Gamma Knife Proton Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hof H, et al. Stereotactic single-dose radiotherapy of stage I non-small-cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 2003;56:335–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Lee SW, et al. Stereotactic body frame based fractionated radiosurgery on consecutive days for primary or metastatic tumors in the lung. Lung Cancer. 2003;40:309–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Schweikard A, et al. Robotic motion compensation for respiratory movement during radiosurgery. Comput Aided Surg. 2000;5:263–77.CrossRefPubMedGoogle Scholar
  4. 4.
    Shell M, et al. AAPM Report No. 54, Stereotactic Radiosurgery: Report of AAPM Task Group 42. 1995.Google Scholar
  5. 5.
    Jordan TJ, Williams PC. The design and performance characteristics of a multileaf collimator. Phys Med Biol. 1994;39:231–51.CrossRefPubMedGoogle Scholar
  6. 6.
    Boyer AL, et al. Clinical dosimetry for implementation of a multileaf collimator. Med Phys. 1992;19:1255–61.CrossRefPubMedGoogle Scholar
  7. 7.
    Bel A, et al. Target margins for random geometrical treatment uncertainties in conformal radiotherapy. Med Phys. 1996;23:1537–45.CrossRefPubMedGoogle Scholar
  8. 8.
    Ling CC, et al. Conformal radiation treatment of prostate cancer using inversely-planned intensity-modulated photon beams produced with dynamic multileaf collimation. Int J Radiat Oncol Biol Phys. 1996;35:721–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Purdy JA. 3D treatment planning and intensity-modulated radiation therapy. Oncology (Williston Park). 1999;13:155–68.Google Scholar
  10. 10.
    Bortfeld T. Optimizing planning using physical objectives and constraints. Sem Radiat Oncol. 1999;9:15.CrossRefGoogle Scholar
  11. 11.
    Llacer J. Inverse radiation treatment planning using the dynamically penalized likelihood method. Med Phys. 1997;24:1751–64.CrossRefPubMedGoogle Scholar
  12. 12.
    Hilbig M, et al. IMRT-Inverse planning based on linear programming. Z Medizinische Physik. 2002;12:8.Google Scholar
  13. 13.
    The BS, et al. Intensity modulated radiation therapy (IMRT): a new promising technology in radiation oncology. Oncologist. 1999;4:433–42.Google Scholar
  14. 14.
    Grant W. Commissioning and quality assurance of an IMRT system. Madison: Advanced Medical Publishing; 1997.Google Scholar
  15. 15.
    Low DA, et al. Phantoms for IMRT dose distribution measurement and treatment verification. Int J Radiat Oncol Biol Phys. 1998;40:1231–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Nevinny-Stickel M, et al. Reproducibility of patient positioning for fractionated extracranial stereotactic radiotherapy using a double-vacuum technique. Strahlenther Onkol. 2004;180:117–22.CrossRefPubMedGoogle Scholar
  17. 17.
    Fuss M, et al. Repositioning accuracy of a commercially available double-vacuum whole body immobilization system for stereotactic body radiation therapy. Technol Cancer Res Treat. 2004;3:59–67.CrossRefPubMedGoogle Scholar
  18. 18.
    Lindquist C. Gamma knife radiosurgery. Semin Radiat Oncol. 1995;5:197–202.CrossRefPubMedGoogle Scholar
  19. 19.
    Van Dyk J. The modern technology of radiation oncology: a compendium for medical physicists and radiation oncologists. Medical Physics Publishing; 2005.Google Scholar
  20. 20.
    Leksell L, et al. A new fixation device for the Leksell stereotaxic system. Technical note. J Neurosurg. 1987;66:626–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Adler Jr JR, et al. The Cyberknife: a frameless robotic system for radiosurgery. Stereotact Funct Neurosurg. 1997;69:124–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Webb S. Conformal intensity-modulated radiotherapy (IMRT) delivered by robotic linac–conformality versus efficiency of dose delivery. Phys Med Biol. 2000;45:1715–30.CrossRefPubMedGoogle Scholar
  23. 23.
    Degen JW, et al. CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life. J Neurosurg Spine. 2005;2:540–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Gerszten PC, et al. CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine. Neurosurg Focus. 2003;14:e16.CrossRefPubMedGoogle Scholar
  25. 25.
    Winston KR, Lutz W. Linear accelerator as a neurosurgical tool for stereotactic radiosurgery. Neurosurgery. 1988;22:454–64.CrossRefPubMedGoogle Scholar
  26. 26.
    Yin FF, et al. A technique of intensity-modulated radiosurgery (IMRS) for spinal tumors. Med Phys. 2002;29:2815–22.CrossRefPubMedGoogle Scholar
  27. 27.
    Schweikard A, et al. Planning for camera-guided robotic radiosurgery. IEEE Trans Robot Autom. 1998;14:12.CrossRefGoogle Scholar
  28. 28.
    Wang LT, et al. Infrared patient positioning for stereotactic radiosurgery of extracranial tumors. Comput Biol Med. 2001;31:101–11.CrossRefPubMedGoogle Scholar
  29. 29.
    Ryu S, et al. Image-guided and intensity-modulated radiosurgery for patients with spinal metastasis. Cancer. 2003;97:2013–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Jaffray DA, et al. Flat-panel cone-beam computed tomography for image-guided radiation therapy. Int J Radiat Oncol Biol Phys. 2002;53:1337–49.CrossRefPubMedGoogle Scholar
  31. 31.
    Penny GP, et al. A comparison of similarity measures for use in 2D-3D medical image registration. IEEE Trans Med Img. 1998;17:10.CrossRefGoogle Scholar
  32. 32.
    Lam KL, et al. Automated determination of patient setup errors in radiation therapy using spherical radio-opaque markers. Med Phys. 1993;20:1145–52.CrossRefPubMedGoogle Scholar
  33. 33.
    Takeuchi H, et al. Frameless stereotactic radiosurgery with mobile CT, mask immobilization and micro-multileaf collimators. Minim Invasive Neurosurg. 2003;46:82–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Mackie TR, et al. Tomotherapy. Semin Radiat Oncol. 1999;9:108–17.CrossRefPubMedGoogle Scholar
  35. 35.
    Salter BJ, et al. An oblique arc capable patient positioning system for sequential tomotherapy. Med Phys. 2001;28:2475–88.CrossRefPubMedGoogle Scholar
  36. 36.
    Harsh G, et al. Stereotactic proton radiosurgery. Neurosurg Clin N Am. 1999;10:243–56.PubMedGoogle Scholar
  37. 37.
    Chen CC, et al. Proton radiosurgery in neurosurgery. Neurosurg Focus. 2007;23:E5.PubMedGoogle Scholar
  38. 38.
    Garcia-Barros M, Kolesnick R, Fuks Z, et al. Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science. 2003;300:1155–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Hallahan DE, Haimovitz A, Kufe DW, et al. The role of cytokines in radiation oncology. Important Adv Oncol. 1993:71–81.Google Scholar
  40. 40.
    Gorski DH, Beckett NT, Jaskowiak DP, et al. Blockade of vascular endothelial growth factor stress response increases the antitumor effects of ionizing radiation. Cancer Res. 1999;59:3374–8.PubMedGoogle Scholar
  41. 41.
    Dalton TP, Shertzer HG, Puge A. Regulation of gene expression by reactive oxygen. Annu Rev Pharmacol Toxicol. 1999;39:67–101.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Radiation OncologyDuke UniversityDurhamUSA
  2. 2.Department of Radiation Oncology and NeurosurgeryHenry Ford HospitalDetroitUSA

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