How quickly will I be allowed to have radiotherapy?

As soon as possible, of course. Once the doctor has defined the type and aim of the necessary radiotherapy and the patient is registered, every effort will be made to start the therapy programme within 5 working days. We do not have long waiting lists.

How long does each radiation session take and how often will I need to come to the clinic?

There is no general answer to this question. The treatment programme depends on the type of tumour, its location and size. Radiotherapy designed to destroy the tumour or prevent its regrowing after an operation will normally take place over 4 to 6 weeks, usually on a daily basis, whereby the irradiation only targets the tumour for 1 to 2 minutes per treatment. Precisely positioning the patient and setting up the linear accelerator takes up the most time. Generally, a visit to the institute for a “normal” radiotherapy session takes 15 to 20 minutes per day.

Who makes sure that I receive the correct dose?

The highly qualified staff at the Institute for Radiotherapy. The procedures are clearly defined and the equipment is tested every day before the first patient receives treatment. All new therapy plans are presented daily at the joint institute meeting and examined carefully by all the staff involved. An individual radiation plan is prepared for each patient before the radiotherapy treatment begins. The doctor defines where the treatment will take place (radiation volume), the dose (total dose) and the number of individual sessions (single doses) to be administered. A suitable plan is then calculated by the planning team and checked by physicists and doctors. This inspection must be confirmed in the patient records (electronic medical records). If this is not done, the radiotherapy cannot be carried out. The exact radiation parameters are then transferred electronically to the linear accelerator. At the time of the first treatment, the patient will again be checked by the MTRAs, the physicist and the doctor and the plan will be signed off on. No treatment will take place without confirmation that everything is correct. It is also impossible for treatment to be carried out in excess of the total dose originally defined by the doctor.

What can be treated with radiotherapy?

In technical terms, any tumour in any part of the body can be treated with radiotherapy. In theory every tumour can be sterilised with a sufficiently high dose of radiotherapy. There are, however, limits which must not be exceeded in order to avoid serious, life threatening side effects. These limits are defined by the tolerance of the healthy tissue which is also subjected to the radiotherapy. Before an organism is subjected to ionising radiation, a clear risk-benefit analysis is required. Therapy should only be started if the benefits clearly outweigh the risks. An unequivocal indication, discussed on an interdisciplinary basis, is therefore compulsory before the start of radiotherapy treatment. It is also possible that additional staging examinations may be carried out before a final decision is made.

What about the side effects?

Every type of therapy causes side effects. Radiotherapy is, however, renowned and feared for its serious side effects. Everyone knows someone who has suffered during and, above all, after radiotherapy. Nevertheless, modern radiotherapy exceeds its reputation. Great progress has been made in the reduction of side-effects, thanks to more precise irradiation techniques, better protection of high-risk organs and more intensive care during and after therapy. The type of skin burns that often resulted from therapy are hardly ever experienced now. On the other hand, the often aggressive toxic therapies (for example with combined, simultaneous chemotherapy) may intensify the side effects. Moreover, the reaction of skin and mucous membranes to the radiotherapy depends on the individual and cannot be estimated before the start of therapy. Regular monitoring by a specialist is therefore extremely important both during and immediately after radiotherapy.

Can radiotherapy still help even if there’s no chance of a cure?

Radiotherapy also plays an important role in palliative therapy. In this instance, it is not used to destroy the patient’s tumour, but rather to alleviate symptoms (such as pain) and to improve the patient’s quality of life. Particularly for pain caused by bone metastases, radiotherapy can provide complete relief or at least alleviate it relatively quickly and with long-lasting effects (often until death). Radiotherapy is also important in the treatment of brain metastases.

To what extent will the treatment be covered by my general health insurance policy?

Radiotherapy is a recognised therapy and will be covered as a standard benefit by all health insurance companies. The costs of outpatient radiotherapy treatment (around 90% of cases) will therefore be covered, less any excess, even when no additional insurance exists. 

When are the linear accelerator and the CyberKnife systems used?

With the linear accelerator, basically all tumours can be treated regardless of their size. The linear accelerator can only move at one level around the body. So several treatment sessions are necessary in order to avoid damage to the skin and surrounding tissues. The CyberKnife system is used primarily to treat small, clearly defined tumours, or those in areas of the body which are difficult to access. The swivelling arm also allows tumours to be irradiated from different directions. The equipment is also used for tumours which are within or close to delicate structures, or which move in conjunction with respiratory movements.

Have these types of technology been in use for a long time?

Radiosurgery has been recognised as a medical method of treatment since 1968. The CyberKnife system is a subsequent development within radiosurgery; it was first used in 1990 and has been continually improved since then. Around 40,000 patients have already been treated all over the world using this technology.

What is the difference between the CyberKnife system and other radiosurgical systems?

For a long time, radiosurgery was limited to the treatment of brain tumours. For this procedure, the patient’s head had to be fixed in a stiff frame in order to prevent any movement during the treatment. This was the only way to apply high doses irradiation to the tumour tissue, while ensuring the healthy, delicate surrounding tissue remained unaffected. Frames are not only uncomfortable for the patient, they also limit the number of angles from which the tumour can be irradiated. The CyberKnife system is the first and only intelligent, robot-controlled, radiosurgical system which, through the combination of image location and computer-controlled robotics, is able to register, follow and compensate for patient movement during the entire treatment. The system is able to accurately target all parts of the body and to irradiate with extreme precision, with deviations of less than one millimetre. This is why it is particularly suitable for the treatment of tumours in and close to the head, in the spine, the lungs, the prostate, pancreas, liver and kidneys. Thanks to the high precision of the CyberKnife system, the use of a head or body frame is not necessary.

What is the procedure for a CyberKnife treatment and how long does it take? How often do I have to be treated?

Prior to treatment, the position of the tumour tissue is defined using imaging techniques (e.g. computed tomography) and the resulting data is used to plan the precision irradiation. The actual radiosurgical therapy lasts between 30 to 90 minutes. The radiotherapy can – as mentioned – take place in one session or be divided up into a maximum of 5 sessions. A control examination is carried out after 4 to 6 months.

What are the advantages of the CyberKnife treatment?

  • With the CyberKnife system, patients can be treated for tumours which were previously inoperable. Patients who do not wish to undergo a surgical procedure can also benefit from this new treatment option.
  • The radiotherapy is a fully automated process. Movements of the tumour and patient are continually detected and compensated.
  • With the CyberKnife system, a high irradiation dose can be applied with a previously unachievable level of precision, with deviations of less than one millimetre. This way, the healthy tissue is optimally protected.
  • Treatment with the CyberKnife system is painless and carried out without anaesthetic. The risks involved in traditional surgery, such as infections, bleeding or mechanical destruction of sensitive structures, are eliminated.
  • The CyberKnife treatment takes place on an outpatient basis. A stay at the clinic is not required and a recovery period is not necessary. Patients are able to return to normal, everyday life immediately after the treatment.
  • As the use of a body frame is not necessary, the associated discomfort is avoided, making the CyberKnife treatment relatively comfortable compared to normal radiosurgery.
  • The treatment may take place in one session or, depending on the medical indication, be divided up into a maximum of 5 sessions.