CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and Outcomes
Pediatric cancers, while rare, pose unique challenges due to the heightened sensitivity of developing tissues and the increased risk of long-term radiation-induced effects. Radiotherapy (RT) is a cornerstone in pediatric oncology, but its application is limited by concerns about toxicity, particular...
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| Format: | Article |
| Language: | English |
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MDPI AG
2025-01-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/32/2/76 |
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| author | Costanza M. Donati Federica Medici Arina A. Zamfir Erika Galietta Silvia Cammelli Milly Buwenge Riccardo Masetti Arcangelo Prete Lidia Strigari Ludovica Forlani Elisa D’Angelo Alessio G. Morganti |
| author_facet | Costanza M. Donati Federica Medici Arina A. Zamfir Erika Galietta Silvia Cammelli Milly Buwenge Riccardo Masetti Arcangelo Prete Lidia Strigari Ludovica Forlani Elisa D’Angelo Alessio G. Morganti |
| author_sort | Costanza M. Donati |
| collection | DOAJ |
| description | Pediatric cancers, while rare, pose unique challenges due to the heightened sensitivity of developing tissues and the increased risk of long-term radiation-induced effects. Radiotherapy (RT) is a cornerstone in pediatric oncology, but its application is limited by concerns about toxicity, particularly secondary malignancies, growth abnormalities, and cognitive deficits. CyberKnife (CK), an advanced robotic radiosurgery system, has emerged as a promising alternative due to its precision, non-invasiveness, and ability to deliver hypofractionated, high-dose RT while sparing healthy tissues. This narrative review explores the existing evidence on CK application in pediatric patients, synthesizing data from case reports, small series, and larger cohort studies. All the studies analyzed reported cases of tumors located in the skull or in the head and neck region. Findings suggest CK’s potential for effective tumor control with favorable toxicity profiles, especially for complex or inoperable tumors. However, the evidence remains limited, with the majority of studies involving small sample sizes and short follow-up periods. Moreover, concerns about the “dose-bath” effect and limited long-term data on stochastic risks warrant cautious adoption. Compared to Linac-based RT and proton therapy, CK offers unique advantages in reducing session numbers and enhancing patient comfort, while its real-time tracking provides superior accuracy. Despite these advantages, CK is associated with significant limitations, including a higher potential for low-dose scatter (often referred to as the “dose-bath” effect), extended treatment times in some protocols, and high costs requiring specialized expertise for operation. Emerging modalities like π radiotherapy further underscore the need for comparative studies to identify the optimal technique for specific pediatric cases. Notably, proton therapy remains the benchmark for minimizing long-term toxicity, but its cost and availability limit its accessibility. This review emphasizes the need for balanced evaluations of CK and highlights the importance of planning prospective studies and long-term follow-ups to refine its role in pediatric oncology. A recent German initiative to establish a CK registry for pediatric CNS lesions holds significant promise for advancing evidence-based applications and optimizing treatment strategies in this vulnerable population. |
| format | Article |
| id | doaj-art-a4a86a5b34df4a61b74c1c9c385b811d |
| institution | DOAJ |
| issn | 1198-0052 1718-7729 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj-art-a4a86a5b34df4a61b74c1c9c385b811d2025-08-20T03:12:02ZengMDPI AGCurrent Oncology1198-00521718-77292025-01-013227610.3390/curroncol32020076CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and OutcomesCostanza M. Donati0Federica Medici1Arina A. Zamfir2Erika Galietta3Silvia Cammelli4Milly Buwenge5Riccardo Masetti6Arcangelo Prete7Lidia Strigari8Ludovica Forlani9Elisa D’Angelo10Alessio G. Morganti11Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40128 Bologna, ItalyDépartement de Radiothérapie, Gustave Roussy, 94805 Villejuif, FranceRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40128 Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40128 Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40128 Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40100 Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40100 Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40100 Bologna, ItalyDepartment of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40128 Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40100 Bologna, ItalyDepartment of Radiation Oncology, Bellaria Hospital-AUSL Bologna, 40139 Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40128 Bologna, ItalyPediatric cancers, while rare, pose unique challenges due to the heightened sensitivity of developing tissues and the increased risk of long-term radiation-induced effects. Radiotherapy (RT) is a cornerstone in pediatric oncology, but its application is limited by concerns about toxicity, particularly secondary malignancies, growth abnormalities, and cognitive deficits. CyberKnife (CK), an advanced robotic radiosurgery system, has emerged as a promising alternative due to its precision, non-invasiveness, and ability to deliver hypofractionated, high-dose RT while sparing healthy tissues. This narrative review explores the existing evidence on CK application in pediatric patients, synthesizing data from case reports, small series, and larger cohort studies. All the studies analyzed reported cases of tumors located in the skull or in the head and neck region. Findings suggest CK’s potential for effective tumor control with favorable toxicity profiles, especially for complex or inoperable tumors. However, the evidence remains limited, with the majority of studies involving small sample sizes and short follow-up periods. Moreover, concerns about the “dose-bath” effect and limited long-term data on stochastic risks warrant cautious adoption. Compared to Linac-based RT and proton therapy, CK offers unique advantages in reducing session numbers and enhancing patient comfort, while its real-time tracking provides superior accuracy. Despite these advantages, CK is associated with significant limitations, including a higher potential for low-dose scatter (often referred to as the “dose-bath” effect), extended treatment times in some protocols, and high costs requiring specialized expertise for operation. Emerging modalities like π radiotherapy further underscore the need for comparative studies to identify the optimal technique for specific pediatric cases. Notably, proton therapy remains the benchmark for minimizing long-term toxicity, but its cost and availability limit its accessibility. This review emphasizes the need for balanced evaluations of CK and highlights the importance of planning prospective studies and long-term follow-ups to refine its role in pediatric oncology. A recent German initiative to establish a CK registry for pediatric CNS lesions holds significant promise for advancing evidence-based applications and optimizing treatment strategies in this vulnerable population.https://www.mdpi.com/1718-7729/32/2/76literature reviewnarrative reviewrobotic acceleratorCyberKnifepediatricradiotherapy |
| spellingShingle | Costanza M. Donati Federica Medici Arina A. Zamfir Erika Galietta Silvia Cammelli Milly Buwenge Riccardo Masetti Arcangelo Prete Lidia Strigari Ludovica Forlani Elisa D’Angelo Alessio G. Morganti CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and Outcomes Current Oncology literature review narrative review robotic accelerator CyberKnife pediatric radiotherapy |
| title | CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and Outcomes |
| title_full | CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and Outcomes |
| title_fullStr | CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and Outcomes |
| title_full_unstemmed | CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and Outcomes |
| title_short | CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and Outcomes |
| title_sort | cyberknife in pediatric oncology a narrative review of treatment approaches and outcomes |
| topic | literature review narrative review robotic accelerator CyberKnife pediatric radiotherapy |
| url | https://www.mdpi.com/1718-7729/32/2/76 |
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