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  • Radiociruga CyberKnife : Nuestra Experiencia

    CHRISTUS MUGUERZA Hospital Alta Especialidad, Monterrey, Mxico. Primer equipo operativo en Latinoamerica, Octubre 2011.

  • HOSPITAL CMAE Pertenece al sistema Interncional de Salud Christus Health con

    base en Dallas, Texas.

    Es el hospital de Alta Especialidad de Chrisuts-Mexico, el cual cuenta con 6 Hospitales, con base en Monterrey, Mexico.

    Equipado con 3 Aceleradores Lineales:

    SYNERGY con plataforma IGRT-IMRT-VMAT

    COMPAQ con plataforma IMRT

    CYBERKNIFE con plataforma de RCX INTRACRANEAL y SBRT

  • Radiociruga CyberKnife : Nuestra Experiencia

    807 lesiones tratadas 431 pacientes tratados

    57% Masculino 43% Femenino

    Edad promedio: 55 aos (4-85 aos)

  • Radiociruga CyberKnife : Nuestra Experiencia

    Total lesiones: 807 Craneales: 61%

    Extracraneal: 39%

    61%

    11%

    10%

    5%

    4%

    3%

    3%

    2%

    1%

    1%

    0% 10% 20% 30% 40% 50% 60% 70%

    Craneal

    Trax (Pulmn, corazn, adenopatas)

    Columna (sea,intramedular)

    Hgado

    Prstata

    Cabeza y Cuello

    Abdomen

    Pelvis (Adenopatas, seas)

    Pncreas

    Extremidades

    Lesiones tratadas con CyberKnife por localizacin

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones en Crneo: 490

    Funcional:

    Neuralga del Trgemino

    Total: 4 pacientes

    Dosis: 60-70 Gy

    1 Fraccin

    Primarias 32%

    Metstasis 67%

    Funcional 1%

    LESIONES EN CRANEO TRATADAS CON CYBERKNIFE

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones Primarias de SNC Total: 159 lesiones

    Dosis: 12-40 Gy

    Promedio 21 Gy

    1-5 fracciones

    35% 9%

    9%

    9%

    9%

    4%

    4%

    3%

    3%

    3%

    2%

    2%

    2%

    6%

    0% 5% 10% 15% 20% 25% 30% 35% 40%

    Meningioma

    Neurinoma Acustico

    Glioblastoma

    Glioma

    Adenoma Hipofisis

    Astrocitoma

    MAVS

    Ependimoma

    Angioma Cavernoso

    Shwannoma

    Hemangioblastoma

    Glomus

    Meduloblastoma

    Otros

    Lesiones primarias de SNC tratadas con CyberKnife

  • Radiociruga CyberKnife : Nuestra Experiencia

    Metstasis cerebrales Total: 327 lesiones

    Dosis: 12-30 Gy

    Promedio 24 Gy

    1-5 fracciones

    31% 19%

    11%

    10%

    9%

    6%

    3%

    3%

    2%

    2%

    1%

    1%

    1%

    2%

    0% 5% 10% 15% 20% 25% 30% 35%

    Pulmn

    Mama

    Rion

    Melanoma

    Cabeza y Cuello

    Vejiga

    Colon

    Gastro-Esofgico

    Ovario

    Prstata

    Rabdomiosarcoma

    T. Cel. Germinales

    Sarcoma

    Otros

    Lesiones metastsicas cerebro tratadas con CyberKnife

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones en cabeza y cuello: 27 Adenopatas

    Dosis: 21-30 Gy

    Promedio: 25 Gy

    3-5 fraccin

    19%

    15%

    15%

    11%

    11%

    7%

    7%

    4%

    4%

    4%

    4%

    0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%

    Lengua

    Mama

    Pulmn

    G. Salival

    Esfago

    Primario Desconocido

    Tiroides

    Neurinoma

    Melanoma

    Paraganglioma

    Sarcoma

    Lesiones de cabeza y cuello tratadas con CyberKnife

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones Pulmn: 72 Dosis: 45-60 Gy

    Promedio 50Gy

    3-5 fracciones

    38%

    25%

    10%

    6%

    6%

    4%

    4%

    3%

    1%

    1%

    1%

    1%

    0% 5% 10% 15% 20% 25% 30% 35% 40%

    Primario

    Colon

    CYC

    Mama

    Sarcoma

    Gastrico

    Recto

    Ovario

    Cervico-Uterino

    Rion

    Linfoma

    Melanoma

    Lesiones en pulmn tratadas con CyberKnife

  • Radiociruga CyberKnife : Nuestra Experiencia

    Corazn: 3

    Fibrilacin Auricular 2

    Taquicardia Ventricular 1

    Dosis: 25 Gy

    1 fraccin

  • RADIOABLACION DE FIBRILACION AURICULAR CON RCX

    Protocolo aprobado por el Comit de tica e Investigacin del HCMAE

    Protocolo aprobado por Cofepris

    Ablacin de tejido cardiaco en la entrada de las venas pulmonares a la aurcula izquierda

    Mltiples estudios in vitro e in vivo con animales en USA

    Estudio Fase I

    Febrero 2016

    25 Gys en 1 fraccin.

    Presentacin en poster oral, ASTRO 2016.

  • First-in-Man Cardiac Radiosurgery for Atrial Arrhythmia C de la Pena, P Maguire, M Hinojosa, C Cardona, E Gardner, P Zei D Wong, J Assad, J Azpiri, E Monroy

    METHODS

    ABSTRACT

    Atrial Fibrillation (AF) is a growing healthcare problem that is underserved

    by current medications and catheter ablation.

    Cardiac Radiosurgery procedures and protocols have been developed to

    ablate areas of the left atrium that can block aberrant electrical signals

    and restore normal sinus rhythm.

    In this first-in-man study, a patient with atrial fibrillation is treated by

    isolation of the pulmonary veins non-invasively with radiosurgery, to treat

    his arrhythmia.

    RESULTS

    There were no adverse events. The patient returned to sinus rhythm within the

    first months post treatment. He is asymptomatic. Patient enrollment continues.

    .

    Following appropriate Informed Consent and with regulatory and Ethics approval,

    a patient with refractory atrial fibrillation was treated.

    A 6.5 Fr atrial fiducial marker was percutaneously placed in the atrial septum

    under fluoroscopic guidance. Cardiac-gated CT scan was used with proprietary

    CardioPlan software to allow the electrophysiologist to contour the desired

    ablation volumes.

    The contours were transferred to MultiPlan and a safe treatment plan (25 Gy)

    was constructed to accomplish ablation goals. The atrial ablation volume was 2.1

    cm. Late gadolinium enhancement demonstrated left atrial scar corresponding

    to placement of the ablation contours.

    Footer or Copyright Information

    The objectives of the study were to establish that a radiosurgically safe treatment

    plan could be generated that accomplished appropriate electrophysiology goals,

    and that respected published tolerances for organs at risk in the chest.

    OBJECTIVES

    CONCLUSIONS REFERENCES Sharma, A, et al. Noninvasive stereotactic radiosurgery (CyberHeart) for creation of ablation lesions. Heart Rhythm. 2010 Jun;7(6):802-10.

    Monroy, E et al. Late Gadolinium Enhancement CMRI post radiosurgical Pulmonary Vein Isolation (RRPVI.) Cureus 8(8): e738. doi:10.7759/cureus.738.

    LOGO

    Cardiac Radiosurgery is feasible, and can be used to ablate cardiac tissue in a noninvasive fashion, to

    accomplish cardiology goals of blocking arrhythmia propagation.

    This first-in-man procedure was accomplished successfully and led to the patient having decreased atrial

    arrhythmia without adverse events. A larger pivotal trial is planned.

    Printed by

  • RADIOABLACION DE FIBRILACION AURICULAR Y VENTRICULAR

    No efectos adversos, en los pacientes tratados por arritmia auricular.

    El primer paciente regreso a ritmo sinusal durante seis meses y ha requerido menor medicacin para el control de su arritmia, Marzo de 2016.

    Segundo paciente en ritmo sinusal, Febrero de 2017.

    Se encuentran bajo control y seguimiento cardiolgico.

    Paciente de Taquicardia Ventricular realizado en octubre de 2017.

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones Hepticas: 37 Dosis: 21-45 Gy

    Promedio 36 Gy

    3 fracciones

    30%

    19%

    16%

    16%

    11%

    8%

    0% 5% 10% 15% 20% 25% 30% 35%

    Coln

    Recto

    Mama

    Gastrointestinal

    Primario

    Otros

    Lesiones hepticas tratadas con CyberKnife

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones Pncreas: 8 Lesiones primarias

    Dosis: 24-30 Gy

    Promedio 24 Gy

    3 y 5 fracciones

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones Pelvis: 17 Adenopatas / lesiones seas

    Dosis: 18-30 Gy

    Promedio 27 Gy

    3 y 5 fracciones

    29%

    18%

    18%

    12%

    12%

    6%

    6%

    0% 5% 10% 15% 20% 25% 30% 35%

    Cervico-Uterino

    Mama

    Ovario

    Pulmn

    Prostata

    Colon

    Rion

    Lesiones metastsicas en pelvis tratadas con CyberKnife

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones Prstata: 33 Dosis: 35-37 Gy

    Promedio 36 Gy

    5 fracciones

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones Columna: 77 Metstasis: 84%

    Dosis: 11- 30 Gy

    Promedio 24 Gy

    Fracciones 1-3

    26%

    15%

    15%

    8%

    6%

    6%

    6%

    5%

    5%

    3%

    3%

    2%

    0% 5% 10% 15% 20% 25% 30%

    Rin

    Pulmn

    Prostata

    Adenocarcinoma

    Mama

    Melanoma

    Ovario

    Cervico-Uterino

    Linfoepitelioma

    Ovario

    Tiroides

    Pancreas

    Lesiones metastsicas en columna tratadas con CyberKnife

  • Radiociruga CyberKnife : Nuestra Experiencia

    Lesiones Columna: 77 Primarias: 16%

    Dosis: 15-37.5 Gy

    Promedio 24 Gy

    Fracciones 1-