Welcome to CyberKnife TV. I'm standing in front of the European CyberKnife Center in Munich, right next to the university hospital. Here, we are going to take a look at some medical innovations in the field of tumor treatment. We will show you what these treatments are, and I will be meeting with the physicians on site.

It is a great pleasure to be able to talk to Professor Alexander Muacevic and Dr. Markus Kufeld from the European CyberKnife Centre here in Munich Großhadern. Mr. Muacevic, for those who may not be familiar with the CyberKnife Centre, how would you describe it? Maybe a few words about its history and how it all came about.

CyberKnife Center is a specialized medical center for so-called radiosurgical tumor therapy. What exactly is that? Radiosurgery is a high-precision radiation treatment, usually administered in a single session, to eliminate a tumor. Thus, it can be an alternative to conventional surgery. Some people perceive this technology as something brand new, but we have been doing this since 2005. So it's not really all that new anymore.

Since 2005, we have worked together with the University Hospital Großhadern to establish and further develop this center. In fact, we thrive on the many cooperations we have been able to establish with departments of the University Hospital. Today, we will talk some more about our cooperation with the Department of Ophthalmology.

When it comes to the technology we use, it is basically a combination of computer-assisted digital imaging and a robotic arm – i.e., an advanced industrial robot such as those used in the automotive industry. In fact, if you drive a German car, this particular type of robot was probably used to weld it together. These two technologies, which were previously unrelated to any medical application, have been combined to achieve extreme precision in tackling tumors.

And this is the key to these treatments – they only become possible because of this unrivaled accuracy. We are talking about an accuracy of less than a millimeter. Plus, it allows us to treat moving organs, and not just areas with bony structures, where there is no movement. For example, we can use it to treat tumors in the lungs or abdomen with incredible precision – and that is quite extraordinary.

That gives us a general idea of the range of applications for CyberKnife technology. What are the indications for treatment with this method?

It all started with brain tumors. Benign brain tumors, so-called meningiomas or acoustic neuromas, are typical cases for radiosurgery. But as time went on, we extended this approach to the rest of the body, treating tumors along the spine and in the lungs, liver and kidneys. In the last year or two, we have also started treating prostate carcinomas with radiosurgery.

It's quite difficult to define exactly what this approach can be used for. It's less about the type of tumor and more about its size and location. Generally speaking, radiosurgery lends itself to small tumors, tumors which would usually be treated with conventional surgery. Radiosurgery is not suitable for patients with widespread metastases, lymph node metastases, etc., who require more traditional forms of treatment such as chemotherapy or conventional radiotherapy.

Since we are both surgeons, you could say it is an advanced form of surgical treatment; though it has now been refined to such an extent that there is no need for actual incisions.

We are also very active in the scientific community, regularly publishing papers. Altogether, we have published almost 200 papers in recent years – quite a lot for a small team like ours. For us, it is essential to look very closely at all the data. For example, we have treated 2,500 patients in the greater Munich area alone. This allows us to evaluate our work and decide whether we need to adjust certain things in the future.

Now let's take a look at the advantages of CyberKnife technology. What are they?

If a patient qualifies for our treatment because they meet all the strict criteria, then it is certainly their most comfortable option. In most cases, it only takes a single session, which is also free from any pain. The treatment requires neither fixation nor anesthesia and the patient does not even sense the radiation. Especially in comparison to alternative approaches, this is a very comfortable procedure.

As soon as you walk in, you can also tell that the atmosphere here is very special. It feels cozy and relaxed – nothing like a hospital. From what I've heard, that's very important to you.

Yes, absolutely. Most patients come to us with quite severe conditions. And, unfortunately, if you go to a typical hospital these days, you may feel even worse than before after stepping inside. That's why we take a different approach. Our staff is very welcoming, and we use color as well as lighting to create a comforting atmosphere for our patients.

That's part of our concept: We believe that there is more to it than just the technicalities of the treatment itself. Patients must feel valued and cared for. You need to take enough time to discuss all of their questions. And that’s what makes you feel comfortable and reassured. When these criteria are met, if the medical indication is suitable and if the patient says, “I feel at home here, this is where I want to be treated,” then everything will usually be fine.

During my treatment today, I enjoyed some music once again. Moreover, I do not experience any fear around here because the doctors are not wearing white coats. To me, the surroundings here feel friendly, almost familial.

Let's talk about the so-called uveal melanoma. Please provide some details about this disease.

We have been treating uveal melanoma with radiosurgical techniques for more than 20 years. In fact, we have also been using the predecessor technology, the Gammaknife. With the help of radiosurgery, this indication no longer requires the patient's eye to be removed, which would be very unpleasant of course. Instead, in most cases, we can eliminate the tumor with a single hich-precision irradiation.

Just this morning, we attended to a patient who we treated three months ago. The tumor has now completely receded. To be fair, I should add that there is no guarentee for success. But in this case, we achieved a great outcome. And this is also why our cooperation with the University Clinic's Department of Ophthalmology is so important when it comes to uveal melanoma.

Uveal melanoma is a difficult disease. Many patients simply do not notice that the nevus is changing and becoming a melanoma. If the tumor is not located in the center of vision, then it can go unnoticed and expand significantly before the patient notices.

Uveal melanoma is the most common type of tumor in the eye. However, it is a fairly rare disease; especially, in contrast to skin melanoma, which occurs more frequently.

I haven't been to an ophthalmologist for at least four years. One day my daughter went, and I thought: Oh, I'd better go too. So, it was pure coincidence that they found it.

The most important thing to know is that this is, of course, a malignant tumor. And in medicine, there is no such thing as 100 percent. This applies to all treatment options – whether it is the CyberKnife or anything else. Nevertheless, we have seen very good results with the CyberKnife with success rates of well over 80 percent.

Working together, and getting it right, is always a very rewarding experience for us. From a technical point of view, it is – of course – fascinating to see what we can achieve. But, in cooperations, it must also click on the personal level. Thankfully, the CyberKnife team and my team are wonderful people with great integrity – and that's what makes this collaboration so special.

If you don't have a smooth cooperation between physicists, radiosurgeons, radiation therapists and other specialists, such as ophthalmologist, it simply does not work. But around here, we have a team that genuinely collaborates.

Could you please describe the treatment steps in more detail? What exactly can I expect as a patient when I come to your clinic?

The first step is always a consultation at the Department of Ophthalmology. If they approve of the treatment, you are referred to us. On the day of your treatment, we start at eight in the morning. We have a brief conversation and then we administer a local anesthetic to the eye. This is necessary because the eye must not move during the treatment.

This is a routine procedure, performed for all kinds of eye surgery. A slight sting at the lower eyelid is all you will feel and – for many patients – sounds a lot worse than it is. Most patients tell us that they did not mind it at all. After another examination, we will take you next door for an MRI scan.

Once that's done, the patient comes back for a CT scan. We then combine the data from your MRI and CT scans to prepare the treatment plan together with an ophthalmologist, a specialist from our team and a medical physicist. This usually takes less than ten minutes, and then your treatment can begin. All in all, this takes about two hours of which 25 minutes make up the actual treatment.

For me, CyberKnife is the best. I had a great experience with my first surgery – well, it's not really a surgery – with my first radiosurgery. And that's why I ruled out everything else.

To us, it is crucial that the CyberKnife can focus its rays so accurately that the surrounding area, i.e. the eye, remains virtually unharmed.

Important question for all patients: Does my health insurance cover the costs of this treatment?

Unlike other parts of the country, we have particularly good conditions here in Munich. 15 years ago, we were able to establish a so-called integrated care contract with the AOK Bayern (Bavarian branch of the largest German health insurance company). Many other health insurance companies have joined the contract over the years, so we have good coverage for patients with both public and private health insurance. Coverage is not 100 percent, but we are at around 75 to 80 percent. Other patients will have to submit a request to their insurer who will decide on a case-by-case basis.

Will insurance coverage expand further in the future? What do you think? Do you have a sense of where things are headed?

We are, of course, continuously trying to reach agreements with health insurance companies – mainly those with whom we do not have signed a contract yet. Our efforts are backed by a growing amount of scientific data, revealing to health insurance companies that our type of treatment is not only comfortable for the patient, but also cost-effective compared to other options. We are constantly working on this and are trying to convince even more health insurance companies of our findings. We are very happy to have many strong partnerships with health insurance companies.

Gentlemen, thank you very much for this fascinating insight into CyberKnife technology here at the European CyberKnife Center in Munich. Thank you for talking to us. And thank you, dear viewers, for tuning in. That is all for today. We will keep you posted on the latest developments here at the European CyberKnife Center.

If you'd like to learn more about this topic, just go online. At www.cyber-knife.net, you'll find everything you need to know. And if you'd like to watch some more episodes of CyberKnife TV, simply head over to our website at www.muenchen.tv. Stay safe and healthy! See you next time.