Welcome to a new episode of CyberKnife TV. It's great that you're tuning in today for our talk on so-called renal cell carcinoma.

To give you some insights into this, I'm going to talk to the experts here at the European CyberKnife Center Munich. I am very excited that Professor Alexander Muacevic and Dr. Christoph Fürweger, two experts from the European CyberKnife Center are joining me today. Gentlemen, I am glad that you have joined me, once again, to talk about medical innovation.

Professor Muacevic, how did you get started here? It’s truly a success story that we have been witnessing here for the past years.

15 years ago, we started rolling out this technology in cooperation with the Großhadern Clinic. CyberKnife is a fairly new and very modern way to treat tumors. Working together with our colleagues from the hospital, this technology allows us to treat many patients with great success.

Over the years, we have been able to expand the range of indications we can treat – renal cell carcinoma for example, which is today’s topic. And I am looking forward to our chat!

Dr. Fürweger, why does the European CyberKnife Center fascinate you so much?

Around here, we can draw on a particularly precise technology: CyberKnife. On the one hand, it is a high-precision robot which targets the tumor with many ultra-fine beams. On the other hand, its image guidance capabilities allow us to detect and track the the tumor during treatment.

Professor Muacevic, as Dr. Fürweger has just mentioned, the unique feature of CyberKnife technology is its incredible accuracy. What impresses you about this approach?

The single most beneficial thing is that it allows us to treat most cases in a single session – that's all it takes to eliminate the tumor. We achieve a typical accuracy of less than one millimeter. For brain and spinal treatments, we are even more accurate – with tolerance ranging from 0.3 to 0.4 millimeters. It's hard to imagine, but the robot remains highly accurate while also continuously readjusting itself.

This level of precision is out of bounds for humans and that is quite fascinating indeed. Think of a modern cockpit: Once we have calculated the route – i.e. the treatment plan – together with our physicists, we transfer the data to the robot, and it proceeds with the high-precision treatment on autopilot.

In general, the treatment is virtually pain-free. All it takes is to show the system where exactly the tumor is located. To do so, we insert three tiny gold plates around the tumor. Instead of one large incision for surgery, this involves three very small incisions. After about a minute, you are done with the procedure. The treatment itself causes no pain – you won't even notice it. You can listen to your favorite music while lying comfortably in the device; no need to worry.

Patients tend to be much more worried about it than necessary. Once it’s done, they all say: "It was much easier than I imagined." They show up in their everyday attire, we have a brief consultation, then one of our assistants takes them to the treatment room.

There, they lie down on the couch, we turn on their favorite music and – should they need one – we can even take a break; a toilet break perhaps. They have all the options.

It's not like you are tied down or unable to escape it. It's all very relaxed. In fact, with the latest generation of devices, the treatment time is very short anyway. On average, it only takes 25 to 28 minutes, which most patients can easily sit through.

Dr. Fürweger, do you sometimes get surprising feedback from patients? Somewhere along the lines of: "Oh, it wasn't that bad after all. In fact, it's completely different from what I imagined – much more relaxed."

Quite a lot. People have their expectations, and they often involve some nervousness. We allay this before the treatment starts. And things go a lot smoother than most patients imagine. After half an hour it's all over and they can go back home.

Let's come back to the topic of indications. Professor Muacevic, what cases lend themselves to CyberKnife treatment?

As we have mentioned in previous episodes: The most common are benign tumors affecting the skull base – like acoustic neuromas or meningiomas. Yet there are also many patients with spinal tumors, small lung tumors, liver tumors or, what we are going to discuss in more detail today, renal cell carcinomas. The latter are special cases, because they are often particularly difficult to treat.

For many years now, we have been cooperating with our colleagues at the Department of Urology in Großhadern. They turn to us whenever their surgeons identify cases which are better suited to our type of treatment – i.e., as an alternative to conventional surgery.

What makes it so special? In other words, why are renal cell carcinomas so difficult to treat?

Look, most people would assume that treating kidneys is far easier than treating the brain. They’re wrong. The kidney is difficult to handle because it moves a lot when the patient breathes. It moves up and down and even rotates a little.

In fact, its position may vary by two to three centimeters because of breathing. We must compensate for these variations during treatment. If we were to irradiate the entire area – including the range of motion –, we would damage the entire kidney by exposing it to radiation. And that’s exactly where we benefit from the robot, as it tracks the tumor automatically to compensate for any movement. Thus, we can protect the surrounding kidney tissue.

Renal cell carcinoma is the seventh most common tumor disease in adults. Two thirds of patients are men and one third are women. It affects the functional tissue of the kidney, which transforms into a tumor and becomes cancerous. Usually, the tumor or the entire affected kidney are removed surgically.

However, consequently, most patients also lose some of the healthy kidney tissue, resulting in impaired kidney function or – in the worst case – the need for dialysis. And patients who must undergo dialysis usually have a much shorter life expectancy.

Your cooperation with the University Hospital and especially the Department of Urology is very important, Professor Muacevic. We spoke to the Head of Department earlier about today’s topic. What makes this cooperation so successful and enjoyable?

Our collaboration is truly remarkable. But this is mainly due to the urologists themselves. They run a large department, which is a prerequisite, and they encounter many patients with renal cell carcinoma. Their large pool of patients allows them to select the right treatment for every situation, which is almost impossible in smaller hospitals.

Smaller facilities would usually say: "We must operate on this." Et voila, there goes your kidney. This might sound a bit drastic, but in the end, this can severely restrict the patient's quality of life.

The CyberKnife Center is a cooperation partner that is open to innovative new approaches – a dream come true in the context of university medicine.

Together, we can assess cases, translate them into data, publish our findings, discuss them with even more specialists and thus establish new treatment methods. And then we can make these methods available to more patients at other medical centers.

Dr. Fürweger, what do you find most impressive about cooperating with the University Hospital – your neighbors?

I thoroughly enjoy how straightforward it is – every single case. We can rely on our colleagues in the Urology Department who are always available to provide advice and support. You must know, some kidney tumors are very difficult to diagnose, so we depend on their expertise to do the best possible job.

Professor Muacevic, you also mentioned that renal cell carcinoma is difficult to treat. In general, how does CyberKnife help when it comes to these critical cases and what do you need to consider?

The tumor must be clearly demarcated since we simply cannot treat tumors extending too far into the tissue. Relatively small tumors with clear demarcation which would normally lend themselves to conventional surgery. However, there are many situations where surgery cannot be carried out. For example, if the patient is too old, if they are under strong medication, if they would have to interrupt an ongoing chemotherapy. For such patients, our treatment allows them to continue with other treatments, which is a major advantage.

Another very important question: "Does my health insurance company cover the costs?" What’s the current situation like?

Here in Munich, we have very good conditions. Together with the University Hospital, we have a cooperation agreement with AOK Bayern – the largest health insurance company in Bavaria. Over the years, many other health insurance companies have joined this contract, where billing takes place automatically – patients do not have to do anything. So, by now, it is not only the AOK, but also the Barmer Ersatzkasse, the SBK and all the company health insurance funds.

In other words, there are plenty of health insurance companies that cover the costs - about 80 percent of them, to be precise. Unfortunately, there are still some health insurance companies who have not joined this contract.

They usually require patients to apply for funding on a case-by-case basis. But overall, we are quite satisfied with the situation.

We already talked about the European CyberKnife Center. What can patients expect when they come to you for treatment – any advantages?

We are located right next to the University Hospital, which is not just an advantage when it comes to travel time. Our close cooperation gives us access to all the tumor boards, where we exchange information with our colleagues on a daily basis. In fact, with such high-tech treatment methods, it is crucial to provide scientific evidence through publications. We regularly publish our findings and since 2005 we have been able to treat more than 7000 patients.

The staff are all incredibly friendly and very thorough. It means a lot to me that they plan ahead and carefully consider what they can do – and what they cannot. All in all, I felt very well looked after.

Depending on your case, you can avoid conventional surgery – i.e., no blood, no incisions, no hospitalization, no rehabilitation, no possibility for wound healing issues and so on. Of course, these are great advantages. Nevertheless, it is very important to mention that we can only treat specific cases – not all types of tumors. I want to point out that you shouldn't set your hopes too high.

I was scared for sure. I was nervous. Even though I was told that the treatment is pain-free and that I would not even notice it.

What stands out to me is that it's all very high-tech, yet the patient barely notices it. The treatment is fully automated and after just 30 minutes it’s over. All the technical effort for something the patient barely even notices. But of course, it ensures the high quality of the treatment.

Gentlemen, thank you very much for another exciting conversation on CyberKnife technology. Thank you for having us here. To our viewers, thank you for tuning in. That was CyberKnife TV for today. Don't forget: You can watch all episodes on-demand at www.muenchen.tv. Stay healthy! See you next time. Servus!