Two Cases of Gastric Cancer Treated with Stereotactic Body Radiotherapy Using Cyberknife®

Special Article – Surgery Case Reports

Austin J Surg. 2019; 6(25): 1229.

Two Cases of Gastric Cancer Treated with Stereotactic Body Radiotherapy Using Cyberknife®

Satani K1*, Onishi H2, Suzuki T1, Morita S3, Nonaka H4, Saito R3, Komiyama T3 and Takahashi H1

1Kasugai CyberKnife Rehabilitation Hospital, Japan

2Department of Radiology, University of Yamanashi, Japan

3Department of Gastroenterology, Shinsyu Ueda Medical Center, Japan

4Department of Radiology, Fujiyoshida Municipal Medical Center, Japan

*Corresponding author: Satani K, Kasugai CyberKnife Rehabilitation Hospital, 436 Kokufu, Kasugai-cho, Fuefuki-city, Yamanashi, 406-0014, Japan

Received: September 26, 2019; Accepted: November 05, 2019; Published: November 12, 2019


We report two cases of gastric cancer treated with stereotactic body radiotherapy (SBRT) using CyberKnife®. Case 1 was advanced gastric cancer (T3N0M0 stage IIA) in an 80-year-old man. Endoscopy revealed a bulky type 3 tumor on the lesser curvature of the gastric upper body. Case 2 was recurrent gastric cancer in an 82-year-old man who had undergone endoscopic submucosal dissection for a previous tumor. Endoscopy revealed a bulky recurrent tumor on the gastric cardia. Both the patients received SBRT using CyberKnife® for symptom improvement and local control of the tumor. After treatment, both the patients showed early reduction of the tumor and improvement of the symptoms caused by the tumor, without serious complications or tumor progression for 8 and 4 months, respectively. SBRT was useful as a local treatment with low invasiveness and rapid action for locally advanced gastric cancer. Although some issues still require clarification, such as the optimal prescription dose and fractionation of irradiation, we expect SBRT to be a suitable treatment option for locally advanced gastric cancer in cases where other treatments are difficult to perform, such as elderly patients and patients with complications.

Keywords: Stereotactic body radiotherapy; CyberKnife®; Gastric cancer


SBRT: Stereotactic Body Radiotherapy; CT: Computed Tomography; ESD: Endoscopic Submucosal Dissection; BED: Biological Effective Dose; OAR: Organs at Risk; GTV: Gross Tumor Volume; PTV: Planning Target Volume; DVH: Dose-Volume Histogram; TLS: Target Locating System; CRT: Conventional Radiotherapy


Radiotherapy is often used as pre-operative or post-operative adjuvant therapy or as palliative treatment for advanced gastric cancer to improve hemorrhage or passage disorders [1-9]. The use of Stereotactic Body Radiotherapy (SBRT) has made it possible to concentrate the dose on the lesion and reduce the dose to the surrounding organs, thereby resulting in higher local control and fewer adverse events [10]. Moreover, SBRT can be completed in a short period, reducing the patient’s physical burden. Accordingly, SBRT is expected to be one of the treatment options used in the multidisciplinary treatment for advanced gastric cancer. Herein, we report our experience of performing SBRT for advanced gastric cancer using CyberKnife®.

Case Presentation

Case 1

An 80-year-old man presented with hematemesis, upper abdominal discomfort, and appetite loss, and was diagnosed with advanced gastric cancer. Endoscopy revealed a bulky type 3 tumor on the lesser curvature of the gastric upper body(Figure 1A). Abdominal Computed Tomography (CT) revealed a bulky tumor on the lesser curvature of the gastric body with a diagnosis of cT3N0M0, stage IIA carcinoma (Figure 2A). Biopsy revealed a well-differentiated tubular or papillary adenocarcinoma. The patient did not undergo surgery because of his advanced age, but instead received a daily dose of 80mg S-1. S-1 was administered for 4 weeks, followed by 2 weeks of rest. Tumor growth was controlled for 5 months, after which it regrew. The patient was referred to our hospital for tumor control and symptom improvement.