CYBERKNIFE® Robotic Radiosurgery System Patient

CYBERKNIFE® Robotic Radiosurgery System PATIENT BROChURE What is the CyberKnife® System? have stabilizing frames bolted to their head or limit their breathing during treatment to minimize movement of the tumor.

Though its name may conjure up images of With the CyberKnife System, patients can ® scalpels and surgery, the CyberKnife Robotic complete treatment in one to five days, Radiosurgery System involves no cutting. For compared to the weeks it takes to complete many patients, the CyberKnife treatment can a course of conventional radiation therapy. In offer a non-invasive alternative to surgery for addition, it provides a pain-free, non-surgical the treatment of both cancerous and non- option for patients who have inoperable or cancerous tumors. surgically complex tumors, or who may be looking for an alternative to surgery. The CyberKnife System is composed of a radiation delivery device, called a linear accelerator (or Linac), which is mounted on a What makes the robotic arm. The flexibility of the robotic arm CyberKnife Different? enables the CyberKnife System to deliver radiation to tumors anywhere in the body, including the brain, head and neck, spine, Despite the best attempts of clinicians, it is lung, prostate, liver, pancreas, breast and virtually impossible to prevent patients and other soft tissues. The CyberKnife System also utilizes sophisticated software and advanced imaging to track tumor and patient movement and adjust the beams of high-dose radiation to ensure treatment is delivered with a high degree of accuracy. Because of this exceptional tracking ability, the CyberKnife System eliminates the need for patients to

2 their internal The company anatomy from set out, from the moving during start, to develop a radiation radiation treatment treatments. system with patient movement and comfort With conventi- in mind. Rather than retrofitting existing onal treatment, technology, Accuray took a new approach patients are by developing an innovative design that subjected to could effectively address patient and tumor invasive and movement during treatment and eliminate the uncomfortable need for antiquated techniques, additional methods to minimize their movement as procedures, and patient discomfort. Instead of much as possible. restricting patient movement, the CyberKnife System’s leading-edge technology was These immobilization techniques can designed to move with the tumor. This unique include attaching a metal frame directly capability results in the delivery of more into a patient’s skull, compression of the accurate and higher doses of radiation to the abdomen to limit breathing and movement tumor, while avoiding the surrounding healthy during treatments, stabilizing body casts, tissue and reducing the side effects commonly and injection of rectal balloons or hardening associated with conventional radiation agents into the rectum to stabilize the therapy treatments. prostate, to name just a few.

Accuray Incorporated, the makers of the What makes the ® CyberKnife System, realized early on that CyberKnife Different? patients, and their internal anatomy, are still going to move, no matter what means was taken to prevent it. Additionally, they believed that with greater accuracy in radiation delivery, the CyberKnife System could provide more effective treatments by minimizing the radiation exposure to healthy surrounding tissue and limit some of the short and long- term side effects that are common with conventional treatments.

3 Benefits of CyberKnife® Treatments Is the CyberKnife Treatment Right for Me? • Pain-free

• Non-invasive With the CyberKnife System, there is not a • No anesthesia required one-size-fits-all approach to patient care. The CyberKnife System’s innovative design and • Outpatient procedure use of leading-edge technologies enables • Exceptional accuracy spares healthy tissue your physician to tailor treatments specific to and organs your tumor(s) shape in order to ensure the best possible outcome. The unique features • No recovery time of the CyberKnife System that allow for • Immediate return to normal activity individualized treatments include:

• No invasive head or body frame Real-Time Image • No breath holding or “respiratory gating” Guidance – The required during treatment CyberKnife System uses imaging software to CyberKnife® patients routinely report that they track and continually have no side effects or minimal side effects adjust treatment for any from their treatment, and in most cases, movement of the patient they can immediately return to their normal or tumor. Unlike other daily activities. Speak with your doctor about radiation treatments that require patients to possible side effects you may encounter. hold their breath during treatment delivery or rely on the use of rigid head frames that are screwed into the patient’s skull to minimize motion, the CyberKnife System will allow you to breathe normally and remain comfortable during your treatments.

4 Unlimited Flexibility The X-rays in the CyberKnife treatment room & Freedom – The are constantly taking pictures of the tumor, CyberKnife® System’s comparing its actual location to the treatment robotic maneuverability plan, and instantly reporting it back through a allows your physician to deliver a highly sophisticated software program to the robot. individualized treatment. With a linear The robot responds to the new location and accelerator mounted on a flexible robotic instantly adjusts the beam to accurately target arm, the CyberKnife clinician can select from the tumor. This unique tracking capability thousands of different angles from which results in an extremely accurate delivery of to deliver radiation treatments. A typical radiation, sparing your surrounding healthy CyberKnife treatment is comprised of 150 tissue and critical organs from damage. to 200 beams, each coming from a unique angle. This is a significant improvement over Convenient – Depending on the type of traditional static or fixed radiation delivery tumor, you will likely need only one to five systems, which typically only can treat a tumor CyberKnife treatments. With other radiation with seven to nine discrete beams and require systems, you could require dozens of patients to be manually adjusted to deliver treatments spread out over several weeks. radiation from additional angles. CyberKnife patients routinely report that they have minimal side effects from their treatment, Unrivaled Accuracy – The and in most cases, they can immediately CyberKnife System can treat return to their normal daily activities. moving tumors with pinpoint accuracy that is unmatched by other radiosurgery systems. This is especially important when treating tumors that move with any bodily function, which may range from predictable movements caused by breathing to unpredictable movements due to other bodily functions, such as a gas bubble moving through the rectum. The CyberKnife System can essentially “paint” your tumor with a high-dose of radiation Patient Safety – From design to delivery, by targeting the tumor from almost every patient safety is paramount with any conceivable angle. Unrivaled by any other CyberKnife treatment. Unlike other gantry technology, the CyberKnife beams are guided based linear accelerators, the CyberKnife by the actual movement of the tumor. operates on a fully integrated closed loop system. Each function works in unison to ensure the safest possible patient experience.

5 Who Can Get CyberKnife treatment. If you are a candidate, CyberKnife® Treatments? you can expect that your CyberKnife treatment(s) will involve a team approach in which several medical professionals will It is up to your collaborate to develop a treatment plan medical team designed just for you. to determine whether the The CyberKnife treatment process generally CyberKnife® requires six simple steps from start to finish: treatment is right for you. Your 1. Evaluation – After being diagnosed, you doctors will make the decision about whether can contact a CyberKnife center directly to treat with the CyberKnife System based or have your treating doctor provide you on their clinical experience. Other factors with a referral. Though it may vary based that will influence their opinion are the tumor on your specific treatment, you will likely type, location and size of the tumor, and work with a team of clinicians, including extent of disease. It is important to keep in a radiation oncologist, surgeon, medical mind that sometimes there are many different physicist, radiation technician and nurse approaches and opinions can differ. The coordinator. CyberKnife System is versatile and can treat cancers from early stages to advanced disease 2. Fiducial Placement – Depending on the and, in some cases, the treatment can be type and location of your tumor, your team partnered with surgery, chemotherapy, and may recommend placement of fiducials conventional radiation therapy. – which are small gold markers inserted near the tumor – to help identify the exact If you are interested in finding out if location of your tumor during treatment. CyberKnife treatments are right for you, Not all treatments require fiducial markers. please contact your local CyberKnife center. The determination will be made based on CyberKnife locations can be found online at the density, size and location of the tumor. www.CyberKnife.com. 3. Imaging – Prior to treatment, an MRI and Your CyberKnife Treatment - a CT or CT/PET scan is taken to determine Step-by-Step the size, shape and location of your tumor(s).

– Using images from After or during your diagnoses, your physician 4. Treatment Planning a CT scan, the data is digitally transferred will determine if you may benefit from the

6 to the CyberKnife® System’s treatment Insurance Coverage planning workstation, where a qualified physician identifies the tumor(s) to be targeted and the surrounding vital Medicare and private insurance carriers in structures to be avoided. This plan is most states cover CyberKnife treatments. designed to match the desired radiation dose to the tumor location and limit Your local CyberKnife center also can be radiation exposure to the surrounding a good source of information regarding healthy tissue. coverage by your specific medical carrier. If you have additional questions, or need 5. Treatment – Once the treatment plan is assistance with insurance-related matters, developed, you can begin your CyberKnife please call Accuray at +1.888.522.3740, ext. treatments. At the CyberKnife center, you 4301 or e-mail [email protected]. will be comfortably positioned on the treatment table. Then the CyberKnife System’s computer-controlled robot will carefully move around you to deliver radiation at various locations as prescribed by your treatment plan. At the same time, the CyberKnife System is taking continual X-ray images that will provide real-time information about the location of your tumor and enable the system to dynamically track and correct for any movement of your tumor. Depending on the type and location of your tumor, you can expect to undergo between one and five treatment sessions.

6. Recovery – Most CyberKnife patients do not experience side effects. Depending on the type of treatment you receive, your side effects will vary. Patients that do experience side effects are typically mild and considered acute and do not require intervention. Patients should speak to their doctor and discuss what side effects may occur and learn about potential risks.

7 Patient Quotes

“I went back in for “At age 79 and having my check-up and the had major surgery tumor was gone – only before, I had no desire airspace was left. My to go through the pain cough is gone, and I am and long recovery again feeling like I am back in when I was diagnosed great health and telling with lung cancer. My as many people as I doctor recommended can about my incredible CyberKnife treatments, CyberKnife treatment story.” which required no hospitalization, no invasion of - Lewis, treated for lung cancer in 2011 your body and no after effects. It simply delivers high doses of radiation to the tumor, and then you get off table and go home and resume your normal life.” “After being diagnosed - Kay, treated for lung cancer in 2008 with prostate cancer, I was concerned about the risks and side effects “Surgery to remove my invasive treatments brain tumor could have would have on my resulted in deafness relationship with my in my left ear, facial wife. The CyberKnife paralysis, and balance allowed me to avoid problems for the rest these potentially devastating complications and of my life. With two get back to my normal life with little to no side young children, I was effects.” concerned about - Scott, treated for prostate cancer in 2006 enduring a long recovery and the possibility of permanent complications. But with CyberKnife, the journey to treat my tumor was very easy. My quality of life never changed and I experienced View videos and more patient stories like no side effects.” these on www.CyberKnife.com - Suzanne, treated for a acoustic neuroma/brain tumor in 2005

As of this publication, these patients are disease free.

8 About Accuray CyberKnife Patient Education Website Based in Sunnyvale, Calif., Accuray (Nasdaq: This website will provide you with greater ARAY) is the premier radiation oncology detail about the CyberKnife System, benefits company that develops, manufactures and of CyberKnife treatment and the locations sells personalized innovative treatment of CyberKnife centers, as well as other solutions that set the standard of care, with educational resources. the aim of helping patients live longer, better lives. Our leading edge technologies www.CyberKnife.com are designed to deliver radiosurgery (SRS), stereotactic body radiation therapy (SBRT), Additional Patient Resources: intensity modulated radiation therapy (IMRT), Follow us on Facebook, Twitter and YouTube image-guided radiation therapy (IGRT) and adaptive radiation therapy. Facebook

® Accuray In addition to the CyberKnife System, Accuray also manufactures the TomoTherapy® CyberKnife System. The TomoTherapy System is a TomoTherapy fully-integrated, 3D image-guided intensity modulated radiation therapy (IG-IMRT ) Twitter system. Through daily CT imaging, the TomoTherapy System allows clinicians to give Accuray each patient the most accurate and highest CyberKnife quality individualized treatments specifically TomoTherapy tailored to their needs. Unique helical delivery means a broader range of tumors can be treated, expanding options for more patients. YouTube Accuray advises that patients should discuss Accuray with their physicians their treatment options in CyberKnife order to determine which one is best for their TomoTherapy individual case.

Twitter@CyberKnifeRS http://www.youtube.com/user/CyberKnifePatients/videos http://www.youtube.com/AccurayCyberKnife

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Accuray Corporate Headquarters Accuray Incorporated Accuray Japan K.K. Accuray Asia Ltd. Accuray Accelerator Technology Accuray International Sarl 1310 Chesapeake Terrace 1240 Deming Way Shin Otemachi Building 7F Suites 1702 - 1704, Tower 6 #39 Huatai Road, Longtan Route de la Longeraie 9 (3rd ﬂoor) Sunnyvale, CA 94089 Madison, WI 53717 2-2-1 Otemachi, Chiyoda-ku The Gateway, Harbour City Industrial Zone, CH – 1110 Morges USA USA Tokyo 100-0004 9 Canton Road, T.S.T. Section 2 East, 3rd Ring Road, Switzerland Tel: +1.408.716.4600 Tel: +1 608 824 2800 Japan Hong Kong Chengdu, Sichuan 610051 Tel: +41.21.545.9500 Toll Free: 1.888.522.3740 Fax: +1 608 824 2996 Tel: +81.3.6265.1526 Tel: +852.2247.8688 People's Republic of China Fax: +41.21.545.9501 Fax: +1.408.716.4601 Fax: +81.3.3272.6166 Fax: +852.2175.5799 Email: [email protected]

© 2013 Accuray Incorporated. All Rights Reserved. Accuray, the stylized logo, CyberKnife, Synchrony, Xsight,N Xchange, RoboCouch, TomoTherapy, TomoHD, Hi·Art, Iris, InCise, MultiPlan, M6 and InTempo are among the trademarks and/or registered trademarks of Accuray Incorporated in the United States and other countries. TomoTherapy is a wholly owned subsidiary of Accuray. Other trademarks used and identiﬁed herein are the property of their respective owners. 500929.B

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© 2013 Accuray Incorporated. All Rights Reserved. Accuray, the stylized logo, CyberKnife, Synchrony, Xsight, Xchange, RoboCouch, TomoTherapy, TomoHD, Hi·Art, Iris, InCise, MultiPlan, M6 and InTempo are among the trademarks and/or registered trademarks of Accuray Incorporated in the United States and other countries. TomoTherapy is a wholly owned subsidiary of Accuray. Other trademarks used and identiﬁed herein are the property of their respective owners. xxxxxx.A