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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery
Gordon, K.1
Slide One
What is stereotactic
radiosurgery?
• Stereotactic radiosurgery is a nonsurgical technique used to selectively
destroy abnormalities within the
brain.
• Using a machine called the Gamma
Knife, 201 sources of Cobalt-60 are
focused to a small point (isocentre)
ranging from 4-18mm in diameter.
• This tiny area provides a very high
dose of radiation which is used to
irradiate a focal point within the brain
with sub-millimetre accuracy.
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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Slide Two
History
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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Clinical applications
• Tumours
Slide Three
• Benign
• Malignant
• Functional disorders
• Vascular disorders
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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
The procedure
Stereotactic radiosurgery is a four
stage procedure:
Slide Four
1. Stereotactic frame fixation
2. Imaging procedures
3. 3D dose planning
4. Gamma Knife treatment.
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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Frame fixation
Slide Five
To immobilise the patient, a frame is
fixed to the outer layer of the skull
under local anaesthetic using four
pins.
*Click on “View”; “Notes Page” for explanatory notes
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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Imaging procedure
Slide Six
All patients will undergo some form
of radiographic imaging study with the
frame in place in order to localise the
area to be treated.
This will either be:
• MRI
• CT
• Angiography
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
3D dose planning
Slide Seven
3D dose planning from the
radiographic images.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Slide Eight
Gamma Knife treatment
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Side effects
• Headaches (most common side
effect)
Slide Nine
• Occasional hair loss
• Other symptoms due to raised
intracranial pressure and oedema
(nausea, vomiting)
• Effects of radiation damage to
normal tissues:
• Cranial nerves
• Optic apparatus
• Brain stem
• Necrosis
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Slide Ten
Acoustic neuroma
TV at
treatment:
6.8cc
TV at 7 months
follow-up: 7.4cc
N.B. cc = cubic centimetres
TV at 1yr
follow-up:
3.2cc
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Slide Eleven
Single melanoma
metastasis
TV at treatment: 17.0cc
TV at 1year followup: 1.0cc
TV at 5 month followup: 1.0cc
TV at 1yr 3month
follow-up: 0.756cc
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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Multiple metastases:
breast
Slide Twelve
3D view at treatment
10 metastases.
Total volume = 13.9 cm3
3D View at 6 month
follow-up. Only 3
metastases now visible on
triple dose contrast
enhanced MRI
Total volume = 0.6 cm3
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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Summary (1)
Slide Thirteen
• Excellent treatment approach for
a number of brain abnormalities
• Non invasive
• Single treatment requiring a short
hospital stay
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FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Summary (2)
Slide Fourteen
• Very few (if any) side effects
• Limitations – due to the nature of
the radiation it is more effective
when delivered to small areas.
Therefore, there is limited use in
large tumours and patients are
referred for more conventional
treatments.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
The future
Slide Fifteen
• More research to realise the
potential in areas such as
Parkinson's disease and epilepsy.
• Publish results of such trials, raising
awareness within the medical
community therefore opening the
treatment up to more patients.
• Open more centres around the
world to make the treatment more
available.
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slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
March 2006
Stereotactic radiosurgery (continued)
Slide Sixteen
References and further
reading
•
http://www.gammaknife.co.uk
•
http://www.elekta.com
•
http://www.irsa.org/radiosurgery.html
•
Gordon K, Eddy D. (2006) The efficacy of
Stereotactic Radiosurgery in the
management of Vestibular Schwannomas - a
retrospective analysis. Journal of Radiotherapy
in Practice. 5 (1): 1-12.
•
Hickey, K. (2004) Role of stereotactic
radiosurgery in the management of single or
multiple cerebral metastases. Journal of
Radiotherapy in Practice. 3 (4): 197-203.
•
Hickey, K. (2004) Conventional and
contemporary management approaches for
the treatment of vestibular schwannomas:
Microsurgery versus radiosurgery, a literature
review. Journal of Radiotherapy in Practice. 4
(1): 39-45.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc