Download Stereotactic Radiosurgery

Stereotactic Radiosurgery (SRS)
Jeremy Galle
BME 281
October 3rd 2012
Introduction
• Also called “stereotaxy”
• Non-invasive form of “surgery”
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A type of radiation therapy
Called surgery because the results compare to
conventional surgery
A highly precise delivery of radiation
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Accurate to within 1 to 2 mm of target
• Relies on:
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3D imaging (such as CT scan)
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Determine location of target
Highly focused gamma ray beams
Image-guided radiation therapy (IGRT)
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Improves accuracy of delivery
• Has broad range of applications
History
• 1908 - First stereotactic method developed in London by Sir Victor
Horsley and Robert H. Clarke
• “Horsley-Clarke apparatus”
• 1930s - The apparatus kept receiving slight improvements
• 1947-1949 – Two stereotactic devices used for brain surgery in
humans
• Henry T. Wycis and Ernest A. Spiegel’s device (American neurosurgeons)
• Lars Leksell’s device (Swedish neurosurgeon) – founded Elekta later
• 1978 – American physician Russell A. Brown implemented CT use in
SRS
• Foundation for current devices
Treatment applications
• Brain tumors
• Cancerous and non-cancerous
• Primary and metastatic – spreading
• Arteriovenous malformations (AVMs)
• Tangling of expanded blood vessels
• Limits blood flow
• Trigeminal neuralgia
• Nerve disorder in face
• Parkinson’s disease
• Tremors
• Epilepsy
• Much more…
Current technology
• Gamma Knife® by Elekta
• Uses 192 to 201 beams of highly-focused
gamma rays
• All beams aim at target region
• Linear accelerator (LINAC) machines
• Deliver high-energy x-rays = photons
• Uses microwave technology to accelerate
photons
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Novalis Tx™ by Brainwave AG
XKnife™ by Integra
Axesse™ by Elekta
CyberKnife® by Accuray
• Proton beam machine
Process
• Injected with contrasting fluid and medicine
• Patient first gets a CT or MRI scan of the target area
• A computer takes the images created and combines them to
form a 3-D map of the target area
• The head frame is then placed on the patient as the operator
sees fit
• The patient then lies on a special bed that moves backward into
the machine
• While the bed moves into the machine, beams shoot from all
different directions towards the target area with the guidance of
the 3-D map
Process
then
Advantages
• Able to reach tumors that are unreachable
by conventional surgery
• Stops the growth by altering DNA
• No physical cuts involved (non-invasive)
• Extremely accurate
• Takes less time to complete (30-60 minutes)
than comparable therapy treatments
• More effective than comparable therapy
treatments
• Cost covered entirely by some medical
insurance companies
• Less side effects than other treatments
Disadvantages
• Side effects exist
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Skin problems in target area
Fatigue
Hair loss in target area
Headaches
Brain swelling
Tissue damage
More…
• Cannot destroy the tumor
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Only stops the growth
• Expensive (if not covered by insurance)
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$12,000 average for 1 treatment
$55,000 average for 5 treatments
• Results take time
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As little as one month to as long as two years
Future of the technology
• Extremely powerful beams that
disintegrate tumors
• Alter DNA so particles dissolve
biologically
• More accuracy
• No surrounding tissue damage
• Much less side effects
• Less expensive
• 4-Dimensional mapping
• Quicker results
• Quicker procedure times
Accuray CyberKnife®
Elekta Gamma Knife®
Proton beam
Works Cited
Chen, Viola, Eric Oermann, Saloomeh Vahdat, Jennifer Riben, Simeng Suy, Xia Yu, Sean Collins, and
Brian Collins. "CyberKnife with Tumor Tracking: An Effective Treatment for High-Risk
Surgical Patients with Stage I Non-Small Cell Lung Cancer." Frontiers in Oncology 2.9
(2012): n. pag. PubMed. Web. 29 Sept. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3356163/>.
Frighetto, Leonardo, Jorge Bizzi, Rafael Annes, Rodrigo Dos Santos Silva, and Paulo Oppitz. "Stereotactic
Radiosurgery for Movement Disorders." Surgical Neurology International 3.1 (2012): n.
pag. PubMed. Web. 29 Sept. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3400484/>.
"Stereotactic Radiosurgery." MedlinePlus. U.S. National Library of Medicine, n.d. Web. 29 Sept. 2012.
<http://www.nlm.nih.gov/medlineplus/ency/article/007274.htm>.
"Stereotactic Radiosurgery Overview." IRSA. N.p., n.d. Web. 29 Sept. 2012. <http://www.irsa.org/
radiosurgery.html>.
"Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT)." Radiology Info. Radiological
Society of North America, n.d. Web. 29 Sept. 2012. <http://www.radiologyinfo.org/en/info.cfm?
pg=stereotactic>.
"Stereotactic Surgery." Wikipedia. Wikimedia Foundation, n.d. Web. 29 Sept. 2012. <http://
en.wikipedia.org/wiki/Stereotactic_surgery>.
Vesper, J., E. Bolke, C. Wille, P. A. Gerber, C. Matuschek, and M. Peiper. "Current Concepts in Stereotactic
Radiosurgery - a Neurosurgical and Radiooncological Point of View." European Journal of
Medical Research 14.3 (2009): n. pag. PubMed. Web. 29 Sept. 2012. <http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3352064/>.
Questions?