Report #17
STEREOTACTIC RADIO SURGERY




BRAIN RADIO SURGERY at Staten Island University Hospital
(http://www.siuh.edu/radoncology//)


Fractionated stereotactic radiosurgery represents the leading technological edge for patients with benign and malignant brain tumors. Work pioneered at Staten Island University Hospital and presented at national and international medical meetings as well as published in major medical journals continues to show the efficacy and safety compared to other methods of treatment.  Through its continued improvement and refinement, stereotactic radiosurgery has succeeded in precisely delivering radiation to tumors in a non-invasive manner. 

In the hands of the experienced doctors at Staten Island University Hospital radiosurgery is totally non-invasive - even avoiding the pins in the skull of other methods of radiosurgery. Currently, more than 10,000 radiosurgery procedures have been performed at SIUH.

For patients with either newly diagnosed or recurrent brain tumors whether standard radiation, surgery or chemotherapy has been previously administered, fractionated stereotactic radiosurgery is a new and exciting treatment option. Fractionated stereotactic radiosurgery represents an advanced age of medical science in which patients with benign and malignant tumors once considered impossible or difficult to treat can receive effective, non-invasive therapy. This approach is free from any anesthesia, hospital stay, surgical convalescence or pins into the skull associated with other procedures. 

Fractionated stereotactic radiosurgery non-invasively directs precisely-guided beams of radiation from many hundreds of different angles all to converge on the tumor. By focusing these beams from so many different positions, the effects on the normal healthy brain are minimized while the target receives the desired prescribed treatment. 

One of the primary differences between standard radiation and fractionated stereotactic radiosurgery is that standard radiation radiates large amounts of normal healthy brain - compared to radiosurgery which is focused on the tumor. Radiation of healthy brain usually cannot be construed as desirable and may, in fact, lead to complications. Radiosurgery represents the opposite end of the spectrum from standard radiation - we precisely direct radiation with more effective doses of treatment. 

How does fractionation of radiosurgery help the patient? 

Radiation oncologists believe that higher doses of radiation are more beneficial in curing disease, in general, than lower doses. However, higher doses cannot be given innocuously. Essentially, all tumors are surrounded by normal tissue. It is the presence of the normal tissue that limits the amount of radiation that can be safely administered. 

Fractionation allows healthy, surrounding tissues to repair radiation effects in a way that single fraction radiosurgery cannot. Fractionation, therefore, exploits the difference between normal tissues and tumors thus resulting in a safer and superior outcome. That is why fractionated radiosurgery is so important. Fractionation protects normal, surrounding brain. 

For patients with brain tumors, the desired treatment is one that produces the most appropriate and beneficial doses of radiation delivered to the tumor while minimizing effects to the normal healthy brain. Fractionated stereotactic radiosurgery helps to achieve this goal most elegantly. 

What are the most common uses of fractionated stereotactic radiosurgery? 

Malignant primary tumors including astrocytomas and glioblastomas as well as metastatic cancers to the brain are frequently treated at Staten Island University Hospital. These cancerous conditions have been - and are - extensively studied at SIUH's Radiosurgery Center. 

Because of close collaboration with medical oncology, studies combining special radiation-enhancing well-tolerated chemotherapeutic agents - such as Taxol - have been regularly evaluated and continue to show marked benefit compared to standard treatment or standard single shot radiosurgery - with statistical significance - for those with newly diagnosed as well as recurrent small as well as large primary brain tumors - like glioblastomas, astrocytomas and other aggressive cancers. This technology can improve outcome in patients with single or multiple sites of disease compared to those who might otherwise receive standard radiation or radiosurgery. 

Benefits of fractionation are numerous. For malignant tumors, there is more protection of the healthy tissue while maintaining - or improving - efficacy of treatment. In fact, studies at Staten Island University Hospital of malignant primary brain tumors such as astrocytomas, gliomas and glioblastomas shows markedly improved survival rates years after treatment compared to single-fraction radiosurgery or other methods of treatment. Furthermore, there is a much lesser need of subsequent operation or intervention. 

Brain metastases means the cancers that have started in another part of the body spread via the bloodstream to the brain. Our work shows benefit from fractionated stereotactic radiosurgery for patients with single or multiple metastases - even those not successfully treated with prior surgery or radiation. Fractionated radiosurgery allows us to treat even larger cancers or those in the most delicate parts of the brain (like the brainstem area or by delicate critical nerves) - with a greater degree of safety than other methods of standard radiosurgery. 

For patients with brain metastases, the appeal of radiosurgery is that, in certain instances, it eliminates the need for whole brain radiation. Whole brain radiation radiates the normal healthy tissues. Many patients come to SIUH with newly diagnosed tumors specifically to avoid standard therapy and unnecessary side effects. Other patients come to Staten Island University Hospital with brain metastases that have remained or grown despite standard radiation or prior surgery. 

Radiation-enhancers have been shown to be highly effective in head and neck cancers, as well. Taxol is not particularly effective by itself for malignant brain tumors, but is an especially important agent in sensitizing the tumor - or making the cancer more susceptible - to the effects of fractionated stereotactic radiosurgery. 

Benign tumors represent a particularly important area. Their treatment is being revolutionized by the introduction of fractionated radiosurgery at Staten Island University Hospital. The most common benign tumors include meningiomas and acoustic neuromas. Other neuromas and schwannomas are well-treated with a high degree of confidence. 

Fractionation for benign tumors like acoustic neuromas means the toxicity of treatment is markedly diminished or eliminated compared to single fraction radiosurgery or open surgery. For example, with open surgery the vast majority of patients with acoustic neuromas lose hearing and many lose facial function - a marked physical and psychological calamity. With fractionated stereotactic radiosurgery developed at Staten Island University Hospital, the likelihood of facial paralysis is essentially unheard of as is trigeminal neuropathy. Audiographic evaluation shows that 90% of patients maintain hearing while having an exceptionally high success rate with this approach. Of course, all treatment is administered as outpatient therapy - adding to this attractive treatment option. 

Pituitary tumors, another benign condition, are commonly treated successfully here using fractionated stereotactic radiosurgery. By fractionation the important nerves for vision - optic nerves and chiasm - are protected while highly effective non-invasive therapy is administered. Many prefer fractionated radiosurgery to standard radiation, open surgery or prolonged use of medicines. 

Patients with meningiomas come for fractionated radiosurgery especially when located around crucial blood vessels and nerves. Frequently tumors remain after surgery. Commonly meningiomas grow and are difficult if not impossible to totally resect surgically. Other people simply do not want surgery and associated hospitalization and convalescence. Fractionated radiosurgery can be used primarily in place of surgery or when surgery has failed to adequately treat the tumor and patient. 

Of course, many other tumors are treated by the experts at Staten Island University Hospital. The group has experience with many more unusual tumors such as craniopharyngiomas, chordomas, hemangioblastomas, oligodendrogliomas, ependymomas, glomus tumors, medulloblastomas and many others. 

How is radiosurgery carried out? 

"For each patient, a custom-fitted head frame is constructed by our skilled staff. This takes approximately one hour. The next step is imaging studies using the non-invasive head frame as a frame of reference. Physicians and physicists create a unique treatment plan for each patient which is then re-confirmed and double and triple-checked by the involved physicians and physicists. Multiple quality assurance steps check and re-check each action - from head frame creation to imaging, planning, head frame placement and treatment. 

Because treatment is totally non-invasive, patients maintain their normal function throughout this process. Patients are completely awake and alert throughout the entire painless procedure. 

Furthermore with fractionated stereotactic radiosurgery there is, in general, the avoidance of any hospitalization. It is for this reason and the strong voices from successfully treated patients that enthusiasm has been stimulated globally for the fractionated stereotactic radiosurgery approach at Staten Island University Hospital. Many times, previously treated patients are our most ardent supporters - passing on to friends and family a new trreatment option tip. 

How does one consider their candidacy for fractionated stereotactic radiosurgery program at Staten Island University Hospital? 

Every week our physicians review submitted cases from the around the world for consideration of fractionated stereotactic radiosurgery. We attempt to make the best decision based upon most effective and least invasive techniques available. Included in this group of researchers are radiation oncologists, medical oncologists, neuro-radiologists, neuro-oncologists, neuro-pathologists, neuro-surgeons, neuro-oncology researchers as well as other health care professionals. 

We have a large group of experts on hand to answer your questions. More specific questions are individually answered by our physicians based on your exact situation. 

If interested, one should send in appropriate records and current radiographic scans to our Brain Radiosurgery Conference. There, on a weekly basis, all submitted material is reviewed and each patient is considered individually for best treatment. If questions arise at any time, call our staff and experts at the Radiosurgery Centerís toll free number. 

In certain instances, assistance with transportation is available and there is affordable housing (in limited supply) available for Radiosurgery patients at Staten Island University Hospital. 

Our radiosurgery work continues to be evaluated and updated by our research group and our current results are presented at national and international meetings as well as published in major medical journals. 

Staten Island University Hospital is the home of the Journal of Radiosurgery - the only peer-reviewed medical journal dedicated to the field of radiosurgery. The editor is Gil Lederman, M.D. 

For more information on Fractionated Stereotactic Radiosurgery for brain tumors and other innovative treatment methods, for a free videotape and information packet or to register for one of our monthly Brain Tumor Update Seminars please contact The Radiosurgery Center at Staten Island University Hospital at 1-800-285-4584."

To submit an inquiry about Brain Radio Surgery, please call 1-718-226-8862

Please note: It is not only brain tumor patients who can benefit from Radio Surgery; the technology can be applied to tumors almost anywhere in the body.

For information on Body Radio Surgery, please go to:   http://www.SIUH.edu/radoncology/bodyrad.html

This technology is also known as Gamma Knife. The use of this procedure is spreading fast. To find it close to where you live, "google" it under Radio Surgery, or Gamma Knife.

© Gabe Bartha 2007. All rights reserved


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