Gamma Knife Surgery - Radiosurgery

Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (sbrt)

Stereotactic radiosurgery (SRS)that is used to treat brain tumors and functional abnormalities of small non-surgical radiation therapy. High-dose therapy compared to conventional treatment in a smaller number of sessions, precise goal-directed radiation can help by sending in the preservation of healthy tissue. SRS, body when used to treat tumors, stereotactic body radiotherapy (sbrt) takes the name of.

SRS and SBRT are mostly out-patient conditions is being implemented. After your treatment you will need to make a plan to take you to a near, and whether the treatment a few hours before eating, drinking or taking drugs ask your doctor whether you need to quit. If you have the possibility of being pregnant or breastfeeding or if you are taking insulin or oral medication to control diabetes if you specify with your doctor. A medical device placed on your body, fear of enclosed space (claustrophobia), or check whether you have allergy to contrast.

What is stereotactic radiosurgery and how is it used?

Stereotactic radiosurgery (SRS) was initially developed to treat small tumors and functional abnormalities of the brain, a highly precise form of radiation. The radiation of rays is sent with a precision of one to two millimeters high-precision radiation called SRS today where the principles of cranial stereotactic body radiotherapy (sbrt) in the treatment of tumors in the body a process called is applied.

SRS, despite its name, a non-surgical procedure compared to conventional radiation therapy, the radiation directed precisely to the target in much higher doses in the treatment of a single or small number of applies. The dose to the surrounding healthy tissue in the target area to be sent to the lowest level that allows downloading with the development of highly advanced radiation technologies, a maximum dose I have been able to use this treatment. Local tumor destruction and permanent objective that will allow you to control the application of doses.

SRS and SBRT based on various technologies:

  • Within the body that determine the exact coordinates of the target three-dimensional imaging and localization techniques
  • During therapy, the patient and the positioning and immobilizing the patient carefully maintains the position of a system.
  • Highly focused on a tumor or abnormality that is combined with gamma or X-ray bundles
  • Image-guided radiation therapy (IGRT)radiation just before applying, and in some cases during the transmission of radiation uses medical imaging to confirm the location of the tumor. IGRT improves the precision and accuracy of treatment.

CT, MRI and PET/CT, such as three-dimensional imaging, tumor or abnormality in the body is used to define the size and shape determine the location of and precise. These images are also different angles and planes of the beam on the target area of the patient in the treatment of merging and give direction to treatment planning that is designed to be carefully positioned.

Despite widely expressing daily treatment with SRS, physicians sometimes propose multiple stereotactic treatment. High-dose single-dose reaching the surrounding normal tissue exposed to radiation and dose should be limited to take account of the volume of normal tissue and the tumor area is increased in proportion to the size of this approach, it is important for tumors over 2.5 cm in diameter. In just a few sessions instead of a single session of radiation can improve the security of sent and allow the normal tissue to heal in between sessions of treatment.Therefore, the separation into fractions of high doses of treatment to be sent to the target while allowing the resumption of acceptable safety profile gives you the opportunity to. This process is mostly fractionated stereotactic radiotherapy (SRT) in two to five treatment sessions, typically focused radiation is called shall be given.

SRS and SBRT, especially for patients who are not able to be taken to surgery, and for tumors and abnormalities with the following characteristics, are important alternatives to invasive surgery:

  • Hard to reach
  • Vital organs/anatomic regions close to
  • The moving regions in the body

SRS is used to treat the following:

  • Many brain tumor type, including the following:
    • benign and malignant
    • primary and metastatic
    • Single and multiple
    • Residual tumor cells after surgery
    • Intracranial, orbital and skull base tumors
  • Arteriovenous malformations (avms) in the brain disrupts normal blood flow bleeding and sometimes ball-shaped enlarged blood vessels.
  • Trigeminal neuralgia (facial nerve), tremor and other neurological disorders

Sport today in the body of benign and malignant small-to-medium sized tumors and is used in the treatment of common ailments of a region that contains the following and/or use are being investigated:

  • lung
  • liver
  • wife
  • life
  • prostate
  • head and neck

SRS basically it works the same way with other types of radiation. Actually to push away the tumor, but damages the DNA of tumor cells. As a result, they lose the ability of proliferation of these cells. Mostly 18 month to two year period after treatment of benign tumors, they contract. Malignant and metastatic tumors more quickly, even within a few months, they may shrink. Arteriovenous malformations (avms), treated with SRS when they slowly thicken and start to shut down in the next few years from the treatment.Many tumor will remain stable and inactive without any change. The goal is to prevent the growth of the tumor, since this is considered to be a success. For some tumors such as acoustic neuroma tumor tissue due to the inflammatory response after SRS is becoming stable over time in observable tumor regression is observed after the temporary expansion or psikoregulasyon called.


In which the equipment is used?

There are three basic types of devices and equipment that use radiation sources each one different:

  • Directed to the entire target region a beam of highly focused gamma rays that uses 192 or 201 gamma knife® gamma knife for small to medium-sized ideal for the treatment of intracranial lesions. For additional information, see the gamma knife page to refer to.
  • All over the world most widely used are the linear accelerator (LINAC) photon machines, known as high-energy X-rays they send. The linear accelerator, large tumors, called fractionated stereotactic radiotherapy in a single session or multiple sessions in the SRS are implemented. Multiple manufacturer, this machine performed by truebeam STx under similar brands and manufactures. For additional information, see the linear accelerator page.
  • Proton beam or heavy charged particles, Radio surgery, proton therapy centre offering over the last few years the number of increased dramatically, although in a limited way in North America are used. For additional information, proton therapy page .

In this process, the equipment is located and who employs who?

Typically a treatment team radiation oncologists, medical radiation physicist, radiologist, dosimetry specialists, radiation therapist, radiation therapy specialized health workers, including nurses, are made up of.

  • Radiation oncologists, and in some cases, the treatment team and treatment guidance to the neurosurgeon controls; the target to be treated(s) draw boundaries appropriate to decide the radiation dose, radiosurgery treatment plan, confirm and interpret results of operations.
  • The radiologist in the brain or in the body to be treated, the target(s) that identifies and interpret imaging studies.
  • Be given guarantees that the radiation dose medical radiation physicists precisely determined.
  • Physicist a physicist or dosimetry under the supervision of a specialist treatment plan for arranging a special computer software uses; calculates the prescribed dose conformal to the target and beam configuration of the exposure therapy.
  • Well-trained radiation therapist places the patient on a treatment table and the machine runs in the protected area nearby. The radiation therapist and the patient you can observe from a window or closed circuit television can communicate with the patient during the procedure. In the case of the use of gamma knife, neurosurgeon, and/or position may help the radiation oncologist for the treatment of the patient, and the amount of radiation the machine can run.
  • Radiation therapy nurse assesses the patient, gives the patient information about the treatment, the patient observations during treatment, and after treatment helps to answer the question.
  • A neurologist or neuro-oncologist, and radiation therapy considering various treatment options for each case of lesions in the brain that helps us identify people who can benefit from a multi-disciplinary team, in conjunction with the neurosurgeon and radiation oncologist, can participate in.

How is the operation performed?

Radiosurgery Linear Accelerators Are Used Where

The linear accelerator (LINAC) SRS consists of four phases: the fitting of the head frame, imaging, planning and radiation dose of computed aided the granting of. LINAC and gamma knife technology in use technology is much more common than for a similar period. During the procedure, that requires the patient to remain motionless unlike gamma knife, LINAC machine (sled called) that sends a section of the beam rotates around the patient from different angles. The head frame also before installing an MRI LINAC-based SRS in the more routine pre-planning application. It is common practice to withdraw it when it is connected to the head frame.

When applied to SRS using cyberknife, the robotic arm translates linac compact image guided around the patient. CyberKnife SRS is based on the head frame being sent without invasive, plastic head and rays the head while the mask is simpler to be kept constant can improve the use of patient comfort. The development of frameless SRS, image-guided therapy has been made possible by the inclusion of. Today, LINAC-based SRS, frameless SRS is moving in the direction of a large portion of the technology.Gamma knife, the patient has developed technology to protect it from invasive head frame frameless placement process. Frameless SRS is, again, large tumors, or tumors or particularly critical locations found in SRS allows the advantage of fractional sbrt.


SBRT is typically implemented in the period of one to two weeks of consists of one to five treatment sessions.

X-ray-based image guidance according to the solution based on some technologies such as the cyberknife, in selected patients, the placement of a measurement mark, you will be prompted in or near the tumor. However, the CT-based image-guided technologies in most of this step is not needed. If you need to mark a measurement, depending on where your tumor is located, your radiation oncologist will be placed near the tumor to one of four measurement mark to a pulmonologist, gastroenterologist, or may work with radiologists.Mark the placement of a measurement is almost always an outpatient process.

After your radiation oncologist will determine the method and this will align with your body’s beams from linear accelerators is called process simulation. Patients and patient during treatment simulation and align very accurately to ensure it remains stationary, often devices are used to hold the patient still. Some of these systems are pretty tight to hold tightly; therefore, claustrophobia (fear of enclosed spaces you should tell your doctor that you are experiencing. After the immobilization device is created for you, the area to be treated, the CT image is scanned.Your doctor is giving information about how the tumor is moving in and out with your breathing CT scans, “4D CT” request. This is for tumors in the liver or lungs is quite common. After the scan is completed you will be sent home.

The third phase of this process is planning. Radiation oncologists, optimal beam arrangement to plan for your tumor, medical radiation physicists and radiation dosimetry experts will work with you. MRI or PET/CT with other imaging techniques such as could include. The team, using special software, in order to determine the most appropriate one for your situation, the combination of a hundred different beam passes through.

Sbrt is performed with linear accelerators in radiation. Some patients before treatment with anti-inflammatory, or anxiety despite receiving preventive medications nausea relief, normally there is a restriction about eating or drinking. You will be connected to a device to hold you still. To align the beam with the tumor before starting radiation therapy X-ray or CT (depending on the method custom image guidance LINAC technology) will be taken.Radiation therapist, radiation oncologist, of the X-rays based on the position in the direction of the instructions that you gave. Then, the radiation therapist will administer the treatment. Sometimes, the tumor during treatment to monitor the position of X-ray or CT scan is performed. The treatment may take an hour or longer.

Do I need any special arrangements to be made for the transaction?

SRS and SBRT are mostly out-patient conditions is being implemented. However, be prepared to spend half a day or longer in the organization. You will be informed whether you will need a companion to drive home after the procedure.

If you eat or drink anything after midnight the night before your treatment, you may be asked. Whether to take your medications on the day of treatment of your medications or ask your doctor whether you want to bring with you on the day of the transaction. In addition, you should ask your doctor whether any of the following apply to you:

  • The use of insulin or oral medication to control diabetes.
  • Given into a vein or contrast agent Allergy or iyodine.
  • In your body, a pacemaker, artificial heart valves, defibrillators, brain aneurysm clips, can be worn or chemotherapy Pump body ports, cardiovascular division (brain cell), eye or ear implants, stents, spiral (coil) or whether or not it has a filter.
  • Your claustrophobia (claustrophobia).

Do I feel during and after the procedure?

Radiosurgery treatment with the X-ray is similar to withdrawal. Usually, X-rays won’t feel will see or you won’t. The only exception to this brain therapy for some patients, when the machine is open, even your eyes can see the bright lights kapatsal. Leading pain or discomfort from the treatment is out of the question.

If you hear pain for different reasons such as back pain, or head frame or the device that holds you immobile at times due to if you feel uncomfortable, you should let your doctor or nurse know.

Your head frame is removed, the nails are placed in the places where small hemorrhages may be seen, and with these bandages will be closed. You may experience headaches and you may be given medicine to help you feel more comfortable.

In most cases, radiosurgery and SBRT, all patients can resume normal activities within a day or two.

The problems which are the result of the side effects of radiation therapy in the treatment, as well as damage to healthy cells from radiation treatment include problems in the area.

The number and intensity you experienced side effects of radiation type, dose and depends on the area of the body that is treated. You have had all the side effects, to assist in the management of them, you should tell your doctor and your nurse.

Radiation therapy, typically arising within a few weeks that disappeared early during treatment or immediately after treatment and can cause side effects. Late side effects can occur months or years later. Common early side effects of radiation therapy fatigue or weakness, and skin problems. Skin in the treatment area becomes more sensitive and develops redness and irritation or swelling may occur. Other skin changes, dryness, itching, hair loss and swelling of the skin areas.

Depending on the area to be treated can be seen in other early side effects include the following:

  • Hair loss in the treated area
  • Oral problems and difficulty swallowing
  • Eating and digestive problems
  • diarrhea
  • Nausea and vomiting
  • Headache
  • Pain and swelling in the treated area
  • Urine changes and bladder

Rare side effects from the treatment can occur after months or years and often are permanent. Within these the following takes place:

  • Brain changes
  • Changes in the spinal cord
  • Lung changes
  • Renal changes
  • Changes Colon and rectum
  • Infertility
  • Joint changes
  • Lymphedema
  • Oral changes
  • Secondary cancer
  • Bone fractures

Risks linked to the development of cancer radiation therapy, albeit low, there are. After the application of radiation due to cancer, recurrence, and new cancers in terms of you should be checked regularly by the radiation oncologist.

By using techniques such as radiation therapy for cancer of sport of the devastation of healthy tissue to limit side effects while maximizing on the properties is intended to minimize the impact

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