Stereotactic cranial radiosurgery
- Clark C Chen, MD, PhD
Clark C Chen, MD, PhD
- Director, Radiosurgery
- Vice Chair, Research and Academic Affairs
- Department of Neurosurgery
- University of California, San Diego
- Paul H Chapman, MD
Paul H Chapman, MD
- Distinguished Nicholas T Professor of Neurosurgery
- Harvard Medical School
- Jay S Loeffler, MD
Jay S Loeffler, MD
- Section Editor — Neurooncology
- Professor of Radiation Oncology
- Harvard Medical School
The potential utility of ionizing radiation to treat cancer was recognized shortly after the discovery of X-rays, which can cause extensive damage to DNA.
Prior to the development of stereotactic techniques, radiation was delivered to the cancer and a significant volume of surrounding normal tissue. Therapeutic efficacy was based upon the increased DNA-repair capacity of normal cells compared with tumor cells following radiation exposure. The total dose of radiation was delivered in small fractions over a period of weeks to allow normal tissue to preferentially recover or heal itself between doses compared with the tumor so that the cumulative damage to tumor cells was much greater. This fractionated approach is known as radiation therapy (RT) (figure 1).
Major advances in stereotactic localization, noninvasive neuroimaging, and radiation physics made it possible to selectively irradiate a sharply defined target, largely sparing the surrounding normal tissue. This approach, called stereotactic radiosurgery (SRS), is achieved by focusing multiple radiation beams on the tumor tissue from different directions (figure 1).
The biologic differences between fractionated RT and SRS and the technology of administering SRS are reviewed here. The applications of SRS for various tumors (both malignant and nonmalignant) are discussed under separate headings. Similarly the potential complications of cranial SRS and the application of SRS to extracranial sites are discussed separately. (See "Radiation therapy techniques in cancer treatment", section on 'Stereotactic radiation therapy techniques' and "Acute complications of cranial irradiation" and "Delayed complications of cranial irradiation".)
Fractionated (conventional) RT — Fractionated or conventional radiation therapy (RT) refers to the repeated administration of small doses of radiation to a relatively large target, as in whole brain RT or focal (involved-field) RT. Fractionation of the total dose minimizes damage to normal tissues by allowing time for repair of damage to DNA and maximizes the killing of tumor cells. Conventional dose fractionation schemes for intracranial lesions typically consist of 1.8 to 2 Gy in daily sessions with cumulative doses of 30 to 60 Gy .
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- Fractionated (conventional) RT
- Stereotactic radiosurgery
- Fractionated RT
- Stereotactic radiosurgery
- Dose homogeneity
- SRS VERSUS CONVENTIONAL RT
- Tumor volume
- Proximity to cranial nerves
- Location of the lesion
- Neurocognitive function
- Stereotactic guidance
- Radiation delivery
- - Gamma Knife
- - Linac
- - CyberKnife
- - Novalis ExacTrac Robotic system
- PROTON BEAM SRS
- INFORMATION FOR PATIENTS