by Lauren Dubinsky
, Senior Reporter | October 05, 2015
From the October 2015 issue of HealthCare Business News magazine
During microradiosurgery, the neuroanatomy is very precisely defined and the dose is conformed to the target volume with very high selectivity in order to preserve any normal structures. Microradiosurgery is commonly used by Gamma Knife centers for extremely exacting indications in very critical anatomical locations such as the brain stem, adjacent to the optic apparatus, in the cavernous sinus and for functional disorders like essential tremor. “[These types of cases are] really the toughest of the tough. You have to be absolutely sure of what you are doing,” says Gilmore-Lawless.
Microsurgery is also used for trigeminal neuralgia, which is a pain disorder caused by a tiny nerve sticking out of the brain stem. The dose must be manipulated around the nerve, which involves very precise sculpting capabilities in a tight space.
New indications for SBRT
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Lung SBRT has become routine for treating non-small cell lung cancer tumors (NSCLC), typically less than 3 centimeters in diameter, because of its high rate of local control and limited toxicity. But new research shows that it can also be used to safely treat inoperable NSCLC tumors larger than 5 centimeters. A new study published in the International Journal of Radiation Oncology Biology Physics
found that SBRT can treat larger tumors with low rates of recurrence at the primary cancer site with minimal side effects.
“There has traditionally been a fear of treating larger tumors with SBRT because it’s really destructive when the high dose of treatment is given compared to most radiation that is given in gentle or smaller doses,” says Dr. Neil Woody
, radiation oncologist at the Cleveland Clinic and one of the authors of the study. The researchers evaluated the outcomes of 40 patients 18 months after SBRT was used to treat their node-negative, medically inoperable NSCLC tumors that were greater than 5 centimeters. They found that SBRT can effectively and safely treat those types of tumors.
There was no evidence of disease at the original tumor site in about 91 percent of the cases and 32.5 percent of the patients experienced distant failure, which is when the cancer spreads to other parts of the body. Additionally, 70.5 percent of the patients didn’t experience any side effects. When the results were compared to published surgical studies, lung SBRT appeared to have similar rates of local control and distant failure. The median age of the patients was 76 and most of them had several significant comorbidities. The preferred way of treating NSCLC is with surgery, but this group of patients couldn’t handle an invasive procedure.