Comparing options for stereotactic radiosurgery

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Comparando opções para o radiosurgery stereotactic

por Gus Iversen, Editor in Chief | February 24, 2015
Elekta’s Gamma Knife Perfexion
From the January/February issue of HealthCare Business News magazine

According to the National Cancer Institute, as many as 170,000 cancer patients are diagnosed with intracranial metastatic disease every year in the U.S., and up to 80 percent of them have more than one lesion (tumor). Determining the best treatment for patients is something a physician must do on a case-by-case basis, in many scenarios, however, stereotactic radiosurgery (SRS) is an excellent option.

Given the various offerings from Varian, Elekta, Accuray, and BrainLab, how does a physician decide which device will deliver the right treatment modality for their patients? And how does a facility decide which radiation device is right for their cancer center? HealthCare Business News reached out to physicians and manufacturers alike to assess the options, and, spoiler alert: there is no one-size-fits-all answer.

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Although not everyone agrees on the best solutions available for SRS, the consensus is that Elekta’s Gamma Knife has historically set the standard. It was invented and developed exclusively for brain treatment. Catherine Gilmore-Lawless, vice president of clinical intelligence at Elekta, tells us that more than 900,000 patients have received Gamma Knife treatment on one of more than 300 systems in use worldwide. She says those figures account for 75 percent of the world’s total stereotactic radiosurgery procedures.

However, there are limitations to the Gamma Knife. Most notably, it is restricted to treating brain lesions and utilizes a stereotactic head frame to achieve immobilization and accuracy of the treatment. Securing the head frame to the skull is uncomfortable and means radiosurgery must (almost always) be performed in a single fraction.

Other devices, such as Accuray’s CyberKnife and TomoTherapy, and the latest linear accelerators, including BrainLab’s Novalis, Varian’s Edge and TrueBeam, and Elekta’s Versa HD, utilize image guidance and motion sensing to stay on target while treating brain lesions as well as tumors located in other parts of the body. Eliminating the head frame also means that those platforms can treat in multiple fractions if the patient’s needs call for it.

So, one may make the assumption that the Gamma Knife set the stage for stereotactic surgery and then new equipment came and improved on every aspect of its innovations. That’s not exactly the case. Dr. Lijun Ma, a physicist from the UCSF radiation oncology department, has all of those options at his disposal, however, he and his colleagues continue to exclusively use Gamma Knife when treating the brain.

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