Radiosurgery from the brain to the spine: 20 years experience
Radiosurgery evolved from brain to spine. Mechanical and computer advances in linear accelerator (LINAC) radiosurgery apply precise single/fractional stereotactic radiation to multiple pathologies.
During a 10-year span the senior author used proton-beam radiosurgery in over 300 lesions, followed by gamma-knife, adapted and dedicated LINACS, including cyber-knife, in another 700 patients. The last 10 years, experience was accumulated with the Novalis in over 3,000 patients. Novalis uses a beam-shaper in a high-speed delivery LINAC. It operates using conventional circular arc, conformai static beam, dynamic conformai or intensity modulated modes. Patients treated with Novalis at the UCLA since 1997 were evaluated regarding effectiveness, complications and failure. These results were compared with previous 1997 data.
Over 4,000 patients with trigeminal neuralgia/intractable pain, arteriovenous malformations/angiomas, métastases, ependymomas, gliomas, meningiomas hemangiopericytomas, schwannomas, adenomas, hemangioblastomas, and chordoma were treated. Spinal lesions were treated with frameless stereotaxis and on-line precision checks. Treatment was expeditious, comfortable and with reduced complications. Success is similar or superior to published data. Reduced treatment time of complex lesions and highly homogeneous dose compares favorably to other radiosurgery.
The senior author’s experience validates the novel shaped-beam approach. Long-term follow-up supports safety and effectiveness and capability to treat brain and spine.
KeywordsProton beam linear accelerator gamma-knife radiosurgery spine
Unable to display preview. Download preview PDF.
- 1.Chenery SGM, Massoudi F, De Salles AAF, Davis DM, Chehabi HH, Adler RD (1999) Clinical experience with the Cyberknife at Newport radiosurgery center. In: Kondziolka D (ed) Radiosurgery. Karger, Basel, pp 34–40Google Scholar
- 2.Chitapanarux I, Goss B, Vongtama R, Frighetto L, De Salles A, Selch M, Duick M, Solberg T, Wallace R, Cabatan-Awang C, Ford J (2003) Prospective study of stereotactic radiosurgery without whole brain radiotherapy in patients with four or less brain métastases: incidence of intracranial progression and salvage radiotherapy. J Neurooncol 61: 143–149PubMedCrossRefGoogle Scholar
- 4.De Salles AA, Bajada CL, Goetsch S, Selch M, Holly FE, Solberg T, Becker DP (1993a) Radiosurgery of cavernous sinus tumors. Acta Neurochir Suppl 58: 101–103Google Scholar
- 6.De Salles AA, Hariz M, Bajada CL, Goetsch S, Bergenheim T, Selch M, Holly FE, Solberg T, Becker DP (1993b) Comparison between radiosurgery and stereotactic fractionated radiation for the treatment of brain métastases. Acta Neurochir Suppl 58: 115–118Google Scholar
- 12.De Salles AAFG, Gorgulho A, Golish R, Medin P, Malkasian D, Selch MT, Solberg T (2006) Technical aspects of novalis stereotactic radiosurgery sphenopalatine ganglionectomy. Int J Radiat Oncol Biol Phys 66: 853–857Google Scholar
- 13.De Salles AAFG, Goetch SJ (1993) Stereotactic surgery and radiosurgery. Medical Physics Publishing, Madison, WiscosinGoogle Scholar
- 17.Golish SRDS, De Salles AAF, Yap C, Solberg TD (2004) Stereotactic radiosurgery for brain métastases and cerebral FDG positron emission tomography. In: Kondziolka D (ed) Radiosurgery. Karger, Basel, pp 92–96Google Scholar
- 24.Medin PM, Solberg TD, De Salles AA, Cagnon CH, Selch MT, Johnson JP, Smathers JB, Cosman ER (2002) Investigations of a minimally invasive method for treatment of spinal malignancies with LIN AC stereotactic radiation therapy: accuracy and animal studies. Int J Radiat Oncol Biol Phys 52: 1111–1122PubMedGoogle Scholar
- 25.Pedroso-Gorgulho ADS, De Salles AAF, Frighetto L, Torres RC, Solberg T, Medin P, Cabatan-Awang C, Selch M (2004) Preliminary Novalis experience in the treatment of skull base chordomas with stereotactic radiosurgery and stereotactic radiotherapy. In: Kondziolka D (ed) Radiosurgery. Karger, Basel, pp 82–90CrossRefGoogle Scholar