Stereotactic Radiosurgery: A Noninvasive Brain Tumor Treatment Option Susan C. Pannullo, MD Director of Neuro-Oncology Department of Neurological Surgery New York-Presbyterian Hospital/ Weill Cornell Medical College Director of Neurosurgical Radiosurgery New York Presbyterian Hospital Associate Professor of Clinical Neurological Surgery Weill Cornell Medical College Adjunct Professor of Biomedical Engineering Cornell University
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Speaker Event with Dr. Susan C. Pannullo - Brain Tumor Foundation
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Director of Neuro-OncologyDepartment of Neurological Surgery
New York-Presbyterian Hospital/ Weill Cornell Medical College
Director of Neurosurgical RadiosurgeryNew York Presbyterian Hospital
Associate Professor of Clinical Neurological SurgeryWeill Cornell Medical College
Adjunct Professor of Biomedical Engineering Cornell University
Stereotactic Radiosurgery (SRS)
• Non-invasive technique for delivery of highly focused radiation with extreme precision
• Creates a desired response (e.g. tumor cell death)• Minimal effect on normal surrounding structures• Uses high resolution imaging for “stereotactic” (3-D)
treatment planning• Generally single session, can be multiple (< 5)• Multidisciplinary team: Neurosurgeon, Radiation
• Higher control rate, fewer complications with smaller tumors
Stereotactic Radiosurgery for Meningioma
Stereotactic Radiosurgery for Brain Metastases
• Newly diagnosed, recurrent, residual brain metastases or sometimes to an area around a tumor after surgery
• Control of treated tumors ranges 60 - 97 %
• Can treat multiple metastases at one time
• Single session therapy allows proceeding with treatment of systemic cancer
Stereotactic Radiosurgery for Brain Metastases
• Need known cancer diagnosis
• Large tumors generally need an operation
• May be used with or without additional radiation treatments
Stereotactic Radiosurgery for Brain Metastases
Stereotactic Radiosurgery for Brain Metastases
Stereotactic Radiosurgery for Pituitary Adenomas
• Radiosurgery can be used for residual, recurrent or occasionally for newly diagnosed pituitary adenomas
• Secreting and nonsecreting pituitary adenomas– Stable/decreased size = 92-100%– Sometimes the goal of treatment is to control tumor
hormone secretion
• If tumor is near visual structures, fractionation may be used
Radiosurgery for Pituitary Adenomas
Stereotactic Radiosurgery for Glioblastoma Multiforme
• Potential indications for radiosurgery for GBM– “boost” following initial conformal radiation
therapy– salvage at time of recurrence– upfront therapy
• Use of stereotactic radiosurgery for GBM is controversial
• Possibly appropriate for use in localized GBM to achieve local control
Stereotactic Radiosurgery for Glioblastoma Multiforme
Stereotactic Radiosurgery: Risks and Benefits
Radiosurgery for Brain Tumors:
General Risks• Time of presentation:
– Acute (hours to days)– Early (weeks to months)– Late (months to years)
• Complications determined by various factors– Tumor type, size, location– Prior radiation– Radiation dose given
Radiosurgery for Brain Tumors:
General Risks• Necrosis/inflammation
– edema– mass effect– seizures
• Late radiation effects on normal structures– Cranial nerves– Optic chiasm– Brainstem
• ? Radiation-induced secondary tumors
Stereotactic Radiosurgery for Brain Tumors: Potential Benefits• Minimally/ Non-Invasive
– Well tolerated– Outpatient procedure– Immediate return to normal activities
• Single (or few) treatments sustained effect• Treats a wide variety of tumors• Can treat multiple tumors at one sitting• Avoids systemic toxicity• May be combined with other therapies
Stereotactic Radiosurgery for Brain Tumors: Conclusions
Stereotactic Radiosurgery for Brain Tumors: Conclusions
• Treats a wide range of brain tumor types
• Single or few sessions • Minimally/ Non-invasive• Safe• Effective
Stereotactic Radiosurgery for Brain Tumors: Conclusions
• A powerful tool in the treatment of brain (and spine) tumors…