Gil Lederman on Common Uses of Fractionated Stereotactic Radiosurgery



Malignant primary tumors including astrocytomas and glioblastomas as well as metastatic cancers to the brain are frequently treated. Primary tumors commence in the brain, while metastases have spread to the brain through the bloodstream. These cancerous conditions have been - and are - extensively studied by our radiosurgery group. With close collaboration of medical oncology, studies combining special radiation-enhancing well-tolerated chemotherapeutic agents - such as Taxol - have been regularly evaluated and continue to show survival benefit compared to standard treatment or standard single shot radiosurgery for those with newly diagnosed as well as recurrent small or large primary brain tumors - like glioblastomas, astrocytomas and other aggressive cancers. With Taxol and fractionated radiosurgery given concurrently, the survival rates are superior even for recurrent glioblastoma multiforme patients.

A greater benefit is seen adding our immunotherapy program after fractionated radiosurgery. Our data for the treatment of recurrent high-grade primary brain tumors like glioblastomas is appealing ? using fractionated radiosurgery followed by immunotherapy. Fractionation benefits are numerous. For malignant tumors, there is protection of the healthy surrounding tissue while maintaining - or improving - efficacy of treatment. In fact, studies of malignant primary brain tumors such as glioblastomas show improved survival rates compared to single-fraction radiosurgery. Furthermore, there is a much less need for subsequent operation or intervention when our techniques are implemented compared to single fraction radiosurgery.

Brain metastases means the cancer started elsewhere in the body and spread via the bloodstream to the brain. Our work shows benefit from fractionated stereotactic radiosurgery for those with single or multiple metastases - even when not successfully treated by prior surgery or radiation. Fractionated radiosurgery allows treatment of larger cancers or those in the most delicate parts of the brain (like the brainstem area or by delicate cranial and optic nerves) - with a greater degree of safety than other methods of standard radiosurgery. For many patients with brain metastases, radiosurgery may replace the need for whole brain radiation. Whole brain radiation radiates the normal healthy tissues. Many patients choose radiosurgery for newly diagnosed tumors specifically to avoid standard therapy and unnecessary side effects. Other patients select radiosurgery for brain metastases that have remained or grown despite standard radiation or surgery. Most patients are treated in four separate sessions each lasting about 30 minutes. We have extensive experience treating brain metastases ? and find it best to discuss each situation based upon the clinical facts and the patient's desires ? after the Informed Consent process.

Radiation-enhancers are highly effective in head and neck cancers. Taxol is not particularly effective by itself, but is used in sensitizing the tumor - or making the cancer more susceptible - to the effects of fractionated stereotactic radiosurgery. When treated with unique approaches pioneered by our physicians, cancers of the Head and Neck area have high response rates. These cancers include the nasopharynx, maxillary sinus and other primary sites within this crucial area of the body. Many come to us after standard radiation, chemotherapy and/or surgery failed to work.

The most common benign tumors treated by our expert physicians include meningiomas and acoustic neuromas as well as pituitary tumors. Other neuromas and schwannomas are treated with a high degree of confidence. This article discusses the benefits in brief.