Brain Surgery Meets Rocket Science
By: Keith Hautala
UK Public Relations & Marketing
It sounds like something out of Star Trek. A doctor treats a brain tumor with precisely targeted invisible beams of energy, guided by a high-definition, three-dimensional digital image of the patient's head. The treatment plan is administered by skilled physicians and medical physicists and coordinated by a supercomputer silently blinking in a corner.
It's “surgery” without the surgery – no blood, no pain, no hospital stay, and no anesthesia in most cases. Treatment is delivered on an outpatient basis, in sessions taking mere minutes. But this is not science fiction; this is 21st century medical science. It's called radiosurgery, and it's happening here, now, at the University of Kentucky Chandler Hospital.
The Brain and Body Radiosurgery Program at the Markey Cancer Center combines state-of-the-art radiation medicine technology with top-level medical expertise in a multidisciplinary patient care setting. The program's brand new treatment space was finished in late April, right on schedule for doctors to begin treating patients May 4, said Dr. Marcus Randall, program director and chief of the Department of Radiation Medicine at the UK College of Medicine.
Two similar, but distinct, technologies are at the center of the program.
The Gamma Knife Perfexion system uses 192 separate, precisely focused beams of electromagnetic energy, called gamma rays, to target and kill diseased cells while sparing surrounding healthy tissue. The beams can be focused onto a target inside the brain as small as 4 millimeters in diameter. Irregularly shaped tumors can be treated by combining treatment spheres of differing sizes.
"It really is the gold standard for brain radiosurgery," said Dr. William St. Clair, associate professor of radiation medicine.
UK installed its first Gamma Knife – the seventh in the United States – in 1991. UK still has the only Gamma Knife in Kentucky and currently treats more than 200 patients annually. The new Perfexion system contains many improvements and upgrades to earlier models. Most significantly, it will reduce patient treatment times by up to 70 percent by eliminating the need to move the patient in and out of the machine to make adjustments during a treatment session.
The other technology, a brand new TomoTherapy Hi-Art treatment system, looks a lot like a CT scanner. TomoTherapy treats tumors using high-power X-rays from a source that rotates around the patient in a spiral pattern, depositing radiation exactly where it is needed with an astonishing degree of accuracy.
"It has been compared to painting with radiation," said Dr. Ronald McGarry, clinical associate professor and vice chairman of radiation medicine. "We can, for example, treat lesions in the lining of the lung without damaging adjacent healthy lung tissue. For some patients, it can actually be a lung-sparing procedure."
Radiosurgery fights tumors by stopping their growth, often shrinking them and rendering them inactive. This alleviates symptoms and can even extend life expectancy in some cancer patients, Randall said.
And treatment with the Gamma Knife can effectively cure some non-cancerous tumors, such as acoustic neuroma – a benign growth on the nerves leading to the ear, which can cause a loss of hearing and balance. Gamma Knife radiosurgery has also been shown to be effective in about 80 percent of patients with trigeminal neuralgia, a chronic condition that causes debilitating facial pain.
"It is not a miracle cure," Randall said. "Patients still need to meet specific criteria with regard to tumor type, size and location, among other factors. But for the right patient, radiosurgery can produce truly remarkable results without hospitalization and without the risks of many of the complications possible with surgery."
Radiosurgery does carry its own risks. Fortunately, Randall says, serious complications are extremely rare, and the overall risk profile compares favorably to that of traditional "open" surgery. It also costs less. It's still expensive, but without the associated costs of hospitalization, the total bill ends up being around half as much or less compared to surgical treatment, Randall said.
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