By Rajni A. Sethi, Igor J. Barani, David A. Larson, Mack Roach III
This guide concisely summarizes cutting-edge information regarding stereotactic radiosurgery (SRS) and stereotactic physique radiotherapy (SBRT), together with the historical past and improvement of those modalities, the biologic purpose for those applied sciences, general practices, and said effects. built as a better half to Handbook of Evidence-Based Radiotherapy, moment variation, edited by means of Eric Hansen and Mack Roach, III, it's equipped through ailment web site and offers therapy concepts and prompt imaging; security and caliber coverage; toxicities and administration; urged follow-up; and helping proof. Inclusion of evidence-based directions is meant to aid tell judgements concerning the appropriateness of SRS and SBRT and advisor remedy and assessment. Handbook of Evidence-Based Stereotactic Radiosurgery and Stereotactic physique Radiotherapy might be simply referenced within the sanatorium and is a beneficial advisor for oncology practitioners.
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Extra info for Handbook of Evidence-Based Stereotactic Radiosurgery and Stereotactic Body Radiotherapy
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Treatment Indications In general, SRS+WBRT is associated with longer survival than WBRT alone in patients with single metastases and KPS ≥70, improved LC and KPS preservation in patients with 1–4 metastases and KPS ≥70, and potentially, improved survival in patients with KPS <70. SRS alone may provide equivalent survival and LC, plus improved neurocognitive outcomes when compared to SRS+WBRT or WBRT alone in patients with ≤3 metastases; close surveillance and salvage treatment is essential. After resection, both SRS+WBRT and WBRT alone are acceptable adjuvant strategies, although SRS alone may be used in select cases with minimal intracranial disease and close surveillance (Linskey et al.
Physics 27 Beam energy: 6 MV photons offer the best compromise between beam penetration and penumbra characteristics. Many techniques use unflattened beams. 5 mm leaves width). MLCs and micro MLCs are used to deliver treatments developed with conformal beams, intensity modulated fields, dynamic conformal arcs, or a combination of these (ICRU 1999). Treatments are delivered via coplanar and non-coplanar beam arrangements. Circular fields provide a sharper penumbra than microMLCs. Beam geometry: multiple non-overlapping beams concentrically pointing to the target; 5–12 coplanar or non-coplanar beams; 1 or 2 coplanar or non-coplanar arcs; a continuously rotating fan beam; hundreds of non-coplanar pencil beams pointing to different parts of the target (non-isocentric beam arrangement) or to the same point (isocentric beam arrangement).
Raleigh et al. 1 RTOG RPA for brain metastases (Gaspar et al. 2). , vestibular schwannomas) arise from myelin sheath Schwann cells surrounding the vestibular nerve; 6–8 % of intracranial tumors, overall incidence ~1 % on autopsy studies. 4. Intracranial Tumors 43 Risk factors include acoustic trauma and coincidence with parathyroid adenoma; bilateral acoustic neuromas pathopneumonic for NF2. Both CN VII and VIII may be affected (hearing loss, tinnitus, vertigo, and unsteady gait), and extension into the cerebellopontine angle may lead to dysfunction of CN V (trigeminal pain) and the facial nerve (facial paresis and taste disturbances), as well as compression of the posterior fossa (ataxia, hydrocephalus, and death).
