Time, the most effective method is radiosurgical treatment. Stereotactic radiosurgery and extracranial stereotactic radiotherapy

For patients with tumors, radiotherapy is more effective and safer than surgery. At the N.V. Sklifosovsky, such operations are carried out for Muscovites free of charge.

Moscow is the only city in Russia where two unique modern Gamma Knife installations operate. They are in the Research Institute for Emergency Medicine named after N.V. Sklifosovsky and N.N. Burdenko. The devices allow you to remove benign and malignant tumors and vascular pathologies of the brain in a non-invasive way, that is, without using needles or surgical instruments.

About 12,000 such operations have already been performed in Russia, and 7,000 of them have been done in the last five years, when the latest models of the gamma knife appeared. And the first operation at the Center for Radiosurgery of the Research Institute N.V. Sklifosovsky was held on February 8. During the February clinical start, 11 Muscovites were operated on with money from the city budget. In total, 150 operations are planned to be performed this year. The equipment of the center - one workstation and two stereotaxic frames for calculations and accuracy of irradiation - allows for 200-300 procedures per year. And in the future, the device will be able to treat up to a thousand - two thousand patients annually.

Usually the cost of such an operation depends on the diagnosis, on average it is 240 thousand rubles - 10 times cheaper than abroad. But Muscovites can count on it for free. Every year in Russia about 60 thousand people need such operations; in the capital, 101 patients are now being considered and examined as candidates for this procedure.

How it works

Gamma Knife (Leksell Gamma Knife Perfexion) is a radiosurgical unit for the treatment of benign and malignant tumors and vascular malformations in the cranial cavity. The operation is performed without skin incisions and trepanation of the skull. For this, radioactive radiation from 196 sources of cobalt-60 is used, the beams of which are collected together and act like a non-invasive surgical knife. They destroy the DNA of tumor cells. At the same time, healthy brain tissue and the whole body are not irradiated.

Benefits of a new installation

Radiosurgical operations can be performed even in children, after the mineralization of the bones of the skull has ended (five to seven years). According to world statistics, about 10-15 percent of patients are children. The procedure is painless and lasts from 20 minutes to four hours, and the patient remains conscious. Soon after the operation, he can go home without fear of inflammation and complications; many people leave behind the wheel of their own cars.

Meanwhile, after surgery, the risk of developing infectious complications, venous thrombosis is quite high. The danger is not only the operation itself, but also anesthesia, especially for elderly patients. Before the operation, the patient lies for three to seven days in the neurosurgical department with other patients, including severe ones. And after it, he spends another three to ten days in the hospital. Not everyone can immediately return to normal life after the intervention. There are other disadvantages in surgery: usually, patients react sharply to the need for a craniotomy and the shaving of the head associated with it and postoperative scarring. These risks and inconveniences sometimes lead to the rejection of the operation, even if there are absolute indications for it.

What is Gamma Knife Treatment?

Among the most common indications for such an intervention are primary and secondary (metastases) brain tumors, parkinsonism, epilepsy, pain syndromes of central origin. Also, patients with arteriovenous malformations are referred for radiosurgery - anomalies in the structure of the vessels of the brain, when blood from the arteries enters the veins, bypassing the capillary vessels. Another disease in which they are referred for surgery with a gamma knife is cavernomas of the brain. These are pathological cavities separated by partitions and filled with blood. They can exist without symptoms, or they can cause epileptic seizures, blurred vision, damage to cranial nerves, and hemorrhage.

How to get help for free

If there are indications for radiosurgical intervention, citizens with permanent registration and compulsory medical insurance policy can be operated on free of charge. To do this, you need to consult a neurosurgeon of the Radiosurgery Center. If there is a referral form 057-U from a neurologist or therapist, it will be free.

After that, the patient receives a list of tests and consultations of specialists and gets in line for the operation. Now patients are waiting for treatment for several months. Radiosurgery is preferred, but not everyone can wait. Such patients are offered alternative surgeries. It can be microsurgery or endovascular surgery.

How is the operation

Patients are prepared for the procedure according to an individual plan, which includes diagnostic tests. On the day of the operation, after installing a stereotaxic frame (a metal ring for calculations and radiation accuracy), magnetic resonance imaging is performed on an expert-class ultra-high-field tomograph. If necessary, studies are supplemented with electroencephalography in magnetic resonance imaging, computed tomography or cerebral angiography. This data is used for treatment planning.

The operation is performed on an outpatient basis, it is not necessary to hospitalize the patient in a hospital. It is completely painless and lasts from 20 minutes to four hours. In the vast majority of cases, one session of radiosurgery is sufficient. After the operation, the patient receives recommendations and returns to normal life the same day.

First operation at the radiosurgery center

A high risk of fatal blood loss, atrophy of the optic nerves and partial loss of vision, a high probability of brain tumor growth - in this condition, the patient was admitted to the Research Institute. N.V. Sklifosovsky. Radiosurgery was the only possible method. The first non-invasive operation using the Gamma Knife was performed here on February 8 this year.

The painless procedure lasted 45 minutes. During this time, active tumor cells died under radiation. This made it possible to prevent the growth of its remnants and in a week to begin a course of treatment for optic nerve atrophy. Now the patient's vision has improved by 10 percent. In 90-95 percent of cases, this operation can prevent further growth of meningiomas.

Gamma Knife World Achievements

Melanoma, which develops from pigment cells, is one of the most malignant tumors. This is the diagnosis made to one patient in the UK. The doctors removed the primary lesion on the skin of the back and administered chemotherapy. But a few months later, the patient began to notice general weakness and speech disorders. The disease progressed rapidly, and MRI showed more than 30 chemotherapy-resistant brain metastases. Luckily they were small. Several radiosurgical operations have allowed the woman to live without symptoms for more than five years. Even 20-25 years ago, it was impossible to achieve such a result, but today the number of people successfully fighting brain metastases is growing.

Now more than 300 departments have been opened in the world, where more than 1.5 million radiosurgical operations have been performed. Abroad, they cost from 30 to 40 thousand dollars. The neurosurgeons and medical physicists working at the facility have united in the Leksell Gamma Knife Society, which organizes annual conferences and prepares training programs for specialists from all over the world.

High-tech assistance in Moscow

VMP is provided in different profiles: from obstetrics and gynecology, dermatovenereology, neurosurgery to rheumatology, pediatrics and endocrinology. A complete list can be found at pravo.gov.ru.

All Russians who have evidence can receive such assistance. They are determined by the doctor of the organization where the patient is examined and treated. He issues a referral for hospitalization. It must be accompanied by an extract from medical documents, certified by the personal signatures of the attending physician and the chief physician (authorized person) of the clinic or hospital. Also in the list of necessary - a copy of a passport or other identity document (for children under 14 years old - a copy of a birth certificate), SNILS (if any), compulsory medical insurance policy. To hospitalize a minor, you must provide a copy of the passport of his legal representative. The patient must consent to the processing of personal data.

If assistance is included in the MHI, the documents must be sent to where the patient will be treated. After that, the clinic or hospital will issue a coupon for the provision of VMP. Within seven working days, a special commission must decide whether the patient has indications for hospitalization.

If assistance is not provided for by compulsory medical insurance, then the documents are sent to the department for high-tech medical care of the Moscow Health Department (2nd Shchemilovsky lane, building 4a, building 4). The Department will issue the ticket. The Patient Selection Committee will make a decision within 10 working days. Further, it is necessary to act in the same way as in the case of providing assistance under compulsory medical insurance. More information about high-tech assistance in the capital will tell the section on the portal site.

Gamma knife is referred to as a means of radiosurgical exposure. In this way, it is possible to remove or stop the growth of many neoplasms of intracranial and other localization, without penetrating into the tissues, without incisions and the risks associated with them.

Hardly accessible, deeply located tumors have always been and remain a significant problem of oncology, because the difficulty arises not only with penetration to the neoplasm, but also with maintaining the integrity of the tissues that lie along this path. This issue is especially acute for intracranial tumors, which relatively recently could only be removed surgically, and if such treatment was impossible, patients were recognized as incurable and received only palliative care, which could not but affect the overall duration and quality of their life.

With the introduction of new methods of radiation exposure, one of which is the gamma knife, it became possible to remove neoplasms without incisions in soft tissues and trepanation of the skull and stop their growth in cases where surgical treatment is technically unfeasible.

Radiosurgery involves the destruction of tumor elements with a beam of radiation directed strictly to the zone of neoplastic growth., while the surrounding tissues receive a minimum of radiation and do not suffer from its harmful effects. This is one of the main advantages of the method. Another indisputable and weighty argument in favor of radiosurgical treatment is minimally invasiveness, which minimizes operational risks and does not require the use of anesthesia.

In addition to the gamma knife, more modern stereotactic installations are also used -. Difference from cyber knife is that when using a gamma knife, there is a need for rigid fixation of the irradiated part of the body, and when using a cyber knife, only a fixing grid is sufficient, while the device itself monitors the smallest movements of the patient and corrects the direction of radiation. In addition, the gamma knife only affects tumors inside the skull with gamma radiation, while the cyber system can remove tumors from other parts of the body.

The Gamma Knife is considered the gold standard in the treatment of intracranial neoplasia. These installations are very common in the USA, Japan, China. In Russia, for the first time, a gamma knife was installed in 2005 at the Research Institute. N. N. Burdenko, and today many other large oncological clinics throughout the country can offer this method of treatment.

Indications and contraindications for the use of gamma knife

Stereotactic radiosurgery is used for a variety of tumors of the brain, cranial nerves, vascular malformations, etc. Indications for the use of the method are:

• Neoplasms of the brain, its membranes and nerves - medulloblastoma, etc .;
• Metastatic nodes in the nervous tissue, including multiple ones;
• Congenital malformations and dysembryogenetic tumors;
• Recurrent gliomas or remnants of neoplasia after surgery, chemotherapy, or external beam radiation therapy;
• Vascular anomalies - aneurysms, hemangiomas, malformations;
• Trigeminal neuralgia;
• Epilepsy;
• parkinsonism;
• Multiple sclerosis;
• progressive glaucoma.

With the help of a gamma knife, neoplasms can be removed, the size of which does not exceed 3.5 cm, otherwise, the technique will be contraindicated, however, malformations from the vessels can be irradiated with a gamma knife even at large sizes. In relation to glioblastomas, the gamma knife is ineffective, therefore it is used extremely rarely in this type of neoplasia. Other obstacles to the use of radiosurgery can be:

1. Severe condition of the patient due to decompensated diseases of the heart, blood vessels, kidneys and other internal organs;
2. Edema and swelling of the brain in the acute phase;
3. Acute hydrocephalus from the closure of the CSF pathways by a mechanical obstacle;
4. Refusal of the patient from other types of treatment, even if they are technically possible and safe;
5. The size of the neoplasm is more than 3.5 cm.

The Gamma Knife is classified as a surgical technique, however, unlike the usual operation with an incision and anesthesia, the treatment takes place without penetration into the tissues, and the patient is conscious throughout the session. The advantages of the method can be considered:

• Non-invasive;
• Minimal risk of complications;
• No need for general anesthesia and tracheal intubation;
• Absence of blood loss;
• Short rehabilitation period;
• Possibility of outpatient treatment;
• High accuracy and efficiency of treatment;
• No radiation exposure to surrounding tissues.

fixation of the head during treatment with the installation of a gamma knife

Despite the high efficiency and good tolerability, the technique is still not without shortcomings. For example, the need to fix the head involves pain, which can be quite intense even after a session of radiosurgical treatment. In addition, unlike the cyber-knife, the gamma-ray unit does not allow to obtain a uniform and identical dose of radiation in different parts of the neoplastic focus, and cells in the periphery can receive a lower dose of radiation than in the center, which creates the prerequisites for relapses of the disease.

In addition to the shortcomings described, it is worth pointing out the high cost of such treatment. Installing a gamma knife is expensive, so it cannot yet be available to absolutely everyone who needs this kind of operation. Many patients not only have to travel significant distances on their way to a properly equipped clinic, but also have to wait months for their turn.

How the gamma knife works

The operation of the gamma knife is based on irradiation with a precisely focused beam of radiation, which comes from more than 200 emitters. Radiation energy is provided by radioactive cobalt, the beams converge at one point, where the maximum dose of destructive action is reached. The point of application of the radioactive beam is carefully verified; only the tumor should become it.

The most powerful radioactive radiation has a damaging effect on tumor cells, destroys their DNA, thereby inhibiting further cell reproduction and the growth of neoplasia. The neoplasm does not disappear at once, as it happens during a surgical operation, it takes time to completely eliminate the tumor.

In some cases, for example, with small sizes, there is no need for its complete destruction. It is enough to stop the growth of the neoplasm, and if it does not compress any structures and does not provoke an increase in intracranial pressure, then after growth stops it will not pose any threat to either the health or life of the patient.

In the treatment of vascular malformations and aneurysms, a gamma-ray beam causes the death of endothelial cells lining the vessels from the inside, which provokes the destruction of the vascular walls themselves with complete obliteration (sclerosis) of their lumens. The aneurysm decreases or disappears completely. In the case of surgical treatment of vascular formations, there is a significant risk of bleeding, which is minimized with radiosurgical exposure.

The complete destruction of the neoplastic focus takes several months and up to two years. During this period, some symptoms characteristic of intracranial tumors may persist, but gradually complaints and manifestations of the disease disappear.

The method of conducting a treatment session with a gamma knife

Unlike the operating room, radiosurgery does not require special or lengthy preparation. The patient can eat and drink on the eve of the treatment session, there is no need to limit his regimen, but it is better to exclude alcohol. A couple of hours before the procedure, you can eat so that hunger does not catch right during the irradiation. The amount of liquid you drink should not be excessive, because many patients have to lie down without the opportunity to go to the toilet for more than an hour.

radiosurgical treatment

Accurate focusing of the beam is possible only with rigid fixation of the patient's head, which is achieved by metal fixators introduced into the soft tissues of the head under local anesthesia. In this position, breathing and subtle movements of the patient do not cause a shift in the trajectory of radiation. During the procedure, the patient does not feel pain, but there may be a feeling of pressure created by the stereotaxic frame.

A stereotactic frame, which excludes the movement of the patient's head, is installed under local anesthesia after treating the scalp with antiseptics, but even after the procedure, the patient may feel severe pain in the places of soft tissue punctures and the head. Anesthesia is not carried out, but especially sensitive patients and children can be prescribed sedatives.

To determine the localization of the tumor, CT, MRI, and angiography in the case of vascular neoplasms are preliminarily performed. The resulting images are processed by a computer, which determines the optimal dose and direction of the radiation beam. Depending on the location and volume of the irradiated area, a treatment session with a gamma knife can last from half an hour to several hours, during which the patient is on a special table with the head rigidly fixed in a stereotaxic frame.

After the end of the irradiation procedure, the patient can immediately go home, there is no need for hospitalization. From the side of skin punctures after fixing the frame, severe pain is possible, so the doctor may recommend taking analgesics in the first day or two after treatment.

After a session of radiosurgical treatment, the patient may feel some fatigue and weakness, which is usually associated not with the procedure itself, which is painless and well tolerated, but with nervous tension and anxiety about the upcoming treatment.

In the postoperative period, it is mandatory to monitor the results of tumor irradiation, which involves MRI with contrast. To determine if the tumor has shrunk and by how much, doctors compare preoperative MRI results with postoperative ones.

The Gamma Knife is well established for use in elderly patients with comorbidities that create additional risks for general anesthesia. In addition, it is many times safer than open intervention for patients with pathology of the blood coagulation system, allergies to drugs and other diseases.

Gamma Knife is successfully used for treatment. This tumor can be removed using microsurgical techniques, but the risk of serious complications is quite high. After treatment with a gamma knife, recovery occurs in more than 90% of cases, and there is no risk of surgical complications or adverse effects of anesthesia at all.

Video: a report on the treatment of meningioma using the installation of a gamma knife

Clinics and prices for Gamma Knife treatment

To date, about a million patients worldwide have been treated with the gamma knife, which confirms the high efficiency and safety of the technique. The high cost of the equipment does not allow it to be installed everywhere, and many developing countries cannot afford the widespread introduction of the Gamma Knife into practice.

Most of the installations for radiosurgical treatment are located in the USA and Japan. Clinics in Russia are also gradually being equipped with high-tech equipment, and gamma knife is already available at the Research Institute of Neurosurgery. N. N. Burdenko, ambulance them. N. V. Sklifosovsky in Moscow, at the Institute of Sergei Berezin in St. Petersburg and some other major oncology clinics across the country.

In Pesochny (St. Petersburg), radiosurgical treatment is carried out at the Sergey Berezin Medical Institute. The patient must arrive for treatment on the eve of the scheduled radiosurgery session or in the morning on the day of treatment, after which he fills out the relevant documents, signs the consent to the procedure, and talks with the attending physician. In addition to the attending physician, the psychologist of the clinic provides additional information to both the patient and his relatives regarding the subsequent recovery.

Patients who need radiosurgical treatment can get it free of charge, having a compulsory medical insurance policy, and if they have Moscow registration, they will receive free treatment at the radiosurgery center at the Burdenko clinic. Before referral for treatment, the patient is supposed to consult a neurosurgeon of the Gamma Knife Center, and if a neurologist or therapist sends her to her by filling out the appropriate form, then the consultation will be free.

Given that the Gamma Knife is an expensive procedure and facilities are sorely lacking, each clinic has limited free treatment options. Most patients have to wait in line, which can last for several months, and if the disease does not allow postponing the operation for some time, then the patient will be offered other possible treatment options - microsurgery, endovascular interventions.

If there are indications for radiosurgical treatment, the polyclinic doctor must issue a referral to the appropriate hospital, which is accompanied by an extract from the medical documentation, a copy of an identity document, an insurance policy, and data from examinations already conducted.

The patient sends the collected documents to the place where the treatment is planned, and the clinic issues a coupon for the provision of high-tech assistance. Indications for hospitalization are determined by a special commission within a week.

The Gamma Knife center at the Burdenko clinic does not provide treatment according to national quotas, since the center is private, however, the patient can still receive free assistance if the insurance company assumes all costs or payment comes from the regional budget.

If the patient does not have time to wait or does not want to, but there is an opportunity to receive treatment on a paid basis, then public clinics and private radiosurgery centers both in Russia and abroad can offer such a service. In Russia, the cost of treatment ranges from 240-250 thousand rubles,repeated sessions - about 150 thousand rubles. Abroad, treatment is much more expensive - about 30-40 thousand dollars.

The possibility of radiosurgery completely changes the view on the treatment of patients with cancer. This technique of radiation treatment has practically no restrictions in application. When using radiosurgery, hospitalization is not required, since the treatment takes place on an outpatient basis. A distinctive feature of stereotaxic methods of radiation therapy is conformal irradiation of the tumor with minimal impact on the surrounding tissues and high accuracy of positioning of the irradiation target. This guarantees a minimum risk of radiation reactions and complications with a maximum impact on the pathological formation. The effect of this technique has been proven in studies in leading clinics in the USA, Europe, and Israel.

For stereotactic radiosurgery, EMC uses the latest generation of medical accelerators EDGE and TrueBeam manufactured by Varian Medical Systems (USA).

The specialists of the EMC Radiation Therapy Center, who have been trained and trained in leading clinics in Israel, Europe and the USA, have significant experience in performing treatment using the SBRT and SRS methods.

What is stereotactic radiosurgery?

Stereotactic radiosurgery- This is a technique in which the destruction of a neoplasm (usually not exceeding 4 cm in diameter) occurs under the influence of a large dose of precision radiation with minimal impact on surrounding healthy tissues. This technique, despite its name, does not involve surgical intervention. Radiosurgery is an absolutely painless technique.

There are two branches of radiosurgery, namely: stereotactic radiosurgery for brain tumors (SRS) and extracranial stereotactic radiotherapy (SBRT).

Radiosurgical treatment requires 3D and/or 4D CT simulation to accurately determine the location, configuration, and size of the neoplasm, and the use of a patient immobilization device to accurately reproduce the patient's position during radiotherapy.

The precision (accuracy) of therapy is ensured by accurately reproducing the position of the patient with the help of fixing devices and optical control of the tumor localization during the entire radiotherapy session.

Radiosurgical treatment is applied:

When the neoplasm is located in places inaccessible for surgical treatment.

In the case when neoplasms are located close to vital organs and structures.

With tumors that change their position depending on the breath.

SBS and SBRT are alternative therapies for patients who, for whatever reason, are contraindicated in surgical treatment.

Indications

When SRS is applied:

1. Metastases of malignant tumors in the brain

2. All benign neoplasms of the brain:

neuromas of the auditory nerve and other cranial nerves

meningiomas of any localization

neoplasms of the pineal gland

pituitary neoplasms

craniopharyngiomas

3. Arteriovenous malformations and cavernous angiomas

4. Trigeminal neuralgia

Neoplasms and metastatic lesions of the brain and spinal cord

Relapses of primary brain tumors

Indications for Stereotactic Body Radiotherapy (SBRT):

Metastatic tumors of the spine

Neoplasms and lung metastases

Primary and metastatic malignant neoplasms of the liver

Neoplasms of the bile ducts

Neoplasms of the pancreas

Localized prostate cancer

Localized kidney cancer

Neoplasms of the retroperitoneal space

Neoplasms of the female genital organs

Neoplasms of the base of the skull

Neoplasms of the orbit

Primary and recurrent neoplasms of the nasopharynx, oral cavity, paranasal sinuses, larynx

How is the treatment

How is radiosurgery treated?

Radiosurgery can be performed in 1-5 treatment procedures (the number of sessions depends on the size of the irradiated focus).

Before starting treatment, a CT scan is performed. For radiosurgical treatment, the correct position of the patient's body on the table is required; for this purpose, fixing devices are used. Next, 3D and/or "4D" computed tomography is performed, which makes it possible to create multiple images of the irradiated volume in motion, such as breathing. This is of great importance in the presence of neoplasms in organs that change their location in accordance with the phases of respiration (lungs, liver, etc.).

After the CT simulation, a treatment plan is created. The radiotherapist and physicist-dosimetrist create a plan in such a way as to bring the configuration of the beam of rays as close as possible to the parameters of the tumor. For SRS and SBRT, radiotherapy is performed using the latest generation of linear accelerators.

Before therapy, the patient is placed on the table using a fixation device made during the CT simulation, after which an image is taken. Based on the results of the image, the radiologist changes the position of the patient on the table. The treatment session lasts about an hour.

Radiosurgery is a modern field of radiation therapy, in which treatment is achieved by the use of high-precision radiation. Initially, SRS was used to treat tumors and other pathological changes in the brain, but later the scope has expanded significantly.

The term "stereotactic surgery" was proposed by the Swedish neurosurgeon L. Leksell in 1951. The first device for radiosurgery was designed by L. Leksell and the biophysicist B. Larsson in the late 1950s.

What is the application effect based on?

Tumors are made up of cells that have an abnormally high rate of division. Radiosurgery targets these rapidly dividing cells. Normally, cells are programmed to stop multiplying (or dividing) after coming into contact with each other. In the case of a tumor, this inhibitory mechanism is disrupted, which causes the cells to divide again and again. DNA is responsible for cell reproduction. Radiological treatment uses high-energy x-rays to damage the DNA of tumor cells, causing them to die or at least stop their reproduction processes.

Radiation damages healthy cells as well, but given their slower growth rate, normal tissues tolerate radiation damage more easily and recover faster than cancer cells. In order to give healthy tissues time to recover and reduce side effects, radiation therapy is given daily, in small doses, five days a week, for 6-7 weeks.

Allocate three main method of carrying out stereotactic radiosurgery operations:

• Gamma Knife

for irradiation, clearly focused gamma rays (192 or 201 beams) are used. The Gamma Knife is suitable for the treatment of small or medium-sized intracranial lesions (no more than 3.5 cm). With larger tumor sizes, the use of a gamma knife may be unsafe and useless (but if there is a hemorrhage zone around the tumor, then it is also irradiated).

Treatment takes place in four phases:

1. A special fixing frame is installed on the head (attached to the skull with special pins under local anesthesia), which allows you to keep the head from moving during treatment.
2. A head CT and/or MRI is performed to determine the exact location and dimensions of the tumor. If an arteriovenous malformation is being treated, then angiography is needed to look for abnormal veins.
3. Planning phase - based on the tests and examination, treatment is planned.
4. Irradiation directly.

Irradiation is not felt by the patient; the doctor or nurse is in the next room during the procedure and monitors the patient, controls the entire irradiation process.

• Linear accelerators (eg Novalis Tx™, XKnife™, CyberKnife®).

are used to deliver high-energy x-rays (photon beams).

They are suitable for the treatment of large tumor foci and can be performed once or in several stages (in this case it will be called fractionated stereotactic radiosurgery). The treatment phases are the same as with the gamma knife, but a fixing frame is not installed on the skull, but a special mask is made.

• Proton therapy

It is one of the types of corpuscular therapy, where protons are used to irradiate diseased tissue.

Stereotactic treatment is carried out by a whole team of specialists:

Radiation oncologist (develops a treatment plan and determines the required dose of radiation)

Neurologist / neurooncologist / neurosurgeon (examines the patient's brain, and also helps to plan the treatment and controls the patient's rehabilitation period)

Medical physicist - helps the oncologist determine the dose of radiation, controls the device that emits radiation (gamma knife or linear accelerator)

Dosimetrist - determines the radiation dose received by the patient

Radiation therapist - works with a radiation machine

Nurse-oncologist - directly cares for patients.

Indications for radiosurgery:

1. Benign tumors of the brain (neurinomas of the auditory nerve and other cranial nerves, meningiomas of any localization, craniopharyngoma, hemangioblastomas, tumors of the pineal gland, pituitary gland and some others.)

2. Malignant tumors: (gliomas, astrocytomas, melanoma and others.)

1. Tumors of other localizations:

Localized peripheral or central non-small cell lung cancer

liver cancer (primary)

pancreatic tumors

prostate cancer (localized)

kidney cancer (localized, in inoperable patients)

spinal cord tumors (primary and secondary)

recurrent retroperitoneal and pelvic neoplasms tumors of limited size

solitary and single metastases of neoplasms of malignant tumors in the lungs, liver, retroperitoneal lymph nodes

breast tumors

1. Cancer metastases to the brain
2. Arteriovenous malformations and cavernous angiomas
3. Trigeminal neuralgia.

General indications for stereotactic radiosurgery of tumors:

Tumors that have a clearly visible border on diagnostic images.

The impossibility of surgical treatment due to the presence of concomitant diseases or the patient's refusal to undergo surgery.

Additional stereotactic radiosurgical effect on the primary tumor and individual lymph nodes remaining after standard radiation treatment of the primary tumor and regional metastasis zones.

The tumor is well delimited from the surrounding organs and tissues.

The tumor is localized in the parenchymal organ.

Irradiation of this area in history.

Relapse after surgical treatment.

Possible complications in stereotactic radiosurgery.

Complications do not always occur, but nevertheless you need to know about them. Although the risk of complications is low, factors such as advanced age, chronic illness, previous surgeries, or previous radiation therapy near the site of the planned operation may increase the risk of complications.

Possible early complications:

Headache, fatigue, general weakness

Irritation of the skin at the site of exposure with slight redness, pigmentation of the skin, itching, peeling at the site of exposure, slight hair loss from exposure to radiation, etc. etc.

Temporary swelling at the treatment site (there may be a worsening of symptoms)

Swelling, numbness, bleeding, or tingling at the junction of the head and neck

Ulceration of the oral mucosa and difficulty swallowing

Nausea with vomiting, convulsions, diarrhea

Late complications include (may occur months or years after radiotherapy, but persist for a long time or permanently):

Changes in the brain and spinal cord

Changes in the oral cavity.

Changes in the lungs, kidneys, colon and rectum, joints.

Infertility

Facial paresis, deafness

Stroke (especially with high doses of radiation (especially above 50 Gy).

Secondary malignancy and the development of new malignant tumors (after treatment for cancer, it is very important to follow the regimen of regular examinations by an oncologist who evaluates signs of recurrence or the appearance of a new tumor).

How is radiosurgery different from conventional radiation therapy?

The main difference is that in radiosurgery, a high dose of radiation is given once, and not in parts, in small doses, for a long time, as in conventional radiation therapy. The tumor is simultaneously irradiated in many directions, which reduces the likelihood of damage to healthy brain tissue.

With radiosurgery, a very high accuracy of focusing radiation on the tumor is achieved, which is inaccessible with conventional radiotherapy.

How long will the treatment take?

Radiation exposure for the Gamma Knife and Linac can take up to 2 hours. Treatment with CyberKnife can take up to 3 hours and span multiple sessions.

Will it hurt?

The treatment itself does not cause pain and the patient does not experience any sensations at all. And the patient can return to his usual activities the very next day, the only thing to consider is the doctor's recommendations for hard work and other prescriptions.

It is important to understand that the results of stereotactic radiosurgery will not be visible immediately, but over time - from several months to several years. And most often, the therapeutic effect is the cessation of further growth, and not the removal of the tumor (although often the tumor decreases in size). Then it is necessary to periodically come for an examination to the doctor who performed the treatment, as well as, in accordance with the established period, undergo MRI / CT / angiography in order to monitor the effect of the treatment.

In many cases, stereotactic radiosurgery procedures can be performed again if needed.

CTX procedures are quite expensive, but it is possible to obtain quotas for treatment.

And in conclusion, I would like to note that radiation in the body does not remain and does not accumulate. After the treatment session, the patient can freely communicate with others without fear of irradiating them.

In fact, any complaints you may have should be evaluated by a medical professional. But you yourself should sound the alarm and schedule a visit to a neurologist or neurosurgeon if you have previously unknown symptoms.

Consultations

The Center's outpatient clinic has two main tasks. The first task is to identify patients with neurosurgical diseases and comprehensively prepare them for neurosurgical surgery. The second task is to monitor patients who have already undergone neurosurgical surgery. If the help of a neurosurgeon is not needed, we will tell you what to do and give you the necessary recommendations.

Diagnostics

Neurosurgical pathology is very diverse. It can manifest itself with various syndromes and symptoms. At the same time, for each specific neurosurgical disease, especially at its earliest stages, certain signs are characteristic. Clinical diagnostics in neurosurgery defines these syndromes and symptoms and describes the entire neurosurgical pathology.

Paid services

The cost of basic medical services is determined by tariffs, which are approved by the Center in the manner prescribed by law.

As elsewhere, as always, there are benefits for paying for medical services and they are provided in cases and in the manner established by the Center on the basis of the current legislation of the Russian Federation.

Hospitalization

The admission department is located on the first floor of the surgical building. On its territory there are services responsible for organizing the process of admission to the Neurosurgery Center. There is an emergency operating room, an anesthesiologist's office, medical registrars' offices.

Treatment

In neurosurgery, three types of treatment are possible: neurosurgical operation, radiation therapy, chemotherapy. Each type of treatment has its own indications, which are always determined collegially at a consultation of doctors.

Rehabilitation

You will receive a discharge summary on the day of discharge. At the end of this document are assignments that must be completed within a certain time. Do not go home without receiving oral advice from your healthcare provider.

After discharge

Neurosurgical pathology is diverse, so the course of the postoperative period can also be different. Recovery after neurosurgery can take 2-3 weeks, and may take several months. This is a normal situation. Here are some tips to help you get back to your normal lifestyle faster.