Stereotactic radiosurgery (SRS) and Stereotactic body radiotherapy (SBRT).

 

Lars Leksell  also known as father of Stereotactic Radiosurgery (SRS) , was  first to describe the concept of Stereotactic Radiosurgery, in 1951 in Sweden.  In 1983, Betti and Derechinsky developed the concept of  delivering SRS with a modified linear accelerator. John Adler was instrumental in developing Cyberknife Radiosurgery system in 1994.

In SRS, high dose radiation is used as a noninvasive alternative to open surgical approaches to manage a various benign and malignant tumors of brain and spine. It  uses 3D imaging to target high doses of radiation to the affected area with minimal impact on the surrounding healthy tissue. Stereotactic Body Radiation Therapy (SBRT) is similar to brain SRS in  dealing with tumors outside of the nervous system such as lung, liver, prostate etc. In SBRT high dose radiation is delivered over few fractions (usually up to 5 fractions). Radiosurgery/SBRT have shown excellent results in brain and extracranial sites. It is now the first line of treatment in many benign brain tumors, brain metastasis, medically inoperable early lung cancers, low to intermediate risk prostate cancer, vertebral metastasis and in numerous oligometastatic conditions.

Frame based and frameless Radiosurgery program (SRS/SBRT/SRT) was initiated at Medanta in 2010 with Elekta Synergy –S Linear accelerator with micro-MLC with beam modulator and 6D-Hexapod couch. Impetus was provided to radiosurgery program after the commissioning of Cyberknife VSI, Accuray, California, 1st in north India in October 2012. Cyberknife is  the only robotic radiosurgery/ SBRT equipment in the world, which in highly accurate, extremely precise and elegantly robust in delivering abilative radiation doses to tumours. It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumours or who may be looking for an alternative to surgery. It can treat moving tumours with pinpoint accuracy, using a very sophisticated 6D image guidance system to track and continually adjust treatment for any movement of the patient or tumour. This is especially important when treating tumours that move with any body function (e.g., breathing, gas filling). SBRT of lung and liver tumors is also performed on mic-MLC based Elekta Synergy-S with Active breathhold coordinator (ABC) System.

Tomotherapy machine was incorporated in our Radiosurgery/SBRT program in 2015.

Till date we have performed  > 1500  Radiosurgies and SBRT .

 

Cranial SRS:

·        Brain tumor.

·        Arteriovenous malformation (AVM).

·        Trigeminal neuralgia.

·        Acoustic neuroma.

·        Pituitary tumors.

·        Tremors.

·        Meningioma.

 

Extracranial SRS/SBRT:

·        Early Lung Cancer(Primary)

·        Lung Secondaries

·        Vertebral Metastasis

·        Low and Intermediate risk prostate cancer  Liver cancers  Lymph Nodal recurrences.

·        Pancreatic cancer

·        Head neck cancers-reirradiation

·        Soft tissue sarcoma – Inoperable/Recurrent Oligometastasis to Cranial and extra cranial sites.