Patient consulting with nurse about stereotactic radiosurgery

If you’ve started researching treatment options for brain tumors, you may have come across one known as “stereotactic radiosurgery” (SRS). What is stereotactic radiosurgery, exactly, and what advantages does it provide over other brain tumor treatment methods? Below, we discuss what stereotactic radiosurgery is, how it works, the benefits it offers and when it’s used. We also explain what to expect during the procedure and review potential side effects.

What is stereotactic radiosurgery?

Stereotactic radiosurgery is a type of highly targeted radiation therapy that may be used to treat certain small brain tumors. Despite what its name suggests, the treatment does not involve surgery. Instead, a Varian Truebeam linear accelerator with BrainLab ExacTrac image guidance system is used to generate narrow beams of high-dose radiation, which are precisely aimed at a cancerous lesion from multiple angles. Unlike traditional radiation therapy, which is usually administered in multiple doses over several weeks, stereotactic radiosurgery is administered in a single dose or just a few doses.

How does stereotactic radiosurgery work?

To prepare for stereotactic radiosurgery, a radiation oncologist and neurosurgeon can define the radiation delivery field within two millimeters of the intended target by utilizing several advanced techniques and technologies, including three-dimensional imaging and localization to locate the lesion and determine its exact size, shape and coordinates. Then, during each treatment session, real-time imaging guidance is continually used to allow for instant adjustments as needed, and a special device is used to carefully hold the patient’s head as still as possible for even greater accuracy.

So, how does stereotactic radiosurgery work to destroy cancer cells? As with other types of radiation therapy, the radiation administered during stereotactic radiosurgery distorts and destroys the DNA within the cells of the targeted brain tumor. This prevents the cancerous cells from reproducing as they normally would, and the cells eventually die.

What are the benefits of stereotactic radiosurgery?

Stereotactic radiosurgery offers numerous advantages over other types of cancer treatment. For example, when compared to surgery, stereotactic radiosurgery is less likely to cause pain, hemorrhaging and infection. It also typically spares patients from the potential side effects of anesthesia (although children and some adults may still require general anesthesia during this procedure). Plus, when compared to other types of radiation therapy, stereotactic radiosurgery more precisely targets brain tumors, helping to ensure that adjacent healthy brain tissue doesn’t receive a dose that’s too strong.

When is stereotactic radiosurgery used?

Stereotactic radiosurgery is used most often for treating cancer that has spread to the brain (brain metastasis). It also may be considered for treating:

Glioblastoma
Meningioma
Acoustic neuroma
A pituitary tumor
An intracranial, orbital or skull base tumor
A metastatic brain tumor

Stereotactic radiosurgery may also be used to address other types of brain tumors (or parts of brain tumors) that cannot be removed safely because they are difficult to access, subject to movement or situated very close to sensitive structures in the brain or spinal cord. Patients who cannot tolerate anesthesia may also be good candidates for stereotactic radiosurgery.

What to expect during stereotactic radiosurgery

During stereotactic radiosurgery, the patient lies on a table. A provider places a frame on the patient’s head and secures it to their skull using four sterile pins. (A local anesthetic is administered beforehand, which may cause minor discomfort but should minimize or eliminate any pain caused by the subsequent pin placement.) The provider then secures the head frame to the table and begins administering radiation. Adult patients will likely be sedated but remain awake throughout the procedure.

Once the treatment is finished, the provider removes the frame from the patient’s head and applies a clean dressing to where the pins were attached. Stereotactic radiosurgery is generally administered on an outpatient basis, meaning that the patient can return home the same day, although an overnight stay may sometimes be required.

Many people are curious about how long stereotactic radiosurgery takes. Of course, the length of the treatment varies from one patient to another. However, it generally takes approximately 30 minutes to treat one tumor or lesion. If the patient has more than one tumor requiring treatment, then the procedure will likely take longer.

What are the side effects of stereotactic radiosurgery?

When compared to traditional radiation therapy methods, stereotactic radiosurgery produces considerably fewer side effects. This is because the radiation used in stereotactic radiosurgery conforms to the tumor’s size and shape, and therefore has less effect on the rest of the brain.

With that being said, as with any procedure, stereotactic radiosurgery has the potential to cause complications, including:

Bleeding at the pin sites
Infection
Swelling around a tumor (a steroid medication may be prescribed before and/or after the procedure to counteract any swelling)
Seizures

With regard to long-term side effects of stereotactic radiosurgery, there is a chance of radiation necrosis, which develops when the body fails to clear tumor cells that were destroyed by radiation. If this occurs, a physician may recommend continued or increased dosing of the prescribed steroid medication, administration of hyperbaric oxygen or surgery to remove the dead tissue. The potential for this and other side effects to develop makes it important that patients attend any scheduled follow-up appointments.

Stereotactic radiosurgery delivered by a collaborative team of experts

At Moffitt Cancer Center, we precisely tailor our brain tumor treatment recommendations to the exact diagnosis of each patient. When a patient’s treatment plan includes stereotactic radiosurgery, his or her treatment is planned, prepared and provided by a collaborative team of radiation oncologists, neurosurgeons, radiation therapists, medical physicists, dosimetrists and supportive care providers. This team has great expertise in treating many different types of benign or malignant tumors, including hard-to-access tumors of the brain and spinal cord. We also offer other advanced forms of radiation therapy, including three-dimensional conformal radiation therapy (3D CRT) and intensity-modulated radiation therapy (IMRT).

If you would like to learn more about stereotactic radiosurgery and other advanced brain tumor treatment options, you can meet with a specialist in the Neuro-Oncology Program at Moffitt Cancer Center. To request an appointment, call 1-888-663-3488. or complete our new patient registration form online. No referral is needed. As Florida’s top cancer hospital, we are proudly changing the model, and we will provide you with access to our cancer expertise as soon as possible.