In some cases, though, a brain lesion is in such a precarious position that it cannot be reached safely with even the most advanced neurosurgical techniques - the operation would simply be too dangerous. The patient would be likely to lose a vital function, such as eyesight or hearing, or may even die during the procedure.
In cases like these, stereotactic radiosurgery may be the best way to target the tumor or lesion. It is a way of treating brain disorders with a single, high dose of radiation. The treatment is so precise and dramatic that it is considered surgical, noted Bahman Emami, M.D., chair of the Department of Radiation Oncology at Loyola University Chicago Stritch School of Medicine, part of Loyola University Health System.

Like other forms of radiation treatment, radiosurgery does not remove the tumor or lesion. It damages the DNA of targeted cells so they no longer reproduce. The dose of radiation may take only a few minutes, but the tumor shrinks and dies at the same rate that it would have grown - over several months or even up to two years.

Compared to traditional radiation treatment, stereotactic radiosurgery delivers a more powerful dose of radiation that is matched to the three-dimensional shape of the tumor while sparing nearby healty tissue from radiation damage. When a tumor sits next to a critical structure, such as the tiny optic nerve, precision is of utmost importance.

Stereotactic radiosurgery is performed in the United States largely with two different types of instruments: linear accelerator-based machines and Cobalt60-based machines. Some institutions favor the latter based on ease of use. However, Emami and his team have found that, while it requires more intensive treatment planning, linear accelerator technology offers many benefits to the patient, such as the ability to precisely target treatment to oddly shaped tumors, the ability also to treat head and neck lesions rather than just brain tumors, and the ability to perform treatments over several days if appropriate (called fractionation).

Accuracy with linear accelerator technology depends on in-depth planning prior to treatment and complete immobilization of the patient's head  during treatment. The intensive planning process involves a neurosurgeon, a radiation oncologist and a radiation physicist who manipulate computerized,  three-dimensional images of the patient's brain to plan the treatment dose. Loyola's team of radiation oncologists and neurosurgeons collaborated with Loyola's oral and maxillofacial  surgeons to devise a precise head frame that positions the patient's head and eliminates the possibility of movement during treatment.

With a new state-of-the-art stereotactic radiotherapy system (Novalis®), the Loyola team will routinely achieve accuracy within 2 millimeters. "This is the most sophisticated system of its kind," said Emami. "We selected it for our new radiation oncology suite because of its precision, patient safety and other features." Loyola is one of the few centers in the country and the only center in the Midwest to acquire the $2.9 million stereotactic radiotherapy system.

The linear accelerator is located in the new dedicated stereotactic radiosurgery suite at the Loyola Outpatient Center. The suite features a private and attractive waiting area, patient education and consultation rooms and a dedicated and highly trained staff.

Loyola will serve as a center of excellence and a training site for health-care providers nationwide to learn this technology. The system not only will be used as a primary treatment for brain tumors and selected head and neck tumors and lesions, but also as an adjunct to surgery and other treatments, and to treat some body cancers.

For more information about this program, contact Edward Melian, M.D., radiation oncologist, at (708) 216-2558 or Emami at (708) 216-2555.

To make an appointment with a radiation oncologist at Loyola, call (708) 216-8563.

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