What is radiosurgery?
First of all, it is NOT surgery! There is no incision, no anesthesia, and essentially no healing time. Radiosurgery is an extraordinarily precise method of delivering radiation (high-energy X rays) to destroy abnormal tissue, such as cancer cells. It is generally completed in one or a few days, unlike traditional radiation treatment that usually takes weeks. We often refer to this procedure as "surgery without a trace."

What is it used for?
Radiosurgery is used to treat many kinds of cancers, as well as some benign diseases such as meningioma, acoustic neuroma, arteriovenous malformations, and trigeminal neuralgia. It can be performed in combination with traditional radiotherapy, chemotherapy and surgery, depending on the situation. It can also be very helpful with tumors that have recurred after prior radiotherapy or other treatments.

What areas of the body can be treated with radiosurgery?
Almost ANY area of the body can be treated with radiosurgery. This includes the brain, other structures in the head and neck, the spine, the lungs, other structures in the thorax, the liver, the pancreas, the pelvis, the sacrum, and the extremities. The only sites that are typically not suitable for radiosurgery are tumors directly involving the gut (stomach, small intestine, large intestine or colon).

How does it work?
Radiosurgery is capable of delivering very high doses of radiation over a very short period of time, maximizing the chance of tumor control. It is also capable of precisely targeting this high-dose treatment to the area of abnormal tissue, protecting nearby normal tissues. This is accomplished by using a large number of radiation beams, each entering the body from a different direction and each carrying a small fraction of the total radiation dose. The effect of each individual beam passing through normal tissues is minimal, but since every beam delivers dose to the tumor, the tumor dose is very high.

What different kinds of radiosurgery systems are there?
Our practice offers every major type of radiosurgery system. We have been offering Gamma Knife treatment since 2003, used exclusively for tumors in the brain. We also have long experience with the Novalis BrainLab system, also used for brain lesions. We have several CyberKnife units, which can treat any area of the body and are capable of tracking tumors as they move with respiration, for maximal targeting accuracy and normal tissue protection. Capitalizing on this capability, our Memorial Cyberknife Center treated more lung cancers than any other CyberKnife center in the world in 2007. Our newest radiosurgery equipment, installed at the Baptist Cancer Institute in 2009, features the revolutionary Novalis Tx shaped-beam radiosurgery system, which like Cyberknife can also treat any body site but also combines the beam-modulation capabilities of traditional radiotherapy with the precision delivery of radiosurgery, as well as a number of on-board imaging options for accurate tumor localization. Both the Cyberknife and the Novalis Tx systems use robotic couches for 6-axis patient positioning. 

How long does it take?
Prior to treatment, one or more specialized scans are generally required for planning the beams—this may involve MRI, PET-CT, or other types of imaging. A special shaped cushion or a flexible mask may be used to help you remain still during treatment, and these will also be used during the planning scan. Depending on the site, placement of markers to guide the treatment beams may also be needed. Planning procedures for Gamma Knife therapy are all done on the same day as the treatment, whereas planning procedures for the CyberKnife and Novalis linear accelerator systems generally require between one and three weeks. Once planning is done, the treatment itself usually occurs over one to five days, with each treatment session lasting from 30 minutes to a few hours.

Is it painful? Will I require anesthesia? Will I have to stay in the hospital?
In short, no to all of the above! The treatment is completely painless. Anesthesia is not required, although oral medicines can be prescribed if needed to help you relax and remain comfortable during treatment. All planning procedures and treatment are done on an outpatient basis—at the end of each treatment, you carry on with your usual daily activities.

What are the side effects?
Generally, minimal or no side effects occur with radiosurgery. In some cases there may be short- or long-term side effects that tend to be mild; this is somewhat more likely if traditional radiotherapy has previously been administered to the site. The exact nature of these effects depends on the size and location of the tumor being treated. Most patients experience no debilitating side effects, making radiosurgery an extremely attractive treatment option.

How long has it been used?
Radiosurgery has been used for brain lesions for more than 30 years. Radiosurgery to sites outside the brain has been performed in the United States since 2001. In FROG, radiosurgical treatment has been available to our patients since 1998, beginning with the Seattle-based pReference system. Our Gamma Knife has been in operation since 2003 and our CyberKnife Center opened in December 2006. The Novalis Tx system was installed in 2009.

What are the steps involved, and who will treat me?
The first step is to see a radiation oncologist experienced with radiosurgery in consultation. For certain kinds of tumors, another specialist, such as a neurosurgeon, may participate in order to create the most optimal treatment plan. In that case you would have a consultation with that specialist as well. The next step would be placement of the markers which guide targeting of the treatment beams, if these are needed (usually done by an interventional radiologist). The specialized imaging scan(s) used for planning the beams follows this. Finally, the treatment itself is administered. The role of the radiation oncologist is to determine whether you are an appropriate candidate for treatment, and to decide on an appropriate dose of radiation to your tumor that will provide the best chance of tumor control and the best protection of important normal tissues.

How do I know it worked?
Imaging scans will be repeated, usually a few weeks after treatment, to assess the response of your tumor. Occasionally there may be other signs, such as relief of pain, which may indicate success of the treatment before the repeat scan is even done.