Recent advances in steriotactic radiosurgery

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Recent advances in steriotactic radiosurgery

  1. 1.  The term “radiosurgery” has been modified to; the stereotactic application in one to five fractions of high-dose radiation to a target with ablative intent, where “high dose” means more than 2–3 Gy, fractional doses commonly used in conventional radiotherapy.  Recent advances in robotics and technology resulted in:  Leksell Gamma Knife Perfexion  Cyberknife and enhanced RT systems  Spinal stereotactic radiosurgery
  2. 2. Dynamic shaping
  3. 3. Suboccipital targets
  4. 4. Extracranial targets
  5. 5. Multiple targets
  6. 6. Gamma knife with Extend program
  7. 7. The 2 major limitations of the gamma knifeThe 2 major limitations of the gamma knife are:are: (1) stereotactic frame (2) inability to treat lesions far away from the cranium HOWEVERHOWEVER,
  8. 8. Limitations of standard radiation techniquesLimitations of standard radiation techniques for treating spinal tumors:for treating spinal tumors: 1)treatment fields extending up to two vertebral segments above and below the target to compensate for set-up errors and patient movement during treatment 2)close proximity of the spinal cord typically makes it impossible to exclude it from the highest dose region 3)relapse within the treatment field is not uncommon BUT unacceptable to use larger and more therapeutically beneficial doses, given the risk of spinal cord injuries such as radiation-induced myelopathy
  9. 9. Immobilisation
  10. 10. CT simulation & Treatment planning
  11. 11. Spinal arteriovenous malformations
  12. 12. Benign Spinal tumors
  13. 13. Combined kyphoplasty and spinal radiosurgery for spinal mets
  14. 14. Thank YouThank You
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