Stereotactic Radiosurgery Goals and Objectives (2010)

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Stereotactic Radiosurgery Goals and Objectives (2010)

  1. 1. Neurosurgery PGY-1 CyberKnife Radiosurgery Rotation I. This rotation lasts one month. II. Course objectives (by the end of the rotation, the resident will understand the following): 1) Be familiar with the principles of CyberKnife stereotactic radiosurgery. a. What is stereotactic radiosurgery? b. What are physical principles of radiation? c. What are biologic effects of radiation? 1. Desired 2. Undesired d. What are trades are implicit in dose planning (radiation effect on tumor control, AVM obliteration, et cetera, dose, fractions, target volume, and side effects)? e. Understand the logistic regression (Flickinger) model.1,2,3,4,5 2) Understand the indications for CyberKnife stereotactic radiosurgery (selection criteria, active studies). a. Cranial. 1. Tumors. 2. AVM’s. 3. Trigeminal Neuralgia. 4. Functional. b. Spine. 1. Tumors. 2. AVM’s. c. Other. 3) Be familiar with the methodology of CyberKnife stereotactic radiosurgery. a. Set up. b. Target identification, target contouring, and the contouring of critical structures. c. Dose selection (for general information, see http://www.radiotherapy.com/calculate/index.html). d. Patient management. e. Outcomes and their assessment. III. Course content. 1) Resident activities. a. The resident will work as an apprentice in the CyberKnife suite and will be actively involved in all aspects of radiosurgical treatment. b. Depending on scheduling, the resident will attend Radiation Biology didactic course, offered annually from July to August. c. The resident will attend weekly Brain Tumor Board meetings (Friday, 12:15 PM, Workroom A, First Floor, Cancer Center). 2) Reading a. Texts 1) Chin and Regine, Principles and Practice of Stereotactic Radiosurgery6 . Good reference text. Comprehensive and clearly written. 2) Szeifert, Kondziolka, Levivier, and Lundsford, Radiosurgery and Pathological Fundamentals.7 This is an excellent collection of summary articles. It mostly focuses on Gamma Knife experience.
  2. 2. 3) Gerszten and Ryu, Spine Radiosurgery.8 Collection of articles regarding CyberKnife treatment of spinal conditions from the Pittsburgh group. b. Journals 1) Journal of Neurosurgery compilation of top 25 articles on Gamma Knife.9 An excellent and recent compendium of landmark articles. 2) International Journal of Radiation Oncology, Biology, and Physics. Leading journal of for radiation oncology. 3) Portfolio of cases. a. The resident will complete patient evaluation, target identification, dose selection, treatment planning, and treatment for a variety of cases. A total of approximately 10 cases total should be logged in a one month rotation and should include a representative sample of the following: 1) metastatic tumor (approximately 5 minimum); 2) vestibular Schwannoma (approximately 2 minimum); 3) arteriovenous Malformation (approximately 1 minimum); and, 4) trigeminal Neuralgia (approximately 1 minimum). b. The resident will submit a surgical log electronically. IV. Evaluation of resident and feedback a. Each resident will be evaluated at the end of the rotation according to the core competencies (evaluations to be submitted electronically) b. The resident will meet with the course supervisor, Steven Chang, MD, to discuss this evaluation. V. Evaluation of course Each resident will be asked to evaluate the content of the course, its presentation and the course’s instructors (evaluations to be submitted electronically).
  3. 3. For the PGY4 Enfolded Fellow For the Postgraduate Fellow
  4. 4. 1 Flickinger JC. An integrated logistic formula for prediction of complications from radiosurgery. Int J Radiat Oncol Biol Phys. 1989 Oct;17(4):879- 85. 2 Flickinger JC, Lunsford LD, Kondziolka D, Maitz AH, Epstein AH, Simons SR, Wu A. Radiosurgery and brain tolerance: an analysis of neurodiagnostic imaging changes after gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys. 1992;23(1):19-26. 3 Flickinger JC, Kondziolka D, Pollock BE, Maitz AH, Lunsford LD. Complications from arteriovenous malformation radiosurgery: multivariate analysis and risk modeling. Int J Radiat Oncol Biol Phys. 1997 Jun 1;38(3):485-90. 4 Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD. Analysis of neurological sequelae from radiosurgery of arteriovenous malformations: how location affects outcome. Int J Radiat Oncol Biol Phys. 1998 Jan 15;40(2):273-8. 5 Flickinger JC, Kondziolka D, Lunsford LD, Kassam A, Phuong LK, Liscak R, Pollock B. Development of a model to predict permanent symptomatic postradiosurgery injury for arteriovenous malformation patients. Arteriovenous Malformation Radiosurgery Study Group. Int J Radiat Oncol Biol Phys. 2000 Mar 15;46(5):1143-8. 6 Chin L, Regine W (eds). Principles and Practice of Stereotactic Radiosurgery. New York: Springer, 2008. 7 Szeifert GT, Kondziolka D, Levivier M, Lundsford LD (eds). Radiosurgery and Pathological Fundamentals. In Progress in Neurological Surgery, v. 20. Basel: Karger, 2007. 8 Gerszten PC, Ryu S (eds). Spine Radiosurgery. New York: Thieme, 2009. 9 See attached collection of PDF reproductions.

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