Stereotactic radiosurgery (SRS) as a local high precision approach for the primary treatment of asymptomatic brain metastases (cancer) has gained wide acceptance. It leads to lasting tumor control with only minor side effects compared to whole brain radiotherapy, since there is only little dose delivered to the healthy brain.

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Stereotactic
Radiosurgery in
Brain Metastases
Presented By:
Group 7
Ipsita Raha – Manas Ghosh – Dibyendu Banik – Arnab Chatterjee – Arijit Dhali
11500120054 – 11500320048 – 11500320062 – 11500320076 - 11500320078

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Introduction
01
Brain Metastases
02
Stereotactic
Radiosurgery
03
Compatible Target
& Procedure
04
Result, Success
Rate & Side Effect
05
Conclusions &
References
06
Table of contents

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Introduction
In recent years, doctors and researchers have made
significant advances in their understanding of
whole-brain radiation, stereotactic radiosurgery and
how these two methods affect people's survival,
cognitive ability and quality of life. In deciding which
type of radiation therapy to use, you and your doctor
will consider many factors, including what other
treatments you're undergoing and the potential for
you to experience cancer recurrences after
treatment.[4]

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What is Brain Metastases?
Brain metastases occur when cancer cells spread from their
original site to the brain.
Any cancer can spread to the brain, but the types most likely to
cause brain metastases are lung, breast, colon, kidney and
melanoma.
It may form one tumor or many tumors in the brain. [3]
Brain primary tumor:
A normal brain cell (glial cell) becomes malignant and is called
a glioma or the most serious a glioblastoma multiforme
(GBM).[2]

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Incidence Proportion Percentage and
Rate of Survival
0
5
10
15
20
25
30
35
40
Lung Melanoma Breast Renal Colorectal
Incidence Proportion Percentage of Brain
Metastases by Primary Cancer [1]
Localized Regional Distant Unstaged
If untreated, the median survival of patients
with symptomatic brain metastases from
solid tumors is approximately one to two
months.
In randomized trials composed primarily of
patients with non-small cell lung cancer
(NSCLC) and breast cancer, the median
survival in patients treated with whole brain
radiation therapy (WBRT) ranges from four
to six months.[2]

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Treatments for Brain Metastases
• Chemotherapy
• Targeted Therapy
• Immunotherapy
Traditional
Surgery[4]
Radiation
Therapy[4]
• Whole Brain Radiation
• Stereotactic Radiosurgery
Medication[4]

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History of Radiosurgery
• Stereotactic neurosurgery originated from the pioneering work of Horsley and Clarke, who
developed a stereotactic apparatus to study the monkey brain in 1908.[5]
• Spiegel and Wycis applied the technology to the human brain in 1947. [5]
• The concept of stereotactic radiosurgery (SRS) described by Lars Leksell in 1951. [2]
• The first Gamma Knife using 60-cobalt was completed in 1968 . [2]
• In 1983 a modified linear accelerator was developed in Buenos Aires. [2]
• The CyberKnife was invented at Stanford Health Care and first debuted in 1994. [2]

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Stereotactic Radiosurgery
Radiosurgery is surgery using radiation, that is, the destruction
of precisely selected areas of tissue using ionizing
radiation rather than excision with a blade.[5]
With stereotactic radiosurgery (SRS), each beam of radiation
isn't particularly powerful, but the point where all the
beams meet — at the brain tumor — receives a very large
dose of radiation to kill the tumor cells. SRS is typically
done in one treatment, and doctors can treat multiple
tumors in one session. [4]
Geometric analysis in SRS

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Machineries of
Stereotactic
Radiosurgery
Vital Beam
Linac
Gamma
Knife
Tomotherapy
Cyberknife

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1. Well defined on CT or MRI
2. Spherical shape
3. Most are < 4cm in max diameter
4. Generally non-infiltrative
5. Located at gray-white junction [2]
Ideal Targets for SRS
Suitable for performing SRS

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Step by step procedure of SRS
• It uses sophisticated, 3-D-computerized imaging to precisely focus photon beams, delivering a
highly-concentrated dose of radiation to a precise target in a single session.
• SRS works by distorting and destroying the DNA of tumor cells, much the same way as other
forms of radiation. As a result, these cells lose their ability to reproduce and die.
• For Fractioned Stereotactic Radiosurgery, the total dose of stereotactic radiation is divided into
several smaller doses of radiation, on separate days of treatment. Typically, this consists of
two to five treatments.
• In order to precisely direct the radiation beams, a frame is placed on the patients head. Local
anesthetic is administered to facilitate patient comfort during the procedure.
• A CT scan is obtained with contrast administration and is then merged or fused with an MRI of
the brain that is usually obtained prior to the procedure.
• At the conclusion of the procedure, the frame is removed, a clean dressing is applied on the pin
sites and the patient is discharged in the care of a family member or friend. [6]

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Architecture of
Stereotactic
Radiosurgery
Before and After Stereotactic Radiosurgery
Dosage Comparison
between brain
Radiation

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Results
Benign tumors :
The treatment effect of stereotactic radiosurgery occurs gradually,
depending on the condition being treated:
The tumor may shrink over a period of 18 months to two years.[7]
Malignant tumors :
Cancerous (malignant) tumors may shrink more rapidly, often within a
few months. [7]
Arteriovenous
Malformations (AVMs) :
The radiation therapy causes the abnormal blood vessels of brain AVMs to
thicken and close off. This process may take two years or more . [7]
Trigeminal neuralgia :
SRS creates a lesion that blocks transmission of pain signals along the
trigeminal nerve. Many people experience pain relief within several weeks,
but it may take several months. [7]

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Graphical Representation of Survival
Rate
Rate of Survival after Diagnosing with
Metastases to Brain [9]
Rate of Survival with Radiotherapy
Treatment [8]

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Side effects of the treatment
As we know for every effect, there is a side effect.
The side effects of Stereotactic Radiosurgery are:
• Fatigue: Tiredness and fatigue may occur for the first few weeks after stereotactic
radiosurgery.
• Swelling: Swelling in the brain at or near the treatment site can cause signs and symptoms
such as headache, nausea and vomiting. Your doctor may prescribe anti-inflammatory
medications (corticosteroid medications) to prevent such problems or to treat symptoms if
they appear.
• Scalp and hair problems: Your scalp may be red, irritated or sensitive at sites where a device
is attached to your head during the treatment. Some people temporarily lose a small amount
of hair.
Rarely, people may experience late side effects, such as other brain or neurological problems,
months after treatment. [7]

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Conclusion
Stereotactic radiosurgery (SRS) uses many
precisely focused radiation beams to treat
tumors and other problems in the brain, neck,
lungs, liver, spine and other parts of the body. It
is not surgery in the traditional sense because
there's no incision.[7]

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1. https://www.cancernetwork.com/view/current-and-emerging-treatments-brain-metastases
2. https://www.slideshare.net/doctorbobm/radiosurgery-for-brain-metastases
3. https://www.mayoclinic.org/diseases-conditions/brain-metastases/symptoms-causes/syc-20350136
4. https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140
5. https://en.wikipedia.org/wiki/Radiosurgery
6. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Stereotactic-Radiosurgery
7. https://www.mayoclinic.org/tests-procedures/stereotactic-radiosurgery/about/pac-20384526
8. https://www.researchgate.net/figure/Overall-survival-after-BRM-of-patients-treated-with-stereotactic-
radiosurgery-or-surgery_fig2_265055699
9. https://www.researchgate.net/figure/Survival-of-patients-with-or-without-brain-metastases-from-time-of-
diagnosis-of_fig1_5785035
References

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Thank
You
For your kind attention towards
our presentation !!