1. Stereotactic Radiosurgery Gamma knife Cyberknife

2. Trends in Melanoma Incidence and Mortality in the United States

4. Primary and secundary CNS Tumors: Incidence November 2002 * These figures apply to adult populations. In children, about three-quarters of cerebral tumors are gliomas. Type of Intracerebral Tumor * Percent Incidence Secondary carcinoma 40 Gliomas, all types 40 Meningiomas 13 Pituitary adenomas Neurofibromas Congenital tumors Tumors of blood vessels Others tumors 4 3

5. Secondary Brain Tumors: Incidence by tumor type November 2002 Primary Tumor Patients Percentage Lung Breast Melanoma Colon Other known primary Unknown primary Total 270 82 50 26 72 61 561 48 15 9 5 13 11 100

6. RESULTS

7. Changes in Overall Cancer Mortality (1975-2003), United States US SEER Cancer Registry, 2003

15. Secondary Brain Tumors: Radiotherapy November 2002

17. Treatment Paradigm

21. Whole brain radiation therapy vs. Stereotactic radiosurgery

24. Computerized Image of Radiosurgery

25. What is Gamma Knife?

26. Side view of the Gamma Knife Patient Couch Helmet Helmet in treatment position Shielding Radiation source

27. Collimator up close Helmet (collimators) Stereotactic headframe

28. What is Cyberknife?

29. Detailed view of Cyberknife Linear accelerator Robotic Arm Radiation Exit point Patient couch

30. CRT linear accelerator A – Cathode B – Conductive coating C – Anode D – Phosphor Coated screen E – Electron Beams F – Shadow mask **A particle accelerator works basically the same way.

31. Brain Lab Novalis ® - 3 – 5.5 mm micro-multileaf collimator to conform to the shape of the target - Dynamic conformal arc therapy

32. www.albertaradiosurgery.ca

36. Image registration CT scan MRI Leksell fiducial markers on both

38. UF LINAC Stereotactic Radiosurgery- Gantry

41. Gamma knife head applicator

42. Patient in gamma knife collimator head (from Ertl et al. Phys. Med. Biol. 42 (1997) 2137)

43. Secondary Brain Tumors: Surgery Galicich JH et al ., Met. Brain tumors,In Wilkins: Neurosurgery, 597-61, 1985. November 2002

44. Secondary Brain Tumors: Radiotherapy November 2002 0 30 x 0 30 s 1 5 2 12 2.5

45. Secondary Brain Tumors: Radiotherapy November 2002

48. La radiothérapie est couramment utilisée pour traiter le cancer 2°) Treatment planning Calculation of deposit dose on the tumor (~1mn): A treatment plan is developed using the images 1°) Obtain scanner slices images The head is imaged using a MRI and/or CT scanner 3°) Radiotherapy treatment Irradiation of the brain tumor with a linear accelerator

50. Linear accelerator

54. RTOG 0023: Results Cardinale, Red J, 2006 FSRT MIGHT BENEFIT GROSS-TOTALLY RESECTED GBM Although overall survival was not improved, there was a trend toward improved survival with FSRT for patients with total resection

63. Thanks for Your Attention & Have a Good Day!!!