Background Information:

What are the other Names for the Procedure?

• SBRT (Stereotactic Body Radiotherapy)
• SRS (Stereotactic Radiosurgery)
• Stereotactic Radiosurgery (SRS)

What is Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure? (General Explanation)

• Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT) are nonsurgical procedures that are used in the treatment of tumors, by delivering precise radiation at very high doses
• Stereotactic Radiosurgery was initially developed for the treatment of brain tumors and functional abnormalities in brain. The same principles have been now applied in the treatment of tumors in other body areas, which is known as Stereotactic Body Radiotherapy
• The goal of this procedure is to deliver high, precise radiation at the tumor site, to provide maximum benefit, and to avoid injury to the surrounding normal tissues

What part of the Body does the Procedure involve?

Stereotactic Radiosurgery and Stereotactic Body Radiotherapy are used for treating brain tumors and tumors located in other areas of body. Thus, depending upon the location of the tumor, different parts of the body could be involved.

Why is the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure Performed?

• Stereotactic Radiosurgery and Stereotactic Body Radiotherapy are performed as an alternative to invasive surgery, or in patients who are not candidates for surgery
• This procedure is very useful for tumors that are hard to reach for surgery, are subject to movement within the body, or are located near any vital organs
• SBRT is used in the treatment of benign or malignant tumors related to the lung, liver, abdomen, spine, prostate, or head and neck
• Stereotactic Radiosurgery is extremely important in the treatment of the following medical conditions:
  • Primary or metastatic brain tumors
  • To destroy tumor cells that are remaining after surgery
  • For intracranial brain tumors, orbital tumors, and tumors located at the base of the skull
  • Arteriovenous malformations
  • Trigeminal neuralgia          
  • Tremor
  • Benign or malignant brain tumors

What is the Equipment used? (Description of Equipment)

Stereotactic Radiosurgery and Stereotactic Body Radiotherapy use the following equipment:

• Gamma knife:
  • Gamma knife is usually used to treat small to medium-size intracranial lesions
  • It uses accurate and focused gamma rays that deliver precise radiation to the tumors
• Linear accelerator:
  • Linear accelerator is usually used in Stereotactic Radiosurgery or treating large tumors
  • The linear accelerator uses photons to destroy the tumor cells
• Proton beam
  • A very limited number of hospitals use proton beam in SRS and SBRT procedure

What are the Recent Advances in the Procedure?

There have been no recent advances with respect to Stereotactic Radiosurgery and Stereotactic Body Radiotherapy.

What is the Cost of performing the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure?

The cost of Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedures and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25709970 (assessed on 3/8/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25707911 (assessed on 3/8/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25706519 (assessed on 3/8/2015)

Prior to Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure:

How does the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure work?

Stereotactic Radiosurgery and Stereotactic Body Radiotherapy works in the following manner:

• The high-dose radiation used during these procedures damages the DNA of the tumor cells and destroys the ability of these cells to reproduce. Since these cells do not reproduce, the tumors shrink over a period of time
• Malignant and metastatic tumors shrink rapidly than benign tumors
• These procedures may only prevent tumor growth without shrinking them, which is important in the case of some tumors
• These procedures are also used in treating arteriovenous malformations, where it causes a thickening of the malformation and closes it after year

How is the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure Performed?

Stereotactic Radiosurgery using gamma knife - the procedure consists of 4 phases:

• The placement of the head frame:
  • During this phase, an IV line is inserted into the patient’s arm vein and medication and contrast material injected
  • Two identified spots on the patients head and two identified spots on the back of the head are numbed using local anesthesia
  • A head frame is attached to the patient’s skull and pins on the head frame are tightened to keep the head from moving
• Imaging of tumor location:
  • This step is performed to localize the site of tumor
  • It could be done before a few days before starting the procedure
  • It basically involves taking images using MRI or CT scan
• Dose planning:
  • This step is performed using specific computer program to determine the minimal dose of radiation needed to destroy the tumor
• Radiation delivery:
  • During this step, the patient lays down on the table with the head frame
  • The treatment team performs the procedure from an adjoining room to avoid radiation; though, the patient is able to communicate with the team
  • The examination table with the patient moves into the gamma knife machine and radiation treatment is delivered using the gamma knife machine
  • The patient does not feel anything while the treatment is taking place
  • After the radiation is completed, the patient may go home (as advised)
  • If multiple sessions are required, the patient may need to make repeated visits

Stereotactic Radiosurgery and Stereotactic Body Radiotherapy using linear accelerator:

• This procedure also involves 4 steps as discussed above
• With a linear accelerator, the machine rotates around the examination table (on which the patient lies), rather than the table moving in and out of the machine (as seen with gamma knife)

Stereotactic Body Radiotherapy:

• This procedure also involves 4 steps as mentioned above
• In certain cases, where CyberKnife (robotic radiosurgery system) is used for radiation, the imaging requires to have the marker placed in or near the tumor, to help identify its location during radiation
• Depending upon the location of the tumor, the immobilization device is built to keep the patient in a certain position
• Radiation is applied using the linear accelerator

Where is the Procedure Performed?

Stereotactic Radiosurgery and Stereotactic Body Radiotherapy is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An interventional radiologist performs the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedures.

How long will the Procedure take?

• The Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedures may take between 1-5 hours
• It may take longer depending upon the complexity of the procedure and the patient’s health

Who interprets the Result?

An interventional radiologist and oncologist interpret the results of Stereotactic Radiosurgery and Stereotactic Body Radiotherapy.

What Preparations are needed, prior to the Procedure?

The following preparations are needed prior to Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedures:

• Patients should inform their physicians about their medical conditions, medications, and any over the counter medications or herbal supplements that they are taking
• Patient should inform their physician if they are allergic to any medications, especially to any contrast material
• The physician must be informed if the patient is claustrophobic
• Also, the physician should be notified if the patient has any neuro-stimulators, implants, stents, coils, defibrillator, artificial heart valve, or pacemakers installed in them

What is the Consent Process before the Procedure?

A physician will request your consent for Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy:

• The SBRT procedure may cure the cancer, shrink the tumor size, or reduce the symptoms of the cancer
• The procedure is completely painless and it can be performed as an outpatient procedure

Following are the risks of the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy:

• There is a minimal chance of developing cancer, due to the exposure of radiation to normal tissues surrounding the tumor
• Normal tissues around the tumor may be destroyed due to radiation
• The patients may experience many side effects depending upon the site of the treatment. The side effects may include hair loss, nausea, vomiting, diarrhea, headaches, unity or bladder changes, secondary cancers, organ changes, and infertility

What are the Limitations of Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure?

The Stereotactic Radiosurgery and Stereotactic Body Radiotherapy cannot be used with certain kinds of tumor, due to the tumors’ insensitivity to radiation therapy, or due to the location of the tumors.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What are Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedures?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure:

What is to be expected during the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure?

• Both Stereotactic Radiosurgery and Stereotactic Body Radiotherapy are completely painless procedures. Patients do not feel any pain during these procedures
• Most of the side effects caused by SBRT depend upon how large the dose of radiation is and what part of the body is involved
• Side effects during or immediately after the therapy usually disappear in a few weeks
• Some of the most common side effects are fatigue, tiredness, skin changes such as redness, dryness, itching, and peeling
• Patients may experience nausea or vomiting during the procedure, which are treated during the course of the procedure
• After Stereotactic Radiosurgery, when the head frame is removed, patients may have some minor bleeding and may experience headaches

What kind of Anesthesia is given, during the Procedure?

Anesthesia is rarely used during the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedure.

How much Blood will you lose, during the Procedure?

Since Stereotactic Radiosurgery and Stereotactic Body Radiotherapy are minimally-invasive procedures, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure?

Stereotactic Radiosurgery and Stereotactic Body Radiotherapy may cause destruction of normal, healthy tissues adjacent to the tumor site. However, the damage is generally much less when compared to regular radiation therapy

What Post-Operative Care is needed at the Healthcare Facility after the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure?

No specific post-operative care is needed at the healthcare facility after Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedures.

After the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure:

What is to be expected after the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure?

There may be several side effects depending upon the area of body being treated and radiation dose used after the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedure. Following are some of the side effects that the patient may experience after the procedure:

• Soreness
• Swelling
• Hair loss
• Nausea and vomiting
• Headaches
• Difficulty swallowing
• Digestion problems
• Urinary retention
• Diarrhea
• Infertility
• Brain or spinal cord changes
• Lymphedema

When do you need to call your Physician?

Patients may need to call their physician in the following situations after Stereotactic Radiosurgery and Stereotactic Body Radiotherapy.

• If the side effects during or immediately after the procedure do not resolve in a few weeks’ time
• Patients have severe nausea and vomiting and unable to eat or drink anything

What Post-Operative Care is needed at Home after the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure?

Patient may need several follow-up appointments to check for effectiveness of the treatment and any signs of cancer recurrence after the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedures.

How long does it normally take to fully recover, from the Procedure?

• Patient may resume their normal activities immediately after Stereotactic Radiosurgery and Stereotactic Body Radiotherapy
• Most of the early side effects are resolved in few weeks after the procedure

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Stereotactic Radiosurgery and Stereotactic Body Radiotherapy do not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Stereotactic Radiosurgery and Stereotactic Body Radiotherapy procedures are performed.