When someone tells us they have a brain tumor, we are terrified. The next thing we think about is a major brain surgery. However, with the advancement of medical science, it is not always necessary to open the head and perform surgery. Today we are going to talk about a special treatment method that can cure small tumors and other problematic areas in the brain using highly targeted radiation beams, without any incisions.
Simply put, what is Stereotactic Radiosurgery (SRS)?
Although it has the word "surgery" in its name, it's not the traditional surgery you might think of using a knife or scissors. Stereotactic Radiosurgery (SRS) is a highly advanced form of radiation therapy. To be precise, it involves using a special machine to deliver a series of high-dose, very fine beams of radiation to the exact location of the tumor in the brain.
Imagine that many beams, like fine laser beams coming from different directions, intersect at the same point, that is, where the tumor is located. Then, while the tumor receives the maximum amount of radiation, the damage to the healthy, good brain tissue around it is minimal. This is the biggest advantage of this treatment.
Although the name says 'surgery', there is actually no incision involved. Therefore, the risks of a typical surgery are much lower.
What situations is this treatment most often used for?
If you have a brain tumor, but it is too risky to remove it with a standard operation, your doctor may recommend SRS. For example, the tumor may be deep in the brain, or it may be near a vital blood vessel or nerve. In such cases, this non-invasive treatment is very safe. Sometimes it is also used to destroy any remaining cancer cells after surgery.
Doctors use this SRS method for both cancerous and non-cancerous (benign) tumors.
| Common conditions treated with SRS | |
|---|---|
| Acoustic neuroma | Chordoma |
| Craniopharyngioma | Glioblastoma |
| Glioma | Hemangioblastoma |
| Meningioma | Metastatic brain tumors (tumors that have spread to the brain from cancer elsewhere) |
| Pineoblastoma | Pituitary adenoma (pituitary gland tumor) |
In addition, this SRS method is used to stop the risk of bleeding due to abnormal blood vessel tangles in the brain (arteriovenous malformation), and to stop pain signals from reaching the brain in severe nerve pain such as trigeminal neuralgia .
Sometimes this technique is also used to treat tumors outside the brain. For example, tumors in the liver, lungs, or pancreas. This is called Stereotactic Body Radiation Therapy (SBRT) .
How should I prepare before treatment?
Your medical team will prepare you well for this. They will usually do the following:
- Reviewing your complete medical history.
- Explaining the treatment process and what to expect in a way that you can understand.
- Informing patients about when to stop eating and drinking before treatment.
- Advice on whether you should stop taking any medications before treatment.
- Providing instructions on how to prepare for the day of treatment (e.g., not to wear jewelry or makeup).
What happens during treatment?
During SRS treatment, you are in the room where the machine is. Your medical team is in a separate room and controls the machine using a computer. Because the computer screen clearly shows where your brain tumor is, they can direct the radiation precisely to its target.
The treatment you receive may vary slightly depending on the type of machine used. There are three main types.
| SRS machine type | How it happens |
|---|---|
| Gamma Knife® | You will lie down on a special bed and wear a special frame or mask to keep your head still. Then the bed will go into the machine (only the head part). The machine will direct the radiation beam at the tumor. |
| Linear Accelerator (LINAC) | In this procedure, you will lie on a bed with a frame to keep your head still. An arm attached to the machine will rotate around you in arcs, directing radiation to the tumor. This type is sometimes called Cyberknife® . |
| Proton Therapy | This is a new and somewhat rare procedure in which a beam of high-energy proton particles is directed at the tumor. |
Steps of treatment
1. Explanation: They show you that you can talk to the medical team at any time through an intercom system.
2. Positioning: You will be placed on a bed and placed in a head restraint (frame or mask). It is important to remain still to avoid exposing healthy tissue to radiation.
3. Scans: Several scans, such as MRI and CT scans , are performed to find the exact location of the tumor.
4. Treatment planning: Based on these scan results, the medical team uses computers to precisely plan how the radiation beams should be delivered. They also decide whether to give a high dose all at once or to give it in smaller doses over several days.
5. Treatment: The machine will deliver the treatment as planned. You will not feel any pain at this time. However, you may hear some noise as the machine operates.
Typically, this entire process can take about 1-4 hours.
What happens after treatment?
Most people can go home after treatment. However, sometimes you may need to stay in the hospital for a few hours to check for side effects. Common side effects include:
- Fatigue
- Headache
- Nausea and vomiting
- Hair loss (at the treatment site)
- Skin changes
These symptoms usually go away within a few days or two to three weeks. If the hair is lost, it will grow back in two to three months. Your doctor will prescribe medication to help manage these symptoms.
They will tell you to come back in about a month to check on your condition. After a few months, they will do another scan to see what has happened to the tumor. Cancerous tumors shrink in a few months. It can take a year or two to see a difference in non-cancerous tumors.
When should you see a doctor?
If any unusual symptoms persist or new ones appear after treatment, be sure to tell your doctor. Sometimes conditions like brain swelling can occur. Medications like corticosteroids may be prescribed for this. Also, speech therapy and occupational therapy may be recommended as needed.
Take-Home Message
- Stereotactic Radiosurgery (SRS) is not a traditional surgery. It is an advanced method of treating brain tumors with highly targeted radiation without an incision.
- This procedure causes very little damage to healthy brain tissue, so there are fewer risks and side effects than conventional surgery.
- There is no pain during the treatment. In most cases, the treatment is completed in one day and you can go home.
- It's normal to feel scared and anxious about this type of treatment. Talk openly with your doctor about any questions or concerns you may have. They will explain everything to you and give you the mental comfort you need.
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