Radiation oncologists, focusing on the specific problems of brain and spinal cord tumors, offer both traditional and innovative treatments to ensure patients have access to a number of radiation therapy technologies.
In 1989, Cleveland Clinic's Radiosurgery Program was the first in Ohio to treat patients with state-of-the-art noninvasive ablative therapy using a modified linear accelerator. Since then, a number of new radiation therapy technologies have been introduced including:
- Gamma Knife Perfexion
- Novalis TX
- intensity-modulated radiation therapy (IMRT)
- intraoperative radiation therapy (IORT)
- image-guided radiation therapy (IGRT)
These technologies may control lethal tumors longer than conventional radiation therapy, decrease the potential side effects of radiation therapy, and may benefit patients whose general health may not withstand a protracted microsurgical procedure.
A team of personnel, including neurosurgeons, radiation oncologists, radiation physicists, and radiation therapists, provides treatment.
For Gamma Knife radiosurgery, a single one- to two-hour treatment is typically required, in which 201 beams of gamma rays are focused at multiple points throughout the target with the aim of matching the delivered radiation to the shape of the tumor.
Thus, the gamma radiation is concentrated in the tumor, and falloff in adjacent tissue is very steep, minimizing radiation to tissue lying in the entry or exit pathways. Because of this precise focusing ability, aggressive, high-dose gamma radiation can be delivered to stabilize, shrink, or destroy some lesions – even those deep in the cerebral hemispheres or brain stem.
Cleveland Clinic's Gamma Knife Center treated its first patient on January 27th, 1997 and was Ohio's first Gamma Knife Center. Gamma Knife radiosurgery accommodates a larger volume of patients compared to linear-accelerator based (LINAC) radiosurgery, thereby reducing the time between diagnosis and therapy.
Our Gamma Knife Center offer the Gamma Knife Perfexion unit, the most technologically advanced model available. We are one of only a few centers in the United States with this new technology. The technology offers enhanced planning, and increased patient comfort. This Gamma Knife model offers enhanced planning using all image modalities, including:
- positron-emission tomography (PET),
- computerized tomography (CT) and
- magnetic resonance (MR) imaging, as well as reduced treatment time.
The most common indication for Gamma Knife radiosurgery is brain metastases, a condition that afflicts nearly a quarter of patients suffering from cancer. The majority of our Gamma Knife treatments at are for metastatic disease. The remaining Gamma Knife treatments are for primary and benign tumors, trigeminal neuralgia, and arteriovenous malformations. Most lesions are treated on an outpatient basis and cranial tumors receive the most accurate focused beam radiosurgery available.
Cleveland Clinic's Gamma Knife Center is one of only a few centers worldwide certified by Elekta (manufacturer of the Gamma Knife) to train physicians new to Gamma Knife radiosurgery.
The Novalis unit further increases the capabilities within radiation oncology and allows for radiosurgery and fractionated radiosurgery treatments for neuro-oncology patients using image guidance. This technology gives us the ability to treat lesions near critical structures, such as the optic nerves and chiasm, as well as retreat some patients who have undergone conventional radiotherapy. In general, the Gamma Knife is used for single treatments of focused radiation that conforms to the shape of small tumors or lesions, while the Novalis delivers fractionated conformal treatment for larger malignant or benign tumors.
Although Novalis was originally developed to treat brain tumors, Cleveland Clinic physicians recognized its potential for treating extracranial tumors, particularly primary and metastatic spinal tumors that are difficult to treat due to their proximity to critical structures.
In addition to the Gamma Knife, linear accelerators, and the Novalis unit, we offer intraoperative radiation therapy (IORT) with the Intrabeam device, a 50 kVp contact unit that is placed in the resection cavity. We have an ongoing phase II trial evaluating the use of the Intrabeam for patients with a single brain metastasis that has been resected.
To schedule an evaluation with a Burkhardt Brain Tumor Center specialist, please call our Appointment Center at 216.636.5860 or toll-free at 866.588.2264.