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The Gamma Knife
Macquarie University Hospital is home to Australia's first ever Gamma Knife. For certain types of tumours and neurological disorders, the Gamma Knife provides better outcomes for patients with fewer complications in a same day treatment with a lower total treatment cost compared to more traditional invasive neurosurgery techniques.
The Gamma Knife is a non-invasive neurosurgical tool for treating brain cancer and a range of other brain-related disorders. The Gamma Knife allows shorter stays and less straining treatment.
Brain tumor treatment
Gamma knife can be a useful tool is the treatment of many different types of brain tumours and abnormalities. These are some of the most common conditions treated:
Metastatic brain tumours: Any malignant tumour in the body has the potential to spread to the brain, but it is much more typical of some types of cancers than others. Melanoma, lung, breast and kidney cancers are the most common sites of origin. Gamma knife can be used to treat singular or multiple metastatic tumours in the brain. It can be used in conjunction with or as an alternative to whole brain radiotherapy and/or surgery.
Acoustic Neuromas: Acoustic Neuromas (also called vestibular schwannoma) are benign tumours that arise from part of the 8th cranial nerve. This nerve is responsible for hearing and balance. These tumours can form on both sides of the brain; this is typical in a condition known as neurofibromatosis type 2. Gamma knife can be used to control tumour growth and can often preserve any remaining useful hearing.
Meningiomas: Meningiomas are generally benign slow growing tumours that arise from the cells that line the brain. The aim of gamma knife treatment is to control tumour growth. Skull based lesions, and particularly those in relatively inaccessible sites such as the cavernous sinus are particularly well suited to gamma knife treatment. Gamma knife can also be used in conjunction with surgery when complete removal is not possible then the remaining tumour is treated with gamma knife. It can also be used for patients with multiple lesions.
Gilomas: Glioma is the general name of a tumour that arises from the glial tissue which supports and nourishes the brain. There are many types of glial tumours including astrocytoma, oligodrendogiloma, ependymona and glioblastoma multiforme. They are generally graded 1-4 depending on the malignancy. Grade one being the least malignant and grade four being the most malignant. Gamma knife can be appropriate in some cases to attempt and reduce tumour growth. Each case will be presented at a multi-disiplinary team meeting and assessed for its suitability.
Pituitary Adenoma: Tumours of the pituitary arise from the anterior portion of the gland and are nearly always benign. Gamma knife is not normally used as a primary therapy because surgery is usually so effective and works more quickly to control hormone levels. Gamma knife is useful however for treating persistent or recurrent tumours.
Other conditions
Arteriovenous malformations (AVM): An AVM is a tangle of dilated blood vessels that can occur anywhere in the body. When they occur in the brain they can disrupt the normal blood in the brain by pooling blood in its dense centre or nidus. Gamma knife aims to reduce the size and blood flow within the AVM. It can used as an alternative or in conjunction with surgery and or embolisation depending on the size and location of the AVM. The usual time to resolution and occlusion in adults is 2-3 years.
Trigeminal Neuralgia: Trigeminal Neuralgia (TN) can be a very disabling condition which is characterised by sudden bursts of facial pain. Any patient with TN who has pain or difficulty with the medication used to relieve the pain can be a suitable candidate for gamma knife. It is especially useful for patients with high anaesthetic risk for whom surgery is not an option or where previous surgery or interventions have failed. Gamma knife involves giving a fairly large dose of radiation to a very small and highly focused area of the trigeminal nerve.
Other conditions that may be suitable for gamma knife are haemgioblastomas, PNET tumours, chordomas, glomous jugulare tumours, craniopharyngioma and essential tremor in patients with Parkinson’s disease. If you are unsure if gamma knife is suitable for you or you would like more information please contact us. We are happy to talk to you over the phone or look at your scans.
Is this a suitable treatment for you?
If you are unsure if gamma knife would be a suitable treatment for your condition or you would like to find out more please contact us. Someone will be in touch to tell you more about the treatment and if it is potentially suitable for you. The Gamma knife team meet every fortnight to discuss new cases and are happy to review your scans. There is no cost for this service. The team includes a neurosurgeon, radiation oncologists, radiation therapists, medical physicist and nurses. Once your case has been discussed we will be in contact shortly afterwards to let you if gamma knife is an option for you or if not we may be able to advise on other treatments. It can be a very valuable second opinion free of charge.
Australia's first Gamma Knife
Gamma Knife surgery has dramatically improved the management of brain tumours & other brain conditions that often required invasive surgery. The concentration of gamma rays to a targeted area of the brain can be performed with the utmost surgical precision.
Patients previously had to travel overseas in search for Gamma Knife treatment, but the Macquarie University Hospital has made this potentially life-saving treatment available in Australia.
Download the Gamma Knife Brochure here (861kb)
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Australia's first ever Gamma Knife, located at the nation's newest and most technologically-advanced hospital - Macquarie University Hospital in Sydney - treated its first patient last year.
For certain types of tumours and neurological disorders, the Gamma Knife provides better outcomes for patients with fewer complications in a same day treatment with a lower total treatment cost compared to more traditional invasive neurosurgery techniques.
Consistent with Macquarie University Hospital's approach to medicine and improving care for patients, Gamma Knife treatment is delivered by a team of leading neurosurgeons, radiation oncologists, medical physicists and nurses using the best technology available. Genesis Cancer Care is delivering the Gamma Knife service on behalf of Macquarie University Hospital.
The Gamma Knife is a non-invasive neurosurgical tool for treating brain cancer and a range of other brain-related disorders. Despite its name, it is not a cutting implement and there is no blood or incision involved in treatment. Instead, some 192 radiation beams from cobalt-60 sources converge with high accuracy on the target inside the brain. Each individual beam has low intensity and therefore does not affect the tissue through which it passes on its way to the target. The beams converge in an isocentre where the cumulative radiation intensity becomes extremely high.
Neurosurgeon Dr John Fuller, who treated the first patient in Australia with the device, said Gamma Knife treatment is very different to traditional neurosurgery.
"Although our first patient had tumours in multiple parts of his brain, we only needed to do one operation lasting an hour or so, no scalpel was used, the patient was awake throughout the entire procedure and only received a local anaesthetic, and he went home last night having been treated in an out-patient setting."
Dr Fuller said the low impact nature of the treatment on the patient has a range of flow-on benefits for their families, the medical treatment team and the wider healthcare system.
"Patients who receive Gamma Knife treatment have fewer complications than traditional neurosurgery patients undergoing a craniotomy reducing the need for hospitalisation and intensive care," he said.
"For patients the Gamma Knife equates to fewer treatment sessions, shorter hospital stays and less physical, mental and emotional strain. Additionally, it reduces the overall burden on the healthcare system."
One published international study shows that one Gamma Knife system can free up to 700 ICU beds per year.
Some of the conditions that can be treated with the Gamma Knife include arteriovenous malformations (AVMs), abnormal arteries and veins which in most cases form prior to birth; acoustic neuromas, benign tumours of the eighth cranial nerve; trigeminal neuralgia, a condition that affects one of the largest nerves in the head and is associated with sharp, piercing pain in the face; and other brain tumours such as, meningiomas, pituitary adenomas, and skull base tumours, as well as glioblastoma multiforme, ogliodendroglioma, astrocytomas in certain cases.
Overseas peer-reviewed studies report that Gamma Knife treatment has resulted in tumour control (elimination of further growth, tumour shrinkage or obliteration) in about 90 percent of cases.
However, the Gamma Knife is most well-known as the preferred type of treatment globally for brain metastases, which develop in 20-40% of all cancer patients. Brain metastases are cancer that has spread (metastasised) to the brain from another site in the body, commonly the lung or breast. Around 300,000 Gamma Knife treatments will occur worldwide this year, mostly to treat patients with brain metastases.
Professor Michael Morgan, a world-renowned neurosurgeon and Dean of the Australian School of Advanced Medicine at Macquarie University said that the Gamma Knife can improve outcomes for these seriously ill patients.
"Now with the Gamma Knife we can offer treatment and along with that hope that the patient's life may not only be extended, but also that their remaining time will involve a much better quality of life," he said.
For more information on the gamma knife please call 9812 3220.
For media enquires please contact Greg Welsh, (02) 9850 7456, 0407 200 474.
FAQs
What is Gamma Knife radiosurgery?
Gamma Knife radiosurgery (GKS) is a safe, effective and non-invasive procedure that uses radiation to treat conditions in and around the brain. It is sometimes used as a replacement for conventional surgery, but at other times it may be effective in situations where there is no conventional surgical alternative available. The radiation treatment is delivered with great precision to the target tissue within or around the brain, whilst at the same time minimising any dose to surrounding healthy tissue. The name 'Gamma Knife' is in some ways misleading - no knife or cutting implement is actually involved at any stage. The term 'Gamma Knife' is intended to convey the idea that this radiation treatment is in some ways delivered as though it were an actual knife, because it offers a similar sort of precision and targeting to that offered by actual surgery. It uses radiation in much the same way as a surgeon uses a knife.
How does Gamma Knife Work?
Radiation damages the DNA in the cells of the tumour or other abnormality being treated, such that the cells that make up the targeted tissue can no longer reproduce. Eventually, when these cells come to the end of their natural life span, they find that they are unable to reproduce and replace themselves because the DNA essential to this process is no longer functioning properly. Some lesions which are very inactive in terms of cell function may take up to 2 or 3 years or more to respond to treatment -this is typically the case for instance with blood vessels, and arterio-venous malformations (AVM) which usually resolve over this sort of time period.
Is Gamma Knife radiosurgery safe?
Yes - in terms of the risk of damage to tissue around the target area. Having said that, as with any form of surgical or radiation treatment, there will always be some small risk attached and this can never be reduced to zero. However, in the case of GKS this can nearly always be brought down to very low levels - one of the more common reasons for recommending GKS is that the overall risk compared to open surgery is frequently much lower. This is sometimes so much the case that the surgical alternative may actually carry a higher overall risk than that of the condition being treated, thereby rendering it effectively inoperable other than by radiosurgery. The precise nature and magnitude of any risk will vary with the size, nature and position of the lesion being treated. You should ask your treating doctor to elaborate on the details of this with respect to your own individual situation - they will be more than happy to give you a very full explanation of all that is involved.
Is Gamma Knife radiosurgery effective?
Yes. GKS has now been used worldwide for about 40 years to treat benign and malignant tumours. It has also been used to obliterate arterio-venous malformations (AVM) and in the treatment of some other disorders including trigeminal neuralgia and some forms of epilepsy. During this time period the results of many thousands of treatments have been published in papers in the medical literature, and the efficacy of GKS is indeed thoroughly well established and accepted. For many conditions a success rate well in excess of 90% can now be confidently predicted, though this is not necessarily the case for all such conditions. As above, you should ask your treating doctor to elaborate on the details of this with respect to your own individual situation.
Furthermore, patients are usually still suitable for GKS even if they have previously undergone conventional neurosurgery, radiation therapy, chemotherapy, or (in the case of an AVM) an embolization/coiling procedure.
What are the possible complications of Gamma Knife radiosurgery?
Serious complications of GKS are really very unusual. Minor side effects, which generally resolve within a few hours, are sometimes seen and do not usually present the patient (or the doctor) with a significant problem. It is fair to say that the large majority of patients suffer no side effects whatsoever, apart perhaps from a feeling of being a bit tired and 'washed out' at the end of a busy day's treatment!
We tend to think of complications in terms of those which may occur early i.e. soon after treatment, and those which can occur at a later stage, some weeks or months following GKS:
Early Complications:
-
Common:
Some local discomfort of the scalp relating to the pin sites which are used to fix the frame - resolves within a few hours, almost certainly by the following morning.
Headache - again usually mild, resolving rapidly.
Mild nausea. -
Rare:
Skin reddening and irritation.
Epileptic seizures - in susceptible patients.
Swelling of surrounding brain tissue.
Delayed Complications:
-
Common:
None -
Uncommon:
Visual Loss, Hearing loss, Epileptic seizures, Radiation effects on surrounding brain tissue. Hair loss (very localised) adjacent to treated area. These complications tend to relate only to treatment for particular conditions. Again your treating doctor will be able to elaborate on the details of this with respect to your own individual situation
What are the potential benefits of Gamma Knife radiosurgery over conventional surgical techniques?
Benefits May Include:
- The risks of infection, haemorrhage and spinal fluid leakage are eliminated, as is the scarring and potential disfigurement that results from conventional neurosurgery.
- The small risk associated with general anaesthesia is also eliminated. A mild sedative is occasionally used.
- GKS usually only involves a single night's stay in hospital, and frequently not even that, as opposed to the extended stay often necessitated by surgery.
- GKS can be sometimes be used in conjunction with conventional surgery, usually taking the place of the more risky component of the latter. In other words, where conventional surgery is absolutely required, its risk can be reduced by partially substituting GKS as a ''boost'' to perform the final part of the job.
- An individual who might be a relatively high risk candidate for conventional surgery may be a much safer candidate for GKS.
- Efficacy when prior surgery or radiation therapy has failed to control the disease - hormone secreting pituitary gland tumours might be a particularly good such example.
- Unlike conventional whole brain radiotherapy Gamma Knife radio surgery is directed very specifically at the target. This spares most of the adjacent normal brain tissue from exposure to unnecessary excess radiation.
- "Fractionation" is not required - unlike conventional radiotherapy which is often delivered in many fractions over several weeks, GKS can nearly always be delivered as a single treatment over the course of less than a day. Multiple hospital visits are therefore avoided.
- As a day case treatment GKS offers the prospect of return to work, driving, and other normal social activities within a few days in the vast majority of cases. This is frequently as soon as the day following treatment.
- Established effectiveness over 40 years of experience worldwide, with a very low rate of complications.
Will the Gamma Knife procedure hurt?
The stereotactic frame is fitted under local anaesthesia. This involves the administration of 4 small injections around the circumference of the head, in order to numb the sites where the 4 pins are to be used to secure the frame. The experience of these is the same as when visiting the dentist for the purpose of having a tooth put to sleep for filling. The same local anaesthetic drug is used in both instances. Very quickly, after a brief stinging sensation, these areas will go numb. The frame is then attached. As the pins are secured you will feel a strange "pressure" sensation which quite soon passes. The whole procedure takes about 5 - 10 minutes, and after the frame is fitted you will gradually get used to the sensation. After a short while you will no longer feel this, and you will almost forget that the frame is there at all! Frame fitting involves a small degree of discomfort, but most patients tolerate it remarkably well, and tend to comment that it was much preferable to the idea of having a major surgical procedure performed. At the end of the procedure the frame is removed. This only takes a minute or two, and is really not at all traumatic. Some patients experience headaches after frame removal which can be treated with pain relief.
Will I be radioactive?
No. All radiation stays within the treatment room. The Gamma rays used in the treatment do not remain in the body.
Will I have any swelling or oedema?
In the postoperative period some tumours may swell a little as a result of being injured by a dose of radiation. This may show as a slight increase in apparent size of the tumour as assessed by MRI or CT scanning at about 6 - 9 months post treatment. This appearance must not be misinterpreted as tumour growth. It is self-limiting, and will soon be followed by reduction back to original size, or even smaller. If this temporary swelling (which is actually indicative that the treatment is starting to work) causes any symptoms, then a short course of steroids or other medication is sometimes used to treat the swelling.
Will I lose my hair?
The vast majority of patients have no risk whatsoever of losing any hair at all. Furthermore, even in those few cases where hair loss is a possibility, such hair loss will never involve the entire scalp - as typically happens with conventional whole brain radiotherapy. Only a small number of patients will have tumours sufficiently close to the scalp to carry the risk of any hair loss at all. If a lesion to be treated is very close to the inside of the skull, it is possible that enough radiation will be delivered to the scalp such that a patch of hair may be lost. This hair usually grows back, though it may be a little lighter in colour and finer in texture than previously.
Can Gamma Knife radiosurgery cause another tumour?
Theoretically yes - all forms of radiation can in principle cause tumour formation - but instances of this actually happening are so rare that we haven't even been able to measure such a low risk. There are some individuals (with rare conditions) who are at risk from developing further tumours because of their underlying condition, and very occasionally (perhaps a dozen times out of tens of thousands of patients over several decades), such new tumour formation has been reported. Based on existing experience, the incidence of radiation caused tumours is extremely low.
How will I feel following treatment?
Most patients feel just as well as they did at the beginning of the day. Some tiredness is quite common, especially if the treatment has occupied most of the day. A little discomfort at the pin sites and a mild headache are also quite common - this may persist for up to a day or two. Mild nausea may also occur during the first 48 hours following treatment. For these reasons we like to keep most patients in hospital overnight or for a few hours observation, and mild anti-nausea and headache medication is routinely prescribed for patients who may require it - nearly everyone is fit to be discharged home by 10 or 11 o'clock the following morning, and a sizeable number of patients don't even require an overnight stay.
Following treatment when can I go back to work?
As soon as you feel well enough. There is no reason why you should not go back to work the following day - some patients have even been known to return to work later the same day, but you should not feel pressured to return to work too quickly. It is fair to say that most people return to work within less than a week.
Following treatment how soon can I travel (by motor vehicle / bus / train / plane)?
Again, as soon as you feel well enough. There is no reason why you could not travel the following day, or even some time later on the actual day of treatment. Any driving restrictions already in place will continue to apply.
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