Stereotactic Radiosurgery Tanpa Frame untuk Tumor Otak & Tulang Belakang
Perawatan Rawat Jalan Tanpa Pendarahan, Non-invasif, untuk Tumor Otak dan Tulang Belakang
Apa itu Stereotactic Radiosurgery ?
Stereotactic Radiosurgery (SRS) adalah pengobatan radiasi yang sangat bertarget dan terfokus yang
memberikan dosis radiasi yang sangat tinggi langsung ke target untuk menghancurkannya.
Istilah stereotactic adalah istilah yang digunakan dalam Bedah Saraf untuk merujuk pada kemampuan untuk mengidentifikasi suatu titik dalam ruang 3 dimensi secara akurat. Bedah Radio (Radiosurgery) menggunakan teknologi yang digunakan dalam bedah saraf untuk menghancurkan tumor.
Akselerator Linear Modern yang dilengkapi sofa robotik dengan kebebasan 6 derajat
Saat ini, Radiosurgery Tanpa Frame dapat dilakukan dengan teknik navigasi modern sehingga pasien
tidak perlu lagi memasang frame logam di tengkorak mereka untuk penargetan yang akurat.
Navigasi digital modern dengan akurasi mencapai sub-mm
Memahami perbedaan antara Bedah dan Bedah Radio (Radiosurgery)
Pembedahan melibatkan pemotongan fisik melalui jaringan dan tulang untuk mencapai tumor sehingga dapat diangkat dari tubuh.
Radiosurgery tidak melibatkan pemotongan sama sekali. Nama itu diberikan karena setelah
menghancurkan tumor dengan radiasi terfokus dosis tinggi, tubuh secara otomatis mengangkat sel-sel mati, dan tingkat kesembuhannya seolah-olah dilakukan operasi.
Metastase Otak Kanker Payudara
- Sebelum SRS
Respons penuh 3 bulan setelah SRS
Metastase Tulang Belakang mencekik sumsum tulang belakang dan menekan thecal sac di sekitarnya.
6 bulan setelah SRS, tumor telah menyusut dan sumsum tulang belakang tidak lagi tertekan. Pasien tidak lagi memiliki rasa sakit dan kelemahan
Metode ini benar-benar tidak menghasilkan rasa sakit, tidak ada pendarahan dan dilakukan sebagai prosedur rawat jalan.
Pasien tidak perlu menjalani operasi terbuka dan tidak menanggung risiko operasi
Why should I choose Radiosurgery?The main reason patients choose Frameless Radiosurgery is because of its effectiveness and because it is non-invasive and painless. It is also very safe with a low side effect profile. Today, there is no need for a metal frame to be screwed into the patient’s skull, and treatment can be completed as fast as within 15min. In addition, in cancer patients, frameless Radiosurgery results in very low downtime, so this allows for patients to receive their chemotherapy cycles on time, so that the other areas of disease in the body can still continue to be kept under control while Radiosurgery addresses the target tumor.
What are the conditions treated using Radiosurgery?The most common type of cancerous tumour treated with Radiosurgery is Brain and Spine metastasis. This describes the situation when cells have spread from the original location either into the brain or to the spine. Studies have shown that using targeted radiation helps to preserve the memory of patients, which may be affected if the whole brain is irradiated. At the same time, hair loss can be avoided too. Many patients with brain or spine metastasis require other treatments such as chemotherapy, or they also may not be optimally fit for open surgery due to their situation. Hence, a non-invasive, low downtime option that is equally effective is preferred for these group of patients as compared to undergoing a major operation. Radiosurgery is also extremely effective for benign brain tumors such as acoustic neuromas (vestibular schwanommas), meningiomas and pituitary tumors with up to 90% cure rates achievable. Because of its effectiveness and very Low rates of side effects, Radiosurgery has replaced open surgery as the treatment of choice for uncomplicated benign brain tumors which require treatment. Patients are spared from major surgery and the risk of nerve damage.
What are other alternative treatment options?Other mainstream alternatives include Open Surgery, Minimally-Invasive surgery, and Thermal or Cryo-Ablations. It is important that treatments are tailored to the individual patient in a multi-disciplinary setting for the best outcomes. As mentioned above, SRS can be given in combination with other local treatments depending on the shape and location of the tumor.
What are the key areas I need to focus on when choosing my Radiosurgery treatment?Radiosurgery involves delivering extremely high doses of radiation to a focused area. Thus the margin for error is very small and radiation once released cannot be reversed. Hence not only must the Radiosurgeon in-charge be well trained in radiation medicine, he must also have the necessary training in handling the navigational software and radiation delivery equipment, as well as have sufficient clinical experience in giving high radiation doses to different areas of the body. In addition, he needs to ensure that his entire radiation team is well coordinated and familiar with Radiosurgery treatment protocols and quality assurance procedures so that the final result is safe and effective. As the saying goes, we are only as strong as our weakest link.
What is the difference between Gamma-Knife and Radiosurgery?Gamma-knife is the brand of one of the early machines used to deliver Radiosurgery. Because the navigational technologies were not as advanced in the past, patients required a Metal Frame to be screwed into their skull at 4 points so as to determine the location of the brain tumour. Today, this is no longer required, and patients are able to undergo ‘Frameless’ Stereotactic Radiosurgery which is able to achieve the same or better results in some cases than using older techniques. The most convenient method of delivering Frameless Stereotactic Radiosurgery is by using an Advanced Linear Accelerator with a 6-dimensions of freedom robotic couch. In gamma-knife, a Frame has to be screwed into the skull, followed by a planning MRI scan while the Frame is in place. After that, the patient waits with the frame on, while radiation planning is done. The treatment time can range from an hour to a few hours depending on the age of the radiation source. This results in the patient spending at least half or the entire day in the hospital for the treatment, with the Frame attached most of the day. Unlike Gamma-knife, patients who undergo Frameless SRS only need to do a planning CT scans (about 30min) a few days before the treatment date and then return after the plan is ready to receive the treatment which is delivered over 15-45 minutes. The reason for the difference lies in speed of the electrical source of the radiation beam and the versatility of the Linear Accelerator machine.
What is the difference between Radiotherapy and Radiosurgery?Radiosurgery packs all the dose usually given over 5-6 weeks, and gives it over 1-5 days. The Radiosurgeon is a Radiation Oncologist who is trained in both radiotherapy, oncology, and the complex technologies used to deliver Radiosurgery. Since radiation is the ‘knife’ which ‘cuts’ the tumor, it is critical that the Radiosurgeon is well versed with radiation medicine.
What is the difference between Proton Beam Therapy and Radiosurgery?Radiosurgery and Proton Beam Therapy are both precision radiation therapies. Radiosurgery avoids treating normal tissue by sophisticated beam shaping and modulation, while Proton Beam avoids treating normal tissue by reducing dose deposition during the exit of the beam. They can be used in combination, depending on the location of the target and the diagnosis of the patient. For more information on Proton Beam Therapy, click here.
Spesialis Radiosurgery Otak dan Tulang Belakang Kami
Direktur Medis & Ahli Onkologi Radiasi Senior (Ahli Onkologi Klinis)
MBBS (SIN), FRCR (Onkologi Klinis, UK)
FAMS (Onkologi Radiasi)
MBA (Manajemen Kesehatan)
Radiosurgery Stereotactic (SRS/SBRT)
Kanker Otak dan Tulang Belakang, Payudara dan Prostat
Dr Daniel Tan Yat Harn
Lihat profil lengkap Dr Daniel Tan disini.
Radiosurgery Articles & Publications by Dr Daniel Tan:
Sumber: Singapore Medical Journal, 2018
Sumber: International Journal of Radiation Oncology, 2017
Technical know-how in stereotactic ablative radiotherapy
Sumber: Journal of Medical Radiation Sciences, published 03 March 2016
Frameless Stereotactic Radiosurgery
Sumber: Medical Grapevine, August 2015
Sumber: The Straits Times, September 2015
Sumber: International Journal of Radiation Oncology, 2014
Sumber: Sage Journal, 26 April 2013
Lihat lebih banyak Artikel & Publikasi oleh Dr Daniel Tan disini.
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