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Everything you need to know about Frameless Stereotactic Radiosurgery for Brain and Spine Tumor

What is Stereotatic Radiosurgery?

Stereotatic Radiosurgery (SRS) is a highly targeted and focused radiation treatment which delivers extremely high doses of radiation directly to the target to destroy it.

 

The term stereotactic is a term used in Neurosurgery to refer to the ability to accurately identify a point in 3-dimensional space. Radiosurgery uses technology used in neurosurgery to destroy the tumour. For more technical details, please see here.

Stereotactic Radiosurgery Singapore

Modern Linear Accelerator with 6 degrees of freedom robotic couch

Radiosurgery

Today, Frameless Radiosurgery is possible with modern navigational techniques such that patients no longer need to have a metal frame screwed into their skull for accurate targeting

Modern digital navigation achieves sub-mm accuracy

  • 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.
  • 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.

Your Radiosurgery Journey

We understand how difficult the cancer journey is for you and our team of specialists is dedicated to helping you navigate your cancer journey at very stage. You can engage our expertise from start to end of your treatment as well as during specific stages of your treatment. These services are available to our both our LOCAL and INTERNATIONAL patients.

Our Services

Customisation of Radiosurgery treatment plan

Our Team will assess your specific conditions, tests & scans and create a treatment and detailed report with recommendations for optimal results and minimal side effects. We will be able to work with your doctors to ensure you receive quality and optimal treatment

Evaluation of Radiosurgery treatment plan

Our Team will evaluate your existing plan and propose alternatives (if necessary) for optimal results and minimal side effects.

Collaborations with your doctors

Our Team will collaborate with your doctors in your home country to ensure that you receive quality and optimal treatment

Navigating the Journey with AARO

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Book a

Virtual Consultation

Send over scans, medical reports etc.

Virtual Consultation

Immediate Follow Up to be determined

Your Radiosurgery Team

Your radiosurgery team matters. They are the critical factor that will determine the success of your treatment. While being equipped with the latest cancer technology is paramount, you require the right expertise to harness the technology in order to manage and navigate the complexities of cancer so that you can go through this journey safely and successfully.

Think of them as your S.W.A.T team, empowered by specialised equipment, to execute a highly classified mission.

Radiosurgery involves the use of cancer technology to deliver extremely high doses of ablative radiation delivered to the tumor in a precise and accurate fashion. While the technology enables, the dose prescription and delivery
depends solely on the
specialist and his team.

Just like how the SWAT Team, armed with the latest weaponry decides when and how they are to eliminate their targets precisely without hurting innocent civilians.

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Your Radiosurgery Team will ensure the following critical aspects of the treatment:

Accurate Identification of the tumor to ensure that all cancer areas are outline and nothing is missed.

Exact Synchronization of Radiosurgery protocol configuration and the preset machine tolerances so that unintended movements on the couch do not lead to misses or wrong targeting.

Precise placement of medium and low doses along the radiation path needs to be determined by the specialist so that sensitive organs and tissue function will not be damaged.

These multiple complexities make radiosurgical treatments 'higher risk' than conventional radiation treatments as what is delivered over 1-5 fractions cannot be modified or retrieved once delivered.

Our Brain & Spine Radiosurgery Specialist

Dr Daniel Tan Yat Harn Radiation Oncologist

Dr Daniel Tan Yat Harn

View Dr Daniel Tan's full profile here.

Local experience with radiosurgery for vestibular schwannomas

Source: Singapore Medical Journal, 2018

​

Hypofractionated Stereotactic Radiosurgery for Management of Large Brain Metastases in Heavily Pre-treated Non–small Cell Lung Cancer Patients

Source: International Journal of Radiation Oncology, 2017

​

Scientific Editorial
Technical know-how in stereotactic ablative radiotherapy
Source : Journal of Medical Radiation Sciences, published 03 March 2016

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Frameless Stereotactic Radiosurgery
Source : Medical Grapevine, August 2015

​

Radiosurgery offers hope for treatment of Spinal tumour

Source: The Straits Times, September 2015

​

Hypofractionated Stereotactic Radiosurgery for the Treatment of Large Brain Metastases

Source: International Journal of Radiation Oncology, 2014

​

Frameless linac-based stereotactic radiosurgery treatment for SUNCT syndrome

Source: Sage Journal,  26 April 2013

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View more Articles & Publications by Dr Daniel Tan here.

​

Medical Director & Senior Radiation Oncologist (Clinical Oncologist)

MBBS (SIN), FRCR (Clinical Oncology, UK)

FAMS (Radiation Oncology)

MBA (Healthcare Management)

 

Clinical Interest:

Stereotactic Radiosurgery (SRS/SBRT)

Brain and Spine, Breast and Prostate Cancers

Radiosurgery Articles & Publications by Dr Daniel Tan:

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