While four in 10 clinicians use frameless radiosurgery exclusively to treat cranial indications, user data collected at the 5th International Conference of the Novalis Circle, held last month in Munich, Germany, shows that there are still significant opportunities to increase utilization of the effective treatment approach.
While many theories exist as to why some clinicians have not expanded use of frameless radiosurgery in treating cranial indications, neurosurgeon Surbhi Jain, M.D., of the Moffitt Cancer Center in Tampa, Fla., believes low utilization can be attributed to an overall lack of awareness as to the extent frameless radiosurgery can effectively treat even the most sensitive regions of the brain.
Dr. Jain resolved her initial concerns over the safety, effectiveness and accuracy of frameless radiosurgery through on-site visits to hospitals that adopted the technique. She began treating patients framelessly in January 2008 using the Novalis Tx™ radiosurgery platform. In her 2010 independent study entitled, "Control of Brain Metastases in the Eloquent Brain Using Stereotactic Radiosurgery," Dr. Jain compared the effectiveness of both framed and frameless radiosurgery. She found that metastatic tumors could be controlled as effectively framelessly as using the more invasive head frame, which must be secured to the skull and removed between treatments.
"We were extremely encouraged to find a non-invasive treatment that can produce a tumor control rate of 95 percent in an extremely sensitive part of the brain, which controls speech, motor function and senses," said Dr. Jain. "The data validate frameless radiosurgery as a safe, precise approach to treatment and make a strong case for increased use among clinicians."
Antonio De Salles, M.D., head of the Stereotactic Surgery Section at University of California – Los Angeles, and Joseph Chen, M.D., a neurosurgeon at Kaiser Permanente in Los Angeles, Cal., both made their transitions to frameless radiosurgery after conducting thorough scientific verifications of the precision of the technique. They have now widely adopted the technique and are applying protocols to treat more than 99 percent of their patients framelessly.
"Most neurosurgeons were taught to treat patients with the stereotactic frame, because of its perceived accuracy," said Dr. De Salles. "Having treated nearly 1,000 patients with frameless radiosurgery over the past few years, I can say that the non-invasive approach is as safe and accurate as frame-based treatment because we are able to constantly monitor the positions of both the treatment beam and patient."