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New radiosurgery system enables improved precision in frameless brain tumor treatment.
March 7, 2016
By: Elekta
Elekta has announced that its Leksell Gamma Knife Icon, touted as the most precise stereotactic radiosurgery (SRS) system currently available, was used for the first time in the United States on March 1 at Sutter Medical Center, Sacramento Gamma Knife Center (in Sacramento, Calif.) to treat a metastatic brain tumor. The patient, a 52-year-old male from El Dorado Hills, Calif., had previously undergone successful treatment for primary melanoma and for melanoma metastases to his lung. The patient’s treatment was planned and guided using a frameless approach. The frameless mask solution is one of several new features of Icon and is integrated with a high definition motion management. The system provides accuracy similar to that of frame-based SRS systems while minimizing dose to normal tissue. “Increasing the precision of frameless cranial SRS is essential for effectively targeting tumor tissue while protecting healthy brain tissue from damage,” said Samuel Ciricillo, M.D., medical director of Adult and Pediatric Neurosurgery at Sutter Neuroscience Institute. “The new Gamma Knife system, Icon, now provides the most accurate motion tracking during treatment. Additionally, with Gamma Knife there is a two- to four-fold improvement in sparing normal brain tissue compared to other linear accelerator platforms. These features allow for greater potential to protect patient quality of life both during treatment and after recovery.” Icon is the latest advance in Elekta’s Gamma Knife radiosurgery, the most clinically proven radiosurgery technique, according to the company. The system will make cranial SRS available to more patients and to improve the efficacy of cranial SRS with fewer side effects. Icon also provides the flexibility for single dose administration or multiple treatment sessions over time, which enables treatment of larger tumor volumes, targets close to critical brain structures and new or recurring brain metastases. At the time of SRS, pre-treatment MRI images and CBCT images are aligned to identify precise coordinates for radiation targeting within the brain. This technology is especially important for patients who undergo multiple treatment sessions. Because the CBCT images are based on fixed structures within the brain, they ensure that dosage and delivery area are calculated correctly for each session, even if the patient’s head is in a slightly different position from one treatment session to another. Ciricillo worked with Sutter Medical Center radiation oncologist Harvey Wolkov, M.D., and physicist Stanley Skubic, Ph.D., on the procedure. They are founding members of the team that started the Sutter Gamma Knife program in 1998. “Elekta is ecstatic that Gamma Knife Icon is now being used in the U.S., and we commend Sutter Medical Center Gamma Knife Center for being an early adopter of the newest SRS technology,” said Bill Yaeger, Elekta’s executive vice president of Region North America. “We strive to give neurosurgeons and radiation oncologists the tools they need to effectively treat the target and protect healthy brain tissue. Gamma Knife Icon exemplifies that commitment and brings a new treatment option to the hundreds of thousands of people living with brain diseases. We are excited to be working with other leading centers across the U.S. to install additional Gamma Knife Icon systems over the coming months.” Gamma Knife has been a radiosurgery platform for more than 30 years, offering improved accuracy in both the location and radiation dose delivered to targeted brain tissue. Gamma Knife is the only SRS system designed specifically to target brain tissue, an area in which precise dose targeting is especially important for preserving brain function and minimizing damage to health brain tissue. This high level of precision makes Gamma Knife an increasingly used treatment option for patients with primary or metastatic brain tumors and other neurologic disorders such as severe facial pain (trigeminal neuralgia) and vascular malformations. Leksell Gamma Knife Icon is the sixth generation of the company’s Leksell Gamma Knife system. In the United States, Gamma Knife is the most commonly used radiosurgery platform for the brain1, is the most clinically proven technology for cranial indications2 and offers the lowest dose to normal tissues.3,4,5,6,7 Elekta develops clinical solutions for treating cancer and brain disorders. References: 1. CMS data through 2013
2. Pubmed through June 2015
3. Ma L, Petti P, Wang B, et al. (2011) Apparatus dependence of normal brain tissue dose in stereotactic radiosurgery for multiple brain metastases. J Neurosurg 114(6):1580-1584. doi:10.3171/2011.1.JNS101056.
4. Ma L, Nichol A, Hossain S, et al. (2014) Variable dose interplay effects across radiosurgical apparatus in treating multiple brain metastases. Int J CARS. Published online: 20 April 2014. doi:10.1007/s11548-014-1001-4
5. Descovich M, Sneed PK, Barbaro NM, et al. (2010) A dosimetric comparison between Gamma Knife and CyberKnife treatment plans for trigeminal neuralgia. J Neurosurg 113:199-206.
6. McDonald D, Schuler J, Takacs I, et al. (2014) Comparison of radiation dose spillage from the Gamma Knife Perfexion with that from volumetric modulated arc radiosurgery during treatment of multiple brain metastases in a single fraction. J Neurosurg (Suppl 2) 121:51-59.
7. Lindquist C, Paddick I. (2007) The Leksell Gamma Knife Perfexion and comparisons with its predecessors. Neurosurgery 61:ONS-130-ONS-141, doi: 10.1227/01.NEU.0000279989.86544.B6.
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