But David Hauge, MD, neurosurgeon, medical physicist and medical director of the center, says reaching that plateau means much more in the way of patient care.
“A thousand is a thousand and that’s MD a landmark,” he said. “But what it really means is that we’ve saved a lot of people a lot of risk and expense compared to an open operation (craniotomy). There is very little risk from the procedure – you don’t have the risk of bleeding and infection or brain damage that you would with an open craniotomy. Plus, a lot of people have jobs and with Gamma Knife, they can go back to work the next day. We’ve been doing Gamma Knife radiosurgery here at Fort Sanders since 2011, and since then, it has increasingly become an option for a lot of patients, including those with benign meningioma brain tumors that are sometimes in difficult locations.”
Gamma Knife also holds advantages over traditional whole-brain radiation. “It’s tolerated much better,” said Dr. Hauge. “There’s much less effect on the cognitive and memory functions of the patient, they don’t have hair loss, they don’t get the skin changes as with conventional radiation, and it’s one treatment in most cases. With conventional radiation you have to go two or three weeks everyday.It’s not going to make you sick like whole-brain radiation can.”
Instead of cutting to make an incision, Gamma Knife uses a technique called stereotactic radiosurgery and a multidisciplinary approach. “You’ve got a radiation oncologist, a neurosurgeon, a radiation physicist and our nurse,” said Dr. Hauge. He said the team holds a conference every two weeks to review cases and go over patient planning, because the therapy demands ultra-precision.
The patient’s skull is fitted with a stereotactic frame under local anesthetic, and then taken to imaging for an MRI or CT, which yields a set of mathematical coordinates that are fed into the Gamma Knife computer. “From that, we are able to assign mathematical coordinates to everything inside that frame. That allows the software in the Gamma Knife to direct 192 cobalt-60 beams of radiation to the individual tumors,” said Dr. Hauge. “The Gamma Knife target gets a lot of radiation but the area immediately outside the frame is very low, which is important to preserve brain function.”
Dr. Hauge estimates 60 to 70 percent of the cases at the Fort Sanders Regional Gamma Knife Center are metastatic tumors from cancers outside the brain such as lung cancer, breast cancer, kidney cancer and ovarian cancer. “Almost any type of cancer can spread to the brain,” said Dr. Hauge. “We are even seeing prostate cancer start to do that, which is really unusual. Prostatic cancer used to never spread to the brain, but people are living longer so we are seeing it more. About 30 percent of all people who have a cancer outside the head, like lung or breast, are going to get a brain mass at some point in the course of their treatment. Some of those people are going to need surgery. Some can’t have conventional radiation, but they might be able to get Gamma Knife.”