THE HISTORY OF STEREOTACTIC RADIOSURGERY DEVELOPMENT AND ITS ROLE IN THE TREATMENT OF BRAIN METASTASES

Abstract

Metastases of primary tumors to the brain develop in 20–40 % of cancer patients. Historical information about the origin and development of the stereotactic radiosurgery method are shown, including GammaKnife and CyberKnife. The development of new centers of radiosurgery in the world makes the method more accessible for patients. The article examines the modern treatment algorithm for cerebral metastases and the place of stereotactic radiosurgery as a high-dose conformal ablative treatment of selected metastatic lesions in the management of these patients. It is shown that radiosurgery provides a high level of local control and survival, similar to surgical resection.The results of trails with combination of the stereotactic radiosurgery and total brain radiation therapy in patients with solitary and multiple lesions are reported. It is shown that the radiosurgery allows to avoid total irradiation in case of solitary metastasis, and also in case of multiple lesions, without affecting the survival. That, probably, helps to preserve neurocognitive function and quality of life for patients with good performance status according to Karnofsky scale (index ³ 70). We also discuss the possibility of stereotactic irradiation of postoperative cavity. The concept of radiosurgery is not divided upon the treatment platform.

Keywords

• : стереотаксическая радиохирургия
• стереотаксис
• гамма-нож
• кибернож
• церебральные метастазы
• тотальное облучение головного мозга
• локальный контроль
• интракраниальный контроль на расстоянии
• прогностический индекс
• шкала карновского