Lars Leksell discovered radiosurgery in the process of searching for a method to treat functional neurological diseases like pain, movement disorders, and psychosurgery. Making a small lesion in deep structure in the normal brain using a metal probe destroys a length of tissue on the way. He used photon radiation after experimenting with heavy particles and electron beams.
The purpose was to save the normal brain while creating lesions at the target. Even today, the procedure remains the same. Radiosurgery is precise and complete destruction of the chosen target containing healthy or pathological cells, without significant concomitant or late radiation damage to the adjacent tissue.
Starting with functional diseases, SRS is now used for treating large numbers of diseases in the brain, spine, and outside neurological system. After effective use in Sella region tumours in 1972, Dr. Ladislau Steiner published a report of treatment of Arteriovenous malformation using Gamma Knife. Later acoustic schwannoma, meningioma and other benign tumors were added to the list of indications.
There was keen interest in using SRS for malignant diseases like glioma, though it still remains a matter of debate. Recent data on the immunological effect of single fraction therapy has brought up the discussion again. The main argument against SRS for malignant diseases is hypoxic resistance to fractionated radiation.
Multiple brain metastases are also an established indication for radiosurgery, especially due to superior control of tumours with less chances of developing late complications of radiation on the normal brain, resulting in cognitive defects after whole brain radiation therapy (WBRT).
Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study: LANCET Volume 15, Issue 4p387-395, April 2014.
[Prof Masaaki Yamamoto et al]
This study suggested that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in patients with two to four brain metastases. Considering the minimal invasiveness of stereotactic radiosurgery and the fewer side-effects than with WBRT, stereotactic radiosurgery might be a suitable alternative for patients with up to ten brain metastases.
Prof Masaaki Yamamoto