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August 28, 2006
First frameless radiosurgery for tumors performed at Winship Cancer Institute

BY vincent dollard

Emory University radiation oncologists recently performed the first frameless radiosurgery brain tumor treatment in Georgia. This state-of-the-art treatment enables physicians to accurately position and monitor patients during radiation treatment without using a standard rigid head-frame. Ian Crocker, MD, FACR, professor of radiation oncology at Emory University School of Medicine and his staff, performed the procedure.

Radiosurgery uses computed tomography (CT) and magnetic resonance imaging to deliver a precisely targeted beam of radiation directly to the brain tumor, without affecting surrounding healthy brain tissue. Because of the need for extreme precision, radiosurgery patients are typically fitted with a rigid head frame, which immobilizes the patient’s head to ensure accurate targeting of the tumor. The head frame is attached to the patient’s skull with screw-like pins. Before its attachment, the areas where the pins pierce the scalp are numbed, and the patient is also put under conscious sedation.

The new frameless radiosurgery procedure requires only a custom-made mask, which is secured to a table on which the patient lies. The patient also is fitted with a dental bite plate with embedded reflective markers.

Immediately prior to treatment, a CT scan is done and compared to an earlier CT scan that was used to plan the patient’s therapy. This is to correct any discrepancies in the patient’s positioning. Next, an advanced optical radio-camera system analyzes the patient’s position by the reflective markers on the bite plate, which ensures there is no movement during radiation treatment.

“While the head frame is a very effective and accurate piece of equipment, it is heavy and frequently uncomfortable for patients,” Crocker said. “Additionally, after the procedure there is often swelling and bruising at the sites where the pins were placed. For these reasons, we started exploring new technologies for our patients at Winship. The frameless radiosurgery system represents the latest and best technology available and provides a new method of delivering safe and precise radiation doses with little to no discomfort for patients.”

Joan Kuhar, the first cancer patient at Winship to have the frameless stereotactic radiosurgery treatment, said she was happy to learn about the new technology. Previously, Kuhar had received radiation using the head frame for treatment of a metastatic brain tumor. She said that she found the process challenging. “The first time that I had radiosurgery it was very stressful. I experienced some pain and discomfort with the head frame. Dr. Crocker was aware of the difficulties that I experienced and asked if I would like to try the frameless radiosurgery for my next treatment,” Kuhar said. “I’m grateful that this new treatment approach became available in time. I feel very lucky.”

“Emerging technologies like frameless radiosurgery are transforming the future in our ability to provide advanced, compassionate care to our patients,” Crocker said.

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