Gamma Knife Treatment
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Broadening neuro training for the next generation of medical professionals

We need to get more students and consultants interested in Stereotactic radiosurgery writes Ms Mary Murphy, MD Fellowship of the Royal Colleges of Surgeons and Clinical Director of Neurosurgery and Consultant Neurosurgeon.

Stereotactic radiosurgery (SRS) has an increasing role to play in the treatment of neurological diseases. Currently, SRS offers a non-invasive outpatient treatment option for complexly located brain tumours and neurovascular lesions. But SRS systems such as Gamma Knife are also increasingly recognised as an alternative treatment option for functional neurological conditions such as tremor, epilepsy, and some psychiatric disorders.

However, currently there is no formal or structured pathways for junior doctors to specialise in SRS, so it is not well known as a treatment modality among the wider medical community.

There are various indications for SRS, and these are expanding with developments in research on how this technology can be utilised. Expansion like this is vital as the global population is ageing at the fastest rate ever, according to the UN’s World Special Report 2023. And while brain tumours can occur at any age, the risk of developing most pathologies increases with age – the risk of brain tumours is greatest in those aged 85-89, an age group that tolerates surgery very poorly. This means that the demand for treatment systems like SRS is steadily growing.

Indications for Gamma Knife radiosurgery are also expected to extend to ‘nodular’ lepto-meningeal disease and other advanced forms previously reserved for palliative whole brain radiotherapy, which tends to impair and/or reduce cognitive brain function. Despite such expected developments though, there is a lack of time and resource among current consultants to proactively encourage and attract students – especially without any initial structured exposure.

Very few centres offer SRS treatment, especially with the equipment and installation of these systems driving a steep upfront investment cost. Not only does this mean that cases suitable for SRS are not being referred, and therefore receive treatment modalities that carry higher risk, unnecessarily; but it also means that there is a lack of awareness among junior doctors that this is an area in which they can specialise.

If there is not robust neurosurgical representation in this area, there is a risk of SRS becoming the domain of radiation oncologists. While both neurosurgeons and radiation oncologists are critical voices to sit on an MDT to determine the best course of treatment, the pathologies treated by SRS are traditionally neurosurgical pathologies. This means a neurosurgeon is best placed to give a balanced view of the most effective treatment, and they can best do that if SRS is in their armoury, or at very least, on their radar.

Currently, the main entry point for junior doctors to specialise in SRS is if they rotate through a centre or work under consultants with a direct interest in this area. This means that they usually ‘fall into’ it by accident. As neurosurgery is not covered in detail during medical school, it takes a remarkable person to seek out SRS as a speciality.

So, there is a potential problem with exposure to SRS expertise and the next generation of medical professionals.

Ideally, currently practicing neurosurgeons should take more control of how SRS expands – in terms of how junior surgeons are educated, and how to involve the existing medical community. Neurosurgery is a vast and very complex area, so it takes an exceptional individual to have the capacity to encompass that extra expertise.

For example, over the past 5-6 years, from approximately five vascular fellows I have trained, only one has managed to take the time to shoe-horn SRS training into an already busy day.

Where traditional neurosurgical education has been focussed on open surgery, medical developments (such as functional neurosurgery, high CPU and focused radiation) are moving away from open surgery in efforts to mitigate risk. Importantly, medical students in neurosurgery should see more than traditional operating practices, yet the neurosurgical representation in this area is not strong enough. More presence is needed in the way of developments, research and academia to attract more practitioners to this area.

One way to address this challenge is to educate consultants in more peripheral units in SRS. Many of them are typically removed from updates and developments in the area. As the indications for SRS are much greater than they were ten to fifteen years ago (and it has a lot to offer elderly, sick or frail patients, for whom open surgery is too risky), there should be a consideration for SRS with almost any patient presenting with neurosurgical pathologies.

In an effort to widen this knowledge base, I recently chaired a session on Radiotherapy for the Society of British Neurological Surgeons Conference Cork 2023 (SBNS).

The panel comprised national and international experts who gave an overview both on traditional SRS platforms like Gamma Knife as well as the whole of SRS. The purpose of the discussion was to provide education to all levels of interest from medical students to consultants to make SRS more accessible, more mainstream and relevant for neurosurgeons who otherwise would not be thinking about it. The hope is to get consultants involved with SRS and communicating more with those specialising in SRS, and specifically to get training grade neurosurgeons involved and understanding when to refer patients.

Ultimately, we must give future generations of neurosurgeons more structured learning around SRS. This puts them in the strongest position to deliver the best possible patient care.

 

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headache - metastatic brain tumour

What Are The First Signs Of A Brain Tumour To Look For?

Getting a brain tumour diagnosis is something nobody wants to go through, which is why it is essential anyone who suspects something is wrong with them seeks medical advice as soon as possible. 

However, in order to know what symptoms are suspicious, you need to have a good idea about the first signs of a brain tumour. Here are a few you should be on the lookout for. 

 

Headaches

Anyone can suffer from headaches and it doesn’t mean you have a metastatic brain tumour, but if these become more frequent, worsen with activity, wake you up at night, make you feel sick, or start to feel severe, they should be checked out. 

 

Seizures

Seizures often affect your entire body, but can also just be twitching of the hands, so pay attention to any involuntary movement. They occur in 80 per cent of people with brain tumours, so if you begin to have them, see a doctor immediately. 

 

Personality changes

If you notice your behaviour has changed, or other people have mentioned that your personality is different, this can be difficult to digest. However, it is imperative you don’t ignore it, as it could be a sign of a brain tumour, especially together with confusion or memory loss. 

 

Problems with vision

Whether you have always had perfect vision or you wear glasses, you might suddenly find your vision deteriorating or you may experience periods of poor eyesight. Any signs of blurred or tunnel vision, or floating shapes, should be checked out.

 

Nausea or vomiting

There could be a lot of causes of nausea or vomiting, but if this is coupled with any of the other symptoms, it could be an indication of a tumour. 

 

Drowsiness, fatigue, or mobility problems

Some people feel drowsy, overwhelmed with fatigue, have a weakness in their body, or struggle with their memory and concentration. These are all early warning signs of a brain tumour, so if it concerns you, seek medical help as soon as possible.

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research

Brain Tumour Charity Awards £1.2m For Glioblastoma Research

A woman who has sadly lost both her mother and brother to brain cancer has welcomed The Brain Tumour Charity’s decision to award £1.2m of funding to brain cancer research. The BBC reports that Nikki Saunders, a nurse from Essex, lost her mother Susan and brother Paul to glioblastoma in 2018.

Ms Saunders said: “As you can imagine, we were devastated. Having to tell my mum that Paul also had the same type of brain tumour is something I will never forget. Paul was determined that he and mum would beat this. They were both so brave and showed dignity, strength and love to us all throughout.”

Ms Saunders added: “Words cannot describe what we went through or how missed and loved my brother and mum are.”

Ms Saunders has since campaigned to boost funding and raise awareness of brain tumours. Glioblastomas are a fast growing and aggressive type of brain tumour that affect over 3,000 people a year in the UK. They are the most common type of high grade primary brain tumour that affects adults, although they rarely occur in children. 

Common symptoms of a glioblastoma include headaches, memory problems, changes in personality, trouble communicating, tiredness, seizures, eyesight disturbances, depression, and numbness or tingling in one side of the body. The average survival time after diagnosis is 12-18 months, and only 25% of patients survive for more than one year. 

Glioblastomas can be treated with chemotherapy, radiation therapy, radiosurgery, and possibly neurosurgery if the location of the tumour in the brain makes this a viable option. Sometimes, surgery is performed to remove part of the tumour and radiotherapy is used to remove as much of the remaining tumour as possible.

Emma Thompson, head of research at the Brain Tumour Charity said: “Our junior fellows grants fund the future leaders of scientific and clinical research into brain tumours, and our aspiration is that this research will help us accelerate a cure for brain tumours. We know that glioblastomas are incredibly difficult to treat due to their complex make-up.

She added: “Therefore, funding this innovative research which aims to understand how the immune system responds to tumour cells and that tackles cells that promote tumour recurrence is important if we want to find new treatments that will enable us to find better ways to treat this disease.”

“We are very excited to continue working with Tyler and Spencer and look forward to following the progress of their research over the coming years.”

Brain tumour research has been significantly underfunded compared to other types of cancer in the UK, with just £15m of a promised £40m investment allocated over the past five years. Campaign groups have worked hard to raise awareness of the issue, including attending a parliamentary committee enquiry earlier this year. 

For more information about glioblastoma brain tumour treatment, please contact Mr George Samandouras of Amethyst Radiotherapy.

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Collaborative Clinical Neuroscience Meeting

Boston – London – Toronto

On Friday 27th October, three of the most of the most important children’s hospitals in the western world will be meeting at Queen Square in London.

Amethyst Radiotherapy is proud to support the Boston – London – Toronto Collaborative Clinical Neuroscience Meeting lead by paediatric neurosurgeon consultant Gregory James. The conference will bring experts from Boston Children’s Hospital /Harvard University, Great Ormond Street Hospital UK and Children’s Charity and SickKids Foundation Toronto.

The session will take place at the National Hospital of Neurosurgery and Neurology with the group of clinical experts and scientists.

Great Ormond Street

Itinerary

Friday 27 October 1000 – 1630

Wolfson Lecture Theatre, NHNN

1000: Welcome and opening remarks
Greg James & Ed Smith

1015: Decision making in asymptomatic moyamoya
Greg James

1045: European Stroke Organization moyamoya guidelines
Vitor Yamaki

1130: Contribution of blood flow control at the capillary level to Alzheimer’s disease and stroke
David Attwell

1230: Lunch
Café @ 42-43 Queen Square

1315: Hot topics in moyamoya
Ed Smith

1400: Intraoperative EEG monitoring for moyamoya surgery – initial experience in London
Steward Boyd

1430: Infantile presentations of HHT
Anoushka Alwis

1500: Revascularisation surgery for AVM steal syndrome
Dulu Silva

1530: Interesting recent cases from GOSH
Dina Hanna

1600: TBC

1630: Drinks
at 42-43 Queen Square and then Queen’s Larder

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radiotherapy

Understanding And Managing The Side-Effects Of Radiotherapy

When undergoing radiotherapy as part of your cancer treatment, it’s essential to be prepared for the potential side-effects. While they can vary depending on the type of radiotherapy, the area being treated and your individual response, it’s crucial to know what to expect and how to manage them effectively.

Common Side-Effects Of Radiotherapy

Side-effects should be expected when it comes to cancer treatment, but some are more common than others. Look out for fatigue as this is one of the most common and can begin to set in a few weeks after treatment and can be quite debilitating. To manage, plan your day to include plenty of rest breaks and make sure to stay well hydrated alongside a rich diet.

Another to look out for is skin reactions on parts of the body where treatment is occurring. It can result in red, dry or itchy patches that may peel or blister, but it is vital not to pick or agitate these as it can do more damage over time. To cope with this, use gentle skincare products and avoid tight clothing to protect these areas.

While side effects are common, some are more specialised to certain treatments as nausea or vomiting can occur if the treatment is near the abdomen or stomach. In order to handle this, look for anti-nausea medication or dietary adjustments.

For patients receiving radiation in the throat or oesophagus, swallowing issues can arise. To combat this, begin consuming soft, moist foods to make it easier throughout the process. In addition to this, staying well hydrated keeps the palate free from dryness while not eating and can help with swallowing foods when it comes time to eat.

Long-term Side Effects

While most side-effects of radiotherapy are temporary and resolve after treatment, some may persist in the long term. These can include changes in skin pigmentation, reduced range of motion in treated areas and a slightly increased risk of developing cancer in the future. It’s essential to discuss the potential long-term side-effects with your medical team.

Communication With Your Medical Team

The key to effectively managing the side-effects is open communication with your doctor. They can provide personalised guidance, recommend over-the-counter products and prescribe medications to ease symptoms. It’s vital to report any side effects promptly so that adjustments to your treatment plan can be made if necessary.

While the side-effects can be challenging, they are manageable. Knowing what to expect and maintaining open communication is essential for a smoother journey. Your doctor is there to support you and with their guidance, you can minimise the impact of side-effects and focus on your path to recovery.

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Open Evening Event at Queen Square Radiosurgery Centre, London

We were honored to have Mr. Stephane Carré, CEO of the Amethyst Group, extend a warm welcome to all our esteemed guests who gathered to mark the beginning of an exciting journey in gamma knife radiotherapy treatments.

Mr. Carré highlighted the significance of this new centre and its commitment to providing cutting-edge radiotherapy solutions.

Mr. Neil Kitchen, Consultant Neurosurgeon and Medical Director at the Queen Square Radiosurgery Centre, shared insights into the current and future plans and proposals for these state-of-the-art premises. His presentation shed light on the remarkable advancements in radiotherapy technology that will benefit patients in the region.

The opening event saw a fantastic turnout, with numerous attendees coming together to explore the facility and engage in discussions about the innovative treatments and services that will be available here. It was a platform for networking and collaboration, fostering connections within the medical community.

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Infrastructure implications of installing a Gamma Knife

Ian Paddick, a Consultant Physicist at specialist in radiation oncology, Amethyst Radiotherapy, discusses some of the challenges, practicalities, design considerations, and logistics, of installing a Gamma Knife radiosurgery machine into medical facilities, with a particular focus on the Queen Square Radiosurgery Centre within the University College Hospital in central London.

Read the full article here

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closeup of a hand woman with a purple ribbon, for the awareness about the unacceptability of the violence against women. International Day for the Elimination of Violence Against Women.

Raising Awareness Of Breast Cancer With Brain Metastases

October is breast cancer awareness month. Throughout the month, there are a range of fund-raising activities and events taking place to support the research and treatment of breast cancer. It also encourages people to be aware of the signs and symptoms of the disease, which is the most common cancer in the UK, representing 15% of all cancers.

The majority of breast cancer patients are women, although it can affect men as well. According to Breast Cancer.co.uk, the rate of breast cancer in women has doubled over the past 50 years and a woman in the UK born after 1960 has around a 1 in 7 risk of developing breast cancer. 

86% of breast cancers in women are diagnosed at stage 1 or stage 2, which means that the cancer hasn’t spread throughout the body. Stage 4 breast cancer is known as metastatic breast cancer. Metastasis is the process of cancer cells breaking away from the original tumour and travelling to other areas of the body. 

The brain is one of the most common areas to which breast cancer spreads, occurring in around 15% to 24% of women with metastatic breast cancer (also known as secondary breast cancer). Breast cancer may also spread to the lungs, liver, and bones, either through the bloodstream or the lymphatic system. 

 

What are the symptoms of breast cancer with brain metastases?

The general symptoms that breast cancer has spread include constant tiredness, nausea, and unexplained weight loss and loss of appetite. 

Specific signs that breast cancer has spread to the brain include headache; feeling sick or being sick, weakness or numbness down one side of the body; seizures; difficulty with speech; problems with vision; confusion; memory problems; and changes in behaviour, mood, and personality.  

 

How is secondary breast cancer to the brain treated?

When breast cancer spreads to the brain, it can be treated but not cured. Treatments may involve slowing down the growth of the cancer and also relieving symptoms, and may be given alone or in combination. 

When breast cancer spreads to the brain, the cells are still breast cancer cells rather than brain cancer cells. This means that the treatment for breast cancer with brain metastases may vary from the treatments for other types of brain cancer. 

The type of treatment will depend on a range of factors, including how many tumours are present and what size they are; the location in the brain; and if the cancer has spread to any other areas of the body. 

The most common treatments include steroid drugs to reduce pressure and swelling on the brain and relieve symptoms; and radiotherapy or stereotactic radiosurgery or radiotherapy. 

Stereotactic radiosurgery is also known as Gamma Knife surgery, and it is not a conventional type of surgery involving incisions or insertions into the brain. It uses highly targeted doses of radiation from an external machine to destroy the cancer cells, whilst avoiding the healthy tissue.

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Sorting pharmaceutical capsules by a sorting machine on a production line

Calls For Brain Tumour Drug To Be Made Available On NHS

Brain tumour patients and their families in the UK have called for a new drug to be made available on the NHS to treat low-grade gliomas. The Guardian reports that the drug, known as Vorasidenib, has been proved to be effective in clinical trials but is not yet used within the NHS. 

Vorasidenib works by inhibiting the enzymes IDH1 (isocitrate dehydrogenase) and IDH2 and is able to cross the blood-brain barrier, according to the The Brain Tumour Charity. A phase 3 clinical trial involving 331 patients showed that the drug significantly slowed the progression of residual or recurrent grade 2 gliomas. 

Patients who took the drug required less frequent treatments and had few side effects. It has been approved by the Food and Drug Administration (FDA) in the US and is available to be fast tracked by those patients in most need. However, it has not yet been approved for use in the UK.

The Guardian reports on the case of Shay Emerton, a 26 year old biochemistry graduate. He was diagnosed with a slow-growing grade 2 glioma in 2021. He had surgery which successfully removed 98% of the tumour, but the remaining tumour requires regular six month monitoring because there is a risk that it might regrow. 

Emerton said: “It’s so frustrating that there is something out there which could potentially help me to live a longer life and I can’t access it. They stopped the clinical trial because it was so successful.” His mum Dawn added: “People say you can wait until the drug is approved, but these patients do not have time. The tumour can progress at any stage.”

There has been widespread criticism from campaigners and researchers regarding the poor progress and funding levels for brain tumour research. 

According to the National Cancer Research Institute, since records began in 2002, £10bn of funding into cancer research in the UK has been provided, but just £126m (1.3%) has been allocated to brain tumour research.

A Department of Health spokesperson said: “Brain cancer is a devastating disease, which is why we’ve allocated £40m for research in this area, on top of £1bn a year for wider health research.”

They added: “We’ve invested in every suitable research application made and the funding will continue to be available for further studies to develop new treatments and therapies for brain tumours.”

Brain tumours are currently the biggest killer of adults under 40 in the UK, with over 12,000 people being diagnosed with a primary brain tumour each year. There are over 130 different types of brain tumour that can cause a variety of symptoms. 

These may vary from person to person, but common signs include headaches, changes in vision, seizures, nausea, dizziness, tiredness, and loss of taste and smell. Most of the time, these symptoms will have other causes, but anyone experiencing persistent or recurrent episodes of two or more symptoms is advised to consult a doctor. 

For information about treatments for glioblastoma and Gamma Knife surgery, please contact Mr George Samandouras of Amethyst Radiotherapy.

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Two medical professionals examining magnetic resonance imaging scans. Examination at specialized medical clinic, diagnosis and healthcare concept.

The Brain Tumour Charity Launches Symptom Awareness Campaign

The Brain Tumour Charity has launched an awareness campaign to boost the speed of brain tumour diagnosis in adults. The Better Safe Than Tumour campaign was launched in July 2022, and the message has already reached millions of people. A specially designed symptom checker on the charity’s website has been used over 38,000 times.

If you or a loved one have been experiencing two or more of the following symptoms, you are strongly advised to get in touch with your doctor: Persistent or recurrent headaches; fatigue; seizures or fits; nausea and vomiting; loss or disturbance of vision; speech difficulties, memory problems, or loss of taste or smell.

Other common symptoms of a brain tumour include cognitive changes, and weakness, numbness or tingling of the extremities. It’s important to remember that while brain tumours are rare, they can progress quickly, so the earlier they are diagnosed and treated, the better the prognosis. 

The Better Safe Than Tumour campaign has been launched on the shoulders of the Brain Tumour Charity’s successful HeadSmart campaign, which focused on improving the speed of brain tumour diagnosis in children and young people. This has led to the average diagnosis time in the UK falling from 13 weeks to 6.5 weeks.

This is clearly a great result, and now the Brain Tumour Charity are aiming even higher with their new campaign, with a target to reduce diagnosis times to four weeks. This will bring the UK on a par with other countries who perform well in brain tumour treatment. 

Currently, 78% of people are diagnosed within three months of seeing a healthcare professional, but 42% had to visit a GP three or more times in order to get a correct diagnosis. Furthemore, 74% resorted to going to A&E with their symptoms, and 46% of patients were informed they had a brain tumour by an A&E doctor rather than a specialist.

If you would like some information about Gamma Knife surgery, please contact Mr Neil Kitchen of Amethyst Radiotherapy.

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