Apr 28, 2022

One of the most important developments in the history of cancer treatment was radiosurgery, which was a technique that could destroy malignant tissue with exacting precision and without the need for more open forms of surgery.

When attempting to remove or destroy malignant tissue, lesions or tumours, where this cancerous material is will strongly affect what types of treatment are possible or within acceptable boundaries of safety, and no place in the body is more sensitive and precarious as the brain.

Before the development of radiosurgery, if someone suffered from a small lesion or tumour in the brain, surgery could be seen as too risky to attempt, given the chance of complications, and neurosurgeons looked for an alternative.

The man who managed to make a breakthrough, however, was a Swedish neurosurgery specialist by the name of Lars Leksell.

His technique, which he called stereotactic radiosurgery (SRS), was described by Dr Leksell himself as a “single high dose” of radiation, targeted using three-dimensional coordinates to target a certain point within the brain, usually where a small lesion or growth had developed.

Initially, despite being called radiosurgery, the very first stereotactic instrument Dr Leksell attempted to use was a series of electrodes and probes, only replacing them with focused x-ray beams in the early 1950s.

Radiation was an essential part of the process, particularly once multiple narrow beams were focused on a particular point since they could deliver a dose of radiation strong enough to kill targeted tissue whilst protecting healthy brain tissue from unnecessary damage.

Over the next decade, the main evolution of radiosurgery, primarily carried by the work of Börje Larsson and Kurt Linden, was the development of dedicated proton beams to stereotactic radiosurgery, rather than relying on x-rays.

Whilst this was a major step forward from x-rays, there were still issues. Proton beam therapy relies on the use of a synchrocyclotron, a type of particle accelerator that whilst effective, was also too big and too bulky to allow for regular use.

This was when Dr Leksell would help to develop the Gamma Knife at the Karolinska Institute in Stockholm, which was developed to be a relatively compact, simple to use practical tool that a surgeon could themselves use to treat patients.

The initial prototype works in a very similar way to the more advanced Gamma Knife systems used today, with several sources of cobalt-60 radiation being placed in a helmet with slits that were designed to treat a range of pain, behavioural and movement disorders that regular treatments could not.

The second, which used 179 cobalt-60 sources, was used to treat brain tumours, and later units would use 201 cobalt-60 sources, a number that continues to be used to this day as the systems used to focus radiation are more accurate than those used by Dr Leksell.

Beyond cancers, however, the Gamma Knife has become an effective tool for treating diseases that previously required surgical intervention, such as acoustic neurinomas, arteriovenous malformations (AVMs) and pituitary adenomas.

Dr Leksell did not unfortunately live too long into the new era of radiosurgery that he had developed, dying peacefully in the Swiss Alps in 1986 at the age of 78.

Apr 20, 2022

The Brain Tumour Charity has joined more than 50 other organisations and signed up to the government’s ten-year cancer plan, which aims at improving care for cancer patients in the UK.

As well as providing evidence to help develop the goals for better cancer care, the Brain Tumour Charity has put its name down on a consensus statement published by One Cancer Voice.

This laid out ten tests the new plan must adhere to for it to be successful in providing better care, support and treatment of cancer patients.

The statement from One Cancer Voice read: “Drawing on our collective experiences from supporting people living with cancer, research, data and insight, we have developed this consensus statement, setting out what actions Government and the NHS need to take to ensure people diagnosed with cancer in England get the very best care and treatment.”

It stated that “people living with cancer must be at the heart of cancer care and support”.

One Cancer Voice wanted to remind the government how important a successful outcome of the ten-year plan is, saying: “[It] must be ambitious in scope to recover from the pandemic and to close the gap between England and the best performing countries in the world.”

According to figures from Cancer Research UK, 858 people are diagnosed with cancer every single day. Despite ongoing research, the number of people who die from cancer every year has increased by eight per cent since 2001.

The ten tests the government’s plan needs to fulfil include having a clear political leadership and being fully funded till the end; England being ‘smoke free’ by 2030; greater awareness of the risk factors and symptoms of cancer to reduce emergency presentation to below five per cent; and early diagnosis rising to 78 per cent of cases.

One Cancer Voice also wants the plan to ensure cancer waiting time targets are met throughout the UK and everyone has access to the treatment they need at the right time; cancer patients have a personalised care plan for their wider wellbeing needs by 2032; patients have access to specialist workforce and equipment they need; giving health service staff more time to dedicate to training and enabling everyone to join clinical trials; and data collection, analysis and publishing is done quickly.

The group of charities also wants the number of cancer cases that could have been prevented if it was not for social inequalities to have decreased within the next decade.

Secretary of state for health and social care Sajid Javid also issued a Call for Evidence earlier this year to encourage groups and people to answer questions on different categories such as treatment, care, support, aftercare, research, data, prevention and faster diagnosis.

In addition to signing up to One Cancer Voice’s consensus statement, the Brain Tumour Charity submitted responses to the Call for Evidence. It specifically highlighted the challenges those with brain tumours have to contend with.

Over 5,300 people die from a brain tumour every year, and reduce the life expectancy by 27 years, which is more than any other cancer.

Shockingly, they are the biggest cause of cancer death in people under the age of 40, including children, and just 12 per cent of adults survive more than five years after being given a diagnosis.

For non-invasive treatment of brain tumours to improve prognosis, consider gamma knife surgery in the UK. To find out more, contact us today.

See Mr Patrick Grover’s full article
Can a hearing test reveal a brain tumour?

A form of benign brain tumour known as a vestibular schwannoma grows on the hearing and balance nerve, and the first sign of its presence can be loss of hearing on one side. Audiologists know about this and if they are concerned that the audiology test suggests an atypical hearing loss requiring further investigation, they will suggest a referral to a neurosurgeon, such as Mr Patrick Grover who specialises in these types of skull based tumours.

Hearing loss or tinnitus on one side

Vestibular schwannomas or acoustic neuromas most commonly present with hearing loss or tinnitus on one side. The tumour can also be the cause of balance problems. In his article, Treating skull based tumours, Mr Grover explains, “As they grow larger these tumours can press on the nerve that gives sensation to the face resulting in facial numbness, or shooting pains in some circumstances. If you do have hearing loss on one side, the first port of call is an audiologist who will be able to tell if this is the kind of problem that can be associated with such tumours (and requiring an MRI scan), or is due to another reason such as impacted ear wax for example.

Mr Grover goes onto explain that, “An MRI of the area known as the internal auditory meati (IAMs) is the diagnostic scan of choice if the audiology test suggests an atypical hearing loss requiring further investigation.

The comedian Vic Reeves has recently talked about how he is now completely deaf in one ear as the result of an inoperable vestibular schwannoma. Mr Grover explains, “The main difficulty with treating vestibular schwannoma is the proximity of the nerve to the face on that side. This ‘facial nerve’ is immediately adjacent to the hearing and balance nerve, and as such becomes progressively stretched by tumour growth”. However, for most people these tumours are treatable, and various treatment options are available including Gamma Knife.

Gamma knife treatment for vestibular schwannomas

The majority of tumours, particularly those of a smaller size, are suitable for treatment with stereotactic radiosurgery techniques such as Gamma Knife radiosurgery. This has the benefit of being non-invasive, and has a lower risk of injury to the facial nerve (in the region of 1% of cases or less). It does not remove the tumour, but it prevents further growth in approximately 95% of tumours or more depending on the size. There are risks of exacerbating balance problems for example for a period of time, or accelerating hearing loss, but compared with ongoing tumour growth these side effects are usually well tolerated. Treatment is carried out as a day case, and normal activities including work can continue within a few days.

Mr Patrick Grover is lead for cranial neurosurgery at the National Hospital for Neurology and Neurosurgery and Postgraduate Medical Education (PGME) education lead.

His areas of expertise include:

See Ms Mary Murphy’s full article
Could gamma knife be the best treatment for my AVM?

Why do we treat arteriovenous malformations AVMs?

AVMs of the brain can have very serious consequences. They can be discovered incidentally (when a scan is done for another reason). Alternatively they can present with symptoms such as seizures or a bleed. AVMs can therefore have a very big impact on patient’s lives. Patients should discuss the specifics of their AVM with a neurosurgeon/interventional neuroradiologist team who are skilled and experienced in dealing with all three treatment modalities.

What are the treatments for AVMs?

There are three different ways of treating AVMs, embolization (“gluing”), surgery and stereotactic radiosurgery (gamma knife). Sometimes we use just one of these treatments and sometimes a mix of treatments depending on the characteristics of the AVM and the patient’s own preference.

What are the benefits of Gamma Knife?

Gamma knife differs from surgery and embolization in not requiring a general anaesthetic and having the capability to treat very deep and sensitively located AVMs which cannot be otherwise treated.

Gamma knife treatment uses a form of highly focused radiation which causes AVMs to gradually close off. Most patients have one treatment but occasionally we need to do a second. The benefits of gamma knife over other ways to treat AVMs include avoidance of a general anaesthetic and the ability to treat deep and difficult AVMs which are untreatable by surgery/embolization.

The top seven Gamma Knife AVM treatment FAQs:

1. Is my AVM suitable for gamma knife?

Almost all smaller AVMs and a selection of larger ones are suitable for GK.

2. My AVM bled, should I have a treatment that works more quickly than gamma knife?

That depends on whether your AVM has high risk features for a re-bleed or not.

3. What are the chances of having a complication from gamma knife treatment?

That depends on the location, size, number of treatments and any previous problems.

4. Is gamma knife more or less accurate than cyberknife?

Gamma knife and cyberknife are equally accurate.

5. Is fitting of the frame painful?

The frame fitting is uncomfortable but we do give local anaesthetic and painkillers and lots of reassurance!

6. When can I go back to work after gamma knife?

Unless you have difficult to manage seizures most patients get back to work the next day.

7. When will we start to see some effects from gamma knife?

The treatment works more slowly than other treatment options like embolization and surgery. It usually takes 4 years for maximum effect.

If you have any further questions on gamma knife, please click here.

See also; Arteriovenous Malformation (AVMs) Information

Mar 31, 2022

If you or a loved one has a brain tumour, you’ll find that there are different types of treatment available, but the most suitable one will depend on the type of tumour, which part of the brain it’s affecting, how big it is, how far it’s spread, the abnormality of the cells and your own general health and fitness.

These days, it’s not always necessary to go down the more traditional surgery route and there are options for less invasive treatment that are just as effective, depending on the kind of tumour you have.

Gamma Knife radiosurgery, carried out here at Amethyst Radiotherapy, is a form of stereotactic radiosurgery, which means that there is no incision required. But it can still be used to treat brain abnormalities, vascular malformation and tumours, using specialist equipment that focuses tiny beams of radiation on their target.

These beams don’t cause any harm to the surrounding brain tissue that they have to pass through, but a high dose of radiation is directed on the target instead, where all the beams of radiation converge.

This makes it a much safer alternative to neurosurgery, where incisions are made in the scalp and the skull is opened before dissection into brain tissue to access the tumour. In some patients, Gamma Knife may have fewer side-effects than other types of radiation and the procedure can be carried out in a single day, delivering even more benefits.

The conditions that Gamma Knife is most commonly used to treat include benign and malignant brain tumours, arteriovenous malformations, trigeminal neuralgia, acoustic neuroma and pituitary tumours.

What to expect

Before the operation, you will be invited for an appointment with a consultant and so you can attend a pre-assessment clinic, where you’ll meet the radiography and nursing staff. Blood samples may be taken at this point. It also gives everyone a chance to visit the centre and ask any questions they may have.

On the treatment day, you’ll meet with the team who will explain the process of the day. You will then be fitted with a stereotactic head frame so the doctor can pinpoint exactly where the target is to be treated.

The frame also stops your head from moving during imaging and treatment. It can be a little uncomfortable but most patients handle it well. A local anaesthetic is used to numb the sites where the frame pins are to be used that hold the frame in place.

You will then be transferred to the imaging team so planning images can be taken. This can take up to 45 minutes. Once the scans have been done, your medical physicist and consultant neuroradiologist will calculate a precise and accurate treatment plan based on the images.

From here, the actual treatment can start. This is similar to having a scan done and you will be awake and able to communicate with the treatment team via an audio and video connection. It is also possible to have breaks during the treatment to make you feel more comfortable, if necessary.

Once the treatment is complete, the head frame will be removed. You may experience a mild headache or some soreness where the frame was attached. The majority of patients go home an hour or two after the treatment has been completed, although you may be kept overnight for observation.

Mar 28, 2022

When exploring treatments for brain tumours and other specific conditions related to brain tissue, one of the specialist options that has been increasingly considered is known as gamma knife surgery, also known as stereotactic radiosurgery.

Contrary to its name, gamma knife surgery does not involve an actual knife, nor is it technically a surgery, but instead is a highly advanced non-surgical treatment used for very specific cases.

Instead, stereotactic radiosurgery is a precise beam of gamma radiation made up of a series of individual weaker beams that are focused on the precise location of a lesion or a tumour so that it does not affect any nearby healthy brain tissue.

Whilst both adults and children can have the treatment, there is a range of factors that your neurologist will consider before prescribing the stereotactic radiosurgery, which includes the size of the area to be treated, overall health and the specific nature of the condition.

Typically, the main conditions that can be treated include:

  • lesions and tumours on the brain,
  • facial pains caused by compressed nerves known as trigeminal neuralgia,
  • a genetic disorder that creates a tangle of abnormal blood vessels known as arteriovenous malformation (AVM),
  • clustered blood vessels at the top of your spinal cord and brain known as cavernoma,
  • specific types of epilepsy.

Typically, whilst the actual gamma knife procedure is relatively short, there are considerable amounts of preparation involved to calibrate the advanced systems that will undertake the radiation process.

The first step involves fitting a lightweight frame to your head to keep it still and ensure the beams are focused accurately, as well as injecting local anaesthetic to ensure the procedure is not painful.

After this is an imaging session, typically using magnetic resonance imaging (MRI) or computed tomography (CT) to find the position of the lesion or tumour relative to the frame and create an exact treatment plan.

This plan is calculated with the help of an advanced computer system and specialists who will determine the correct treatment for you before the treatment takes place.

Mar 16, 2022

The government needs to plough more money into brain tumour research if it wants to make an impact in saving lives, a charity stated in response to the Department for Health and Social Care’s War On Cancer.

Earlier this month, the government launched an open consultation entitled 10-Year Cancer Plan: Call For Evidence, requesting ideas and evidence over a period of eight weeks to shape a decade-long plan to improve patient care, advance technologies and reduce the number of people affected by this dreadful disease.

The secretary of state Sajid Javid said: “It is time to declare a national war on cancer, which is the biggest cause of death from disease in this country. It is a menace that has taken far too many people before their time and caused grief and suffering on a massive scale.”

While the Brain Tumour Research charity welcomes the government’s plans to tackle disparities and inequalities, focus on early diagnosis, intensify research and improve cancer prevention, its director of research, policy and innovation Dr Karen Noble noted “the devil is in the detail”.

She said only 40 per cent of cancer cases are triggered by preventable risk factors, and the causes of brain tumours, specifically, remain unknown. Therefore, it is extremely difficult to provide health education on how to prevent certain cancers.

“The answer to that lies in greater understanding of the disease because before public health advice comes scientific research,” Dr Noble stated.

At least £35 million a year is required to invest in brain tumour research in order to find a cure for the disease within the next 20 years.

Brain Tumour Research, therefore, would have wanted to see more details about how the government intends to ‘intensify cancer research’ within its plan.

For radiosurgical brain tumour treatment, book a call with us today.