We are proud to offer a world-class stereotactic radiosurgery service for the treatment of tumours of the brain and spinal cord
What is stereotactic radiosurgery?
Stereotactic radiosurgery, or SRS, is an advanced radiotherapy technique that precisely delivers multiple beams of radiation to a tumour, sometimes in one single treatment session. Despite its name, SRS is not surgery – it doesn’t involve any incisions and the procedure is painless.
SRS is often referred to as a ‘brain-sparing’ radiotherapy approach as it’s widely recognised for its ability to preserve the quality of life in people with cancers that have spread to the brain (brain metastases).
We offer SRS as part of our comprehensive state-of-the-art neuro-oncology service in Oxford and London. This also includes an array of advanced diagnostics and planning techniques that enable us to create your own tailored treatment plan. Our neuro-oncology service is underpinned by leading professionals and world-class technology so that we can offer exceptional care and maximise your chance of the best possible outcomes.
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SRS versus conventional brain radiotherapy
Conventional radiotherapy for the treatment of brain tumours involves high-energy X-ray beams that deliver a prescribed dose of radiation directly to your tumour cells. The aim is to shrink your tumour and stop it from growing. If you have several small tumours (metastases) the radiation is often directed across the whole brain area.
SRS uses narrower X-ray beams which are from different angles. As a result, SRS can target small tumours with exceptional accuracy while avoiding the surrounding healthy brain tissue. Because of this greater accuracy, we are able to deliver higher doses of radiation to the tumour site and minimise the side effects you’ll experience.
The three main advantages of stereotactic radiosurgery (SRS) over conventional radiotherapy are:
- Single treatment
You may need as many as 10 treatments with conventional radiotherapy. But with SRS, the radiation is far more powerful and can be delivered in as little as a single dose, allowing you to get on with your day-to-day life.
- Reduced side effects
Increased accuracy means the radiation beam is less likely to hit your healthy tissue – and so less likely to cause side effects. Research shows that this can help to preserve everyday cognitive function and an improved quality of life after treatment.
- Less likely to need conventional surgery
In many cases, SRS means you can avoid having conventional surgery. This means no invasive treatment, no scarring, a quicker recovery period and little risk of infection.
What happens during SRS?
SRS can be delivered using many different advanced technologies. We use a linear accelerator (linac) and X-ray radiation at our centre in Oxford, while our centre in London has a Gamma Knife which uses gamma rays. Both these techniques are equally effective in treating brain metastases, but there are some differences in the planning and treatment for each.
Follow this link if you want more information about Gamma Knife radiosurgery at our GenesisCare Centre for Radiotherapy at Cromwell Hospital
Here’s what to expect during your SRS treatment plan in Oxford – including before, during and after the procedure.
Face mask fitting
For your treatment you’ll need to be fitted with a custom-made mask that keeps your head still during the procedure – this helps limit the damage to your healthy brain tissue. A sheet of plastic that has been softened in warm water will be placed over your face and head and moulded to fit you. It’ll remain on your face as it hardens, but you’ll be able to breathe normally and shouldn’t feel any discomfort. The mask will be removed once it’s dried.
Ahead of SRS, you’ll need a CT or MRI scan. This helps your care team accurately plan your treatment. These scans help us determine the exact size, shape and position of your tumour. We use this information to calculate the optimum radiation dose and accurately direct the radiation beam during your procedure.
In some cases, you may need an additional functional MRI (fMRI) scan to help your team locate the areas of your brain that are involved in important processes – such as movement or speech.
Before your treatment begins, you may be given steroids to help minimise the risk of swelling in your brain. Once you’re ready, you’ll be helped into position on the treatment couch and your radiographers will fit your custom face mask from your planning appointment.
Your radiographers will leave the room for the duration of the procedure, but they’ll be monitoring you at all times and you’ll be able to talk to them via an intercom.
You won’t be able to feel anything during treatment as SRS is completely painless. Your session may take between 20 to 30 minutes, though this can be a little longer for more complex cases.
When the treatment has finished, your radiographer will come back into the room and help you off the couch. You’ll be able to go straight home, however, you wont be able to drive due to DVLA regulations – your consultant will discuss this in more detail with you.
Your doctor will let you know what your follow-up schedule will be, depending on the number, size, location and prognosis of your tumours.
Usually, a member of your care team will call you to check on your recovery around a week after your treatment. You’ll then have a review after four to six weeks with your consultant, and a follow-up MRI of your brain to see how the treatment has worked two to three months later.
Who is suitable for SRS?
SRS may be suitable for you if you have either a tumour that started in your brain (primary tumour) or a tumour that has spread from elsewhere in your body (metastatic or secondary tumour). This includes:
- If you’ve had surgery to remove brain metastases to reduce the risk of recurrence
- Small tumours such as pituitary adenomas and chordomas or meningiomas at the base of the skull
- Benign (non-cancerous) tumours such as acoustic neuromas (vestibular schwannomas)
SRS may not be suitable if:
- Your treatment area includes certain important nerves that could be accidentally damaged by radiation
- Your tumour is larger than 3cm across
- Your tumour is not low grade
Our clinicians are experts in the use of SRS as well as other techniques and will only decide if this is the best option for you after careful evaluation of your condition.
Possible side effects
All treatments carry the risk of some side effects, however, you can expect fewer side effects with stereotactic radiosurgery (SRS) than conventional radiotherapy because its greater accuracy means that the risk of damage to healthy brain tissue is lower.
Not everyone experiences side effects but your risk may be affected by your general health, other treatments you’ve had and the location of your lesion or tumour.
If you do experience some changes after treatment, your care team will advise you on the best way to deal with them.
These usually disappear within two to four weeks of treatment:
- Nausea and/or vomiting
- Seizures (fits)*
- Temporary worsening of your symptoms
- Skin changes in the area of treatment
* Risk of seizures is slightly increased after treatment but usually only affects people who have a history of seizures. Ask your medical team for advice. If you have a seizure for the first time, go straight to your nearest hospital’s accident and emergency department.
Around 10% of people notice side effects months, or even years, after SRS. These are related to the treatment area within the brain and may include:
- Hearing loss
- Loss of brain function
- Memory loss
- Pituitary gland damage
- Radiation damage to the normal brain
- Visual impairment
- Secondary cancer years later, though this is rare
Up to half of these side effects can be successfully treated. It’s important that you attend your follow-up visits and scans so we can identify and treat any problems as soon as possible.
If you have a primary or secondary brain tumour, you may have to notify the DVLA. You may not be allowed to drive for a certain period of time depending on the type of tumour and treatment received. Your doctor can advise you further.
Our multidisciplinary team
Prof Natalie Voets
Special clinical interest in MRI, functional MRI and tractography.
Mr David Peterson
Special clinical interest in tumours of the central nervous system, spinal degenerative disease and hydrocephalus and stereotactic radiosurgery on the Gamma knife
Dr Pieter Pretorius
Special clinical interest in diagnostic imaging of conditions of the central nervous system, spine, head and neck region including ENT and orbital conditions
Dr Fintan Sheerin
Special clinical interest in diagnostic imaging of conditions of the central nervous system, spine and head and neck region.
Dr Meera Nandhabalan
Special clinical interest in stereotactic radiotherapy (gliomas and benign tumours).
Dr Luis Aznar-Garcia
Special clinical interest in hepato-pancreato-biliary, breast cancers, SBRT and stereotactic radiosurgery (brain metastases, benign tumours and spine).
Mr Richard Stacey
Special clinical interest in neuro-oncology and epilepsy.
Prof Puneet Plaha
Special clinical interest in awake surgery and minimally invasive endoscopic brain tumour surgery.
Dr Anup Vinayan
Special clinical interest in stereotactic radiosurgery such as Cyberknife and Gamma knife (primary brain, brain metastases and central nervous system).