At the Jefferson Hospital for Neuroscience, innovations in stereotactic radiosurgery have been ongoing since the inception of the program in 1994. With a Gamma Knife and the world’s first installation of a linear accelerator designed for and dedicated to stereotactic radiation, neurosurgeons, radiation oncologists, and medical physicists have worked together to refine techniques in stereotactic radiation. They have pioneered fractionated stereotactic radiotherapy, or FSR for short, and designed national trials which have led to new standards of care for a variety of diseases including brain metastases, malignant gliomas, acoustic neuromas, and optic nerve sheath meningiomas. For these diseases, FSR has prolonged life, preserved hearing, and recovered vision in patients who otherwise would have had no options.
Publications which have reshaped standard practice include:
- Neurosurgery 2002, the first paper describing FSR for optic nerve sheath meningiomas demonstrating recovery of vision (over 120 citations)
- The International Journal of Radiation Oncology Biology and Physics 2001, the first paper demonstrating an advantage of FSR over single fraction radiosurgery for patients with acoustic neuromas (over 180 citations)
- The Lancet 2004, the first prospective randomized trial demonstrating the benefit of radiosurgery when coupled to whole brain radiation for patients with brain metastases (over 890 citations)
- The Journal of Clinical Oncology 2010, the first paper to demonstrate that FSR boost to recurrent gliomas is not only safe but effective in extending life with quality in patients with malignant gliomas (over 50 citations and serving as the basis for a new RTOG protocol)
As we look to the future, we are designing new protocols that promise to improve hearing in acoustic tumor patients and preserve cognition in patients with brain metastases. Our original linear acceleratorhas recently been replaced by the state-of-the-art Varian Truebeam STX Slim allowing us to achieve new heights in precisely sculpted patient-specific stereotactic radiation treatments.
NEUROLOGICAL SURGERY FACULTY
David W. Andrews, MD FACS
James J. Evans, MD
Christopher J. Farrell, MD
Kevin D. Judy, MD