International Stereotactic Radiosurgery Society

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Past Webinars

Extracranial

SBRT for Liver | by Brian CZITO, MD, PhD & Fang-Fang YIN, Professor | November 22, 2016

by Brian CZITO, MD, PhD & Fang-Fang YIN, Professor

This talk was focused on 1) The rational of for liver SBRT; 2) The clinical indications for liver SBRT; 3) The management strategies (fractionation and post treatment assessment) for SBRT; 4) SBRT workflow; 5) Delivery techniques and 6) The motion management techniques.

SBRT as an Alternative for Surgery in Early Stage NSCLC | by Ben SLOTMAN, MD, PhD, Associate Professor | January 17, 2017

by Ben SLOTMAN, MD, PhD, Associate Professor

SBRT is now the standard treatment for patients with medically inoperable NSCLC. SABR is safe, effective and is associated with limited toxicity. These excellent results have led to the question whether SABR can also be used in medically operable NSCLC patients. In this webinar, after a short overview of the accomplishments of SABR in medically inoperable patients, available evidence from non-randomized and randomized studies in operable patients will be discussed.

New Frontiers: SBRT for Primary Kidney Cancers | by Shankar SIVA, MD, Radiation Oncologist | April 25, 2017

by Shankar SIVA, MD, Radiation Oncologist

Primary kidney cancer has historically been considered a resistant tumour to radiotherapy. However, with the incidence of primary kidney cancers increasing in the developed world at the same time as an increase in life expectancy and prevalence of obesity, there are a growing number of patients who may present with inoperable primary kidney cancer.  Advances in technologies have facilitated the application of ablative radiation as a viable alternative in this scenario. In this webinar, we cover the biological and technical considerations for kidney SBRT, as well as update the current evidence base.

SBRT for Borderline Resectable/Locally Advanced Pancreatic Cancer | by Marta SCORSETTI, MD, PhD, Associate Professor | November 24, 2017

by Marta SCORSETTI, MD, PhD, Associate Professor

Pancreatic ductal adenocarcinoma is characterized by a poor prognosis, with a 5-year overall survival rate of about 6%. Surgery is the gold standard of care with 5-year OS rates of 20% to 25%. More than 50% of patients, however, are borderline resectable or unresectable at the time of diagnosis, mainly due to locally advanced disease or distant metastases. In patients with locally advanced pancreatic cancer, the integration of chemotherapy and chemo-radiation treatment is the current therapeutic option. In the recent years, the role of SBRT in the treatment of borderline resectable and unresectable pancreatic cancer was investigated to confirm the hypothetical advantages of this therapy over conventional chemo-radiation.  In this webinar clinical data of SBRT efficacy and toxicity will be discussed.

SBRT for Oligometastatic Disease | by Marta SCORSETTI, MD, PhD, Associate Professor | March 09, 2018

by Marta SCORSETTI, MD, PhD, Associate Professor

SBRT in oligometastatic patients is an extremely exciting topic, as it may represent a fantastic opportunity to improve cancer patients' prognosis and also to possibly cure some of them. I will try to define who is the oligometastatic patient and I will show what evidence we currently have of local ablative approaches integrating the traditional systemic therapies. I will also talk about what challenges we are facing at the moment and that we need to address in the near future, to be able to benefit from this new approach.

Prostate Radiosurgery | by Maris MEZECKIS, MD, PhD | August 23, 2018

by Maris MEZECKIS, MD, PhD

The webinar will cover the following items:

  • evidence for hypofractionation for prostate cancer
  • technical aspects (marker implantation, imaging, patient preparation, tracking the prostate)
  • the role of PET-CT in prostate radiosurgery
  • homogenous and heterogenous (HDR-like) dose distribution
  • future perspectives of prostate SRS (the role of SRS in high-risk prostate cancer, potency sparing, further hypofractionation etc.)

SBRT for Early Stage Lung Cancer | by Nikolay VOROBYOV, MD, PhD, Associate Professor | September 04, 2018

by Nikolay VOROBYOV, MD, PhD, Associate Professor

Stereotactic body radiotherapy (SBRT), is now a standard treatment option for patients with stage I non-small cell lung cancer or oligometastatic lung tumor who are medically inoperable or medically operable but refuse surgery. SBRT is extremely well tolerated, is an outpatient procedure, and has been reported to yield local tumor control rates exceeding 90%: it is an attractive alternative to an invasive surgical procedure.

The webinar will cover the following items: 

  • SBRT use in operable tumors
  • SBRT for central tumors
  • Possible role of SBRT in oligometastatic lung disease
  • Role of CT and PET in differentiating tumor recurrence from radiation fibrosis
  • Proton SBRT

A Bright Future Ahead Using Radiotherapy for Prostate Cancer | by Robert TIMMERMAN, Professor | September 24, 2018

by Robert TIMMERMAN, Professor

Historically, improved technologies were used primarily to deliver a higher total dose of radiotherapy (RT) for prostate cancer.  For lower risk groups, such protracted RT is well tolerated but inconvenient and costly.  These same risk groups migrated to surgery in the 1990s with the promise of preserving potency with the “nerve-sparing prostatectomy.” Long term data shows potency is far from preserved with surgery.  More recently, many higher risk patients have also migrated to surgery justified by the notion that RT cannot control high grade tumor.  We’ll discuss how current shortcomings constitute future opportunities.  Clinical research has shown that shorter RT courses are just as effective.  Even ablative radiation can be safely delivered with ultimate convenience and potential to address high risk disease.  Indeed, better delineation of anatomy and shaping of dose might actually deliver a true, potency preserving treatment.  Improved technologies such as image guidance and protons could achieve even more if used prudently.

SBRT for Liver Lesions | by Marta SCORSETTI, MD, PhD, Associate Professor | December 17, 2018

by Marta SCORSETTI, MD, PhD, Associate Professor

Stereotactic body radiation therapy (SBRT) represents a promising option in the management of liver lesions, both metastases and primary tumors. Through the ability to deliver high ablative doses to the tumor and low doses to the healthy liver and other organs at risk, SBRT has been reported to reach high rates of local control and good tolerance with a mild pattern of toxicity. This lecture will summarize the recent literature, the practical issues and future perspectives.

Hypofractionated Stereotactic Reirradiation for Recurrent Head and Neck Cancers | by Aleksey MIKHAILOV, MD, Radiation Oncologist | January 10, 2019

by Aleksey MIKHAILOV, MD, Radiation Oncologist

This webinar will highlight reirradiation for the recurrence of head and neck cancer, answering the questions of normal tissue tolerances, dose regimens and the risk of severe complications. Also we will present cases from own clinical experience.

Intracranial benign

SRS for Meningiomas | by Laura FARISELLI, MD, Professor & Marcello MARCHETTI, MD, PhD, Associate Professor | December 12, 2016

by Laura FARISELLI, MD, Professor & Marcello MARCHETTI, MD, PhD, Associate Professor

Meningiomas are rare benign tumors. The surgical excision still remains the first treatment option but, when a complete removal is not achievable, an alternative treatment modality has to be considered. In this sense, the radiosurgery represents the rising treatment paradigm.
The present report, focus on the main problems related to the radiosurgery of the anterior skull base meningiomas. Particularly the radiobiology, the rationale and the limits of the single and multisession radiosurgery as well as the risk of toxicity will be debated.

SRS for Pituitary | by Jason P. SHEEHAN, MD, PhD, Associate Professor | January 31, 2017

by Jason P. SHEEHAN, MD, PhD, Associate Professor

In this webinar, I will cover the topic of Stereotactic Radiosurgery (SRS) for pituitary adenomas. In this context, I will review the safety and efficacy of SRS for nonfunctioning and functioning adenomas. In addition, I will discuss the results of multicenter trials on this topic.

Multi-Session Stereotactic Radiosurgery for Large Cavernous Sinus Hemangiomas: Medium- and Long-Term Outcomes | by Enmin WANG, MD, PhD | August 24, 2017

by Enmin WANG, MD, PhD

Cavernous sinus hemangiomas (CHSs) are rare extra-axial highly vascular, benign tumors that account for 2-3% of all lesions within the cavernous sinus. Before the era of magnetic resonance imaging (MRI), the preoperative radiological diagnosis of CSHs was difficult. Stereotactic radiosurgery (SRS) has emerged as a principal alternative to microsurgical resection for small and medium-sized CSHs. However, large CSH management remains a challenge for the neurosurgeon. Although preliminary studies have demonstrated that multi-fraction radiosurgery for large CSHs is both safe and effective, the number of patients in the clinical series and the length of follow-up were limited.In this webinar, we will cover the role, rationale, planning technique, outcomes and complicatons of stereotactic radiosurgery in the treatment of large CSHs.

Gamma Knife Radiosurgery of Craniopharyngiomas | by Abid SALEEM, Consultant Neurosurgeon | August 28, 2017

by Abid SALEEM, Consultant Neurosurgeon

Craniopharyngiomas are benign tumors with malignant clinical course. The microsurgical removal is desirable but perilous due to its adherence with adjacent neurovascular structures.  In this webinar an   account of our own experience with adult and pediatric cases will be provided and the literature reviewed to define the role of gamma knife radiosurgery in the management of craniopharyngiomas.

Radiosurgery for the Management of Vestibular Schwannomas | by Marc LEVIVIER, MD, Professor | October 31, 2017

by Marc LEVIVIER, MD, Professor

In this webinar, I will cover the topic of the use of radiosurgery for the management of vestibular schwannomas (VS). In this context, I will review the safety and efficacy of upfront radiosurgery for small- to medium-size VS. In addition, I will address the role of radiosurgery for very small (intracanalicular) VS, especially in the context of early treatment versus observation. Finally, I will also discuss the role of radiosurgery for large VS, focusing on the functional outcome of combining the approaches of microsurgery and radiosurgery.


SRS/SRT Convexity and Parasagittal Meningiomas | by Sergey ANIKIN, MD, PhD | December 21, 2017

by Sergey ANIKIN, MD, PhD

Complete tumor resection is not always possible. Many patient will not choose surgery treatment in case small- and medium sized tumors. Gamma-knife radiosurgery is effective method of treatment for convexity and parasagittal meningiomas as the adjuvant and initial treatment.The results treatment of meningiomas following stereotactic radiosurgery have been reported numerous publications. We focus on convexity and parasagittal meningiomas, treated with stereotactic radiosurgery, as most neurosutgeon prefer resection of radiosurgery to treat this type of tumor.

The Role of Stereotactic Radiosurgery in the Treatment of Glomus Jugulare Tumors | by Antonio NICOLATO, MD, Chairman | October 12, 2018

by Antonio NICOLATO, MD, Chairman

Glomus jugulare tumors (GJTs) are highly vascularized lesions, benign in 96-98% of cases, that arise from the chief cells of the paraganglia in the chemoreceptor system and are closely associated with cranial nerves derived from brachial arches. GJTs represent 0.6% of all head and neck tumors, appearing most frequently between the fifth and sixth decade of life, occur predominantly in women in a ratio of 1:1,000,000, and may have a genetic association. Treatment options include surgical resection, embolization, radiosurgery (SRS), and conventional radiation therapy, or combined treatments.

The aim of this lecture will be to show and discuss SRS outcome for the tretatment of this rare skull base tumor. A summary of recent literature results and a comparison with our experience data will be presented, as well.

Finally, the managment of particular issues – such as the treatment of tumor progressions or recurrent GJTs – and the future perspectives will be debated.

SRS for Meningiomas | by John SUH, MD, Chairman | November 09, 2018

by John SUH, MD, Chairman

Meningiomas are the most common primary adult brain tumor.  Treatment options include surgery, stereotactic radiosurgery, and radiation therapy.  The outcomes and complications associated with stereotactic radiosurgery when used as a upfront or adjuvant treatment will be reviewed.  The key factors such as tumor grade, size, and location that affect tumor control and complication will also be discussed.  In addition, the role of radiation therapy along with ongoing clinical trials will be reviewed.

Radiosurgery for Rare Skull base Tumours | by Dade LUNSFORD, M.D., F.A.C.S., Professor | January 28, 2019

by Dade LUNSFORD, M.D., F.A.C.S., Professor

In this presentation Professor Lunsford will discuss outcome studies  of both his center at UPMC  as well as multicenter   studies from the International Radiosurgery Research Foundation related to glomus tumors, chordoma, chondrosarcoma, foramen magnum meningiomas, and lower cranial nerve schwannomas.  Frame based SRS approaches, targeting, dose prescription, and the importance of both conformality and selectivity will be emphasized. In order to preserve existing cranial nerve function and acheive long term tumor control, SRS is often the most effective and safest management strategy.

Intracranial functional

Radiosurgery for Trigeminal Neuralgia | by Alessandra GORGULHO, MD, Professor | May 10, 2017

by Alessandra GORGULHO, MD, Professor

Radiosurgery for Trigeminal Neuralgia (TN) was the birth of radiosurgery. The popularization of this technique was only possible upon improvement of imaging techniques, which allowed proper targeting of the trigeminal pathway. Radiosurgery is a very attractive surgical modality, especially to the elderly. Radiosurgery centers offering Functional Radiosurgery need to be aware of extra scrutiny during protocol implementation and treatment execution. This webinar will place radiosurgery in the context of other surgical modalities options for TN, discuss indications, results, complications and nuances of different radiosurgery protocols, including frameless.

Advances in Functional Radiosurgery | by Roberto MARTINEZ ALVAREZ, MD, Professor | September 29, 2017

by Roberto MARTINEZ ALVAREZ, MD, Professor

The functional indications were the first procedures treated by radiosurgery. The purpose of these procedures is to correct the tissue disorder related to symptoms by damaging the nervous system or performing a "neuromodulation". Functional indications treated by Gamma Knife radiosurgery have increased in the last two decades. From a total of nearly one million patients treated by Gamma Knife, 7% of these cases correspond to these procedures. Of all patients treated for functional problems, 87% suffer from trigeminal neuralgia. Nowadays we can consider radiosurgery as an initial treatment for treating Trigeminal Neuralgia with a similar efficacy to MVD with a lower recurrence rate if we pay attention to this extensive review. Treatment by radiosurgery of epileptic foci in mesial and extratemporal epilepsy revealed very promising results with 60% of cases in Engel I and no relevant complications. The results obtained with the treatment of hypothalamic hamartomas are very promising too: no side effects and improvement in both seizures, aggressiveness and cognitive impairment. The good results observed after radiation of VIM nucleus have increased the number of candidates in recent years for treating hereditary or Parkinsonian tremor. We perform by radiosurgery capsulotomies, and cingulotomies to treat OCD, depression and anorexia nervosa with great success. We will review in this seminar the functional indications that are treated by radiosurgery with Gamma Knife and the effectiveness of these procedures.

Stereotactic Radiosurgery for Intractable Tremor | by Constantin TULEASCA, MD, PhD | April 20, 2018

by Constantin TULEASCA, MD, PhD

Tremor is the most common movement disorder, usually as a cardinal symptom of essential tremor, or in the course of other disorders, mainly Parkinson’s disease. Primary treatment is pharmacological. Drug-resistant tremor can benefit from standard neurosurgery procedures (DBS or radiofrequency thalamotomy) or, alternatively, minimally invasive procedures, such as radiosurgery or high-focused ultrasound. The ventro-intermediate nucleus (Vim) of the thalamus has been identified as the most suitable and common target for tremor arrest. The main purpose of this Webinar is to review the safety and efficacy of radiosurgery in this indication. The limitations of radiosurgery come from the indirect targeting with no intraoperative confirmation, delayed clinical and radiological effect and a limited understanding of radiobiology. All these aspects will be discussed. Although we will primary focus on essential tremor, Parkinsonian and multiple sclerosis tremor will be also briefly considered. Recent advances in neuroimaging for improving the targeting, as well as those related to a better understanding of radiobiology will be overviewed. 

Radiosurgical Management of Trigeminal Neuralgia | by Mojgan HODAIE, MD, Professor | May 03, 2018

by Mojgan HODAIE, MD, Professor

This webinar will focus on trigeminal neuralgia, a unique facial neuropathic pain disorder that is highly amenable to radiosurgical treatment. The diagnosis, methods of treatment as well as the role of radiosurgery in the management of this condition will be discussed. Important research studies contributing to our understanding of trigeminal neuralgia and the effect of radiation will be reviewed.

Gamma Knife Surgery for Intractable Obsessive Compulsive Disorder | by Steven RASMUSSEN, MD | February 05, 2019

by Steven RASMUSSEN, MD

In spite of the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired.  Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD. 

Fifty-five patients with severely disabling, treatment-refractory OCD received bilateral lesions in the ventral portion of the anterior limb of the internal capsule over a twenty-year period using the Leksell Gamma Knife. The patients were prospectively followed over three years with psychiatric, neurologic, and neuropsychological assessments of safety and efficacy, as well as structural neuroimaging.  

Thirty-one of fifty-five patients (56%) had an improvement in the primary efficacy measure, the Yale Brown Obsessive Compulsive Scale (YBOCS), of greater than or equal to 35% over the three year follow-up period. Patients had significant improvements in depression and anxiety as well as quality of life and global function. Patients tolerated the procedure well without significant acute adverse events.  Five patients (9%) developed transient edema that required short courses of dexamethasone. Three patients (5%) developed cysts at long-term follow-up, one of whom developed radionecrosis resulting in an ongoing minimally conscious state.

Gamma knife ventral capsulotomy is an effective radiosurgical procedure for many treatment-refractory OCD patients.  A minority of patients developed cysts at long-term follow-up, one of whom had permanent neurological sequelae. 

Intracranial malignant

SRS for Brain Metastases | by Bodo LIPPITZ, MD, PhD | October 11, 2016

by Bodo LIPPITZ, MD, PhD

There has a been a recent paradigm change in the treatment of brain metastases. On one hand, there has been significant progress in developments of chemotherapy, on the other hand, recent data have raised significant doubts concerning effectiveness and safety of Whole Brain Radiotherapy. With increasing survival of cancer patients with brain metastases, the requirements in terms of efficacy and quality of life are being re-evaluated. The high efficacy and low complication rates of stereotactic radiosurgery, even in radio-resistant or multiple metastases, solve a number of the mentioned shortcomings of fractionated WBRT. Technicalities of radiosurgical treatment will be discussed.

Radiosurgery for Brain Metastasis | by Clark CHEN, Professor | May 23, 2017

by Clark CHEN, Professor

Approximately 25-35% of all cancer patients suffer from brain metastasis (BM). Stereotactic radiosurgery (SRS) is an attractive therapeutic option for patients afflicted with BM.  However, the decision between SRS and whole brain radiation therapy (WBRT) remain a matter of clinical judgment. A key factor in this decision involve survival expectation. The objective of the webinar will be to 1) review the rationale for SRS versus WBRT in the treatment of BM 2) review the available prognostic scales available for SRS-treated BM (RPA, mRPA, BSBM, SIR, GPA, ds-GPA) and 3) review cumulative intracranial tumor volume as a prognostic variable.

Stereotactic Radiosurgery in the Treatment of Recurrent Glioblastoma: The Recent Evidence | by Bodo LIPPITZ, MD, PhD | July 18, 2017

by Bodo LIPPITZ, MD, PhD

Despite recent improvements, even after resection and fractionated radiother­apy, glioblastoma tends to recur locally. In recurrent glioblastoma only few treatment options remain and survival both after re-operation or chemotherapy is generally limited.

Stereotactic radiosurgery using Gamma Knife, stereotac­tic Linear Accelera­tor (LINAC) or CyberKnife is a potential treatment alternative. While it was shown that radiosur­gery had no addi­tive effect when given as upfront treatment in addition to surgical resection and fraction­ated radiotherapy, stereotactic radiosurgery can be applied as minimal invasive treatment in the almost inevitable situation of a glioblastoma recurrence even after previous fractionated radiotherapy. Due to the risk of adverse radiation effects however, larger recurrences should not be treated using single session radiosurgery. The median survival after glioblastoma recurrence was ≥ 10 months in 9 out of 13 studies represent­ing 80% of published radiosurgically treated patients, which compares favourably to the out­come after reoperation, treatment with temozolomide or bevacizumab. The retrospective evidence indicates that stereotactic radiosurgery offers a safe and effective treatment option for glioblastoma recurrences in a situation when only very few alternatives exist.  

The webinar will review and discuss the current evidence. 

Combination of Immunotherapy (IT) and Radiotherapy (RT) in CNS Metastases | by Frederic DHERMAIN, MD, Professor | December 06, 2017

by Frederic DHERMAIN, MD, Professor

To date, we know that an increasing number of metastatic patients (pts) will benefit from Immunotherapy (IT), not only from melanoma but also from lung and other primaries. In the same time, due to a better control of extra-CNS metastatic disease, more ‘long survivors’ will be exposed to the risk of developing brain metastases (BM), all along their life. Consequently, direct deaths from uncontrolled BM (more than 40% in melanoma pts) will increase and an effective ‘intra-cranial treatment’ as Radiotherapy (RT), either Whole-Brain (WBRT) or Stereotactic Radiotherapy (SRT), is essential to be considered in the global therapeutic strategy. In this webinar, we will analyze and discuss recent key publications, enlightened by selected relevant ‘real-life’ cases. Clinical implications of ‘Combined WBRT / SRS with IT’ (as Ipilimumab, Nivolumab and / or Pembrolizumab) will be presented, focused on short and mid-term outcome of pts, suggesting that it is essential to take into account both 3 different factors: (1) the ‘specific’ interactions of each drug with RT (2) the ‘dose-volume and fractionation’ paradigm (3) the timing of IT – RT combination: ‘simultaneous’ or with a ‘window’ between IT and RT (and if yes, what specific recommendation). In summary, only the results of ongoing and future prospective, large and randomized International trials will be able to answer the key pending question on ‘the best combination / timing’ of IT and RT.

Radiosurgery of Metastatic Melanoma to the Brain with Focus on Treatment Planning, Tumor Response and Patient Prognosis | by Irina ZUBATKINA, Medical Physicist | January 16, 2018

by Irina ZUBATKINA, Medical Physicist

Melanoma has a high propensity to metastasize to the brain. Due to its internal radioresistance, radiosurgery is the main treatment option for metastatic melanoma to the brain. Radiosurgical treatment planning has particularities connecting with metastasis heterogeneity caused by intratumoral hemorrhages. Evolution of the tumor on follow-up MRIs will be presented with regard to the time course and magnitude of volumetric changes. A new conception of “tumor dynamic index” will be introduced as an important consideration of patient prognosis.

Optimal Sequencing of Stereotactic Radiosurgery and Systemic Therapies in the Management of Patients with Brain Metastases | by Mark PINKHAM, MD, PhD | January 25, 2018

by Mark PINKHAM, MD, PhD

Stereotactic radiosurgery (SRS) is a standard approach for appropriately-selected patients with a limited number of brain metastases (BM) at diagnosis.  In recent years, treatment paradigms have been changing because SRS utilisation has expanded and systemic therapies with intracranial penetration are emerging.  Data describing activity of common targeted and immunotherapy agents in the brain will be reviewed.  The rationale for individualised treatment selection and optimal sequencing with SRS will be discussed.

Replay will soon be available.

Brain Metastasis: An Update on Management Principles | by Rupesh KOTECHA, Physician & Minesh MEHTA, MD, Professor | February 26, 2018

by Rupesh KOTECHA, Physician & Minesh MEHTA, MD, Professor

Over the past couple of years, there have been several new developments regarding the role of surgery, whole-brain radiotherapy, stereotactic radiosurgery, and chemotherapy in the management of patients with brain metastasis. Individually, each study has provided new perspectives on the roles of each of the modalities in the treatment of these patients but collectively they have also brought new questions to light. In the following webinar, Dr. Mehta and Dr. Kotecha will review the recent trials to provide the participants with an updated knowledge base about how to approach patients with brain metastasis in the contemporary era.

Contemporary Management of Brain Metastases | by John SUH, MD, Chairman | June 08, 2018

by John SUH, MD, Chairman

Objectives:

•     Provide an overview of the natural history and prognostic factors for patients with brain metastases.

•     Review the results of whole-brain radiation therapy, surgery, and stereotactic radiosurgery.

•     Discuss ongoing and completed studies.

•     Review the impact of tumor biology on outcomes.

Optimising Management for Melanoma Brain Metastases in the Targeted Era | by Matthew FOOTE, MD, PhD, Associate Professor | November 22, 2018

by Matthew FOOTE, MD, PhD, Associate Professor

The management of patients with melanoma brain metastases is becoming increasingly complex.  Despite effective local therapies many patients experience brain relapse and a significant proportion of patients die a neurologic death.  The effectiveness of targeted systemic and immunotherapies with known brain activity has been a significant paradigm shift in the management of these patients.  This webinar explores this rapidly changing field of radiosurgery and targeted therapy and highlights opportunities for collaborative research.

Stereotactic Radiotherapy for Oligometastatic Cancer: Expanding Reality | by Barbara Alicja JERECZEK-FOSSA, MD, PhD, Associate Professor | May 23, 2019

by Barbara Alicja JERECZEK-FOSSA, MD, PhD, Associate Professor

The incidence of oligometastatic cancer (low burden metastatic disease) is constantly growing due to the advancement in medical imaging and increase in primary cancer cure rates. Metastasectomy and other local modalities including stereotactic radiotherapy, termoablation, high intensity focus ultrasound (HIFU) etc. have been introduced in this particular clinical scenario. New terms like metastasis-directed therapy (MDT) and local or lesion ablative treatment (LAT) have been coined and help to distinguish the radical local strategies from palliative local therapies (palliative treatment). Stereotactic radiotherapy is now frequently proposed in oligometastatic cancer patient and provides high local control and, in some cases, long lasting progression-free and treatment-free intervals. 

Intracranial vascular

Gamma Knife Radiosurgery of Arterio-Venous Fistulas (AVF) | by Wade HUAI-CHE YANG, MD, PhD | September 13, 2017

by Wade HUAI-CHE YANG, MD, PhD

Intracranial arteriovenous fistulas (DAVFs) are abnormal arteriovenous communications within the dura, in which meningeal arteries shunt blood directly into the dural sinus or leptomeningeal veins. Stereotactic radiosurgery has long been used for treatment of cerebral AVMs, and treatment of DAVFs would be a natural extension. In this webinar, we will cover the role, rationale, planning technique, outcomes and limitations of stereotactic radiosurgery in the treatment of DAVFs.

SRS and AVMs After the ARUBA Trial | by Antonio DE SALLES, MD, Professor | October 11, 2017

by Antonio DE SALLES, MD, Professor

The ARUBA Trial came to "organize and challenge" the treatment of AVMs. Extreme aggressive treatment to these challenging lesions brought harm to patients to a level that alarmed the Neurologists. They made the diagnosis of AVMs in healthy asymptomatic patients, just to have the difficult experience of seeing their patients returning to them with neurological disasters. They especially questioned the then proposed treatments for these lesions. The multi-disciplinary approach so much preached by all teams working in teaching centers was frequently not practiced in the private offices of the doctors proposing treatments. Now, in the aftermath of the hard truth of the data generated by the ARUBA trial, Radiosurgery takes a new role approaching the patients with AVMs. This webinar seeks to summarize the discussion of the ARUBA data; the new data generated since the disclosure of ARUBA results and propose an algorithm for approaching patients with AVMs that hopefully will generate trust among the Neurologists referring the patients for treatment.

Everything You Always Wanted to Know About Radiosurgery of AVM (But Were Afraid to Ask) | by Mikhail CHERNOV, Assistant Professor | February 08, 2018

by Mikhail CHERNOV, Assistant Professor

Stereotactic radiosurgery (SRS) is an effective management option of intracranial AVM. It is particularly indicated for deep-seated or critically-located lesions. Successful treatment results in obliteration of the nidus within 1-3 years (so-called “latency period”) due to gradual thickening of the vessel wall. In small AVM (® is used. In general, it seems that for Spetzler-Martin grades I-II AVM microsurgical resection is the treatment of choice, for grade III single-staged SRS may be considered, whereas for grade IV-V either staged SRS or combined treatment is reasonable. However, this scheme is very general, and determination of the optimal treatment strategy for such patients depends on the various additional parameters.

Cavernous Malformations and Gamma Knife Radiosurgery | by Roberto MARTINEZ ALVAREZ, MD, Professor | March 23, 2018

by Roberto MARTINEZ ALVAREZ, MD, Professor

The natural history of cavernous malformations (CMs) has remained unclear. This lack of knowledge has made treatment decisions difficult. Indeed, the use of Stereotactic Radiosurgery is nowadays controversial. Our purpose paper is to throw light on the effectiveness of Gamma Knife radiosurgery (GKRS) therapy. We reviewed our data collected from a prospectively maintained database. The pretreatment annual hemorrhage rate was 3.06% compared with 1.4% during the first 3-year latency interval, and 0.16% thereafter. Although the efficacy of Radiosurgery in CMs remains impossible to quantify, a very significant reduction in the bleeding rate occurs after a 3-year latency interval. No permanent neurological morbidity is reported in our series. These results defend the safety of GKRS in surgical high-risk CM from the first bleeding event.

We apologise, the video of this presentation is not available.

Management of Unruptured AVMs in the Post ARUBA Era. What is the Natural Course and Should We Recommend Treatment? | by Bengt KARLSSON, MD, PhD | July 30, 2018

by Bengt KARLSSON, MD, PhD

The ARUBA trial assumed that unruptured AVMs have a low risk for hemorrhage, that the clinical outcome after the first AVM hemorrhage is benign and concluded that unruptured AVMs should be watched and not treated. We decided to analyze these assumptions in detail as well as challenge the conclusion that all unruptured AVMs should be left untreated. We could show that the ARUBA conclusion is not applicable to AVMs suitable for Gamma Knife Surgery and also that the assumptions made in the study are inaccurate. By using a novel method based on the age distribution of the first AVM hemorrhage we could conclude that the annual risk for hemorrhage in an unruptured AVM is around 3.1%, that central AVMs have a higher risk for hemorrhage, that AVM volume is unrelated to the risk for hemorrhage and that pregnancy is a risk factor for AVM rupture. 

Ocular

Radiosurgery for Uveal Melanoma | by Pavel IVANOV, MD, Professor | February 28, 2017

by Pavel IVANOV, MD, Professor

Over the years SRS has been established as a reliable eye-sparing option in the management of uveal melanoma against enucleation. However it cannot be called a routine procedure in daily radiosurgical activity due to the necessity of close cooperation with ophthalmologists. A detailed review of all stages of the treatment procedure emphasizing the most crucial points such as the reliability of eye fixation, imaging requirements, treatment planning and post-treatment care, will be given in this Webinar.

Stereotactic Radiosurgery in Vicinity to Anterior Optic Pathways | by Vladyslav BURYK, MD, PhD | July 10, 2018

by Vladyslav BURYK, MD, PhD

Treatment of pathological lesions in the zone of the anterior optic pathways still challenges radiosurgery. Visual pathways dose tolerance continues to be the subject of radiobiological and clinical investigations. The webinar will discuss SRS for lesions in vicinity to anterior optic pathways, as well as the risk and prevention of radiation-induced optic neuropathy (RION) depending on the radiation dose to the optical apparatus and the fractionation regime.

Treatment of Uveal Metastases with Gamma Knife SRS | by Edward MONACO, MD, PhD | August 17, 2018

by Edward MONACO, MD, PhD

Uveal metastases from systemic cancer (to the iris, ciliary body, or choroid) are not infrequent ophthalmologic events.  Treatment options have consisted of enucleation, systemic chemotherapy, plaque brachytherapy, and fractionated external beam radiation.  Although SRS with the Gamma Knife is an accepted treatment for primary uveal melanoma with good efficacy and safety, its documented use in the treatment of uveal metastases is lacking.  In this webinar, the indications, technique, and outcomes of treatment of uveal metastases with the Gamma Knife will be explored.

Physics

SRS Physics - Imaging and QA | by Ian PADDICK, Medical Physicsist | October 11, 2016

by Ian PADDICK, Medical Physicsist

This 60 minute presentation covers Quality Assurance tests for radiosurgery, including the QA of image distortion, which potentially can represent the largest factor in treatment uncertainty.

MR-Guided Adaptive Stereotactic Radiotherapy | by Miguel PALACIOS, PhD, Medical Physicist Radiotherapy | April 13, 2017

by Miguel PALACIOS, PhD, Medical Physicist Radiotherapy

Magnetic resonance imaging (MRI) offers the best anatomical information and it can be used for adaptive radiation therapy.  In this webinar an overview of the key components to implement stereotactic magnetic resonance adaptive radiotherapy (SMART) will be discussed. Examples will be highlighted with the MRIdian system (ViewRayTM), which enables to perform continuous MRI during RT delivery and rapid adaptive planning and beam-delivery control based on visualization of soft tissues.

Dose Differences According to Different Planning Philosophies | by Ian PADDICK, Medical Physicsist | August 03, 2017

by Ian PADDICK, Medical Physicsist

Common parameters quoted with clinical treatment often give an incomplete picture of the actual doses delivered to the radiosurgical target. Doses adopted from one centre to another can in reality be significantly different due to subtle variations in parameters such as target definition, normalisation, coverage, gradient and margins applied. In this webinar, the effect of planning parameters on the delivered treatment are examined and the case for a standardisation of dosimetric parameters made.

The Patient QA Problem in Radiosurgery: What Are the Most Recent Recipes in the Dosimetry Cookbook? | by Elena DE MARTIN, Medical Physicist | May 24, 2018

by Elena DE MARTIN, Medical Physicist

Considering the complexities of the dose delivery process in stereotactic radiosurgery, dosimetry verification of patient-specific treatments prior delivery is critical to the clinical outcome. Despite this, there are no single definitive detector or procedure recommended and an overview of the possible different approaches will be given in this presentation. 

The Challenge of Dosimetry in Stereotactic Radiosurgery: New Detectors for Machine and Patient’s Quality Assurance | by Marco PETASECCA, MD, PhD, Associate Professor | June 25, 2018

by Marco PETASECCA, MD, PhD, Associate Professor

Use of photon small fields have been an established practice in stereotactic radiosurgery for many years and have more recently been extended to extra‐cranial stereotactic treatments. Large discrepancies in dosimetric measurements amongst institutions have been reported as well as incidents primarily as a result of the use of inappropriate detectors and consequent inadequate modelling of the photon beam in the treatment planning systems. The source of many of the mistreatments is the fact that it's often forgotten that much of the theory, practice and beam modelling in radiation therapy is based on the implicit assumption of the more common broad fields. Small field conditions occur as a result of the initial beam energy, lack of charge particle equilibrium and geometrical source occlusion. Lateral disequilibrium varies the central-axis spectrum while collimation of the beam varies the off-axis spectrum with a strong dependence upon the type and composition of the collimator. Accurate measurement of dosimetric quantities for modelling of the beam in such conditions, strongly depends on the size and technology of the detector adopted with respect to the field dimensions and beam energy. Commercial and state-of-the-art dosimeters and their performance in small field dosimetry are presented in relation to their use in stereotactic radiosurgery.

How Small is Too Small? QA & QC for HyperArcTM SRS | by Richard POPPLE, PhD, Professor and Vice-Chair for Physics | May 07, 2019

by Richard POPPLE, PhD, Professor and Vice-Chair for Physics

Quality assurance for linear accelerator intracranial radiosurgery using the Varian HyperArcTMsystem will be discussed. Both mechanical and dosimetric QA will be reviewed, with particular emphasis on patient-specific dosimetry of targets as small as 3 mm. The experience at The University of Alabama at Birmingham will be presented.

Spine

SRS for Spine Tumors | by Samuel RYU, MD, Professor | March 14, 2017

by Samuel RYU, MD, Professor

In this webinar session, I will cover the topic of Stereotactic Radiosurgery (SRS) for spine tumors. In this context, I will review the safety and efficacy of SRS for spine metastasis, and discuss the ongoing RTOG (NRG) 0631 trial. There will be an emphasis on the spinal cord partial volume tolerance and radiosurgical decompression of malignant spinal cord compression.

Post-Operative SBRT | by Arjun SAHGAL, MD, PhD, Associate Professor | March 28, 2017

by Arjun SAHGAL, MD, PhD, Associate Professor

The objective of this presentation is to understand the current evidence as it pertains to the rationale for post-operative SBRT, the clinical data to support it, the technique and current consensus guidelines with respect to contouring, and the issues with respect to the presence of hardware and response determination.

SRS in Spinal AVMs | by Kita SALLABANDA, MD, Professor | February 27, 2019

by Kita SALLABANDA, MD, Professor

Spinal Arteriovenous Malformations (AVMs) are rare but very important with high morbidity pathology, especially when localized intra-medullary. We have to transfer all our knowledge about the treatment of brain AVMs in different conditions, and different organs at risk. For these reasons, it is very important to have all the necessary information including angiography, MRI, and to clarify which type of intra-medullary AVMs we can treat.  There are four types of medullary AVMs but only type II can be treated.

Is very important the adequate technology and the margin dose have to be decided in relationship with the localization, volume and blood supply. 

In this webinar, we will present some cases and plan the philosophy of treatment.

Other

Radiobiology of Radiosurgery (A Neurosurgeon’s Perspective) | by Antonio DE SALLES, MD, Professor | November 07, 2016

by Antonio DE SALLES, MD, Professor

Radiosurgery has revolutionized Neurosurgery, Radiation Oncology and Medical Physics. The matched surgical results and even superior in many instances with radiation delivery precision asks for novel Radiobiology understanding... read more

Exploring, Understanding and Exploiting the Radiobiology of Radiosurgery | by John KIRKPATRICK, MD, PhD, Associate Professor | February 13, 2017

by John KIRKPATRICK, MD, PhD, Associate Professor

Stereotactic radiosurgery (SRS) provides a unique ability to ablate tumors while minimizing damage to surrounding normal tissues.  While the efficacy and safety of SRS have been established based on several decades of treatment of intracranial and, more recently, extracranial disease, the underlying radiobiology is controversial.  In this presentation, we will present and discuss the evidence and opinions on the fundamental and clinical aspects of radiobiology at high dose/fraction, focusing on the reduction of what is known to guide clinical practice, today, and what needs to be understood to optimize SRS, in the future.

Differentiation of Radiation-Induced Changes and Tumor Progression After Intracranial Radiosurgery | by Mikhail CHERNOV, Assistant Professor | November 09, 2017

by Mikhail CHERNOV, Assistant Professor

A number of intracranial tumors demonstrate some degree of enlargement after stereotactic radiosurgery. It necessitates differentiation of their regrowth and various treatment-related effects. The diagnosis is frequently complicated by histopathological heterogeneity of the lesion with coexistent viable neoplasm and radiation-induced tissue changes. Several neuroimaging modalities, namely structural MRI, DWI, DTI, perfusion CT and MRI, single-voxel and multi-voxel proton MRS, as well as SPECT and PET with various radioisotope tracers, may provide valuable diagnostic information. Each of these methods has advantages and limitations that may influence their usefulness and diagnostic accuracy.

Synergy of Immunotherapy and SRS | by Daniel TRIFILETTI, MD, Assistant Professor | December 05, 2018

by Daniel TRIFILETTI, MD, Assistant Professor

Stereotactic radiosurgery has been proposed as a method to create a personalized, in situ tumor vaccine, allowing for the patient’s innate immune system to target malignant cells within and well outside of the radiosurgical target (either intracranial or extracranial). This brief lecture will summarize this biologic rationale, existing clinical data to date, as well as future unanswered questions.

The Origins and Development of Radiosurgery and the Leksell Gamma Knife | by Dan LEKSELL, MD, Chairman | March 07, 2019

by Dan LEKSELL, MD, Chairman

In the 1930’s a young Lars Leksell joined Herbert Olivecrona in his operating room in Stockholm. The experience, with all its “blood, sweat and tears” and with up to 60 percent surgical mortality, prompted a lifelong quest for ways to minimize neurosurgical trauma. In the late 1940’s he developed his own stereotactic instrument, the basic principle of which became the basis for the methodology that in a landmark paper of 1951 was termed radiosurgery. The first tool for radiosurgery, the Leksell Gamma Knife, was finalized in 1967. Since then radiosurgery has evolved to cover much of what neurosurgeons do every day and over 1.2 million patients have benefited from non-invasive Gamma Knife brain surgery worldwide.

The History of Linac Radiosurgery | by Raymond A SCHULZ, MSc | March 27, 2019

by Raymond A SCHULZ, MSc

The origins of SRS begin with cross-fired radiation beams in the early 1900s followed by early stereotactic neurosurgery in the 1930s.  The first Linac-based SRS treatments were performed by neurosurgeons Betti in 1982 and Colombo in 1983 preceded by the pioneering work of Leksell in the 1950s. With thousands of SRS capable or dedicated linac-based SRS systems installed, treatments are performed on many systems around the world on many patients with unparalleled precision and speed. This talk will review key milestones and related technologies in the development of Linac-based SRS for intra and extra-cranial SRS with an eye to future developments.

Boron Neutron Capture Therapy: Current State and Future Perspectives | by Alexander ZABORONOK, MD, PhD, Assistant Professor | April 10, 2019

by Alexander ZABORONOK, MD, PhD, Assistant Professor

Boron neutron capture therapy (BNCT) is a unique alternative approach to malignant tumor radiotherapy that provides eradication power at the single tumor cell level within normal tissues holding curative potential for invasive cancers, including head and neck cancer, malignant melanoma, and multiform glioblastoma.

Stereotactic Radiotherapy and Radiosurgery for Neurosurgical Pathology in Pediatric Patients | by Andrey GOLANOV, MD, PhD | April 25, 2019

by Andrey GOLANOV, MD, PhD

The presentation will be devoted to the experience of treatment (more than 1,500 observations) of pediatric patients with various tumors (benign and malignant gliomas, craniopharyngiomas, medulloblastomas, etc.) and vascular pathology in the radiotherapy and radiosurgery department and in the center of Gamma Knife (Moscow, Russia). Indications, peculiarities of carrying out, long-term results of application will be given and the possibilities of stereotactic irradiation in the children's neurosurgical clinic will be discussed.