Authors' objectives:

In a number of diseases of the brain and associated structures the methods of microsurgery are limited. For such situations radiosurgery is an option. Radiosurgery is defined by the biological inactivation or destruction of intracranial 3D targets by high-precision ionising radiation during on single session. One important indication is the treatment of brain metastases. Different forms of applying radiosurgery exist including gamma knife, adapted linear accelerators and proton beam systems. For this assessment we compared two of these – gamma knife and adapted linear accelerator – with a focus on clinical effectiveness and cost.

Authors' recommendations: There are statements from studies indicating a similar effect of both technologies – gamma knife and adapted linear accelerator. However, the strength of this evidence is low. In addition most of the indications for radiosurgery seem to be questionable and should be evaluated by randomised controlled studies which compare radiosurgery with the latest available treatment options. In the interest of a growing population of affected people, studies that evaluate the benefits and harms of radiosurgery should predominantly be funded. If both modalities are available the dose distribution characteristics indicate the use of gamma knife for small lesions (better conformity, efficient workflow), while the adapted LINAC has advantages with bigger volumes (faster, better coverage, homogeneity). From a cost perspective the LINAC system seem to be more versatile in it’s use and thereforerecommended, when radiosurgery case numbers are small. Local variables (consented indications, case numbers, existing equipment, experience of personnel) should be carefully evaluated to allow a decision that meets criteria of an efficient patient care.

Project Status: Completed

URL for project: http://eprints.hta.lbg.ac.at/901/

Year Published: 2010

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Austria

Organisation Name: Ludwig Boltzmann Institute for Health Technology Assessment

Contact Address: Ludwig Boltzmann Institute for fuer Health Technology Assessment (LBI-HTA), Garnisongasse 7/rechte Stiege Mezzanin (Top 20), 1090 Vienna, Austria. Tel: +43 1 236 8119 - 0 Fax: +43 1 236 8119 - 99

Contact Name: tarquin.mittermayr@aihta.at

Contact Email: office@aihta.at

Copyright: Ludwig Boltzmann Institut fuer Health Technology Assessment (LBI-HTA)