Stereotactic radiosurgery: an update

Alberta Heritage Foundation for Medical Research
Record ID 32002000809
Authors' objectives:

This report has been prepared in response to a request from Alberta Health and Wellness for an update on advice provided in earlier assessments by the Foundation on stereotactic radiosurgery (SRS) treatment.

Authors' recomendations: The present report is consistent with findings from assessments by other agencies that the quality of the available evidence on SRS effectiveness in comparison with other types of treatment is limited. There is still no evidence that any one form of SRS is superior over another. There is some indication, from small studies, of similar outcomes from the Gamma Knife (GK) and focused linear acceleration (LINAC) versions of SRS. There is increasing use of fractionated stereotactic radiotherapy (FSRT) as an alternative or supplement to SRS. There is some indication, from small series, that FSRT may have advantages over SRS in some situations in terms of incidence of complications. A version of SRS, using robotic technology (the Cyberknife), that enables treatment in any part of the body is now commercially available and preliminary clinical results have been published. The GK approach is more expensive than that using standard LINAC approaches or FSRT. Costs of using recent developments in LINAC technology are not yet clear. The need remains to go beyond cost analysis to economic evaluation, taking appropriate account of local circumstances. Many journal articles, as well as HTA reports, confirm advice given in earlier AHFMR assessments that excellent quality assurance and placement of SRS in specialized centres are essential. On the basis of information available in the published literature, conclusions on the place of SRS in the applications considered in the assessment are as follows: - Acoustic neuroma: Microsurgery remains the treatment of choice for many patients. SRS has a useful place where surgery would have an unacceptable risk or be refused. Long term follow up data on SRS treatment are still comparatively limited. FSRT appears to have potential as an alternative to LINAC or GK SRS. - AVMs: Microsurgery and SRS should be regarded as complementary approaches. Surgery is preferred if the lesion can be safely excised. Further information is emerging on longer term complications of SRS. - Trigeminal neuralgia: There are a number of options for treatment of trigeminal neuralgia and the place of SRS in its management does not seem to be established. - Brain metastases: SRS has a place in the management of appropriately selected patients, is a useful option when the patient is not a candidate for surgery and may offer advantages through relief of neurological symptoms. SRS plus radiotherapy appears more effective than radiotherapy alone. - Brain tumours: SRS appears to be a useful adjunctive treatment, though with reletively limited success with malignant glioma, in appropriately selected patients. It is helpful where surgery is not possible or carries unacceptably high risks. - Parkinson's disease: Encouraging results have been reported by one centre, but the place of SRS in the treatment of Parkinsons Disease does not appear to be established. - Epilepsy: The efficacy of SRS in the management of epilepsy appears not to have been established, other than in association with its use in treatment for AVMs or brain tumours. SRS is now being used in Alberta, with a LINAC facility at the Tom Baker Cancer Centre, Calgary for treatment of malignant disease. Any referral of patients from Alberta for SRS treatment outside the province should be to centres of excellence with experience in management of the condition in question, and take account of the availability of other, appropriate, treatment options.
Authors' methods: Review
Project Status: Completed
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Arteriovenous Malformations
  • Brain Neoplasms
  • Epilepsy
  • Neuroma, Acoustic
  • Parkinson Disease
  • Radiosurgery
  • Trigeminal Neuralgia
Organisation Name: Institute of Health Economics
Contact Address: 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4. Tel: +1 780 448 4881; Fax: +1 780 448 0018;
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Alberta Heritage Foundation for Medical Research (AHFMR)

This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.