Stereotactic radiosurgery: options for Albertans

Schneider W L, Hailey D
Record ID 31998008643
Authors' objectives: Provide an overview of the effectiveness and status of stereotactic radiosurgery (SRS). Compare the two most commonly used devices, gamma knife and focused linear accelerator. Provide costs for sending patients out of province/country versus offering SRS in Alberta.
Authors' results and conclusions: SRS has been most widely used in the treatment of brain metastases, arteriovenous malformations (AVMs) and acoustic neuromas. The two most common approaches to SRS use the Gamma Knife- or focused linear accelerator (LINAC). Each delivers a focused beam of radiation to a tumour or malformation while sparing healthy tissue. There is insufficient information to determine the comparative effectiveness of the GK and LINAC approaches. The data on comparison of SRS with other types of treatment are also limited. Excellent quality assurance and placement of SRS in specialized centres are essential.
Authors' recommendations: SRS is a useful technology in the treatment of a number of neurological conditions. However, the quality of the evidence of effectiveness, especially in terms of long-term outcomes, remains limited. SRS in the treatment of brain metastases show indications of good local control, and improvements to quality of life through increased functional independence. The effects on survival are less clear and the basis for comparison with other approaches to treatment is weak. The role of SRS in relation to surgery still does not seem well defined with respect to treatment of AVMs and acoustic neuromas. Microsurgery will remain a major option for patients with these conditions. Both the GK and LINAC approaches to SRS continue to be widely used. There is no evidence that either one is more effective than the other. Given the substantially higher costs of the GK approach, only referral to good quality LINAC SRS facilities should be considered for patients in Alberta. Excellent quality assurance, expertise in advanced diagnostic imaging and planning, and involvement of a multi-disciplinary team of health professionals are essential for an SRS facility. Only one SRS site in Alberta would be appropriate, given the caseload and the need for expertise and the wish for cost-efficiency. The Alberta cost per case might be of the order of $4,000. This compares favourably with costs of out-of-province referral, either to centres in Canada or in the U. S. For some cases, SRS would provide a cheaper option than surgery, at least in the short-term. However, there would be a need to consider patient selection and longer-term outcomes very carefully before a judgment could be made on the appropriate place of each technology. An Alberta-based SRS centre should systematically collect data on the patients it treats, including long-term follow-up, and seek to develop links with other SRS centres in North America.
Authors' methods: Systematic review
Project Status: Completed
Year Published: 1998
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Humans
  • Brain Neoplasms
  • Radiosurgery
  • Treatment Outcome
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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Copyright: <p>Alberta Heritage Foundation for Medical Research</p>
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