Brain and Spinal Cord Cancer
The Departments of Radiation Oncology and Neurosurgery work together to provide patients with the most comprehensive multidisciplinary management of brain and spinal cord (Central Nervous System or CNS) cancer available. Each case is discussed at a CNS Tumor Board, a meeting with oncology specialists from all related departments where a consensus is reached about the best course of treatment. The most current and effective treatment approaches are provided in ultramodern settings where patient privacy and comfort are foremost.
There are two main types of radiation treatments, external and internal, that can be used according to the needs of the patient. External beam radiation is delivered by a linear accelerator or other specialized radiation equipment that produces high energy x-ray, gamma rays or electron beams. Internal radiation or brachytherapy uses radioactive materials that are placed within or next to the cancerous tissue.
External Beam Radiotherapy
External beam radiation is the most common form of radiotherapy for brain and spinal cord cancers. A linear accelerator or a treatment machine called a Gamma Knife® produces beams of radiation that are aimed at the cancerous tissue. Based on the needs of each patient, the treatment may be administered during either a single treatment session or a series of up to 33 sessions. There is little or no discomfort from the actual radiation treatment.
Gamma Knife® Radiosurgery
At NewYork-Presbyterian, Gamma Knife® treatments are provided as part of a full spectrum of precision radiation therapy techniques. Our center is one of only 100 sites worldwide to have this 20-ton radiosurgery system and it is used in the treatment of tumors, arteriovenous malformations and other abnormalities of the brain.
The Gamma Knife® is not a knife, but rather a highly developed treatment system, capable of directing up to 201 beams of gamma radiation to converge on a targeted abnormality within the brain. When concentrated, the rays provide enough radiation to treat the diseased area effectively; while the low intensity of each individual beam ensures the safety of the surrounding healthy brain tissue.
Gamma Knife® radiation is either given after surgery or it is used instead of surgery. It is non-invasive, virtually painless and unlike traditional open-skull surgical procedures, patients can usually go home the same day and return to work or school immediately.
With the Gamma Knife®, areas of the brain for which other therapies or conventional surgery are ineffective, can be successfully treated. The precision and safety of the Gamma Knife® make it a highly appropriate choice for both pediatric and adult patients.
Linear Accelerator Based Brain Radiosurgery
NewYork-Presbyterian also offers linear accelerator based stereotactic radiosurgery which provides radiation in the form of a single highly focused beam applied in multiple sweeps around the brain lesion. This highly accurate form of treatment is ideal for the treatment of certain types of tumors. This method uses either a single session treatment called stereotactic radiosurgery or multiple treatment sessions called fractionated stereotactic radiotherapy, with each offering advantages for appropriately selected patients.
Both stereotactic radiosurgery and stereotactic radiotherapy are non-invasive treatments that use pencil-thin beams of radiation generated by a special linear accelerator to treat brain abnormalities safely, effectively, and without any incisions. There is little or no discomfort during the actual treatments and they can be performed on an outpatient basis without many of the usual risks and side effects associated with surgery. Our expert radiation oncologists use sophisticated 3-dimensional computer-generated treatment plans that allow the radiation dose to be concentrated on the tumor while sparing surrounding healthy brain tissue.
Our treatment team is staffed by experts with highly specialized knowledge and skills in neurosurgery, neuroradiology, neurology, radiation therapy and radiation physics. Supported by many years of research and successful treatment of patients, the stereotactic program applies the latest technological advances in neurosurgical and radiation therapy principles to provide patients with the most advanced treatment available.
Stereotactic Body Radiosurgery for Spinal Cord Cancers
Cancers of the spinal cord can be effectively treated using a linear accelerator based technology called Stereotactic Body Radiotherapy (SBRT). A sophisticated Stereotactic Body Frame is used during imaging studies to precisely map a patient's internal anatomy in 3 dimensions relative to the frame. Later, the frame allows us to very accurately aim radiation beams at the area to be treated. A highly sophisticated computerized radiosurgery program is used to direct multiple pencil-like radiation beams to converge precisely on the target area. The added precision of this system allows higher tumor doses and less radiation to the surrounding normal tissue.
Intensity-Modulated Radiation Therapy (IMRT) and 3D Conformal Therapy
We are also leaders in using IMRT and 3D conformal therapy for pediatric and adult CNS tumors since its first application over 10 years ago. During IMRT and 3D therapy, the intensity of the radiation beam is varied or modulated and shaped to exactly match the shape of the tumor being treated.
Advanced Imaging Techniques
At NewYork-Presbyterian, we often use technology that combines or "fuses together" magnetic resonance images (MRI), positron emission tomography (PET) and CAT Scan images to help us determine the geometric and metabolic characteristics of each tumor. This process allows for better treatment planning and maximizing the benefit of IMRT.
Brachytherapy For Brain Lesions
The Radiation Oncology and Neurosurgery departments collaborate to offer the GliaSite®: Program for the treatment of certain kinds of brain tumors. After the surgical removal of a brain tumor, this program uses internal radiation or brachytherapy to treat the tissue that was formerly surrounding the tumor.
With GliaSite® technology, a small catheter is inserted into the affected area of the brain following the removal of a brain tumor. Later, a radioactive solution is put into the catheter for several days to treat any tumor cells that might still be in the surrounding tissue. After the treatment is completed the catheter is removed.