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Gamma Knife Alone vs Whole Brain Radiation

Gamma Knife Radiosurgery alone is a preferred treatment to whole brain radiation therapy for brain metastasis, or cancer that has spread to the brain. Gamma Knife radiosurgery without whole brain radiation therapy should be an option to all patients diagnosed with brain metastasis except people with small cell lung cancer. The conventional therapy for brain metastasis has been whole brain radiation therapy. It is still the most common treatment because most hospitals and radiation oncology facilities do not have a Gamma Knife. Whole brain radiation therapy has been shown to cause severe memory deficits and severe thinking ability problems. In addition, sometimes it causes inability to walk. Recently there was a study that demonstrated people who had whole brain radiation therapy did not live as long as people who just had their individual tumor treated with radiosurgery using pinpoint accuracy. The study demonstrated longer survival statistics and improved quality of life for patients who just had their tumor treated with radiosurgery and had no whole brain radiation.

  1. What is Gamma Knife Radiosurgery?
  2. What is better whole brain radiation or Gamma Knife radiosurgery for brain metastasis?
  3. What is whole brain radiation therapy?
  4. What are brain metastasis?
  5. If Gamma Knife Radiosurgery is superior to whole brain radiation therapy, why aren't all centers giving it?
  6. Are there devices other than Gamma Knife for radiosurgery?
  7. What are the effects of Whole Brain Radiation Therapy?
  8. It is clear that Gamma Knife Radiosurgery is superior to whole brain radiation therapy. Is there any role or benefit for whole brain radiation therapy?
  9. My doctor told me that whole brain radiation therapy decreases the chance of other brain tumors arising compared to radiosurgery alone. Is that true?
  10. Does insurance cover Gamma Knife Radiosurgery alone without whole brain radiation therapy?
  11. Can I talk with a doctor about Gamma Knife Radiosurgery or whole brain radiation therapy?
  12. How many brain tumors can be treated with the Gamma Knife?
  13. After Gamma Knife radiosurgery, if new tumor arises in the future, can those new tumors be treated with Gamma Knife radiosurgery?
  14. Are people with metastasis from small cell lung cancer to the brain candidates for Gamma Knife radiosurgery alone?

What is Gamma Knife Radiosurgery? top

Gamma Knife Radiosurgery is composed of 201 pinpoint focused radiation beams all targeted to a persons tumor. The multiple focused converging beams come together to create a high intensity of radiation on the tumor but almost no radiation to normal brain tissue. Gamma Knife Radiosurgery is not surgery at all. The treatment is a single treatment and does not require hospitalization. Because the rest of the brain receives very little radiation, dangerous side effects and complication such as permanent memory loss, hair loss, severe fatigue, and permanent decreased thinking ability are not experienced with Gamma Knife radiosurgery as they are with whole brain radiation therapy.

What is better whole brain radiation or Gamma Knife radiosurgery for brain metastasis? top

Gamma Knife Radiosurgery is a better treatment than whole brain radiation therapy for patients who are candidate for it. Patients who have radiosurgery without whole brain radiation therapy live longer and have better quality of life without permanent memory loss and decreased thinking ability. Also, they avoid the side effect of persistent fatigue, scalp irritation, and hair loss.

What is whole brain radiation therapy?  top

Whole brain radiation therapy is what it sounds like. It is a daily treatment Monday through Friday of radiation therapy to the whole brain. Whole brain radiation therapy treats the whole brain with radiation using a linear accelerator. The linear accelerator gives half the treatment from one side of the patients head for half the treatment and the other side for the other half of the treatment. The treatment takes about 5 minutes.

What are brain metastasis? top

Brain metastases are cancerous tumors that arise in the brain from another site. The most common example is from lung cancer that moves to the brain. Other cancer that go to the brain are breast, melanoma, kidney, and colon.

If Gamma Knife Radiosurgery is superior to whole brain radiation therapy, why aren't all centers giving it? top

Gamma Knife Radiosurgery is not offered for a few reasons. First, the Gamma Knife is very experience high tech piece of equipment and most radiation centers and hospitals do not possess one and therefore do not offer it to their patients. Secondly, whole brain radiation therapy has been the only treatment for as long as we have had radiation therapy because that was the only thing that was available. Trends in medicine often move slowly and most doctors outside of the field are not aware of the technology and the poor outcomes of whole brain radiation therapy. Whole brain radiation therapy is not wrong. It just does not produce the best results of length of survival and quality of life.

Are there devices other than Gamma Knife for radiosurgery? top

Yes. Gamma Knife is the gold standard for radiosurgery. Other devices with different mechanism exist. They are linear accelerator based devices. Some are on a gantry and some are on a robot.

What are the effects of Whole Brain Radiation Therapy? top

Whole brain radiation therapy causes early side effects of hair loss, severe fatigue, occasional nausea, and scalp sunburn like reaction. Long term effects can occur months to years into the future and include permanent short term memory loss, permanent decease thinking ability, risk of not being able to walk, risk of stroke. Occasionally patients suffer fatigue that lasts for months but eventually goes away. There is recent evidence suggesting patients that get whole brain radiation therapy don't live as long as patients with Gamma Knife Radiosurgery alone.

It is clear that Gamma Knife Radiosurgery is superior to whole brain radiation therapy. Is there any role or benefit for whole brain radiation therapy? top

Whole brain radiation therapy is necessary when there are too many cancerous tumor in the brain to treat practically with Gamma Knife Radiosurgery. Also, tumor can be too large to treat with radiosurgery. In situation such as this, it is often worth trying to shrink the tumor with partial brain radiation therapy and then using Radiosurgery to give a boost of radiation to the tumor. This approach avoids whole brain radiation therapy. Whole brain radiation therapy has been shown to decrease the rate of new tumors that arise in the brain. These if new tumor arise in the brain they can be effectively eliminated with Gamma Knife radiosurgery.

My doctor told me that whole brain radiation therapy decreases the chance of other brain tumors arising compared to radiosurgery alone. Is that true? top

Whole brain radiation therapy does decrease the chance of other tumors arising in the brain. Whole brain radiation therapy decreases the chance from about 30% to 10%. However, whole brain radiation therapy causes side effects and late effects on memory and thinking ability. Also, there is evidence that length of survival is worse with radiation therapy to the whole brain. After Gamma Knife Radiosurgery, the brain needs to be monitored with MRI scans every three months. If other tumors arise, they can be treated with Gamma Knife radiosurgery.

Does insurance cover Gamma Knife Radiosurgery alone without whole brain radiation therapy? top

Yes. It is a standard treatment covered by insurance.

Can I talk with a doctor about Gamma Knife Radiosurgery or whole brain radiation therapy? top

You can contact a doctor from Cancer Treatment Group but telephone - 219-945-1050 or emailrwctg@comcast.net. A doctor will get back to you within 24 hours. To learn more about Cancer Treatment Group and the technology at Methodist Hospital Cancer Center vist the web site, Cancer Treatment Group.

How many brain tumors can be treated with the Gamma Knife? top

Each institution has general guidelines. Most try will start recommending whole brain radiation therapy with patients have over 7-10 tumors.

After Gamma Knife radiosurgery, if new tumor arises in the future, can those new tumors be treated with Gamma Knife radiosurgery? top

Yes. It is important to obtain regular MRI scans of the brain to ensure that the new tumors are caught small and will therefore be easily amenable to Gamma Knife radiosurgery.

Are people with metastasis from small cell lung cancer to the brain candidates for Gamma Knife radiosurgery alone? top

No. Small cell lung cancer, not to be mistaken for NON-small lung cancer, has a very high probability of coming back in the brain elsewhere(80%) and therefore whole brain radiation therapy is necessary to decrease the very high chance.