On the morning of December 17, 2009, Physicians at the University of Pittsburgh Medical Center (UPMC) used Gamma Knife? surgery to treat the center’s 10,000th patient, an 81-year-old male with a tumor deep in his brainstem, a site where traditional surgery would have been impossible. Gamma Knife surgery was performed using Elekta’s Leksell Gamma Knife system, which directs up to 201 pencil-thin beams of therapeutic radiation precisely on brain tumors and other targets in the head.Minimally invasive and highly focusedThe 10,000th patient came to the University of Pittsburgh Medical Center with worsening balance problems. A magnetic resonance imaging (MRI) scan of his brain revealed the small lesion, known as a metastasis — a secondary tumor whose origin was a primary tumor located somewhere else in his body. The site of this patient’s primary lesion was unclear, as are approximately 30% of cancers that go to the brain, said L. Dade Lunsford, M.D., Lars Leksell Professor and Distinguished Professor of Neurological Surgery at the University of Pittsburgh, and co-director, Center for Image-Guided Neurosurgery, UPMC.”Because the patient had no known primary tumor, we performed a minimally invasive biopsy of the brain tumor during a procedure that began at 6:30 a.m. We confirmed that the lesion was a metastatic tumor requiring intervention,” said Dr. Lunsford, who was the first clinician to use Leksell Gamma Knife in the United States. “At 9:30, we used our Leksell Gamma Knife? Perfexion? system to deliver the radiosurgery, which took about 38 minutes.”The patient is in excellent condition, and went home after his biopsy followed by Gamma Knife surgery, UPMC officials reported.The first casePhysicians working for the University of Pittsburgh Medical Center treated the first case in 1987, a patient with an acoustic neuroma, a benign tumor of the nerve that connects the ear to the brain.The center incorporates the expertise of individuals in stereotactic and functional neurosurgery, brain tumor surgery, Gamma Knife radiosurgery, neuro-oncology, radiation oncology, and neuroradiology. The goal of the center is to provide quality patient care using minimal access or minimally invasive techniques that utilize stereotactic and radiosurgery technology, high resolution neuroimaging, and advanced computer systems. The center provides care to patients with brain tumors, vascular disorders, movement disorders, and pain problemsSince 1987, and particularly in the last 15 years, UPMC has used Leksell Gamma Knife to treat almost 4,000 patients who had one or more metastases. Although historically, clinicians have turned to Gamma Knife surgery when whole brain radiation therapy fails or if new tumors arise, this non-invasive technique is rapidly becoming the first treatment option, Dr. Lunsford noted.In 1987, UPMC acquired its first Leksell Gamma Knife system. Radiosurgery also is used to manage benign lesions, including acoustic neuromas, meningiomas and skull base tumors. In addition, Gamma Knife surgery has been used to eliminate arteriovenous malformations (AVM).Since 1987, the number of patients receiving Gamma Knife surgery at UPMC has increased from 150 patients annually to between 650 and 700 patients per year using both of the two Gamma Knife units at the UPMC Center for Image Guided Neurosurgery. The UPMC Gamma Knife Center’s staff now includes four neurosurgeons, three radiation oncologists and four medical physicists. The medical center’s most recent advance was the 2007 acquisition of Leksell Gamma Knife Perfexion, the fifth generation and most sophisticated radiosurgery system on the market.”Where Gamma Knife surgery is available, I suspect more than 50% of patients will receive this therapy as the primary treatment for newly diagnosed cancer that has spread to the brain, to avoid the known long term cognitive decline associated with whole brain radiation,” he said.Advances in imaging technology, such as MRI, enable doctors to detect metastases at earlier stages of cancer evaluation, before the tumors become large and begin to cause symptoms. This development, coupled with Gamma Knife precision, has led to its increased use to treat brain metastases.”With Gamma Knife, patients whose cancer has spread to the brain now have an excellent chance that the problem can be controlled,” Dr. Lunsford observed. “Doing less invasive surgery is a way that we can definitely improve patient outcome. We reduce hospital stays, we reduce cost and we get patients back in the workforce faster.”More than 500,000 patients worldwide have had Gamma Knife surgery, with about 50,000 patients annually receiving the therapy.
