Current radiosurgery practice: results of an ASTRO survey. Task Force on Stereotactic Radiosurgery, American Society for Therapeutic Radiology and Oncology.
ABSTRACT Although there is increasing interest in radiosurgery, little quantitative data regarding current patterns of radiosurgery practice are available. We developed a radiosurgery questionnaire to obtain information on radiosurgery practice.
We distributed the questionnaire to the entire membership of the American Society of Therapeutic Radiology and Oncology in early 1993. Responses were obtained from 74 facilities that practice radiosurgery, corresponding to over 6000 treatments carried out since 1983 by 135 radiation oncologists and 130 physicists.
Most respondents were found to work within a multidisciplinary team, consisting of the following specialists (average hours devoted per patient on day of treatment in parentheses): radiation oncologist (3.8), neurosurgeon (3.2), physicist (6.1), radiologist (0.7), nurse (2.7), other (3.0). On average, neurosurgeons and nurses who perform Gamma Knife radiosurgery devote significantly more time-per-patient on the day of treatment than their peers who perform linac radiosurgery. On average, less experienced radiation oncologists and physicists (< or = 24 months experience, or < or = 50 patients treated) devote significantly more time-per-patient on the day of treatment than their more experienced peers. Although there are many more linac radiosurgery facilities than Gamma Knife facilities, on average the number of patients treated per month per facility is significantly larger at the latter. On average, follow-up responsibilities are nearly equally shared by radiation oncologists and neurosurgeons, except at Gamma Knife facilities, where neurosurgeons assume a larger percentage of follow-up responsibility. The percentages of patients treated at linac facilities for metastases or primary CNS malignancy are larger than the corresponding percentages at Gamma Knife facilities; the opposite is true for arteriovenous malformation, acoustic neuroma, and meningioma.
Current radiosurgery practice usually involves a team approach, with participation of specialists from radiation oncology, neurosurgery, physics, radiology, and nursing. The average number of M.D. and Ph.D. hours required per treatment on the day of radiosurgery is high.
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ABSTRACT: For this article a comprehensive and politically legitimate list of criteria to evaluate energy systems was constructed from interviews with leading representatives of a broad spectrum of West German society. In the interviews, we probed the fundamental values of nine political and social organizations, including the Catholic and Lutheran Churches, the Federation of German Labour Unions, the Association of German Industries and the German Nature Society. A hierarchical representation of value criteria was logically structured for each group separately, and then aggregated into a combined ‘value tree’. The result facilitates communication and constructive compromise, promotes the creation of policy options and helps evaluate future energy systems.Energy Policy 08/1987; 15(4-15):352-362. DOI:10.1016/0301-4215(87)90025-5 · 2.70 Impact Factor
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ABSTRACT: The dramatic proliferation of radiosurgery in the 1980s and 1990s has resulted in the development of a plethora of hardware systems and an exponential increase in clinical use. This article summarizes the initial, now mostly historical, developments and emphasizes that most linear accelerator radiosurgery systems are based on three early prototypical systems from Buenos Aires, Heidelberg, and Montréal. These systems have more recently been tailored to permit fractionated radiosurgery, blurring the distinction between radiosurgery and radiotherapy. The commonly used fractionated systems are described. Clinical outcome data for arteriovenous malformations, acoustic neuroma, and meningioma, are mostly preliminary but substantial data are available for the radiosurgical management of metastases. With the recent emphasis on cost containment, cost-effectiveness issues have become significant and at least for metastases some preliminary data suggest a potential “cost benefit” with radiosurgery. The recent publication of data from a prospective randomized trial has established the superiority of boost therapy for malignant glioma and in this article, we present preliminary evidence supporting the use of radiosurgery. Finally, some of the new and exciting developments such as the robot-mounted linear accelerator, the use of shaped fields, and tomotherapy are described.Seminars in radiation oncology 08/1995; 5(3-5):203-212. DOI:10.1016/S1053-4296(05)80018-9 · 3.77 Impact Factor
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ABSTRACT: Since Leksell's description of the concept of radiosurgery in 1951, probably more than 20,000 patients worldwide have been treated with this technique. Initially designed as a tool for functional neurostereotaxis, it has found widespread applicability for conditions as diverse as vascular malformations, benign tumors such as acoustic neuroma, meningioma, pituitary adenoma, and also malignant tumors such as brain metastases and malignant glioma. From rudimentary knowledge of the ability to produce focal necrotic lesions, the biologic understanding of the process of single-fraction, small-volume, high-dose brain radiation has evolved into a multicompartmental model, with reasonable appreciation of the dose, volume, and time factors involved. With the explosion of technology on several fronts in the 1980s and 1990s, a multitude of devices for radiosurgery, ranging from cyclotron-generated particle beams to multisource cobalt-60 units to an immense variety of modified linear accelerators has become available. A parallel explosion of technology in the fields of imaging and computing will ensure that this is just the beginning; already, technologies for automated image segmentation and target identification, long the physician's monopoly, are around the corner; image fusion now allows simultaneous visualization of target and normal tissue anatomy, physiology, and other exciting possibilities such as chemical composition and vascular characteristics. Advances in physics and robotics have led to development of prototypical machines that will blur the distinction between radiosurgery and conformal radiotherapy. Already, several "first generation" devices to free stereotaxis from its fixation to frames are available. Substantial enthusiasm among clinicians has ensured that, unlike many fleetingly and momentarily exciting technologies of the last 2 decades, radiosurgery has made and will continue to make a strong commitment for clinical efficacy, safety, and cost-effectiveness through the process of thorough multiinstitutional clinical trials, as opposed to seeking validation from anecdotal experiences. In this regard, the Radiation Therapy Oncology Group (RTOG) and the Gamma Knife User's Group (GKUG) are to be commended; if the plethora of radiosurgery-related publications is evidence of scientific interest, the field will likely continue to expand. In the future, issues pertaining to appropriate regulatory review, patient selection, quality assurance, and training will need to be addressed. Major clinical and biological studies still need to be undertaken.Current Problems in Cancer 09/1995; 19(5):265-329. DOI:10.1016/S0147-0272(06)80003-6 · 1.00 Impact Factor