Jefferson Hospital for Neuroscience Neurology Neurosurgery News Archive Featured in the Media JeffNEWS Department of Radiation Oncology

In contrast to traditional surgical techniques, neurosurgeons and radiation oncologists at Thomas Jefferson University Hospital in Philadelphia are using a new type of advanced radiation technology to “surgically” treat a wide range of tumors in the brain and spine, curing tumors that they couldn’t treat before.

The new technology, called shaped beam surgery, can mold radiation beams to fit the exact size and shape of a tumor. It is available now only at Jefferson in the Delaware Valley and in a small number of medical centers in the nation.

“Shaped beam surgery is a major advance in treating both benign and malignant tumors in the brain and the spinal cord regions,” says neurosurgeon David Andrews, M.D., professor of neurosurgery at Jefferson Medical College of Thomas Jefferson University and director, division of Neuro-oncologic Neurosurgery and Stereotactic Radiosurgery, Thomas Jefferson University Hospital.

The majority of the new technology’s use to date has been for benign tumors in the brain, Dr. Andrews says. 

Radiation oncologist Maria Werner-Wasik, M.D., left, and neurosurgeon David Andrews, M.D., head a team of specialists at the Jefferson Hospital for Neuroscience, Philadelphia, which has begun using shaped beam surgery to treat a wide range of tumors in the brain and spine, many of which couldn’t be treated before.

“We are curing benign tumors we couldn’t treat before,” he says, and as a result, “often restoring vision and hearing where tumors involve these functions.”

“Shaped beam surgery gives us infinite flexibility to deal with lesions from the top of the head to the bottom of the spine,” says Dr. Andrews, who is director, Radiosurgery Units, Jefferson Hospital for Neuroscience. “We can wrap doses around structures such as the spinal cord, and can create a very high dose of radiation and leave the cord untouched. There’s no other technology out there that can do this.”

The new technology enables specialists to focus radiation more precisely on specific targets while leaving healthy tissue virtually untouched, holding great therapeutic promise for hard-to-reach and difficult-to-treat tumors, including meningiomas, pituitary tumors, recurrent brain tumors, spine tumors and acoustic tumors, among others, notes Walter J. Curran Jr., M.D., professor and chair of Radiation Oncology at Jefferson Medical College and clinical director of the Kimmel Cancer Center at Jefferson.

Shaped beam surgery relies on sophisticated computers to develop and carry out a treatment plan that includes tailoring the shape and intensity of the radiation beams to fit the exact size of the tumor –  all while sparing healthy tissue.

Part of the challenge in radiosurgery is to position the patient properly for radiation treatment. The new technology overcomes this in part by rotating around the patient, constantly editing the beams of radiation and adapting the shape of the beam to the shape of the tumor to meet the specific therapy needs at any angle.
X-rays are taken to locate the tumor. Then, along with results from a computed tomography (CT) scan, a computer program calculates to the millimeter the best position for the therapy for the patient’s tumor. A computer-guided treatment couch then positions the patient – re-positioning when necessary – moving the individual’s tumor into exactly the position needed to receive radiation. With the computer’s help, treatment planning that might take hours – if not days – can be reduced to minutes.

“This is important because tumors are frequently very irregularly shaped, and we want to spare healthy tissue,” notes Maria Werner-Wasik, M.D., associate professor of radiation oncology at Jefferson Medical College and director of radiation oncology in the Radiosurgery Program at the Jefferson Hospital for Neuroscience.

The new technology, called Novalis Shaped Beam Surgery, is manufactured by BrainLab, Inc., which is based in Munich, Germany.

While it’s early in its use at Jefferson, Dr. Andrews notes that there is evidence that the technology is already helping improve survival for individuals with the usually deadly brain tumor, glioblastoma multiforme.

Preliminary data show that patients’ median survival time has improved from 12 to 19 months. Unfortunately, the treatment is palliative at best and not a cure. He says the therapy is comparable to if not better than standard treatment.

The new technology will not replace the Gamma Knife, which is used in many similar ways for treating difficult-to-reach areas in the brain. According to Dr. Andrews, the Gamma Knife is more likely to be used when the individual patient’s tumor requires targeting a very high dose of radiation at a very specific point in the brain. The Gamma Knife is static, he notes, whereas shaped beam surgery is dynamic.

“Shaped beam surgery does everything the Gamma Knife can do and more,” he says, including treatments for various types of tumors, epilepsy, trigeminal neuralgia, and even, in some cases, obsessive compulsive disorder and movement disorders.

While the new technology doesn’t always promise a cure, it can often improve a patient’s quality of life. “It will be both therapeutic and palliative,” Dr. Andrews says.

For more information, call 1-800-JEFF-NOW or visit online at www.JeffersonHospital.org/neurosurgery.