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CMAJ
CMAJ - August 11, 1998 JAMC - le 11 août 1998 date

Surgery in stereo

CMAJ 1998;159:219-220

See response from: M. Schwartz
Dr. Michael Schwartz's article "Stereotactic radiosurgery: comparing different technologies" (CMAJ 1998;158[5]:625-8 [abstract / résumé]) should help to clarify for the medical community at large the nature and relative merits of the different technologies available for this type of treatment.

In addition to the Canadian centres to which Schwartz refers, there has been since June 1997 a stereotactic radiosurgery program at the University of British Columbia, a collaborative effort of the BC Cancer Agency and the Division of Neurosurgery of the Vancouver Hospital and Health Sciences Centre.

Further to Schwartz's comments on fractionation, it should be specified that, at present, fractionated radiotherapy cannot be administered with the Gamma Knife (Elekta Instruments Inc., Atlanta). Fractionation holds particular promise in the treatment of larger neoplastic lesions, especially those adjacent to important normal structures and those in children's brains, tissues that may be particularly susceptible to the adverse effects of irradiation.

Although stereotactic radiotherapy is used most often to treat intracranial disease, its use in the treatment of lesions just below the skull base has been reported.1 Current technologies do not allow this treatment for lesions located more inferiorly in the head and neck region. Stereotactic localization systems for the head and neck are under development for linear accelerators.

Stereotactic radiotherapy necessitates cooperative efforts involving not just neurosurgery and radiation oncologists, but also neuroradiologists, medical physicists, radiation therapists and professionals in other disciplines. The quality of stereotactic radiotherapy at a given centre has more to do with the expertise of the team as a whole than with the particular technology employed.

I believe that here in Canada collaboration between centres is essential, since many of the lesions treated by this method are decidedly uncommon. Eventually, this collaboration may make it possible for us to standardize techniques or even undertake prospective clinical trials.

Michael R. McKenzie, MD
Radiation Oncology
BC Cancer Agency
Vancouver Cancer Centre
Vancouver, BC

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Reference
  1. Firlik KS, Kondziolka D, Lunsford LD, Janecka IP, Flickinger JC. Radiosurgery for recurrent cranial base cancer arising from the head and neck. Head Neck 1996;18(2):160-5.