Gamma Knife: Brain Tumor Treatment in a Day

Your brain is your body's GPS. Receiving sensory input, your brains network of 86 billion nerve cells are connected with a precise highway of nerve fibers that tell your body's systems what to do and when. Its quite amazing when you stop to think about it.

But, sometimes, one or some of those 86 billion nerve cells goes awry often for reasons unknown leading to cancer or other neurological conditions. Once upon a time, treatments for many brain disorders were limited.

However, today, at AdventHealth, emerging treatments and a world-class medical team are offering new hope using highly effective, precise, advanced technologies and a personalized, team approach to neurological care. One example of AdventHealth's team approach to complex brain diseases is using highly advanced technology in its Gamma Knife radiosurgery program.

Gamma Knife Radiosurgery is a form of radiation therapy that delivers very precise beams of radiation to complex tumors targeted to only the areas of the brain that need treatment, all while protecting surrounding tissue. While the name may be a little scary, it does not involve a knife or a single incision. Most patients receive treatment and go home the same day. It offers many benefits to the patient, including a care plan personalized by a coordinated team of medical experts in neurosurgery, radiation oncology and medical physics.

Members of the Gamma Knife team at AdventHealth, Melvin Field, MD, neurosurgeon; Samir Sejpal, MD, MPH, radiation oncologist; and Peter Potrebko, PhD, board-certified therapeutic radiological physicist, share their expertise on how the Gamma Knife Program at AdventHealth is excelling at helping patients today and creating innovative care paths for the future.

How does it work?

Gamma Knife is the gold standard for minimally invasive, precision radiosurgery for specific disorders of the brain, says Dr. Field.

He explains that these disorders can range from brain metastasis (cancer), acoustic neuromas, meningiomas, vascular malformations, movement disorders such as Parkinson's disease, and trigeminal neuralgia (facial nerve pain).

With Gamma Knife, we use a very specialized frame that allows us to precisely localize an area of the brain that needs to be treated with radiation therapy, Dr. Field says. We then focus multiple beams of radiation to a tumor, for example, giving a high dose of radiation to the brain lesion and virtually no dose of radiation to the surrounding, healthy tissues. The accuracy of this system is less than one millimeter.

Dr. Sejpal adds, With Gamma Knife, we can even treat very tiny brain lesions with extreme accuracy. With our team approach, we are always very confident in every patient's treatment plan.

Dr. Potrebko chimes in, Gamma Knife delivers an extremely high dose of radiation in a short amount of time, and, at AdventHealth, patients can rest assured that someone is diligently ensuring that their treatment is as safe and effective as possible.

Patient Benefits

Precision aside, Dr. Field describes additional benefits to patients who qualify for Gamma Knife treatment.

First, compared to other types of treatment, some brain tumors can be successfully approached with a single Gamma Knife treatment. Once more, it can be completed outpatient, meaning the patient can return home the same day. This is because Gamma Knife does not require anesthesia or more invasive incisions.

For patients with high risks for undergoing anesthesia due to other health conditions or for those that have a tumor located in an inoperable region of the brain, Gamma Knife can be a viable option, says Dr. Field.

We find that patients are very satisfied with the procedure. They can get back to their normal routines fairly quickly, and most patients do not have to stop their medications prior to treatment, including those undergoing cancer treatment. It offers very minimal disruption to patients lives.

Another tremendous benefit of Gamma Knife at AdventHealth is the team approach to care.

When Gamma Knife is performed, three highly experienced medical team members are always involved and collaborating on every detail of the patient's care plan, says Dr. Field.

It Takes a Team

A neurosurgeon, like Dr. Field, uses imaging tests to isolate which area of the brain needs treatment, and places the Gamma Knife frame (or helmet) on the patient to achieve ultimate precision. This guides the team to understand where the radiation needs to be aimed to be most effective.

Then, a radiation oncologist, like Dr. Sejpal, confirms the dose of radiation necessary to adequately treat the brain lesion. Dr. Sejpal explains, My role is to coordinate with the neurosurgeon and medical physicist to ensure that we have an optimal treatment plan based on several factors including the type of lesion being addressed, size of the lesion, and its location in the brain, for treatment delivery with the Gamma Knife.

Connecting all of the dots, the medical physicist's job is to guarantee the safety of patients and the accuracy of the dose delivered by the Gamma Knife machine. Essentially, our role is to assist in treatment planning by serving as the technical expert, optimizing radiation dose and distribution, describes Dr. Potrebko.

Prior to starting treatment planning, when the patient has medical imaging, I perform an analysis with sophisticated software to certify that there are no distortions in the images. This helps the neurosurgeon and radiation oncologist, because it promises accuracy of where the radiation must be delivered and at the safest and most effective dose, describes Dr. Potrebko.

He adds that his role is also to care for the Gamma Knife technology itself. I do routine quality assurance testing on the machine to ensure that the radiation dose that we treatment plan is exactly what the Gamma Knife delivers with accuracy of less than one millimeter.

Dr. Sejpal shares that this coordinated approach involves frequent communication and treatment planning for each patient. We have a weekly neuro-oncology meeting to discuss each Gamma Knife patients treatment plan. For this meeting, each medical discipline is represented, including neurosurgery, radiation oncology, neuro-oncology, neuroradiology, pathology, medical physics, otolaryngology (ENT), neuropathology and nursing.

With the whole team in one room, we leverage each disciplines expertise to recommend the best modality and approach for each patients unique treatment, and sometimes, that leads us to recommend Gamma Knife, he continues.

Dr. Sejpal explains that the coordinated care only begins there. If a patient is a candidate for this treatment, AdventHealth's dedicated Gamma Knife coordinator works with him or her to arrange appointments with the medical team and help guide the patient throughout the entire treatment and recovery process.

During Gamma Knife treatment, the radiation oncologist is present along with a nurse and medical physicist throughout the entire procedure; together, we make sure the proper radiation dose is being delivered in the right location and the patient is safe, says Dr. Sejpal.

Treatment planning can be a challenging process, adds Dr. Potrebko. When treating tumors, every tumors volume is different, so we use complex computer software to optimize radiation dose distributions using medical images to improve our treatment planning and accuracy of where radiation is delivered.

And the continuum of care doesn't end there. Dr. Sejpal notes, Once the procedure is complete, patients then follow up with the neurosurgeon and radiation oncologist to evaluate their outcomes and discuss any side effects.

He continues, The team effort truly is a differentiator of Gamma Knife radiosurgery, and patients can have peace of mind that there are many experts determining the best plan of care for them, and its nice to have that collaboration and with several years of experience among some of our team members.

Gamma Knife at AdventHealth

Patients who receive Gamma Knife treatment at AdventHealth have the benefit of a leading treatment team, but also the expertise built upon decades of clinical research and practice.

AdventHealth is the only hospital in Central Florida to offer Gamma Knife, and we've been offering this treatment since 1996 with constant upgrades and modifications to improve the preciseness of our treatments and, in turn, patients outcomes, says Dr. Field.

He explains that the AdventHealth Gamma Knife team is specifically trained and certified to use this technology, which carries over 20 years of data to confirm its accuracy and success rate.

Gamma Knife treatment at AdventHealth is special in that we also have an academic research focus to our program. We carry an extra devotion to developing and delivering more personalized, leading-edge medicine while also having a faith-based mission behind it, says Dr. Potrebko.

The Future of Gamma Knife

Treating patients today is just one focus of the AdventHealth Gamma Knife team. Staff, including Dr. Potrebko, are actively involved in research. Dr. Potrebko is a faculty professor at the University of Central Florida College of Medicine and Adventist University of Health Sciences. Dr. Field is also an associate professor of neurosurgery at the University of Central Florida.

Our current research focus is finding information in diagnostic images to predict patients outcomes with the Gamma Knife, notes Dr. Potrebko.

By learning how we can look at individual tumors and predict outcomes, we can better customize treatment plans for patients that's the future of Gamma Knife and ensures we can provide more personalized medicine.

The Doctors Thoughts

With neurosurgery, I have the ability to truly impact each patient's and family's life. Many people are extremely scared when they are told they must see a brain surgeon. But, we try to appease our patients and, in most cases, we can offer treatments that get them back to living a functional life. And Gamma Knife is a less invasive way to get people on the path to healing, says Dr. Field.

Dr. Sejpal shares, While I am often coordinating with many other medical experts in helping patients with radiation therapies, Gamma Knife offers a unique advantage because it offers such accuracy as well as true team involvement; a team that is putting all of its brainpower together to personalize and deliver a treatment plan from start to finish. I enjoy offering this attention and precision to patients, and seeing their satisfaction throughout and after the procedure.

Dr. Potrebko remarks, I originally wanted to be an astrophysicist, but, in my second year of university, my dad got cancer. Through this, I learned about medical physics. When my father passed away, it changed my course with a deep devotion to helping others through medical physics and, more specifically, Gamma Knife radiosurgery. This inspires my passion for research and innovation in cancer treatments using particles not necessarily medicines as we traditionally use them today.

For more information about the Gamma Knife Program at AdventHealth, call our Gamma Knife care coordinator, Denal Wilson, at Call407-303-7944.