Chocolates and Stereotactic Radiosurgery

Monday morning, I was sitting in my clinic  looking after  my follow up patient.Mr.Ram was bit anxious as he was waiting for his test results, he was actually a diagnosed case of ca lung with brain metastasis. He was treated by our radiotherapy team with stereotactic radio surgery and after six weeks I told them to do brain scan and follow with  the report. I can clearly see the eagerness in his eyes to know the test results. I disclosed the results with  a smile on my face, as usual, that results are too good and after hearing this, he held this breath and tears started flowing through his eyes and he and his wife thanked me with folded hands and this moment became memorable for me.  i heard a noise outside my clinic and  I can clearly recognize the voice of child, may be 10 years old. He was peeping into my room from frosted mirror of my door. As turn of this boy came ,I was amazed to see the age of the boy is 4 years only,referred from Delhi from renowned hospital for further treatment. On entering my room he walked with confidence and came straightway to patient chair.The parents followed the boy and they entered hesitantly with a  hope in their eyes. As usual, I greeted them with a smile and then they started the story of the boy, how he started with swelling in the right eye and underwent cat scan that revealed tumour behind the eyeball.
Biopsy the st to confirm the diagnosis was done in some other hospital and patient was sent to us for radiotherapy. After discussing the scans carefully, we as a team planned stereotactic radio-surgery(SRS).SRS is a technically demanding procedure which is generally used for primary brain tumours and metastatic tumour deposits.
The first obstacle that we feel as a radiation oncologist is maintaining immobilization during treatment. Usually, kids do not maintain position during radiotherapy and most of the times need anaesthesia to make them sleep during radiotherapy but this kid was so intelligent that when counselled about the procedure and with few chocolates he was ready to undergo the procedure. We did brain scans(High resolution) with frame and defined the target for radiotherapy .we did detailed planing and discussions and made the best plan for treatment delivery. On the day of treatment the kid was active and smiling and my team was ready with few chocolates and with  radiotherapy also. We planned high dose of radiotherapy to small target (tumour) and we have  saved all the surrounding structures , organs at risk,  which were drawn with the help of special software.After completing the contouring beam arrangement were placed  .This complicated procedure requires roughly around two days. On the day of delivery of radiation, again one cone beam CT is taken, and it is matched with reference CT scan, and after checking any error, treatment is delivered. The patient will also require steroids on the day of therapy. We planned three sittings of Radiotherapy on alternate day for our young fellow.we have treated him with  state of the art radiotherapy machine to deliver radiotherapy treatment. The treatment was completed without any pain, burning sensation and shock (myths.) Finally, the kid got rewarded with candies and he was happy, we as a team and his parents were also happy as our short term goal was achieved.I was feeling contented as my small(in size)friend has completed treatment without any side effects. This technique has shown promising results and it will change the practice in future. This radiation can lead to hair loss but the hairs usually comes back.

Common tumors that can be treated with this techniques are the Pituitary adenoma, Meningioma, Acoustic Neuromas, Brain metastasis and Recurrent Gliomas.

SRS Is an OPD procedure and is painless, without any incision, and no anesthesia is required.

Author

Dr.Vikas Roshan

Senior Consultant

Department of Radiation Oncology,

American Oncology Institute,Jammu.