Radiosurgery for brain tumours | Cancer Research UK
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Radiosurgery for brain tumours

Radiosurgery is a type of stereotactic radiotherapy. Stereotactic radiotherapy aims the radiotherapy beams very precisely at the area of the brain tumour. So it gives a very high dose of radiation to a very small precise area. Radiosurgery is usually a single dose of treatment but may include up to 5 treatments.

This treatment works very well for some types of brain tumour. It is used for small tumours less than 3cm in size, including vestibular schwannomas (acoustic neuromas), secondary brain tumours, pituitary adenomas, haemangioblastomas, meningiomas, and glioma that has come back.

Having radiosurgery treatment

To have radiosurgery your head needs to be kept as still as possible during the treatment. Doctors call this stereotactic immobilisation. You may have treatment with a head frame or treatment with a mask.

Treatment with a head frame takes the best part of a day. Your treatment team make a frame to attach to your skull using pins. They attach the head frame to your head. You feel some pressure and tightness and it may be sore. Your doctors and radiographers check the frame and you have a CT scan or MRI scan. You wait for a couple of hours while your treatment team plans the treatment. Then your head frame is fixed into the radiotherapy machine while you lie on the treatment couch. You are awake the whole time. The couch slides into the machine. The treatment may take f20 to 40 minutes or up to 2 hours. Afterwards, the radiographers help you out of the machine and take the frame off. Then you go back to the ward, usually for an overnight stay.

Treatment with a mask is done in 2 stages. You have a thermoplastic mask made in the mould room. Then you have a CT scan. You then go home and your treatment team tells you when to go back for the treatment. On the treatment day you lie on the radiotherapy treatment couch. The radiographers fit your mask and attach it to the couch. They then fix a frame to the mask. The radiographers leave the room. The treatment takes around 20 to 40 minutes and afterwards you can go home.

Side effects of brain tumour radiosurgery

There are usually very few side effects from radiosurgery. Your doctor may give you a dose of steroids before the treatment or straight afterwards to help prevent side effects. It is usual to feel very tired for some days after the treatment. You may feel sick or faint at first, or have a headache. You may also feel a bit weak and dizzy. There is a small risk of having a fit (seizure) after treatment, so you should not drive for at least a month. Your treatment team advise you about this.

 

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What radiosurgery is

Radiosurgery is a high dose of radiation treatment that you have usually as a single treatment. It is not a type of surgery. It is a type of stereotactic radiotherapy. 

Stereotactic radiotherapy aims the radiotherapy beams very precisely at the area of the brain tumour. So it gives a very high dose of radiation to a very small precise area. Radiosurgery is usually a single dose of treatment but may include up to 5 treatments.

Sometimes radiosurgery is called Gamma Knife or CyberKnife treatment, after the machines used to give it. You can also have the treatment using the more common radiotherapy machine, the linear accelerator (also called LINAC). Several LINAC machines are designed to give stereotactic radiotherapy and they include, the Novalis Tx and Edge radiosurgery system.

 

Tumour types that radiosurgery can treat

Radiosurgery treatment can work very well for some types of brain tumour. You are most likely to have it if you have an acoustic neuroma, that is less than 3cm across. 

You may also have it if you have other types of tumours, including

  • Small secondary brain tumours
  • Small pituitary adenomas
  • Haemangioblastomas that couldn't be removed, were only partially removed, or came back after surgery
  • Meningiomas smaller than 3cm
  • Glioma that has come back and is smaller than 3cm

Doctors also use this type of treatment for non cancerous conditions, such as arteriovenous malformation (AVM).

Specialists don't recommend radiosurgery for larger brain tumours. It isn't possible to get the same dose of radiotherapy throughout the treatment area with a large tumour. 

Radiosurgery may also not be suitable if there are certain nerves running through the treatment area. The nerves could get too much radiation and be damaged. This could cause problems, what those problems are, depends on what the function of those nerves. Your doctor will talk to you about the risks and benefits of the treatment.

 

Having radiosurgery treatment

To have radiosurgery, your head needs to be kept as still as possible during the treatment. Doctors call this immobilisation. There are a number of different ways of doing this. You may have

  • Treatment with a head frame or
  • Treatment with a mask

Treatment with a head frame

Your treatment team attach a frame to your skull using 4 pins. Before they attach the frame, you have 4 injections of local anaesthetic at the points where the frame is attached to your head. This takes about 10 minutes. 

As the the frame is fitted, you feel some pressure and tightness, but it usually feels better within a few minutes. 

Photo showing the head frame for radiosurgery treatment

Once the frame is in place, the doctors and radiographers check it and you have a CT scan or MRI scan. 

After the scan there is a wait while your treatment team plans the treatment. This can take up to a couple of hours. During this time, you can have something to eat and drink, unless there are medical reasons why you shouldn't. 

When the planning is complete, you go to the treatment room. Your head frame is fixed into the radiotherapy machine while you are lying on the treatment couch. You are awake the whole time. Once everything is in place, the couch slides into the machine and the treatment begins. 

You won't not feel, or see anything while you are having treatment. Most people either listen to music or sleep.

Photograph showing radiosurgery treatment

Treatment with the Gamma Knife or CyberKnife machines takes an hour or two, depending on the amount of treatment and position of your tumour. If you have treatment with a LINAC machine, it takes around 20 to 40 minutes for each treatment session. When the treatment is over, the radiographers help you out of the machine. They remove the frame. Then you go back to the ward, usually for an overnight stay.

Treatment with a mask

For some radiosurgery treatments using the LINAC system, you have a thermoplastic mask made instead of a frame. You go to the mould room to have the mask made.Once the mask is made you have a CT scan. You then go home and your treatment team tell you when to go back for the treatment.

Photograph of a stereotatic radiotherapy mask worn for treating brain and head and neck cancers

On the day of treatment you lie on the radiotherapy treatment couch. The radiographers fit your mask and attach it to the treatment couch. They then fix a frame to the mask. Although you can't move your head, there is nothing directly attached to you. The radiographers leave the room and you may feel the couch move as they adjust it. The treatment takes around 20 to 40 minutes. After the treatment you can go home.

 

Side effects of brain tumour radiosurgery

There are usually very few immediate side effects from radiosurgery. Your doctor may give you a dose of steroids before the treatment, or straight afterwards to help prevent side effects due to swelling of the brain. You may feel sick or faint at first, or have a headache. You may also feel a bit weak and dizzy.

If you had treatment with a head frame, you may have slight bleeding from the points where the frame was attached to your skull. You may also have tingling or itching where the frame was attached. This is a normal sign of healing. 

You may lose a patch of hair if your tumour was near the surface of your skull. But hair loss is not normally a side effect of radiosurgery. It is usual to feel very tired for some days after the treatment.

There is a small risk of a fit (seizure) after radiosurgery so the Driver and Vehicle Licensing Authority (DVLA) does not allow you to drive for at least a month afterwards. It may be even longer depending on your type of brain tumour.

There are not usually any other side effects. But tell your doctor or nurse if you have any new symptoms or your old symptoms seem to be getting worse.

 

Long term side effects

A small number of people have long term side effects from radiosurgery. This is because you have a very high dose of radiation given to a very small area. Over a period of time the treated area may develop a small area of dead cells. This is called radiation necrosis. Most people who develop this have no symptoms. The affected area is too small to make any difference to them.

In people who develop radiation necrosis after radiosurgery, fewer than 1 in 10 have swelling that is large enough to cause symptoms. If you do develop this, your specialist gives you steroids to take. Some people need high doses of steroids for long periods of time. An even smaller proportion of people need surgery to remove the dead tissue. In people who develop radiation necrosis, fewer than 1 in 20 need surgery to have the area of dead tissue removed.

 

More information

Find out about

National Centre for Stereotactic Radiosurgery has a series of videos showing how the frame is fitted, planning and how you have treatment

Stereotactic radiotherapy

Types of brain tumours

Thermoplastic masks

Steroid medication

Managing fear, anxiety and panic

For general information and support

Contact the Cancer Research UK nurses on freephone 0808 800 4040 (Open 9am - 5pm, Monday to Friday)

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Updated: 3 December 2015