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Stereotactic radiotherapy

Stereotactic radiotherapy is a way of targeting radiotherapy very precisely at a tumour. This type of treatment is not available at all hospitals because it needs specialist equipment and skills.

Stereotactic radiosurgery

You might hear the term stereotactic radiosurgery. This isn’t a type of brain surgery. It means having a very high dose of stereotactic radiotherapy to a small area. You usually have a single treatment.

What is stereotactic radiotherapy?

Stereotactic radiotherapy gives radiotherapy from many different angles around the body. The beams meet at the tumour. This means that the tumour receives a high dose of radiation and the tissues around it receive a much lower dose. This lowers the risk of side effects.

You usually have treatment through a machine called with a linear accelerator (LINAC). But you may also have it on a CyberKnife or GammaKnife machine.

Photo of a linear accelerator

When you have stereotactic radiotherapy and radiosurgery

Stereotactic radiotherapy and radiosurgery isn’t suitable for everyone. You might have this type of treatment if you have a:

  • vestibular schwannoma
  • meningioma that started in the base of the skull
  • pituitary gland tumour
  • cancer that has spread to the brain from somewhere else in the body (secondary brain tumour)

You are most likely to have it for small tumours that measure less than 3 cm across.

Secondary brain tumours are different from primary brain tumours. We have separate information about secondary brain tumours.

How often you have stereotactic radiotherapy and radiosurgery

The full dose of stereotactic radiotherapy treatment is usually divided into a number of smaller doses called fractions. The number of fractions you have can vary from between 3 and 8. You have one treatment (fraction) a day.

For radiosurgery, you usually have a single treatment (fraction).

Before radiotherapy starts

Your head needs to be kept as still as possible during radiotherapy. This is so the treatment is as accurate as possible. Keeping the head still is called immobilisation. So, before you start radiotherapy you have a radiotherapy mask made or a head frame fitted.

Radiotherapy mask

Most people have a radiotherapy mask made from plastic. It is called a thermoplastic mask. The mask attaches to the scanner or radiotherapy machine while you are wearing it. This means that you can't move your head.

Head frame

You have a head frame fitted if you are going to have treatment from a GammaKnife machine.

Your treatment team attaches a frame to your skull using 4 pins. Before they attach the frame, you have injections of local anaesthetic so that you don’t feel any pain. As the frame is fitted, you might feel some pressure and tightness, but it usually feels better within a few minutes.

The treatment team removes the frame when your treatment finishes. 

Having radiosurgery treatment
Photograph showing woman having radiosurgery treatment

Planning CT scan

Before treatment, you also have a planning CT scan. This helps your doctors map where the radiation needs to go.

The radiotherapy room

Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine rotates around you to give the treatment. But it doesn't touch you at any point.

Before your first treatment, your radiographers will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in your music player. So you can listen to your own music.

Having stereotactic radiotherapy

To have treatment you lie on the treatment table. Because your position is so important, the radiographers may take a little while to get you ready. The radiographers attach your mask or head frame into the treatment table. They then leave the room before your treatment starts. This is so they are not exposed to the radiation.

Your radiographers watch and listen to you on a CCTV screen in the next room. Tell them if you need to move or want the machine to stop.

You need to lie very still. The machine makes whirring and beeping sounds. You can't feel the radiotherapy when you have the treatment. 

When the treatment is over, the radiographers help you out of the machine. They remove the mask or the frame and you can go back home or to the ward.

You won't be radioactive

This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.

Travelling to radiotherapy appointments

Tell the radiotherapy department if you prefer treatment at a particular time of day. They can try to arrange this.

Car parking can be difficult at hospitals. It’s worth asking the radiotherapy unit staff:

  • if they can give you a hospital parking permit
  • about discounted parking rates
  • where you can get help with travel fares
  • for tips on free places to park nearby

If you have no other way to get to the hospital, the radiotherapy staff might be able to arrange hospital transport for you. But it might not always be at convenient times. To see if you're eligible they usually work it out based on your earnings or income.

Some hospitals have their own drivers or can arrange ambulances. Some charities offer hospital transport.

Side effects

Stereotactic radiotherapy and radiosurgery have fewer side effects than the standard type of external radiotherapy. This is because the area treated is smaller and so less healthy brain tissue is exposed to radiation.

You might feel tired for some time after treatment. But there are other possible side effects.

Last reviewed: 
07 Aug 2019
  • Brain tumours (primary) and brain metastases in adults
    The National Institute for Health and Care Excellence (NICE), 2018

  • Cancer Principles and practice of oncology (8th edition)
    VT. De Vita, TS. Lawrence, and SA. Rosenberg
    Lippincott, Williams and Wilkins, 2008

  • External Beam Therapy (2nd edition) 
    Peter Hoskin
    Oxford University Press, 2012

  • Clinical Commissioning Policy: Stereotactic Radiosurgery/Radiotherapy for Meningioma
    NHS England, September 2013

  • Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy (SBRT)
    D Heron, M Huq and J Herman
    Springer Publishing, 2019

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