ORIGINAL

Stereotactic Radiosurgery and Fractionated Radiotherapy in a Brazilian Institution

Radiocirurgia Estereotáxica e Radioterapia Fracionada em uma Instituição Brasileira

  • Leila Maria Da Roz 1 2    Leila Maria Da Roz 1 2
  • Evandro César de Souza 1 2    Evandro César de Souza 1 2
  • Carolina Fernandes Junger 1    Carolina Fernandes Junger 1
  • Geovanne Pedro Mauro 2    Geovanne Pedro Mauro 2
  • Rosângela Correa Villar 2    Rosângela Correa Villar 2
  • Eduardo Weltman 2    Eduardo Weltman 2
  • Eberval Gadelha Figueiredo 1    Eberval Gadelha Figueiredo 1
  • Manoel Jacobsen Teixeira 1    Manoel Jacobsen Teixeira 1
  • Carlos Gilberto Carlotti Junior 1    Carlos Gilberto Carlotti Junior 1
  Views: 392
  Downloads: 22

Resumo

Introdução: em 2007-2008, o Departamento de Radioterapia do Hospital das Clínicas da Universidade de São Paulo (HCUSP) iniciou a radiocirurgia estereotáxica (SRS) e a radioterapia estereotáxica fracionada (FSRT). Em 2010, um projeto de pesquisa com a Agência Internacional de Energia Atômica (AIEA) possibilitou a aquisição de equipamentos e a capacitação de todo o pessoal em centros de referência internacionais. Somos uma grande exceção na saúde pública do Brasil ao realizar esses tratamentos. Objetivo: o objetivo deste estudo é traçar nossa experiência, rotina e protocolos em SRS e FSRT em 14 anos de experiência. Ainda, de descrever as patologias mais prevalentes submetidas a SRS e FSRT. Métodos: analisamos retrospectivamente todos os casos submetidos a SRS ou FSRT em nossa instituição de 2008 a 2022. Resultados: um total de 2.147 pacientes foi submetido a SRS ou FSRT. Do sexo feminino totalizaram 1.340 (62,4%); a média geral de idade foi de 47,95 anos (variação de 1 a 87 anos, desvio padrão de ± 18,12 e mediana de 51 anos). Conclusão: o diagnóstico mais frequente foi metástase cerebral. Contudo, as lesões benignas correspondem a pelo menos metade de todas as patologias submetidas à SRS ou FSRT. Esta é uma fração representativa dos tratamentos radioterápicos e acreditamos que será mais um recurso para modernizar e manter nosso departamento.

Palavras-chave

Neoplasia cerebral; Técnicas estereotáxicas; Radiocirurgia; Radioterapia

Abstract

Introduction: in 2007-2008 the Radiotherapy Department at Hospital das Clínicas da Universidade de São Paulo (HCUSP) initiated stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT). In 2010, a research project with International Atomic Energy Agency (IAEA) made possible the acquisition of equipment and the training of all staff in international reference centers. We are quite an exception in public health in Brazil by performing these treatments. Objective: the purpose of this study is to draw our experience, the routine and protocols in SRS and FSRT within 14 years of experience. Further to describe most prevalent pathologies submitted to SRS and FSRT. Methods: we retrospectively analyzed all cases submitted to SRS or FSRT in our institution from 2008 until 2022. Results: a total of 2147 patients was submitted to SRS or FSRT. Female patients were 1340 (62.4%); general mean age was 47.95 years (ranging from 1 to 87 years old, standard deviation of ± 18.12 and median of 51 years). Conclusion: the most frequent diagnosis was brain metastasis. However, benign lesions correspond to at least half of all pathologies submitted to SRS or FSRT. This is a representative fraction of radiotherapy treatments and we believe that more resource to modernize and maintain our department is needed.

Keywords

Brain neoplasms; Stereotactic techniques; Radiosurgery; Radiotherapy

References

1. Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand. 1951;102(4):316-9. PMid:14914373.

2. Lasak JM, Gorecki JP. The history of stereotactic radiosurgery and radiotherapy. Otolaryngol Clin North Am. 2009;42(4):593-9. http:// doi.org/10.1016/j.otc.2009.04.003. PMid:19751866.

3. Chen JC, Girvigian MR. Stereotactic radiosurgery: instrumentation and theoretical aspects. Part 1. Perm J. 2005;9(4):23-6. http://doi. org/10.7812/TPP/04-075. PMid:22811641.

4. Buatti JM, Meeks SL, Friedman WA, Bova FJ. Techniques and clinical applications. Surg Oncol Clin N Am. 2000;9(3):469-87, viii. http://doi. org/10.1016/S1055-3207(18)30135-2. PMid:10853137.

5. Flickinger JC, Kondziolka D, Lunsford LD. Clinical applications of stereotactic radiosurgery. Cancer Treat Res. 1998;93:283-97. http://doi. org/10.1007/978-1-4615-5769-2_13. PMid:9513786.

6. Gilbo P, Zhang I, Knisely J. Stereotactic radiosurgery of the brain: a review of common indications. Chin Clin Oncol. 2017;6(S2, Suppl 2):S14. http://doi.org/10.21037/cco.2017.06.07. PMid:28917252.

7. Yang I, Udawatta M, Prashant GN, et al. Stereotactic radiosurgery for neurosurgical patients: a historical review and current perspectives. World Neurosurg. 2019;122:522-31. http://doi.org/10.1016/j.wneu.2018.10.193. PMid:30399473.

8. Hodapp N. The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlenther Onkol. 2012;188(1):97-9. http://doi.org/10.1007/s00066- 011-0015-x. PMid:22234506.

9. Lippitz B, Lindquist C, Paddick I, Peterson D, O’Neill K, Beaney R. Stereotactic radiosurgery in the treatment of brain metastases: the current evidence. Cancer Treat Rev. 2014;40(1):48-59. http://doi. org/10.1016/j.ctrv.2013.05.002. PMid:23810288.



1Neurosurgery Discipline, Neurology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo – USP, São Paulo, SP, Brasil.

2Instituto de Radiologia – INRAD, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo – USP, São Paulo, SP, Brasil.

 

Received May 27, 2024

Accepted June 10, 2024

JBNC  Brazilian Journal of Neurosurgery

JBNC
  •   ISSN (print version): 0103-5118
  •   e-ISSN (online version): 2446-6786
iThenticate
Open Access

Contact

Social Media

   

ABNc  Academia Brasileira de Neurocirurgia

  •   Rua da Quitanda 159 – 10º andar - Centro - CEP 20091-005 - Rio de Janeiro - RJ
  •   +55 21 2233.0323
  •    abnc@abnc.org.br

Sponsor

  • Brain4Care
  • Hospital INC
  • Strattner
  • Zeiss