BEST HOSPITALS

PANTAI HOSPITAL KUALA LUMPUR

“ Smaller , Better , Faster ” Pantai Hospital Kuala Lumpur ’ s consultant neurosurgeon , spine and radiosurgeon Dr Kevin Sek details how gamma knife radiosurgery is a microcosm of the evolution of medical treatments .

New generation of Gamma Knife uses 192 gamma rays , through precise computer calculations and stereotactic image treatment plans to target lesions , by generating high energy to destroy target cells , resulting in similar outcome as the surgical operations . Similar to the effect of putting the magnifying glass under the sun , the outcome is strong and precise . The healthy tissue around the lesion is less affected , side effects are reduced , and the treatment is more effective , providing patients with brain tumour or related diseases with better treatment options .

Radiotherapy refers to all types of radiation therapy , while radiosurgery refers to precise radiotherapy .

Generally , cancer patients with brain metastases belong to stage IV cancer . The standard treatment is whole-brain radiotherapy after the brain tumour removal . Whole-brain radiotherapy results in many side effects . With the advent of better treatments including chemotherapy , targeted therapy , and immunotherapy to prolong the survival of cancer patients , these result in the development of radiotherapy systems with higher efficacy and lower side effects .

Whole-brain radiotherapy is the radiation of whole brain to kill cancer cells , and patients will have side effects following the radiotherapy , such as swelling , forgetfulness , loss of cognitive ability , etc , and there may be long-term effect such as increasing risk of dementia . Some acute side effects such as

Leon Low , Assistant Manager , International Business Development Pantai Hospital Kuala Lumpur

swelling may require another operation . The concept of radiation surgery is to target brain tumours . Although cancer cells may recur in other parts of the brain , radiosurgery reduces the damage of surrounding normal tissues , so there are fewer side effects , which can extend the survival time of patients and improve quality of life .

If the survival time of a cancer patient is only a few months , then this may not matter , however in the current era , the survival time of many cancer patients is prolonged by better treatments . Thus , if the treatment of brain metastasis can have lesser side effects , this will improve the patient ’ s quality of life . Therefore , accurate , safe and few side effects treatment is very important for patients .

The new generation of gamma knives conforms to the function of radiosurgery . Its precision error can be controlled at 0.5 mm , which is an accurate and safe radiosurgery system .

Gamma knife is suitable for the treatment of three major brain diseases which are brain tumour , cerebrovascular disease and brain function diseases . Brain tumours are divided into benign and malignant tumours . The most common malignant tumour we use it for is brain metastasis .

Cerebrovascular diseases include arteriovenous malformations ( AVM ), which is a dangerous cerebrovascular malformation , and cerebral functional diseases include trigeminal neuralgia , Parkinson ’ s disease , etc . Gamma knife is suitable to be used to treat all these brain diseases .

When the brain radiotherapy system was first used , no one knew how much dose should be used to treat brain diseases , as the larger the dose or the larger the treatment range , the higher the leakage of radioactive substances which then impact the surrounding healthy tissues . Over time , the dose of radiotherapy was adjusted based on cases , to figure out how much dose is needed in which case , so that the radiotherapy can be more precise and have fewer side effects .

Sheffield Teaching Hospital has accumulated many experiences in using gamma knife over the years , and has developed a set of treatment plans , that is , to provide recommendations on the use of radiation dose based on different brain diseases , lesion size and location .

Dr Kevin Sek has worked on over 500 cases utilising gamma knife radiosurgery during his fellowship in Sheffield .

68 NOVEMBER 2021 GlobalHealthAsiaPacific . com