RADIATION BEYOND INDICATION(BENIGN DISEASES)
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RADIATION BEYOND INDICATION (BENIGN DISEASES)
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RADIATION BEYOND INDICATION(BENIGN DISEASES)
- 1. Radiation Beyond Indication DrKanhu Charan Patro MD,DNB(Radiation Oncology),MBA,FICRO,FAROI(USA),PDCR,CEPC Clinical Director, HOD-Radiation Oncology ISRo- Institute of Stereotactic Radiation oncology Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam [email protected] /M- +91-9160470564/ www.drkanhupatro.com
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- 4. 09/04/2025 4 Remember thisslide • There is a role of Radiation in benign diseases • Many sites are under explored • Practice with caution • Mostly indicated in refractory/recurrent cases • Practice with caution in young population • Follow guideline • More awareness required • Do not forget about radiation induced malignancy
- 5. DEGRO Guidelines –Radiotherapy of Non- Malignant Disorders (Part I)
- 6. DEGRO Guidelines –Radiotherapy of Painful Degenerative Skeletal Disorders (Part II)
- 7. DEGRO Guidelines –Radiotherapy of Non- Malignant Hyperproliferative Disorders (Part III)
- 8. Radiotherapy for Non-MalignantSymptomatic Functional Disorders (Heterotopic Ossification & Graves Orbitopathy) (Part IV)
- 9. 1. Anti-inflammatory Effects •Low-dose radiation reduces inflammatory cell migration • Inhibits adhesion molecules (ICAM-1, E-selectin) • ↓ Pro-inflammatory cytokines (TNF-α, IL-1, IL-6) • ↑ Anti-inflammatory cytokines (TGF-β1, IL-10) • Useful in arthritis, bursitis, fasciitis
- 10. 2. Immune Modulation •Alters macrophage polarization (M1 → M2) • Reduces nitric oxide and oxidative burst • Prevents chronic tissue damage • Restores tissue homeostasis
- 11. 3. Analgesic (Pain-Relieving)Pathways • Indirect effect via ↓ inflammation • ↓ Pain mediators (substance P, bradykinin) • Reduces edema and vascular permeability • Helps in degenerative skeletal disorders
- 12. 4. Anti-proliferative Effects •Inhibits fibroblast proliferation • Reduces collagen deposition • Prevents abnormal tissue growth • Applied in keloids, heterotopic ossification, Graves’ orbitopathy
- 13. 5. Vascular andTissue Remodeling • Endothelial apoptosis at higher doses • Low-dose stabilizes vascular function • ↓ Leukocyte adhesion, permeability • Contributes to healing and reduced swelling
- 14. 6. Long-Term Adaptation •Balance of benefit vs. late toxicity • Benign disease uses low total doses • Risk of late carcinogenesis is minimal • Effective for chronic conditions with high safety margin
- 15. Radiobiological Mechanisms • Dose–response: •≥2 Gy: pro-inflammatory • <1 Gy: anti-inflammatory (LD-RT) • Effects at ~0.5 Gy: – ↓ Leukocyte adhesion to endothelium – ↑ TGF-β1 (anti-inflammatory cytokine) – Apoptosis of PBMC, PMN → ↓ inflammation – ↓ iNOS, ROS, NO → reduced edema, pain – ↓ NF-κB, IL-1; ↑ TGF-β1
- 16. Preclinical Evidence • Animalarthritis models confirm benefits: • Reduced cartilage/bone destruction • Improved joint swelling & pain • Inhibition of IL-1, iNOS • Upregulation of protective proteins (Hsp70, HO-1) • Optimal at 0.5 Gy fractions
- 17. Radiogenic Risk • Effectivedose (Sv): weighted organ/tissue doses • Cancer risk: ~5.5% per Sv (ICRP 2007) • Genetic risk: negligible in LD-RT • DDREF: ICRP=2 (<0.2 Sv), German SSK=1 • Example: Knee RT 6×0.5 Gy → ~0.1% added cancer risk • Higher risk in younger patients
- 18. Key Takeaways • BenignRT uses same principles as cancer RT • LD-RT (≤1 Gy/fraction) → strong anti- inflammatory effects • Clinical benefit proven, esp. at 0.5 Gy • Radiogenic risks must be weighed, esp. in young patients • More epidemiological data needed
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- 20. Shoulder Syndrome • Painfulperiarthritis of shoulder joint. • Response rates: 58–100% (CR+PR). • Large series (7,928 pts): – CR 55%, – PR 33%, – Non-responders 12%. • Better outcomes with early RT (<6 months pain). • Technique: Opposing fields (LINAC 6 MV) or orthovoltage. • Dose: 0.5–1 Gy/fx, 3–6 Gy total, 2–3 fx/week. • LoE 4, GR C.
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- 24. Elbow Syndrome (Epicondylitis) •Painful degenerative enthesiopathy at epicondyles. • Evidence: >2000 pts, ~82% pain relief. • CR 45%, PR 35%. • Dose trials: 1 Gy/fx superior to very low dose. • Technique: Orthovoltage single field or LINAC fields/electrons. • Dose: 0.5–1 Gy/fx, 3–6 Gy total. • LoE 2c, GR B.
- 25. 09/04/2025 25 Elbow Syndrome(Epicondylitis)
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- 28. Trochanteric Bursitis • Inflammation/degenerationof trochanteric bursae. • Results: 73% response (CR 23–38%, PR 18–50%). • Technique: Include bursae (gluteus maximus region). • LINAC: opposing fields (6–10 MV). • Dose: 0.5–1 Gy/fx, 3–6 Gy total. • LoE 4, GR C.
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- 32. Plantar Fasciitis (HeelSpur) • Painful enthesiopathy at heel insertion. • Response: CR 12–81%, PR 7–74%. • RCTs: 0.5 Gy x 6 vs 1 Gy x 6 → both effective. • Technique: Orthovoltage with bolus; • LINAC 4–6 MV opposing fields. • Dose: 0.5–1 Gy/fx, 3–6 Gy total. • LoE 1b, GR A.
- 33. 09/04/2025 33 Plantar Fasciitis(Heel Spur)
- 34. 09/04/2025 34 • Plantarfasciitis – It is an inflammation or degeneration of the plantar fascia, the thick band of tissue that connects your heel to your toes. – The main symptom is heel pain, especially worse with the first steps in the morning or after long periods of rest. – It happens because of overuse, strain, or micro-tears in the fascia. • Calcaneal spur – It is a bony outgrowth (osteophyte) from the calcaneus (heel bone). – It often forms where the plantar fascia attaches to the heel. – Many people with a calcaneal spur do not have pain. Sometimes it is just an incidental finding on X-ray. • Relationship between the two – Plantar fasciitis can lead to the formation of a calcaneal spur because of chronic traction at the heel attachment site. – But a spur is not necessary for plantar fasciitis. You can have plantar fasciitis without a spur, and you can have a spur without pain. – Heel pain is usually due to plantar fasciitis itself, not the spur. • 👉 In short: Plantar fasciitis is a soft-tissue problem; calcaneal spur is a bone change. They are different conditions, but they often coexist. Plantar Fasciitis (Heel Spur)
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- 36. Osteoarthritis Knee • Degenerativedisease of knee joint. • Response rates: 58–91% (10,000+ pts). • Technique: Include cartilage, bone, synovia, muscles. • LINAC: opposed ventro-dorsal or lateral fields. • Dose: 0.5–1 Gy/fx, 3–6 Gy total. • LoE 2c, GR B.
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- 40. Osteoarthritis HIP • Degenerativehip joint disease. • Response rates: 24–89% (895 pts). • Technique: Include cartilage, bone, synovia, muscles. • LINAC: 2 opposed ventro-dorsal fields. • Gonadal shielding advised. • Dose: 0.5–1 Gy/fx, 3–6 Gy total. • LoE 4, GR C.
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- 43. Hand & FingerJoint Arthrosis
- 44. Hand & FingerJoint Arthrosis • Degenerative arthritis of small joints. • Response rates: 63–75% (809 pts). • Technique: Cover cartilage, bone, synovia, periarticular tissues. • LINAC/Orthovoltage: dorsal or ventral field. • Shield nails if possible. • Dose: 0.5–1 Gy/fx, 3–6 Gy total. • LoE 4, GR C.
- 45. Hand & FingerJoint Arthrosis
- 46. Hand & FingerJoint Arthrosis
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- 48. Morbus Dupuytren • Palmarfascia → finger contractures • Best results in early nodular stage • Dose: 30 Gy (2 × 5 × 3 Gy, 12-wk gap) • LoE: 2c; GR: B • 67–84% long-term control
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- 52. Morbus Ledderhose • Plantaraponeurosis involvement • RT for progression or post-surgery • Dose: 15–21 Gy in 5 fractions • LoE: 4; GR: C • Symptom relief/stabilization
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- 56. Keloids • Excessive scartissue, high recurrence post-excision • RT reduces recurrence: 60–80% → 10–30% • Dose: 16–20 Gy in 5 fractions • Start within 24h post-surgery • LoE: 4; GR: C
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- 61. Peyronie’s Disease • Plaquesin tunica albuginea → penile curvature & pain • RT effective in early/soft plaques • Dose: 10–20 Gy (2–3 Gy fractions) • LoE: 2c; GR: B • Improves pain & plaque softening
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- 65. Desmoid Tumors • Aggressivefibromatosis, high recurrence post-surgery • RT improves local control • Dose: 50–60 Gy (post-op); 60–65 Gy (primary/inoperable) • LoE: 3; GR: C • Effective in primary & recurrent disease
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- 74. Pigmented Villonodular Synovitis •Synovial proliferation, high recurrence post-surgery • RT improves local control (~90–95%) • Dose: 30–40 Gy, CT/MRI planning • LoE: 2c; GR: B
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- 76. 09/04/2025 76 Pigmented VillonodularSynovitis
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- 78. Gorham–Stout Syndrome • Rareosteolysis (vanishing bone disease) • RT controls progression in ~77% • Dose: 36–45 Gy • LoE: 2c; GR: B
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- 82. Pterygium Aspect Details Indication Recurrent pterygiumafter surgical excision; aggressive/vascular pterygium with high recurrence risk Timing Usually applied postoperatively within 24–48 hours of excision Dose Single fraction 5–10 Gy (commonly 7–8 Gy) to scleral surface; or fractionated regimen e.g., 2 Gy × 5 fractions (total 10 Gy) Technique Surface application using strontium-90 (Sr-90) applicator or beta-plaque; shields used to protect cornea and lens Procedure Local anesthesia, surgical excision of pterygium, immediate application of beta-radiation probe to bare sclera for prescribed duration Advantages Reduces recurrence rate significantly compared to surgery alone Risks/ Complication s Scleral necrosis, cataract, keratitis, delayed epithelial healing (rare with modern dosing)
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- 86. ORBITAL PSEUDOTUMOR Aspect Details Indication Refractoryorbital pseudotumor (idiopathic orbital inflammation) not responding to corticosteroids or immunosuppressants. Pain, proptosis, vision-threatening inflammation. Dose Conventional: 20 Gy in 10 fractions (2 Gy/fraction).Alternative: 20–30 Gy in 10–15 fractions.Low-dose regimens: 4–10 Gy in 2–5 fractions for palliation/recurrence. Procedure External beam radiotherapy (EBRT), typically with 6 MV photons.Immobilization with thermoplastic mask.CT-based planning, conformal fields/IMRT preferred to spare lens and optic nerve.Field: orbit only, margin to cover inflammation. Response Symptom relief in 60–80% of cases (pain, edema, proptosis).Best results in lymphoid-predominant histology; fibrotic type responds less. Toxicity Usually minimal with low doses. Possible late effects: cataract, dry eye, retinopathy (rare at ≤20 Gy).
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- 89. 09/04/2025 89 Heterotopic Ossification(HO) • Heterotopic ossification (HO) is a medical condition where bone grows in soft tissues and muscles where it doesn't normally exist. • It's a common complication after injuries, surgeries, or certain conditions like spinal cord injuries and burns. • HO can be asymptomatic, but more severe cases may cause decreased joint motion, pain, and a palpable mass. • Treatment often involves a combination of physical therapy, medications like NSAIDs, and sometimes radiation or surgery to prevent or remove the abnormal bone growth.
- 90. Heterotopic Ossification (HO) •Timing: 4h pre-op to 72h post-op • Dose options: –Single fraction: 7–8 Gy –Fractionated: 5 × 3.5 Gy • Effect: reduces incidence from 90% → <10% • LoE 1–2; Grade A–B
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- 93. Graves Orbitopathy (GO) •Autoimmune, thyroid-associated orbital inflammation • Risk factors: Graves’ disease, hyperthyroidism, smoking, genetics • Clinical: exophthalmos, diplopia, optic nerve compression • Classification: NOSPECS (0–VI), LEMO
- 94. GO – Radiotherapy •Used in moderate active phase (NOSPECS II–V) • Response rates: 65–75% good/excellent • Best in early inflammatory phase • Can combine with corticosteroids (superior to steroids alone) • Doses: • • Low dose: 0.3–2 Gy/fx, total 2.4–16 Gy • • Standard: 2 Gy × 8–10 fx, total 16–20 Gy • LoE 2; Grade B
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- 97. 09/04/2025 97 Neurogenic excessSalivation- Ptyalism
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- 99. 09/04/2025 99 Neurogenic excessSalivation- Ptyalism
- 100. 09/04/2025 100 Neurogenic excessSalivation- Ptyalism
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- 106. 09/04/2025 106 DFSP Dermatofibrosarcoma Protuberans SettingDose Margins/Technique Outcome Post-op (close/positive margin) 60 Gy Scar + 3–5 cm CTV, IMRT/3DCRT ↓ Recurrence, ~85– 90% control Gross/unresectable 66–70 Gy Wide CTV, advanced technique (IMRT/VMAT) Local control ~80% Definitive (non- surgical) 66–70 Gy Conformal/IMRT, cover tumor + margin Useful if surgery not feasible
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- 110. 09/04/2025 110 Plantar wart AspectDetails Indication Refractory plantar warts (painful, recurrent, resistant to topical, cryotherapy, laser, or surgical treatment) Rationale Radiation induces local immune modulation and destruction of HPV-infected keratinocytes Technique Superficial radiotherapy (SRT-100 or contact therapy), low-energy X-rays Dose Typically 2–3 Gy per fraction, 4–5 fractions; total dose 8–15 Gy (varies by protocol) Procedure Outpatient; direct application with lead shielding to protect normal tissue Efficacy High clearance rates (70–90% in small series) with durable control in many patients Toxicity Usually mild—erythema, desquamation, transient tenderness; very low risk of long-term complications with low-dose localized treatment Limitations Rarely used today due to concern for carcinogenesis, reserved for resistant or painful lesions in adults
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- 114. 09/04/2025 114 Nasopharyngeal Angiofibroma AspectDetails Dose Typically 30–36 Gy in 1.8–2 Gy fractions; some series go up to 40–45 Gy for resistant disease Technique Conformal RT or IMRT preferred (minimizes dose to optic structures, pituitary, brainstem) Fractionation Conventional fractionation (1.8–2 Gy per fraction)
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- 119. 09/04/2025 119 Psoriatic arthritis AspectDetails Indication Severe, refractory psoriatic arthritis not controlled with medical therapy (NSAIDs, DMARDs, biologics). Used mainly for local joint pain and inflammation. Mechanism Low-dose radiation exerts an anti-inflammatory and immunomodulatory effect, reducing synovitis and joint pain. Dose Typically 0.5–1.0 Gy per fraction, delivered 2–3 times per week; total dose 3–6 Gy per course. Sometimes repeated after 2–3 months if needed. Technique Orthovoltage or megavoltage radiotherapy. Treated joints (hands, knees, ankles, etc.) are localized. Low-energy photons commonly used. Efficacy Symptomatic relief (pain reduction, improved function) reported in 60–80% of patients. Toxicity Minimal at these doses; mild skin erythema possible. Carcinogenic risk is very low at such low doses but considered in young patients. Current Use Rare in routine practice due to availability of biologics. Still used in Europe (especially Germany) for benign inflammatory conditions.
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- 122. 09/04/2025 122 Rheumatoid arthritis AspectDetails Indication Historically used for severe, refractory RA when other treatments failed. Now largely abandoned due to effective disease-modifying anti-rheumatic drugs (DMARDs) and biologics. Technique Low-dose external beam radiotherapy or intra-articular radionuclide synovectomy (radioisotopes like Yttrium-90, Rhenium-186, Erbium-169). Dose - External beam: 0.5–1 Gy per fraction, total 3–6 Gy.- Radionuclide synovectomy: isotope activity varies by joint size (e.g., Y-90 for large joints, Re-186 for medium, Er-169 for small). Procedure Outpatient; isotope injected intra-articularly under aseptic conditions, often with local anesthesia. Immobilization for 48 hours post-injection. Effect Anti-inflammatory effect, relief of pain and swelling, reduced synovial proliferation. Limitations Slow onset of effect (weeks to months), not curative, risk of radiation-induced damage, largely replaced by modern pharmacotherapy. Current Role Rare, reserved for selected refractory cases or when surgery/biologics are contraindicated. More commonly used in Europe (radioisotope synovectomy) than in routine oncology practice.
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- 126. 09/04/2025 126 Aspect Details Indications -Recurrent ABC after surgery/embolization - Inoperable or surgically inaccessible sites (spine, skull base, pelvis) - Symptomatic lesions with pain, neurological compromise, or progressive growth Dose - 30–36 Gy in 1.8–2 Gy/fraction (standard) - Some reports: 20– 25 Gy effective Technique - 3D-CRT / IMRT - Target: lesion with safety margin based on CT/MRI Outcomes - Local control: ~80–90% - Pain relief and functional/neurological improvement - Tumor regression over months Risks - Rare risk of radiation-induced sarcoma (historical concern) - Growth disturbance in young patients if growth plates irradiated - Long-term monitoring required ANEURYSMAL BONE CYSTS
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- 129. 09/04/2025 129 LANGERHANS CELLHISTIOCYTOSIS
- 130. 09/04/2025 130 LANGERHANS CELLHISTIOCYTOSIS Aspect Details Indications Symptomatic unifocal lesions (bone, orbit, CNS, spine), painful or threatening function/structure, refractory to surgery/curettage, recurrence, or risk of deformity. Radiation Sensitivity LCH is highly radiosensitive. Even low doses can provide durable control. Dose (Common Range) 6–10 Gy in 1.5–2 Gy fractions for local control. In selected resistant or recurrent cases, up to 15–20 Gy. Higher doses usually not required. Technique Conformal RT or modern techniques (IMRT/VMAT) for critical structures. Photons (orthovoltage, electrons, or megavoltage depending on depth). Response High local control (>90%) with pain relief and functional preservation. Toxicity Minimal due to low doses. Long-term risk of growth disturbances in children, cataract (if orbit treated), and second malignancy risk (rare but relevant in pediatric cases). Special Notes RT should be considered only when less toxic options (surgery, steroids, chemotherapy) are inadequate or contraindicated. In children, careful justification and dose minimization are critical.
- 131. 09/04/2025 131 LANGERHANS CELLHISTIOCYTOSIS
- 132. 09/04/2025 132 LANGERHANS CELLHISTIOCYTOSIS
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- 134. 09/04/2025 134 Gynecomastia Aspect Details Indication Painfulgynecomastia, prophylaxis in men on antiandrogen therapy (e.g., prostate cancer) Dose Single fraction 8–12 Gy; 10–12 Gy in 2 fractions; 20 Gy in 5 fractions Technique Electron beam (6–9 MeV) with bolus; field over nipple–areolar complex; lung/heart shielding Effectiveness Prevents gynecomastia in ~70–80%; relieves pain in ~60–80% Toxicity Mild erythema, tenderness, nipple color change; rare fibrosis; very low carcinogenic risk
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- 140. 09/04/2025 140 Cardiac Arrhythmia- medical resistance
- 141. 09/04/2025 141 Cardiac Arrhythmia- SBRT Aspect Details Indication Refractory ventricular tachycardia (post-drug and failed catheter ablation) Target Arrhythmogenic scar/substrate (20–40 cc), defined by electroanatomic map + MRI/PET Dose 25 Gy in 1 fraction (most common) Procedure Multidisciplinary planning → 4D-CT with ECG/respiratory gating → image fusion → SBRT/VMAT/CK delivery with ECG monitoring Follow-up ECG/Holter, echo, MRI; effect appears over weeks to months (blanking period) Toxicity Acute: fatigue, nausea, rare pericarditis; Late: pericardial effusion, coronary or valvular injury (under study)
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- 145. 09/04/2025 145 Choroidal hemangioma AspectDetails Indication Symptomatic circumscribed or diffuse choroidal hemangioma causing vision loss, exudative retinal detachment, or when other treatments (laser, PDT, anti-VEGF) fail. Techniques External beam radiotherapy (EBRT), Plaque brachytherapy (Ru-106, I-125), Proton beam therapy, Stereotactic radiotherapy. Typical Dose - EBRT: 20–25 Gy in 10 fractions (commonly used, safe for macula/optic nerve). - Plaque brachytherapy: 30–40 Gy to tumor apex. - Proton therapy: ~20–25 Gy in 5 fractions. Procedure - Immobilization with retrobulbar anesthesia or mask fixation. - Imaging (OCT, ultrasound, fundus) to define target. - Small margins applied; sparing of lens and optic nerve prioritized. - Delivered with precise conformal techniques. Response High rates of retinal reattachment and resolution of subretinal fluid; improvement or stabilization of vision in majority of patients. Toxicities Generally mild; may include radiation retinopathy, optic neuropathy, cataract (less with low doses).
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- 149. 09/04/2025 149 Carotid-cavernous fistula(CCF) Aspect Details Indication Indirect (dural) CCF, failed/contraindicated embolization, poor surgical candidates Mechanism Radiation induces endothelial proliferation and fibrosis → gradual fistula closure Dose SRS: 18–20 Gy single fraction; Fractionated RT: 30–45 Gy in 15–25 fractions Procedure CT/MRI fusion → target cavernous sinus → conformal/SRS planning → optic pathway sparing Outcome Closure in ~60–80% over 6–18 months; improvement in proptosis, chemosis, diplopia Toxicity Usually mild; rare optic neuropathy, cranial nerve palsy, temporal lobe necrosis
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- 153. 09/04/2025 153 Aspect Details IndicationDrug-resistant mesial temporal lobe epilepsy, usually associated with mesial temporal sclerosis Target Amygdala and anterior hippocampus (sometimes parahippocampal gyrus) Dose 20–24 Gy in a single fraction (Gamma Knife or LINAC SRS) Procedure - MRI-based target delineation Medical Refractory Epilepsy
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- 165. 09/04/2025 165 Aspect Details Indications •Deep/eloquent cavernomas (brainstem, thalamus, basal ganglia) • High surgical risk or patient refusal of surgery • Recurrent symptomatic hemorrhage • Intractable seizures not controlled with drugs and not suitable for surgery • Residual/recurrent cavernoma after incomplete resection Dose • Single fraction (SRS): Margin dose 12–16 Gy (commonly 15–16 Gy), Max dose ~30–32 Gy • Hypofractionated SRT: 18–24 Gy in 3–5 fractions (used near critical structures e.g., brainstem) Procedure • MRI (T1, T2, GRE/SWI) + CT fusion for planning • Stereotactic frame or frameless mask immobilization • Target = cavernoma nidus (core + hemosiderin rim), no margin expansion • Conformal planning with steep dose fall-off • Delivered via Gamma Knife, LINAC, or CyberKnife • Follow-up MRI: 6–12 months, then yearly CAVERNOMA
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- 169. 09/04/2025 169 INTRACRANIAL EPIDERMOIDCYST Scenario Preferred Treatment Radiation Role Dose / Technique Primary (newly diagnosed, resectable) Maximal safe microsurgical excision Not indicated – Residual cyst after surgery Observation ± re- surgery Consider SRS in select cases SRS: 12–14 Gy single fraction (margin dose) Recurrent cyst (multiple surgeries done) Limited surgery if feasible SRS reasonable option SRS: 11–14 Gy Inoperable cyst (critical location or comorbidity) Conservative management SRS possible SRS: 12–13 Gy Malignant transformation (epidermoid → squamous cell carcinoma) Surgery + RT ± chemo Definitive/Adjuvant EBRT 60–66 Gy / 30–33 fractions (IMRT/VMAT)
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- 173. 09/04/2025 173 INTRACRANIAL HAMARTOMA Step/ Parameter Typical Practice Imaging MRI (T1, T2, contrast-enhanced) fused with CT for target delineation Target definition Hamartoma core (avoid optic chiasm, pituitary stalk, hypothalamus margins as much as possible) Immobilization Frame-based (Gamma Knife) or frameless mask (LINAC/CyberKnife) Planning system High-resolution stereotactic planning with MRI fusion Prescription dose 14–18 Gy to lesion margin (50% isodose line) Optic apparatus dose < 8–10 Gy (single fraction limit) Dose conformity Conformal planning with steep fall-off (multiple isocenters/shots in GK, non- coplanar arcs in LINAC, robotic beams in CK) Treatment time Typically 1–2 hours depending on system and complexity Procedure - Apply stereotactic frame (GK) or mask (LINAC/CK)- Acquire stereotactic MRI/CT- Target delineation and plan optimization- Quality assurance and dose verification- Single session delivery Follow-up MRI at 6–12 monthsSeizure response often after 6–24 months latency
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- 181. 09/04/2025 181 CHORDOMA CASESELECTION
- 182. 09/04/2025 182 CHORDOMA CASESELECTION
- 183. 09/04/2025 183 CHORDOMA CASESELECTION
- 184. 09/04/2025 184 ACOUSTIC NEUROMA 1.An acoustic neuroma is a noncancerous growth that develops on the eighth cranial nerve. 2. Also known as the vestibulocochlear nerve, it connects the inner ear with the brain and has two different parts. 3. One part is involved in transmitting sound; the other helps send balance information from the inner ear to the brain.
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- 188. 09/04/2025 188 MENINGIOMAS • Meningiomasare generally benign lesions that account for 15–20 % of primary brain tumors, affect predominately middle- aged patients, and occur predominately in females • The atypical and malignant meningiomas are characterized by successive recurrences and an aggressive behavior. • Among all meningiomas, their incidence varies in the literature ranging from 4.7 to 7.1 % and 1.0 to 3.7 % for atypical and malignant, respectively
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- 192. 09/04/2025 192 ARTERIOVENOUS MALFORMATIONS •Radiosurgery is an effective alternative treatment for selected AVM patients rather than microsurgery , especially in those with surgically inaccessible lesions with comorbidities which hinder surgical intervention or if microsurgery is not feasible. • In terms of radiobiology, AVM are late responding target within late reaction of normal tissue. • Following bleeding , part of nidus may be hidden or compressed by clots hence it is rational to wait till resolution of hematoma (average 2-3 months).
- 193. 09/04/2025 193 AVM MXALGORITHM-ISRS GUIDELINES
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- 197. 09/04/2025 197 Summary • Thereis a role of Radiation in benign diseases • Many sites are under explored • Practice with caution • Mostly indicated in refractory/recurrent cases • Practice with caution in young population • Follow guideline • More awareness required in both physician and population groups • Do not forget about radiation induced malignancy
- 198. 09/04/2025 198 EITHER INFLAMMATION ORBENIGN CONDITION WHEN THERE IS NO OPTION CONSIDER RADIATION LOW DOSE RADIATION IN REFRACTORY CONDITION EVIDENCE WITH CAUTION YOU MAY GET SOME SOLUTION
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