Stereotactic Radiosurgery (SRS) - Procedures, Preparation, Cost, and Recovery

Stereotactic Radiosurgery (SRS) is a non-invasive medical procedure that delivers precisely targeted radiation to treat various conditions, primarily tumours in the brain and other parts of the body. Despite its name, SRS is not a surgical procedure in the traditional sense; rather, it uses advanced imaging techniques and high doses of focused radiation to destroy abnormal tissue while minimising damage to surrounding healthy tissue. This method enables effective treatment of conditions that may be difficult to reach through conventional surgery.

The primary purpose of SRS is to treat tumours, both benign and malignant, as well as other abnormalities such as arteriovenous malformations (AVMs-abnormal blood vessel connections) and certain neurological disorders. SRS is particularly beneficial for patients who may not be suitable candidates for traditional surgery due to the location of the tumour, their overall health, or other medical conditions. The procedure is typically performed in an outpatient setting, allowing patients to return home the same day.

SRS is commonly used to treat:

• Brain Tumours: This includes primary tumours (e.g., gliomas) and metastatic tumours that have spread from other parts of the body.
• Arteriovenous Malformations (AVMs): These are abnormal tangles of blood vessels in the brain that can lead to bleeding and other complications.
• Trigeminal Neuralgia: A chronic pain condition affecting the trigeminal nerve in the face, often treated with SRS to alleviate pain.
• Acoustic Neuromas: Benign tumours on the vestibulocochlear nerve that can affect hearing and balance.

The precision of SRS allows for high doses of radiation to be delivered in a single session or a few sessions, making it a highly effective treatment option for many patients.

Why is Stereotactic Radiosurgery (SRS) Done?

Stereotactic Radiosurgery (SRS) is typically recommended for patients experiencing symptoms related to specific conditions that can be effectively treated with targeted radiation. The decision to proceed with SRS is often based on a combination of factors, including the type and location of the tumour, the patient's overall health, and the potential benefits versus risks of the procedure.

Common symptoms that may lead to the recommendation of SRS include:

• Headaches: Persistent or severe headaches that may indicate increased intracranial pressure or the presence of a tumour.
• Neurological Deficits: Symptoms such as weakness, numbness, or difficulty with coordination that may suggest a brain tumour or other neurological condition.
• Seizures: New-onset seizures can be a sign of a brain tumour or other abnormalities in the brain.
• Vision or Hearing Changes: Alterations in vision or hearing can indicate the presence of a tumour affecting the optic or auditory pathways.

SRS is often considered when traditional surgical options are not viable due to the tumour's location, the patient's age, or other health concerns. It is also an option for patients who prefer a non-invasive approach to treatment. The procedure is typically recommended when:

• The tumour is small to medium-sized and well-defined.
• The tumour is located in a region of the brain that is difficult to access surgically.
• The patient has a limited life expectancy, and the goal is to alleviate symptoms rather than pursue aggressive treatment.

In summary, SRS is a valuable treatment option for patients with specific conditions that can benefit from targeted radiation therapy, particularly when traditional surgical methods are not feasible.

Indications for Stereotactic Radiosurgery (SRS)

The decision to use Stereotactic Radiosurgery (SRS) is based on a thorough evaluation of the patient's medical history, imaging studies, and clinical findings. Several clinical situations and diagnostic criteria can make a patient a candidate for SRS. These include:

• Tumour Characteristics: Patients with tumours that are small to medium-sized, well-defined, and located in areas of the brain that are difficult to access surgically are often considered for SRS. Tumours that have not spread beyond the primary site are ideal candidates.
• Type of Tumour: SRS is effective for various types of tumours, including:
  • Primary Brain Tumours: e.g., gliomas and meningiomas.
  • Metastatic Tumours: Tumours that have spread from other parts of the body, such as lung or breast cancer.
  • Benign Tumours: Such as acoustic neuromas and pituitary adenomas.
• Patient Health: The overall health of the patient plays a crucial role in determining candidacy for SRS. Patients who are not suitable candidates for traditional surgery due to age, comorbidities, or other health issues may benefit from SRS.
• Symptomatology: Patients experiencing significant symptoms related to their tumours, such as seizures, headaches, or neurological deficits, may be recommended for SRS to alleviate these issues.
• Imaging Findings: Advanced imaging techniques, such as MRI or CT scans, are used to assess the size, location, and characteristics of the tumour. Clear imaging results that indicate a well-defined target for radiation therapy are essential for SRS candidacy.
• Previous Treatments: Patients who have undergone previous treatments, such as surgery or chemotherapy, may still be candidates for SRS if there are residual tumours or new growths.

In conclusion, the indications for Stereotactic Radiosurgery (SRS) are based on a combination of tumour characteristics, patient health, and the presence of symptoms. A multidisciplinary team of healthcare professionals, including neurosurgeons, radiation oncologists, and medical physicists, collaborates to determine the best treatment plan for each patient, ensuring that SRS is a suitable option for their specific condition.

Types of Stereotactic Radiosurgery (SRS)

Stereotactic Radiosurgery (SRS) encompasses several techniques that utilise different technologies to deliver targeted radiation. While the fundamental goal remains the same—precisely targeting tumours or abnormalities—various methods can be employed based on the specific clinical scenario. The most recognised types of SRS include:

• Gamma Knife Radiosurgery: This technique uses a specialised machine that delivers focused gamma radiation beams to the target area. The Gamma Knife is particularly effective for treating brain tumours and AVMs. It is known for its precision and ability to treat multiple targets in a single session.
• Linear Accelerator (LINAC) SRS: This method employs a linear accelerator to deliver high-energy X-rays to the tumour. LINAC-based SRS can be used for both intracranial and extracranial targets, making it versatile for treating various conditions. It allows for real-time imaging and adjustments during treatment, enhancing accuracy.
• CyberKnife: The CyberKnife system combines a robotic arm with a linear accelerator to deliver radiation. It is capable of treating tumours in various locations, including the spine and lungs, in addition to the brain. The CyberKnife system is known for its ability to track tumour movement, allowing for precise targeting even as the patient breathes.
• Fractionated Stereotactic Radiotherapy (FSRT): While not strictly classified as SRS, FSRT is an alternative technique that delivers radiation in multiple smaller doses over several sessions, when SRS is not the appropriate technique. This approach can be beneficial for larger tumours or those located near critical structures, as it allows for a more gradual delivery of radiation while minimizing side effects.

Each of these techniques has its advantages and is chosen based on the specific needs of the patient, the type of tumour, and the treatment goals. The choice of SRS method is made collaboratively by the healthcare team, ensuring that patients receive the most effective and appropriate treatment for their condition.

In summary, Stereotactic Radiosurgery (SRS) is a cutting-edge treatment option for various conditions, particularly tumours in the brain and other areas. Understanding the procedure, its indications, and the different types available can empower patients to make informed decisions about their treatment options. As technology continues to advance, SRS remains a vital tool in the fight against cancer and other neurological disorders, offering hope and improved outcomes for many patients.

Contraindications for Stereotactic Radiosurgery (SRS)

While Stereotactic Radiosurgery (SRS) is a highly effective treatment option for various conditions, certain factors may render a patient unsuitable for this procedure. Understanding these contraindications is crucial for ensuring patient safety and treatment efficacy. Not all patients are suitable candidates for SRS. Below are situations in which it may not be recommended.

• Tumour Size and Location: SRS is typically most effective for small to medium-sized tumours. Large tumours, especially those exceeding 3-4 centimeters, may not respond well to SRS due to the difficulty in delivering a concentrated dose of radiation without affecting surrounding healthy tissue. Additionally, tumours located near critical structures, such as the brainstem or optic nerves, may pose a higher risk for complications.
• Patient's Overall Health: Patients with significant comorbidities, such as severe cardiovascular disease, uncontrolled diabetes, or other serious health issues, may not be ideal candidates for SRS. The procedure requires patients to remain still for extended periods, and any underlying health conditions could complicate this.
• Previous Radiation Therapy: Patients who have previously undergone radiation therapy to the same area may have an increased risk of complications. The cumulative dose of radiation can lead to tissue damage, making SRS a less viable option.
• Pregnancy: Pregnant patients are generally advised against undergoing SRS due to potential risks to the developing fetus. Radiation exposure can have harmful effects, and alternative treatment options should be considered.
• Inability to Tolerate Immobilisation: SRS requires patients to remain in a fixed position during the procedure. Patients with conditions that prevent them from lying still, such as severe anxiety or certain movement disorders, may not be suitable candidates.
• Infection or Inflammation: Active infections or inflammation in the area to be treated can complicate the procedure and increase the risk of complications. It is essential to address these issues before considering SRS.
• Certain Medications: Some medications, particularly those that affect blood clotting or immune response, may pose risks during SRS. Patients should discuss their current medications with their healthcare provider to determine if any adjustments are necessary.

By carefully evaluating these contraindications, healthcare providers can ensure that SRS is performed on patients who are most likely to benefit from the treatment while minimising potential risks.

How to Prepare for Stereotactic Radiosurgery (SRS)

Preparing for Stereotactic Radiosurgery (SRS) involves several important steps to ensure the procedure goes smoothly and safely. Here’s what patients can expect in the lead-up to their treatment.

• Initial Consultation: The preparation process begins with a thorough consultation with a radiation oncologist. During this appointment, the doctor will review the patient's medical history, perform a physical examination, and discuss the specifics of the SRS procedure. This is also an opportunity for patients to ask questions and express any concerns.
• Imaging Tests: Prior to SRS, patients will undergo imaging tests, such as MRI or CT scans. These tests help the medical team accurately locate the tumour and plan the precise delivery of radiation. Patients should follow any specific instructions regarding these tests, such as fasting or avoiding certain medications.
• Pre-Procedure Instructions: Patients will receive detailed instructions on how to prepare for the day of the procedure. This may include guidelines on eating and drinking, as well as any medications to avoid. It’s essential to follow these instructions closely to ensure the best possible outcome.
• Medication Review: Patients should provide a complete list of their current medications, including over-the-counter drugs and supplements. The healthcare team may recommend stopping certain medications, particularly blood thinners, in the days leading up to the procedure.
• Support System: Arranging for a support person to accompany the patient on the day of the procedure is advisable. This individual can provide emotional support and assist with transportation home afterward, as patients may feel fatigued or disoriented post-treatment.
• Mental Preparation: SRS can be an anxiety-inducing experience for some patients. Engaging in relaxation techniques, such as deep breathing exercises or meditation, can help ease pre-procedure nerves. Patients should also be encouraged to discuss any fears or anxieties with their healthcare team.
• Day of the Procedure: On the day of SRS, patients should arrive at the treatment center early to allow time for check-in and any last-minute preparations. They may be asked to change into a hospital gown and will be guided through the process by the medical staff.

By following these preparation steps, patients can help ensure a successful SRS experience, setting the stage for effective treatment.

Stereotactic Radiosurgery (SRS): Step-by-Step Procedure

Understanding the Stereotactic Radiosurgery (SRS) procedure can help alleviate anxiety and prepare patients for what to expect. Here’s a step-by-step overview of the process, from arrival to recovery.

• Arrival and Check-In: Patients will arrive at the treatment center and check in at the front desk. They may be asked to complete some paperwork and confirm their medical history.
• Pre-Procedure Assessment: Before the procedure begins, the medical team will conduct a brief assessment. This may include checking vital signs and reviewing any last-minute questions or concerns.
• Positioning: Patients will be taken to the treatment room, where they will lie down on a treatment table. Depending on the type of SRS being performed, a specialised frame or mask may be used to immobilise the head and neck. This ensures that the radiation is delivered precisely to the targeted area.
• Imaging Confirmation: Once positioned, imaging scans may be performed to confirm the exact location of the tumour. This step is crucial for ensuring that the radiation beams are accurately targeted.
• Radiation Delivery: The actual SRS procedure typically lasts between 30 minutes to several hours, depending on the complexity of the treatment. During this time, patients will be monitored closely. The radiation oncologist will use advanced technology to deliver high doses of radiation to the tumour while minimizing exposure to surrounding healthy tissue.
• Post-Procedure Monitoring: After the radiation has been delivered, patients will be moved to a recovery area for monitoring. Medical staff will check vital signs and ensure that patients are stable before allowing them to go home.
• Discharge Instructions: Once patients are cleared for discharge, they will receive detailed instructions on post-procedure care. This may include information on managing any side effects, when to follow up with their healthcare provider, and signs of complications to watch for.
• Follow-Up Care: Patients will typically have follow-up appointments scheduled to monitor their progress and assess the effectiveness of the treatment. These visits may include additional imaging tests to evaluate the tumour's response to SRS.

By understanding each step of the SRS procedure, patients can feel more prepared and confident as they undergo this innovative treatment.

Risks and Complications of Stereotactic Radiosurgery (SRS)

Like any medical procedure, Stereotactic Radiosurgery (SRS) carries certain risks and potential complications. While many patients experience positive outcomes, it’s essential to be aware of both common and rare risks associated with the treatment.

• Common Risks:
  • Fatigue: Many patients report feeling tired after SRS. This fatigue can last for several days or weeks but typically improves over time.
  • Headache: Some patients may experience headaches following the procedure. These are usually mild and can be managed with over-the-counter pain relievers.
  • Nausea: A small number of patients may feel nauseous after treatment. This side effect is generally temporary and can be alleviated with medication if necessary.
  • Skin Irritation: Patients may notice mild redness or irritation at the site where the radiation beams were directed. This usually resolves on its own.
• Rare Risks:
  • Neurological Effects: In rare cases, patients may experience neurological symptoms, such as seizures or changes in vision. These effects are typically associated with the location of the tumour and the amount of radiation delivered.
  • Radiation Necrosis: This is a rare but serious complication where healthy brain tissue becomes damaged due to radiation exposure. Symptoms may include headaches, seizures, or neurological deficits. Treatment may involve medications or, in some cases, surgery.
  • Secondary Cancers: Although extremely rare, there is a slight risk of developing a secondary cancer as a result of radiation exposure. The risk is generally considered low compared to the benefits of treating the primary tumour.
• Monitoring and Management: It’s important for patients to communicate any new or worsening symptoms to their healthcare provider promptly. Regular follow-up appointments will help monitor for any potential complications and ensure that any issues are addressed quickly.

By understanding the risks and complications associated with SRS, patients can make informed decisions about their treatment options and work closely with their healthcare team to achieve the best possible outcomes.

Recovery After Stereotactic Radiosurgery (SRS)

Recovery from Stereotactic Radiosurgery (SRS) is generally swift, with many patients experiencing minimal downtime. Most individuals can return home the same day as the procedure, although some may require a short hospital stay for observation. The expected recovery timeline varies, but here’s a general overview:

• Immediate Post-Procedure: After SRS, patients may feel tired or experience mild headaches. These symptoms are typically manageable with over-the-counter pain relief. It’s essential to rest and allow your body to recover.
• First Week: During the first week, patients should avoid strenuous activities, including heavy lifting and vigorous exercise. Light activities, such as walking, are encouraged to promote circulation and healing.
• Two Weeks Post-SRS: Most patients can gradually resume normal activities, including work, unless otherwise advised by their healthcare provider. It’s crucial to listen to your body and not rush the recovery process.
• Follow-Up Appointments: Regular follow-up appointments are essential to monitor progress and manage any side effects. Your doctor will provide specific aftercare tips tailored to your situation.
• Long-Term Recovery: While many patients feel back to normal within a few weeks, some may experience delayed side effects, depending on the treated area. It’s important to maintain open communication with your healthcare team throughout your recovery.

Benefits of Stereotactic Radiosurgery (SRS)

Stereotactic Radiosurgery (SRS) offers numerous benefits, making it a preferred treatment option for various conditions, particularly brain tumours and vascular malformations. Here are some key health improvements and quality-of-life outcomes associated with SRS:

• Precision Treatment: SRS delivers high doses of radiation precisely to the target area, minimising damage to surrounding healthy tissue. This precision reduces the risk of complications and side effects.
• Non-Invasive: Unlike traditional surgery, SRS is non-invasive, meaning there are no incisions or prolonged recovery times. This aspect significantly enhances patient comfort and reduces hospital stays.
• Quick Recovery: Most patients can return to their daily activities shortly after the procedure, allowing for a quicker return to normal life compared to conventional surgical options.
• Effective Tumour Control: SRS has been shown to be effective in controlling tumour growth and, in some cases, shrinking tumours. This effectiveness can lead to improved survival rates and better long-term outcomes.
• Quality of Life: Many patients report an improved quality of life post-SRS, as the procedure can alleviate symptoms caused by tumours or other conditions, such as headaches or neurological deficits.
• Minimal Side Effects: While some side effects may occur, they are generally mild and manageable. This aspect makes SRS an attractive option for patients who may not tolerate traditional surgery well.

What is the Cost of Stereotactic Radiosurgery (SRS) in India?

The cost of Stereotactic Radiosurgery (SRS) in India typically ranges from ₹1,00,000 to ₹2,50,000. Several factors influence this cost, including:

• Hospital Choice: Different hospitals have varying pricing structures. Renowned institutions like Apollo Hospitals may offer competitive rates while ensuring high-quality care.
• Location: The city or region where the treatment is performed can affect costs. Urban centres may have higher prices due to increased operational costs.
• Room Type: The choice of room (private, semi-private, etc.) can also impact the overall cost of the procedure.
• Complications: If any complications arise during or after the procedure, additional treatments may be necessary, increasing the total cost.

Some Indian hospitals, such as Apollo, offer advanced SRS technology and are frequently chosen for their expertise, experienced medical professionals, and comprehensive care, making it a preferred choice for SRS in India. Compared to Western countries, the affordability of SRS in India is significant, often costing a fraction of the price while maintaining high standards of care.

For exact pricing and personalised treatment plans, we encourage you to contact Apollo Hospitals directly.

Frequently Asked Questions about Stereotactic Radiosurgery (SRS)

• What dietary changes should I make before Stereotactic Radiosurgery (SRS)?
  Before Stereotactic Radiosurgery (SRS), it’s advisable to maintain a balanced diet rich in fruits, vegetables, and whole grains. Staying hydrated is also essential. Avoid heavy meals before the procedure, and consult your doctor for any specific dietary restrictions. 
   
• Can I eat normally after Stereotactic Radiosurgery (SRS)?
  Yes, after Stereotactic Radiosurgery (SRS), you can generally resume your normal diet unless advised otherwise by your healthcare provider. Focus on nutritious foods to support your recovery. 
   
• Is Stereotactic Radiosurgery (SRS) safe for elderly patients?
  Stereotactic Radiosurgery (SRS) is often safe for elderly patients, as it is non-invasive and has a quick recovery time. However, individual health conditions should be assessed by a medical professional. 
   
• Are there any pregnancy-related concerns with Stereotactic Radiosurgery (SRS)?
  If you are pregnant or planning to become pregnant, discuss your situation with your doctor before undergoing Stereotactic Radiosurgery (SRS). They will evaluate the risks and benefits specific to your case. 
   
• Is Stereotactic Radiosurgery (SRS) suitable for pediatric patients?
  Yes, Stereotactic Radiosurgery (SRS) can be used in pediatric cases, particularly for brain tumours. The procedure is tailored to minimise risks and ensure safety for younger patients. 
   
• How does obesity affect Stereotactic Radiosurgery (SRS)?
  Obesity may complicate the treatment process for Stereotactic Radiosurgery (SRS) due to potential comorbidities. It’s essential to discuss your weight and overall health with your healthcare provider before the procedure. 
   
• Can patients with diabetes undergo Stereotactic Radiosurgery (SRS)?
  Yes, patients with diabetes can undergo Stereotactic Radiosurgery (SRS). However, it’s crucial to manage blood sugar levels effectively before and after the procedure to ensure optimal recovery. 
   
• What precautions should hypertensive patients take before Stereotactic Radiosurgery (SRS)?
  Hypertensive patients should ensure their blood pressure is well-controlled before undergoing Stereotactic Radiosurgery (SRS). Regular monitoring and medication adjustments may be necessary. 
   
• How long does it take to recover from Stereotactic Radiosurgery (SRS)?
  Recovery from Stereotactic Radiosurgery (SRS) is typically quick, with many patients returning to normal activities within a week. However, individual recovery times may vary. 
   
• What are the side effects of Stereotactic Radiosurgery (SRS)?
  Common side effects of Stereotactic Radiosurgery (SRS) may include fatigue, headaches, and mild swelling at the treatment site. Most side effects are manageable and resolve over time. 
   
• Can I continue my medications after Stereotactic Radiosurgery (SRS)?
  Yes, most patients can continue their regular medications after Stereotactic Radiosurgery (SRS). However, consult your doctor for specific instructions regarding any medications. 
   
• Is there a risk of hair loss after Stereotactic Radiosurgery (SRS)?
  Hair loss may occur in the treated area after Stereotactic Radiosurgery (SRS), particularly if the scalp is involved. This is usually temporary, and hair often regrows over time. 
   
• How does Stereotactic Radiosurgery (SRS) compare to traditional surgery?
  Stereotactic Radiosurgery (SRS) is less invasive than traditional surgery, resulting in shorter recovery times and fewer complications. It is often preferred for patients who may not tolerate surgery well. 
   
• What should I do if I experience severe headaches after Stereotactic Radiosurgery (SRS)?
  If you experience severe headaches after Stereotactic Radiosurgery (SRS), contact your healthcare provider immediately. They can assess your symptoms and provide appropriate care. 
   
• Can Stereotactic Radiosurgery (SRS) be repeated?
  Yes, Stereotactic Radiosurgery (SRS) can be repeated if necessary, depending on the individual case and the condition being treated. Your doctor will determine the best course of action. 
   
• What is the success rate of Stereotactic Radiosurgery (SRS)?
  The success rate of Stereotactic Radiosurgery (SRS) varies based on the condition being treated. Generally, it is highly effective for controlling tumour growth and improving patient outcomes. 
   
• Are there any lifestyle changes I should make after Stereotactic Radiosurgery (SRS)?
  After Stereotactic Radiosurgery (SRS), maintaining a healthy lifestyle, including a balanced diet and regular exercise, can support recovery and overall well-being. 
   
• How does Stereotactic Radiosurgery (SRS) affect my daily life?
  Most patients find that Stereotactic Radiosurgery (SRS) has minimal impact on their daily lives, allowing them to return to normal activities quickly. However, individual experiences may vary. 
   
• What follow-up care is needed after Stereotactic Radiosurgery (SRS)?
  Follow-up care after Stereotactic Radiosurgery (SRS) typically includes regular check-ups to monitor progress and manage any side effects. Your healthcare provider will guide you on the necessary schedule. 
   
• How does Stereotactic Radiosurgery (SRS) in India compare to other countries?
  Stereotactic Radiosurgery (SRS) in India is often more affordable than in Western countries while maintaining high standards of care. Patients can expect quality treatment with advanced technology at competitive prices. 

Conclusion

Stereotactic Radiosurgery (SRS) is a revolutionary treatment option that offers precision, effectiveness, and a quick recovery for various medical conditions. Its benefits extend beyond just tumour control, significantly enhancing patients' quality of life. If you or a loved one is considering SRS, it’s essential to consult with a medical professional to discuss your specific situation and determine the best course of action.