World-renowned Groupe Hospitalier Pitié Salpétrière’s new Leksell Gamma Knife Perfexion could provide alternative to whole brain radiation therapy for treating multiple brain metastasesFrance — Monday, May 9, 2011
Groupe Hospitalier Pitié Salpétrière, a world-renowned teaching hospital, and among Europe’s largest medical centers has continued its long tradition of excellence in neurosciences and its expertise in radiation therapy with the acquisition of Leksell Gamma Knife® Perfexion™. On October 25, 2010, clinicians used Perfexion – Paris’s first and only dedicated radiosurgery system – to treat Salpétrière’s first patient, a 55-year-old woman with a brain metastasis.
“Her Gamma Knife® surgery went very well and her follow up examination in February showed she is doing well post-operatively,” says Charles Ambroise Valery, M.D., a neurosurgeon and head of the radiosurgery department at 1,600-bed Salpétrière. “Perfexion will have a huge impact due to our large population and the incidence of cerebral pathologies that can be treated with radiosurgery. Neurosurgeons have confidence in Gamma Knife, and particularly in Perfexion because it is designed as a dedicated specialist tool for intracranial brain diseases in contrast with other radiosurgery systems. In two or three years, I predict we could treat 700 patients per year.”
Gamma Knife surgery is a gentler alternative to traditional brain surgery for illnesses such as metastatic disease – cancer that has traveled to the brain from elsewhere in the body. The system precisely delivers up to thousands of low-intensity radiation beams to one or more targets in a single session. Perfexion provides even greater speed and ease of use than previous models, especially for treating multiple metastases.
Since October, Salpétrière has treated about 177 patients presenting 375 lesions, of which about 75 percent were patients with brain metastases.
Since 2005, Salpétrière had been using a linac-based system equipped with “micro multi-leaf” beam shaping technology to treat patients with brain tumors, but also had to use this system for tumors in the rest of the body as well. Salpétrière’s current high volume of patients with brain tumors – and high potential volume of patients with other serious brain disorders that would benefit from radiosurgery – demanded a solution dedicated to brain and head treatments.
For now, Salpétrière clinicians have many patients with metastases, a majority with more than a single lesion. Before Perfexion arrived, the threshold number of brain metastases above which the patient was scheduled for multiple treatment sessions or referred to whole brain radiation therapy (WBRT) was much lower.
“The linac we used was not dedicated to brain cases,” he says. “Prostate cases would start in the morning, and we would get the machine for two or three hours in the late afternoon. We had time to treat three brain mets maximum per patient per session. If the patient had six metastases we had to schedule another treatment session, or if the patient had many more we had to refer for WBRT, which is undesirable due to the possibility of neurocognitive deficits.
“With Perfexion,” he continues, “it is more convenient because we can treat any number of metastases with no delay and much less likelihood we’ll refer for WBRT. For patients, the treatment day is shorter, which is important because they are wearing a frame.”
Dr. Valery reports that in a recent case, they treated a patient with 13 brain metastases in a single session in just over two hours of treatment time.
Gamma Knife has been a long time in coming to Paris, he adds, noting that a colleague, Prof. Philippe Cornu, began lobbying the public hospital organization in 1993 to enable its purchase.
“We knew it would take a long time,” Dr. Valery says. “But, now we are very happy that we’ll be able to treat any patient who requires this system. They won’t have to travel to Marseilles or Lille, and it will be much easier to ensure a proper follow-up. For all these reasons, we are very pleased to attain Perfexion.”
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