November 12, 1999

WORCESTER, Mass. – UMass Memorial Health Care now has the ability to offer the latest state-of-the-art technology for patients with difficult-to-treat brain tumors. The Center of Excellence partnership with Radionics, Inc. (a Massachusetts-based medical technology company) ensures that UMass Memorial will play a significant role in advancing the technology in radiation treatment.

This technique is encompassed in the X-Knife Stereotactic Radiosurgery System, which uses a high speed computer to allow the neurosurgeon and radiation oncologist to shape a lethal dose of radiation to the tumor and avoid critical structures and healthy tissue. The computer-assisted system allows the clinical team to administer higher doses to the lesion than with other technology, such as the gamma knife. Although it may seem like a small improvement, even single percentages and mere millimeters can be critical to the preservation of vital brain functions.

For Tom Barrasso of Stow, that small difference was important. Diagnosed with a brain tumor in April, Mr. Barrasso, 67, underwent open surgery in Boston to remove 90% of the tumor. The remaining tumor, however, presented a continued risk for him and he came to UMass Memorial for the X-Knife treatment. The procedure took most of the day, he said, but he went home "feeling fine. I get a little tired because of the radiation treatment, but it's better than the alternative."

"If we can prevent injury to sensitive structures in the brain, we can preserve, for example, the patient's vision, speech or motor abilities," said Barrasso's doctor, N. Scott Litofsky, MD, director of Surgical Neuro-oncology and co-director of the Center for Skull-based Diseases at UMass Memorial. "The key is this new software and equipment that allows us to configure the beam so precisely."

The computer software, developed by Radionics, Inc., of Burlington, Mass., uses images collected using traditional CT scans and MRIs to produce a three-dimensional model of the tumor and its exact location among nearby brain structures. A team comprised composed of a neurosurgeon, radiation oncologist and physicist then determines the precise target position and configuration of radiation beams, adjusting the system's ConforMax mini multi-leaf collimator (MMLC) to focus the beam precisely on the lesion and spare surrounding tissue.

The procedure is performed on an outpatient basis and, while the administration of the dose of radiation itself takes only approximately 30 minutes, the entire procedure takes the better part of the day. The neurosurgeon attaches a frame to the patient's head to provide a reference platform for imaging and allows the physicians to pinpoint the affected area. The frame, planning software, and the MMLC work together as an integrated system to achieve the high accuracy that's required. "Much of what the patient sees is similar to older gamma knife technology," said Dr. Litofsky, who is also an associate professor of surgery at the University of Massachusetts Medical School. "But this new technique allows us to shape the X-ray beam to conform to the tiniest fragments of tumor without hitting surrounding tissue. For people with recurrent brain tumors or perhaps some leftover tumor that surgery couldn't reach, this procedure can help control their disease and allow them to resume a more normal life without the risks of open surgery."

This technique can be used for several types of brain tumors and disorders, including arteriovenous malformations (AVM), brain metastases, gliomas, acoustic neuromas, pituitary adenomas, and certain functional brain disorders. Surgeons will soon be able to use the technique to treat difficult-to-treat tumors in other areas of the body, such as head and neck cancers. Further developments will lead to applications in other body sites.

UMass Memorial is one of just five centers in the world to earn the distinction of Center for Excellence for its partnership with Radionics in product development and advancements of clinical applications. The first radiosurgery case was performed at UMass Memorial early this fall. UMass Memorial, the clinical partner of the University of Massachusetts Medical School, is the largest health care system in central Massachusetts, with 1,700 physicians and over 10,000 employees. Its comprehensive network of care includes teaching hospitals, community hospitals, outpatient clinics, community-based physician practices, long-term care facilities, and home health, hospice, rehabilitation and mental health services.