Stereotactic Radiosurgery Treatment in Raipur

Not every brain tumour can be removed with a scalpel. Some are deep within the brain, adjacent to structures controlling speech, movement or vision where surgery carries a risk of devastating neurological injury that outweighs the benefit. Others arise in patients unfit for anaesthesia or have recurred in a scarred operative field. For these patients stereotactic radiosurgery offers a non-invasive, outpatient treatment delivering a precisely focused, high dose of radiation to the tumour with submillimeter accuracy.

Despite its name, stereotactic radiosurgery is not surgery. There is no incision, no general anaesthesia, no craniotomy. The radiation is the scalpel, concentrated from multiple directions onto a precisely defined target, with the dose falling off sharply at the tumour boundary so that adjacent critical structures receive a fraction of the target dose. Treatment is typically completed in one session or a small number of sessions; the patient goes home the same day.

What is Stereotactic Radiosurgery (SRS/SRT)?

Stereotactic Radiosurgery (SRS) uses multiple precisely shaped high-energy radiation beams converging from different angles on a single intracranial target, delivering a large ablative dose in a single fraction. The term 'stereotactic' refers to the three-dimensional coordinate system (derived from pre-treatment imaging) used to define and verify the target position to submillimeter precision.

The key distinction from conventional radiotherapy is the dose per fraction. Conventional treatment delivers 1.8 to 2 Gy per fraction over weeks; SRS delivers 15 to 24 Gy in a single session. This dose achieves tumour cell death through mechanisms beyond DNA repair, including vascular injury and immunogenic cell death, and is effective against tumours that are radioresistant to conventional fractionated doses.

When is Stereotactic Radiosurgery (SRS/SRT) Performed?

Doctors recommend stereotactic radiosurgery for:

• Brain metastases: The most common SRS indication. Patients with one to ten metastases each less than 3 to 4cm, as primary treatment or after surgical resection
• Acoustic neuroma (vestibular schwannoma): SRS achieves tumour control with hearing & facial nerve preservation superior to surgery in most series
• Meningioma: Particularly skull base meningiomas adjacent to the cavernous sinus, optic apparatus or posterior fossa where surgery carries significant cranial nerve risk
• Arteriovenous malformations (AVMs): Progressive obliteration over two to three years (eliminating haemorrhage risk without open surgery)
• Trigeminal neuralgia: SRS targeting the trigeminal nerve root achieves pain relief in medically refractory cases without open surgery.

What Types of Brain Tumours Can Be Treated with SRS/SRT?

SRS and SRT are highly precise radiation treatments that are used to treat:

• Brain metastases: Lung, breast, melanoma, renal, and colorectal metastases 
• Acoustic neuroma (vestibular schwannoma)
• Skull base meningiomas not resectable without cranial nerve morbidity 
• Glioma (selected low grade and recurrent cases)
• Pituitary adenoma particularly non functioning adenomas and hormonal normalisation in functioning tumours
• Craniopharyngiomas
• Chordomas and chondrosarcomas
• Residual or recurrent brain tumours after surgery
• Other small, well-defined brain tumours that are suitable for highly focused radiation treatment.

Who is a Candidate for SRS/SRT?

SRS and SRT are most suitable for carefully selected situations. They are:

• Tumour size: SRS is best suited to lesions up to 3-4 cm. Larger lesions carry higher oedema risk with single fraction treatment so SRT in multiple fractions is preferred
• Well-defined margin: Lesions with clear MRI margins are best targeted. Infiltrative tumours with poorly defined margins require fractionated SRT
• Number of targets: The Versa HD treats multiple brain metastases simultaneously. Evidence supports SRS for up to ten or more discrete metastases in selected patients
• Medical fitness: SRS requires still positioning for 15 to 45 minutes. No general anaesthesia is needed

Diagnosis Before SRS/SRT

Doctors perform various investigations to determine eligibility. These are:

• High-resolution MRI brain: Gadolinium-enhanced MRI with thin-slice acquisition (1mm) provides the anatomical detail required for target delineation. 
• CT simulation with immobilisation: A planning CT in a custom thermoplastic mask ensures reproducible positioning for all sessions. The CT is registered with the MRI for accurate target delineation on the CT-based planning dataset
• PET CT: When distinguishing recurrent tumour from radiation necrosis is clinically important particularly after prior radiotherapy FDG PET CT provides metabolic information MRI alone cannot resolve. The uMI 550 with Time-of-Flight imaging and 2.76mm resolution is used in these specific conditions.

Risks and Possible Side Effects

Stereotactic radiosurgery is generally safe and well tolerated but it carries certain risks. They are: 

• Acute reaction: Transient headache, fatigue, and nausea within 24 to 48 hours of treatment 
• Radiation oedema: Swelling around the treated target appears weeks to months after treatment (may cause temporary worsening of neurological symptoms). 
• Radiation necrosis: Focal radiation-induced tissue injury, progressive and symptomatic in some patients with single-fraction SRS. Risk is reduced with fractionated SRT for large or critically located targets
• Cranial nerve effects: Rarely radiation dose can reach optic nerves, cochlea, and facial nerve  but the Versa HD's 1,024 control points per arc allow tight dose shaping around critical structures; Monaco Monte Carlo calculates actual tissue dose with high accuracy that causes minimum nerve effects
• Hair loss: Temporary hair thinning in the beam path but with VMAT delivery on the Versa HD, dose is distributed over a larger scalp area, typically producing minimal to no visible hair loss
• Tumour progression: SRS is not curative for most malignant tumours. Local control rates for brain metastases are 80 to 90% at one year but new metastases may develop elsewhere, requiring further treatment.

SRS vs SRT: What is the Difference?

• SRS (single fraction): 15 to 24 Gy in a single session. Preferred for small, well-defined targets at safe distance from critical structures. The large single fraction produces vascular injury and direct cell kill achieving rapid tumour control. Treatment takes 30 to 90 minutes
• SRT / FSRT (fractionated): The total dose divided across two to five fractions over consecutive days or one to two weeks. Fractionation allows safe treatment of targets adjacent to the optic chiasm, brainstem or cochlea where a single fraction would exceed tolerance and for targets larger than 3cm

At Ramkrishna CARE Hospitals both SRS and SRT are delivered on the same Elekta Versa HD. The treatment decision is made at our tumour board based on target size, location, proximity to critical structures and clinical objective.

Benefits of SRS/SRT

Advantages are:

• Non-invasive: No incision, no general anaesthesia, no craniotomy; the patient is awake throughout
• Outpatient procedure: Post SRS and SRT courses are day procedures; patients go home the same day
• Submillimeter precision: HexaPOD six-degree-of-freedom positioning and CBCT image guidance confirm intracranial target position before each session
• Surgically inaccessible lesions: SRS reaches the brainstem, thalamus, basal ganglia and eloquent cortex where surgery is not feasible
• Minimal disruption: Most patients resume normal activities within 24 to 48 hours after treatment
• Multiple targets simultaneously: Single-isocenter treatment of multiple brain metastases in one session on the Versa HD, without repositioning
• Neurocognitive preservation: SRS limits high dose radiation to the targets, avoiding the diffuse exposure associated with long-term cognitive decline from whole-brain radiotherapy
• Complementary to surgery and systemic therapy: SRS can treat the resection cavity post-surgery and is increasingly used concurrently with checkpoint immunotherapy for synergistic tumour control.

Why Choose Ramkrishna CARE Hospitals for SRS/SRT in Raipur?

At Ramkrishna CARE Hospitals, advanced technology and expert cancer specialists come together to deliver highly precise SRS/SRT treatment:

• Elekta Versa HD: Purpose-built for High Definition Radiosurgery. Delivers highly accurate, high-dose radiation while protecting surrounding healthy brain tissue.
• HexaPOD six-degree-of-freedom couch: Intracranial SRS requires correction in all six degrees of freedom (translational and rotational). The HexaPOD corrects all six simultaneously, positioning the target to submillimeter tolerance before each arc
• Monaco Monte Carlo planning: Gold-standard dose calculation at tissue interfaces (brain-skull boundary and air cavities) calculating actual tissue dose rather than an analytical approximation. For SRS where a 1mm error at the steep dose gradient could underdose tumour or overdose a critical structure, this accuracy is clinically essential
• AQUA quality assurance and EPID in-vivo dosimetry: Automated machine quality assurance before every fraction; in-vivo EPID dosimetry compares delivered dose with the planned dose in real time providing independent safety verification at every SRS session
• XVI CBCT image guidance: Volumetric cone-beam CT immediately before treatment registered to the planning MRI and CT to verify intracranial target position to submillimeter accuracy
• Neuro-oncology multidisciplinary team: Every SRS and SRT patient is reviewed by neurosurgery, radiation oncology, medical oncology and neuroradiology before treatment ensuring the right treatment for the right indication
• MRI-integrated planning: Gadolinium MRI fused with planning CT provides anatomical accuracy for target delineation. For recurrent glioma, the uMI 550 PET CT with 2.76mm resolution and Time-of-Flight imaging defines the biological target volume when MRI alone is insufficient
• Accessible from across Chhattisgarh: SRS and SRT previously available only at specialised neurosurgical centres in metro cities but now available in Raipur for patients from Bilaspur, Durg, Rajnandgaon, Bastar, and across Central India.

Conclusion

Stereotactic radiosurgery provides an effective, non-invasive option for patients with intracranial lesions previously inoperable or not safely treatable with conventional radiation. Delivered on the Elekta Versa HD with submillimeter accuracy and Monte Carlo dose verification SRS has become a mainstream treatment for brain metastases, acoustic neuromas, meningiomas and AVMs with outcomes matching or exceeding surgery without surgical risk.

At Ramkrishna CARE Hospitals, Raipur SRS and SRT are delivered on the Elekta Versa HD within a neuro-oncology multidisciplinary programme that reviews every case before treatment begins. Specialist-level stereotactic radiosurgery is available in Raipur for patients across Chhattisgarh and Central India without the journey to a metro city.