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Gamma Knife Effectively Treats Intractable Cancer Pain, Essential Tremors
Since opening Long Island Gamma Knife® in 2002, nearly 1,000 patients have received Gamma Knife treatment at South Nassau, including patients with trigeminal neuralgia, arteriovenous malformations (AVM's) and a wide variety of tumors such as pituitary tumors, acoustic neuromas, meningiomas, metastatic brain tumors, and primary brain tumors.
The LI Gamma Knife’s interdisciplinary team of neurosurgeons, radiation oncologists, physicists, and nurses, who are specially trained in performing Gamma Knife procedures, have expanded the use of the Gamma Knife to treat intractable cancer pain as well as essential tremors (ET).
“The Gamma Knife incorporates leading-edge technologies that enable us to treat a variety of debilitating and life-threatening conditions,” said Edward Mullen, MD, South Nassau’s chair of radiation oncology and co-medical director of Long Island Gamma Knife. “When we invested in this life-saving technology it was with the knowledge that it would be of great benefit to the communities we serve and that it provided us the capability to effectively and efficiently treat a gamut of disorders including brain tumors, malformations, and other conditions.”
Intractable cancer pain (also referred to as thalamic pain syndrome) is considered to be incurable. The American Alliance of Cancer Pain Initiatives (AACPI) defines intractable cancer pain as “a pain state in which the cause of the pain cannot be removed or otherwise treated and in which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts.”
Cancer pain may be caused by the cancer itself or it could result from the treatment. Pain lasting more than a few days or longer may be caused by a tumor putting pressure on organs, nerves or bone; poor blood circulation because the cancer has blocked blood vessels; blockage of an organ or tube in the body; metastasis – cancer cells that have spread to other sites in the body; infection or inflammation; side effects from chemotherapy, radiation therapy, or surgery; and stiffness from inactivity.
Treatment regimens including medication (chemical hypophysectomy) and functional neurosurgery (surgical hypophysectomy) have been used to control intractable cancer pain without much short- or long-term success. Gamma Knife Pituitary Radiosurgery (GKPR) or Gamma Knife hypophysectomy has proven to be an effective alternative and it is being used with increasing frequency to bring short- and long-term pain relief to cancer patients without any secondary side effects.
The pituitary gland is called the "master gland" because it controls all other glands, constantly monitoring body functions and sending signals to organs and glands to control their function and to maintain the appropriate environment in the body. GKPR delivers a single high dose of radiation to the pituitary, ablating or creating a lesion in the gland, eradicating the sensation of pain. (Gamma Knife radiosurgery of the pituitary gland is used as a last resort. It is known that even partial destruction of the pituitary gland can improve cancer-induced chronic pain from hormonally dependent metastatic tumors.)
The Gamma Knife’s 201 intersecting cobalt beams provide a dose of precise radiation equal to 20-30 traditional radiation treatments, in one 45-minute session. Because of the very steep fall-off of the radiation field outside the specified target area, the dose to immediately surrounding tissue is minimized.
Studies on the effectiveness of GKPR have shown that patients experience significant pain reduction within 48 hours after treatment and that it has long-lasting clinical effect in controlling cancer pain.
Essential Tremors (ET) affects millions of children and adults. They are not caused by a neurological condition, injury, or side effect of a medication and can become debilitating over time. ET most often affect the hands, but may also affect the head and neck, face, jaw, tongue, voice (causing a shaking or quivering sound), and the trunk. ETs are rhythmic, back-and-forth or to-and-from movements that are caused by an involuntary (uncontrollable) contraction of muscles. The episodes and duration of ETs vary from hour to hour and day to day. Most people with ETs have an episode when the body or a part of the body is held in a certain position (referred to as postural tremor) or when performing a particular action such as writing or eating (action-specific tremor). Approximately 1 in 20 people older than age 40 and 1 in 5 people over 65 have ETs. It is estimated that ETs are eight to ten times more common than Parkinson's. Only stroke disease is more common.
Gamma Knife Thalamotomy (GKT) is a safe and precise, non-invasive intervention that has proven to produce life-altering improvements in otherwise unmanageable cases of ETs. GKT treats the thalamus, a tiny area of the brain that controls some involuntary movements. After GKT, 90% of patients with ETs have experienced a clinically meaningful improvement in their ET score, with 50-78% of patients reporting either no or very slight intermittent ETs. Patients with multiple sclerosis have also reported significant improvement with their ETs, increasing their ability to perform acts of daily living (routine activities that people do everyday) without needing assistance.
Since Gamma Knife surgery is minimally invasive, the lengthy hospital stays associated with brain surgery are avoided. Patients return home the same day of treatment, and can usually resume their normal activities, including working and driving, within days. There is little risk of potential morbidity, such as hemorrhage and infection, that is associated with conventional surgery. More than 30 years of clinical studies documented in multiple published, peer-reviewed articles have shown that the Gamma Knife has clear benefits compared to traditional neurosurgery.
“Our track record and tradition of excellence is attributable to our team’s acumen and experience and commitment to patient-centered treatment plans that maximize the benefits of the technology,” said Michael Brisman, MD, co-medical director of the Long Island Gamma Knife.
South Nassau was the first (and is currently the only) hospital on Long Island to use the Gamma Knife. For additional information on the Long Island Gamma Knife, or to arrange for an evaluation, please call 1-866-LI GAMMA.