Gamma Knife and Linear Accelerator Stereotactic Radiosurgery

The huge challenges posed by treating small-volume brain lesions prompted researchers and neurosurgeons to develop a new treatment technique known as "stereotactic radiosurgery" (SRS). Using stereotaxy, which permits the very precise three-dimensional localization of the treatment target, the objective of SRS is to expose the tumor to a single high dose of radiation while at the same time minimizing radiation exposure to the healthy surrounding structures. However, SRS is a leading-edge technology that requires expert skills and the use of elaborate and expensive equipment, such as a linear accelerator or a gamma knife.

The primary objective of this report is to answer the Régie de l'assurance-maladie du Québec's questions concerning the efficacy of SRS in treating brain lesions near sensitive areas. In addition to this objective was the need to determine whether or not it would be beneficial for Québec to acquire a gamma knife. This is why two university hospitals, the regional health and social services boards that these hospitals come under, and the Ministère de la Santé et des Services sociaux, which is responsible for the deployment of tertiary services throughout Québec, contacted the Agence d'évaluation des technologies et des modes d'intervention en santé to obtain an overview of this issue.

Given the current knowledge about the clinical, economic, technical, and epidemiological aspects, and given the need to adequately fulfill the offer of SRS services and to adequately meet research needs, the Agency recommends that a specialized radiosurgery centre with a gamma knife be set up at a university hospital. The institution chosen must have the necessary logistical wherewithal for SRS, i.e. a multidisciplinary treatment team, patient management quality and continuity, and the role of training. The Agency stresses that this recommendation is conditional upon the technological evolution of the various types of instruments and the emerging therapies at the time when the decision to create a centre providing SRS services is made.