Stereotactic Radiosurgery (SRS) at John Muir Health TRUE Radiosurgery

Abstract
There were an estimated 149,000 people living with primary brain and spinal cord cancer in the
U.S. in 2012. In 2015, there will be an estimated 22,850 new cases and 15,320 deaths, indicating
that brain and spinal cord cancer is one of the deadliest forms of cancer1. In addition to primary
brain and spinal cord cancers, another 10-30% of adults with cancer will develop brain metastases,
accounting for up to 170,000 new cases per year. Brain metastases are most commonly diagnosed
in patients with breast and lung cancer, and melanoma. Skeletal regions are the third most common
areas for cancer to metastasize, with the spine being the most frequent.
The rising incidence of brain metastases is primarily due the aging population, improved treatment
for the primary disease, and improved imaging techniques. Brain metastases are an increasing
source of morbidity, mortality and cognitive impairment at the time of diagnosis. Left untreated,
brain metastases lead to rapid neurologic deterioration and death.
Management has become increasingly complex as patients with brain and spinal cord metastases
are living longer and more treatment options develop. This white paper reviews the treatment of
brain and spinal cord cancer, with a particular focus on stereotactic radiosurgery (SRS).

Introduction
Treatment of brain and spinal cord cancer depends on the tumor’s size, location, and type, as well as
the patient’s age and general health. Recently, there has been a re-definition of the various types of
brain cancer, along with recommended treatments. The main treatments include surgery, radiation
therapy, and chemotherapy. A combination of treatments is often used. Treatment goals should
consider patient survival, and preserving quality of life and neurologic function. Goals for treating
spinal cord cancer also include managing pain and preserving mechanical stability, as a small
percentage of patients present with spinal cord compression and spinal instability.