Clinical Indications

All patients are required to have a favorable KPS.

• Malignant Tumors
• Non Malignant Tumors
• Arteriovenous Malformations
• Functional Disorders (e.g. movement disorders, trigeminal neuralgia)

Malignant Tumors

• Brain metastases
• 1 to 3 lesions - Single fraction SRS
• <3.5 cm in largest diameter
• Favorable KPS (>80)
• Extracranial disease is under control with treatment
• Life expectancy > 6 months
• Used as primary treatment or retreat for failures after resection
• Primary Brain Tumors
• Treatment for malignant gliomas is not indicated for SRS (outside of experimental protocols) due to the mechanism of growth (see frequently asked questions)
• Treatment for extracranial sites is achievable with the Novalis system and will be implemented in 2005

Diagnostic Work up required for referral

1. Pathology verifying a positive diagnosis of cancer.
2. MRI showing the metastatic lesions in the brain.
3. Reports of diagnostic tests for the assessment of extra cranial disease in the assessment of establishing life expectancy >6 months (CT chest-abdomen-pelvis, bone scan, normal LFTs).
4. Creatinine & CBC (within last 2 months)

Non Malignant Tumors

• Acoustic neuroma
• < 3 cm, no functional hearing --- Single fraction SRS
• > 3 cm, functional hearing --- Fractionated SRT
• For the elderly, evidence of tumour growth (elderly patients often can harbour benign tumours without apparent growth- observation may be the best management for such patients)

Diagnostic Work up required for referral

1. Recent MRI
2. Recent Audiometry

• Sella and Parasellar tumors (e.g. pituitary adenoma, craniopharyngioma, menigioma etc.)
• Fractionated SRT for large lesions, or lesions adjacent to critical nerves.
• SRS for small lesions

Diagnostic Work up required for referral

1. Recent MRI with report

• Other (e.g. meningioma, choroids plexus, hemangioma, etc.)
• < 3.5 cm --- Single fraction SRS
• > 3.5 cm --- Fractionated SRT
• evidence of tumour growth in the elderly (elderly patients often can harbour benign tumours without apparent growth- observation may be the best management for such patients)

Diagnostic Work up required for referral

1. Recent MRI

Arteriovenous Malformations

• < 3.5 cm for single treatment
• may consider fractionated SRT or planned staged SRS for lesions > 3.5 cm.

Diagnostic Work up required for referral

1. Angiogram
2. MRI

Functional Disorders (e.g. obsessive-compulsive disorder, trigeminal neuralgia)

• Please contact Dr. Kiss regarding indications and alternatives for functional

General Information

ARC may request that the patient have another MRI prior to treatment using particular protocols to assist in the planning process.

Patients under 18 may be required to have a baseline neuropsychological test.

Not all patients are appropriate for SRS. Some tumour locations or pathologies may also not be amenable to SRS. In some cases we will advise that the patient return to their primary neurosurgeon/oncologist for conventional treatment or may suggest combination treatment in discussion with their referring surgeon.