NSW Government NSW Health
South Eastern Sydney Local Health District
nsw health

Fractionated Stereotactic Radiotherapy (FSRT)  

What is Fractionated Stereotactic Radiotherapy?

Many tumours in the brain and in other parts of the body are not suitable for treatment by surgery.

Features that determine this include:

  • Site (including proximity to important brain structures such as the optic chiasm and the brain stem)

  • Involvement of the spinal cord

  • Previous treatment

  • Patient preference for non-surgical treatment

 

Types of brain tumours suitable for Fractionated Stereotactic Radiotherapy include:

Benign:

Malignant:

Meningiomas Gliomas
Pituitary tumours Medulloblastomas
Vestibular Schwannomas/Acoustic Neuromas Chordomas     
Craniopharyngiomas  
Haemangiomas  

Stereotactic radiation treatment relies upon precisely locating the lesion in the brain with exact co-ordinates (as with latitude and longitude).

Fractionated Stereotactic Radiotherapy (FSRT) is delivered over a number of fractions for a specific number of days. The number of treatments is determined by the size and type of the tumour and proximity to adjacent tissues. FSRT can be delivered as 'multiple fixed beams' using the MMLC (Mini-Multi Leaf Collimator), or IMRT (Intensity Modulated Radiotherapy). This department was the first in the world to treat any patient with stereotactic IMRT.  IMRT is used to treat tumours of irregular shape.  This technique enables the specialist to shape the beam to better treat the tumour and minimise the dose to normal tissue.

Consultation for FSRT with the Specialist

Not all patients are suitable for FSRT.  The proximity of the tumour(s) to critical brain structures determines whether the radiotherapy should be given in small doses over a number of fractions each day, ranging from 5-30Gy, and for a number of days or weeks.

Scans are evaluated at the time of consultation with your doctor and discussion regarding the benefits and possible side effects of the treatment will also be discussed. Treatment sessions average from fifteen to twenty minutes daily with little to no acute side effects, however over the course of the treatment there may fatigue, alopecia (hair loss) and sometimes mouth discomfort associated with using the dental plate (this generally settles quickly after treatment is concluded).

At consultation a Stereotactic Radiotherapy Brochure will be given to you. If the decision is made to have treatment you will be contacted by the Planning Co-ordinator confirming the date and time of your planning session.

Planning Sessions

Planning sessions are usually organised 1-2 weeks prior to commencement of radiotherapy treatment and take approximately half a day. This includes:

 

  • Impression of your upper palate and the back of the head (occipital region)
  • Head frame fitting
  • Attachment of impression moulds to the base head ring.
  • CT scan
  • MRI

It is important that all dental work is avoided during the period of the head frame fitting, planning and during the course of treatment.  Also, any changes of hair style may affect the accuracy and stability of the 'head frame set' during treatment.

The head frame fitting session is usually attended in the morning. Once the fitting is done there is a free 1-2 hour break (this allows time for the impression to set, to have lunch and familiarise yourself with the department and our resources available). When the impression is set you will have a CT scan with the head frame fitted in the afternoon. An MRI is also needed to complete your plan for your treatment and is usually arranged during your planning session.

Radiation Treatment

Treatment usually commences approximately one week after planning. When arriving the first day for treatment, please notify the radiation reception staff of your arrival and you will be escorted to the Treatment Area. When the radiotherapists are ready you will be called into the treatment room where the head frame is fitted daily prior to each treatment. At the conclusion of each treatment the following day's treatment time will be confirmed with you (this occasionally may change).

Weekly Reviews

Review with your clinician is weekly either before or after treatment. This allows time to discuss any concerns you may have and informs the clinician how treatment is progressing.

In the final week of treatment at clinic review your clinician will organise a follow-up appointment 4-6 weeks post treatment. A follow-up scan may also be organised at this time.