Brain Cancer Options Comparison Table – Visualase LITT and SRS
Every case is different and this in no way represents your treatment options. A patient’s case is always specific to them and must be discussed with their treating physician as to what may be an appropriate treatment for them. If in doubt, the patient should consider a second or third opinion..
| Method | LITT | Stereotactic Radiotherapy (SRS) |
| Industry Name | Visualase | Gamma Knife, LaserKnife, Novalis, Radiosurgery, Cyberknife, Linear Accelerators (LINAC), Proton Therapy |
| Description | Laser targets and destroys the unwanted tissue in minutes. The impact is immediate and the tumor cells are dead at the moment the ablation is complete. | Beams of radiation prescribed to converge in a target region induce damage to critical biological molecules in cells. If enough damage is done to the chromosomes of a cell, it will spontaneously die or it will die the next time it tries to divide. SRS is often delivered in multiple sessions over 1—5 days. |
| Invasiveness | Minimally-invasive.
Target is accessed through a small 3mm diameter hole and the entry site is closed with a single suture. |
Generally considered “non-invasive” though radiation treatments can sometimes result in bleeding or other side effects generally associated with surgical interventions. For GammaKnife treatments a neurosurgeon is required to bolt a registration frame to the skull with pins. |
| Anesthesia | Patient can be wide awake with local anesthesia only or sedated to various levels. | Anesthesia (usually local) is required when a registration frame is pinned to the skull. Different levels of anesthesia may be used for patients who cannot hold still. |
| Pain | Little or no pain during or after procedure. | Possible if pins are used. |
| Procedure | In an operating room, a small hole is drilled in the skull, and a flexible laser probe (thinner than a standard pencil lead) guided to the target area (about 30 minutes). The patient is moved to an MRI unit and imaged repeatedly while laser energy is applied (about 20 minutes). After treatment, extra images of the brain are taken (about 20 minutes). The patient is then removed from the MRI machine, the laser applicator is removed and the entry site closed (5 minutes) without need to return to the OR. | Radiosurgery lasts 30min. to 4 hours. During treatment The patient lies on a table which slides into a machine that delivers radiation beams. The machine may rotate around the patient. A head frame may be attached to the scalp to keep you still. A fitted plastic mask for the face may be used. Anchors may go through the skin. If this is done, skin will be numbed and you may be given medicine to help you relax. |
| Post-procedure | Brain reaction to thermal treatment includes some short-term swelling. Your surgeon will prescribe steroids which will be tapered off over about a month. Entry wound heals quickly. | Brain reaction to radiation includes swelling. Your physician may prescribe steroids for months or years after treatment. |
| Recovery | Patients are 100% functional immediately after procedure. Usually stay overnight for observation. | Following radiation therapy, there may be persistent fatigue that can sometimes last for several months. Steroids (such as dexa-methasone) may lessen some of these symptoms, but the minimum effective dose should be used because of possible systemic side effects. |
| Contraindications | Must be able to undergo MRI. Visualase laser ablation does not limit use of other therapies. | Does not contraindicate other treatment options, but is associated with a “limit” dose after which further radiation cannot be safely delivered. |
| Complications | The Visualase procedure is a relatively new treatment. No serious complications are yet known or reported. The size and shape of some tumors may make it impossible to treat the entire tumor with the laser probe in which case it may regrow over time. |
Reported complications of radiation include swelling, intracranial bleeding. In 5-10% of patients, a condition called radionecrosis may occur which can require surgical correction. Rarely, oncogenesis (a process by which treatment radiations induces another tumor in brain) may occur. Some tumors are resistant to radiation and may continue to grow or to recur over time. |
| Side Effects | No serious side-effects are yet known or reported. Minor swelling, usually controlled with drugs. | Reported side-effects of radiation include nausea, headaches, skin and scalp irritations, hair loss, confusion, and neurocognitive changes. |
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