ONS 2014: What Oncology Nurses Need to Know About Stereotactic Radiosurgery for Brain and Spine Tumors

Many of you have heard of stereotactic radiosurgery (SRS), but do you have an understanding of what this actually is, what kind of tumors are treated, and its associated side effects?

Stephanie Bino, RN, BS, OCN, and Kathleen Maloney-Lutz, RN, MSN, presented a session, “Stereotactic Radiosurgery for Brain and Spine Tumors: What the Oncology and Neurosurgery Nurse Needs to Know,” at the 2014 Oncology Nursing Society (ONS) Annual Congress.

SRS is a non-surgical procedure that delivers a targeted dose of radiation to a specific area, performed when surgical resection is contraindicated. SRS is typically used for solitary brain or spinal lesions. The kind of tumors treated may either be malignant (primary and metastatic) or benign lesions, and the treatment may be considered either palliative or curative, depending on the nature of the disease.

Why not administer whole-brain radiation therapy (WBRT) instead? Well, WBRT may increase the risk of learning and memory problems due to the irradiation of healthy brain tissue. The extent of neurotoxicity may require patients to take medications such as steroids, as well as closer monitoring of patients due to the potential risk of cognitive dysfunction. Also, WBRT may not deliver a high enough dose of radiation to the tumor, in the way that SRS can.

SRS may offer a better prognosis because there’s more local control of disease, taking into account age, performance status, and primary tumor control. The goal of treatment is not only disease management, but preservation of neurological function.

Generally performed on an outpatient basis, pre-procedure teaching is required considering the patient will be NPO if sedation is used. Also, a detailed description of the procedural events planned for the day must be discussed with the patient.

Whether using Gamma Knife, CyberKnife, or Novalis radiosurgery, the risks and benefits must be discussed with the patient, including radiation exposure, tumor and pain control, potential vertebral body collapse post-surgery, and edema; dexamethasone is oftentimes used during treatment to help minimize central nervous system edema. The cancer care team must also assess for neurological dysfunction post-radiosurgery, taking into consideration treatment to the spine vs the brain.

How well have you been prepared to treat patients receiving SRS?