Podgorsak E B
Department of Radiation Oncology, McGill University, Montréal, Québec, Canada.
Neurosurg Clin N Am. 1992 Jan;3(1):9-34.
Radiosurgery had a long development period and, for more than three decades, was used only in a few specialized centers around the world. The development of LINAC-based radiosurgical techniques combined with the concurrent advances in imaging modalities during the 1980s, however, caused so much interest in this treatment modality that most major radiotherapy centers now offer this service or at least plan to offer it in the near future. When considering a LINAC for radiosurgical use, one should remember that technical and clinical requirements for accurate radiosurgery are far more stringent than those applied to standard radiotherapy. This is because in radiosurgery, the targeted volumes are much smaller and the dose is usually delivered in a single irradiation session, whereas in radiotherapy, the dose is delivered to a relatively large target volume on a fractionated basis. Linear accelerator-based radiosurgery broadens the scope of radiotherapy departments. The impetus to introduce this service at a medical center usually comes from neurosurgeons, however. Even after the service becomes routine at an institution, it is the neurosurgeon who refers the patient and who plays the most important role in determining the target volume and its location within the brain. The decision on the choice of isodose surface and the prescribed dose, however, belongs to the radiotherapist. It is becoming clear that radiosurgery is a complex treatment modality for which a successful outcome requires a collaborative team effort by several hospital-based professionals, including neurosurgeons, radiation oncologists, neuroradiologists, and medical physicists. As in standard radiotherapy, physics plays an important role in radiosurgery, not only in the development of target localization, treatment-planning, and dose delivery techniques, but also in the actual patient contact, from the diagnostic target localization procedures, through treatment planning, to patient preparation on the device and dose delivery.
放射外科经历了漫长的发展时期，在三十多年的时间里，仅在全球少数几个专业中心使用。然而，20世纪80年代基于直线加速器的放射外科技术的发展，再加上成像技术的同步进步，引发了人们对这种治疗方式的极大兴趣，以至于现在大多数主要的放射治疗中心都提供这项服务，或者至少计划在不久的将来提供。在考虑将直线加速器用于放射外科时，应该记住，精确放射外科的技术和临床要求比标准放射治疗的要求要严格得多。这是因为在放射外科中，靶体积要小得多，剂量通常在单次照射中给予，而在放射治疗中，剂量是分次给予相对较大的靶体积。基于直线加速器的放射外科拓宽了放射治疗科室的范围。然而，在医疗中心引入这项服务的动力通常来自神经外科医生。即使在一个机构中这项服务变得常规化之后，也是神经外科医生转诊患者，并且在确定靶体积及其在脑内的位置方面发挥最重要的作用。然而，等剂量面的选择和处方剂量的决定属于放射治疗师。越来越明显的是，放射外科是一种复杂的治疗方式，要取得成功的结果需要包括神经外科医生、放射肿瘤学家、神经放射学家和医学物理学家在内的多个医院专业人员的协作团队努力。与标准放射治疗一样，物理学在放射外科中起着重要作用，不仅在靶定位、治疗计划和剂量递送技术的发展方面，而且在实际与患者接触方面，从诊断靶定位程序，到治疗计划，再到在设备上对患者的准备和剂量递送。
