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Radiosurgery for brain tumours

BMJ 1999; 318 doi: (Published 13 February 1999) Cite this as: BMJ 1999;318:411

Triumph of marketing over evidence based medicine

  1. Michael Brada, Senior lecturer in clinical oncology (,
  2. Garth Cruickshank, Professor of neurosurgery
  1. Institute of Cancer Research and Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT
  2. Queen Elizabeth Hospital, Birmingham B15 2TH

    Recent publicity surrounding the opening of a private radiosurgery facility in the United Kingdom suggested near miraculous properties for a radiation technique developed over 30years ago. According to media reports, “many potentially fatal brain conditions which are inoperable using conventional surgery can now be treated successfully.”1 This form of marketing is misleading and offers false hope.

    Radiosurgery is a term applied to high precision localised irradiation given in one session. One technique uses cobalt sources arranged in a hemisphere and focused on to a central target (described as a gamma knife). A gamma knife unit has been in operation in Sheffield since 1986.Identical high precision radiosurgery can be delivered by appropriatelyadjusted linear accelerators and has been available in Britain since 1989.Currently, at least six radiosurgery facilities are available to NHS patients. The limited usefulness of the technique for treating brain tumours suggests that the existing NHS facilities are sufficient for the expected workload.

    The aim of radiosurgery is to deliver a sphere of high dose irradiation more localised than would be achieved with conventional radiotherapy. However, this is possible only for small lesions …

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