Radiosurgery in Israel
by Roberto Spiegelmann, M.D.
The stereotactic radiosurgery unit at The Chaim Sheba Medical Center, Tel HaShomer (Israel) was installed in December 1992. This was the corollary to an effort that began in 1989, when I travelled to the US for a 2 year fellowship in stereotactic neurosurgery and radiosurgery at the University of Florida. My mentor there was William Friedman, MD, who is one of the pioneers in stereotactic radiosurgery in the US. After returning to Israel at the end of 1991, I already had experience in treating some 150 patients with LINAC radiosurgery in Florida.
The unit in Sheba was built around the radiosurgery treatment software created in Florida by Friedman and Bova. Both my mentors came to Israel during 1992 and helped me out in installing our first unit. Since 1993 to date, we have treated some 500 patients in our unit. Our system was updated early on in 1998, when we acquired Brainlab equipment, which allowed us to make use of MRI imaging for treatment planning. In addition, we acquired a minimultileaf collimator and corresponding software, which placed us among the first units worldwide to have this capability.
We treat between 2-3 patients a week. Radiosurgery treatments are concentrated in one day. Patients undergoing fractionated stereotactic radiation (FSR) are usually treated twice a week. These patients are fit with a relocatable frame (the GTC) and are treated with the minimultileaf collimator.
Our group was originally composed of myself, a coordinating nurse, two radiation physicists, and LINAC technicians. During the last 3 years Dr. Pfeffer, from Radiation Oncology, has become an organic member of the Radiosurgery Team. The Unit has treated more than 150 meningiomas in different locations, some 75 acoustic neurinomas, AVM's (around 50), and more than 150 patients with metastases. Results for the different pathologies have been presented lately at different international meetings, and will begin to appear in peer-review publications for selected pathologies for which we have gathered sufficient long-term follow-up.
We reserve FSR for tumors too large to be addressed by conventional radiosurgery, as opposed to several other LINAC facilities, which have moved almost exclusively to FSR. Our results for single fraction radiation justify this phylosophy. For example, control rate for acoustic neuromas is currently 98%, with an 8% transient facial neuropathy complication rate (historically compounded by too-large doses: in the last 25 cases we haven't had any facial neuropathies) and close to 70% hearing preservation rate. Our policy has been and remains to achieve the highest possible mechanical accuracy, which is checked repeatedly before and during each treatment. The multidisciplinary team assures that a high know-how is applied to the treatment of each patient.
We are the only radiosurgery facility available in Israel, although for a time a facility for FSR has been on and off active in Hadasah Medical Center, Jerusalem. That unit though, has treated only a handful of patients. Referrals for radiosurgery are done usually to our outpatient clinic. Follow-up is done the same way. Please do not hesitate to contact me should you need any further information.
Roberto Spiegelmann, MD
Director, Stereotactic neurosurgery and Radiosurgery Unit
The Chaim Sheba Medical Center, Tel Hashomer Israel 52621
<spiegel AT inter.net.il>
Last Edited: Friday, November 01, 2002