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Centers of Excellence are worldwide!


United States   |   Canada   |   Mexico   |   Latin America   |   Europe   |   Asia   |   China   |   Japan

Centers of Excellence must meet many criteria to be listed. First and foremost all treatments within the brain must be planned and directed by a neurosurgeon. The neurosurgeon must work with a team that includes a radiation oncologist, a physicist, and a registered nurse. Each patient must be fully evaluated against their own diagnosis and medical criteria to assess whether stereotactic radiosurgery or other treatment is recommended including surgery. Additionally, each patient should be provided with guidance on other treatments for their condition.

Each Center of Excellence must perform a minimum of 100 one-session radiosurgery treatment each year. A copy of credentialing standards for neurosurgeon and radiation oncologists must be on file. This means that each physician has completed specific stereotactic radiosurgery training and performs a minimum number of treatments per year to maintain competency.

Each Center of Excellence must offer both Cobalt Gamma Knife surgery and LINAC radiosurgery within their medical systems. LINAC equipment and Gamma Knife surgery each have some treatments that are performed better than others. Some clinical conditions may best be treated on one machine and not the other. The patient's medical condition will guide whether the patient is recommend one type of treatment over another. Some patients with large tumors can not be treated with the Gamma Knife and may be offered treatment with a LINAC machine in a multi-session or fractionated basis to try to lower damage to healthy tissue.


Patients should be careful that research results are from many institutions and many researchers over a period of at least 10 years. Multiple results from only 4-5 institutions and researchers will not have long term follow up as to side effects and clinical outcomes. Experience has shown that it takes greater than 10 year of research and development and comparable data to establish the correct dosing and targeting for each type of manufactured machine. Long term development and research usually results in proven techniques that have the best clinical outcomes with the least side effects.

Radiosurgery LINAC equipment is produced by many manufacturers and some do not have long term comparable data to support their usage. Some newer manufacturers have very little in the way of long term results from their machines. It is important to realize that research on one is not comparable to research on another manufacturers machine. Each type of manufactured machine targets differently, deliver radiation differently and have different overlap to healthy tissue. Therefore, it is understandable that each machine may have a clinical outcome that will not be the same as a machine from a different manufacturer that operates differently.

Research that is printed on a web site for a physician or hospital and is published only to the hospital's web site or that hospital's journal is not considered research. Only research that has been peer reviewed and printed in a medical journal is considered reliable. Many web sites may listed 'submitted' literature. 'Submitted' literature should not be relied upon as it has not been reviewed and may only represent the thoughts of the author. Many hospitals do not monitor the information their medical staff puts on their web site. The caliber or reputation of the hospital may not be the same for the researcher or physician that advertises through the hospital web site. A physician that is respected by his peers will have published research that has been reviewed and commented upon by his/her colleagues.

Currently, the medical advisors of IRSA recommend that each patient be assessed for treatment with the Gamma Knife first as it is a neurosurgerical machine designed specifically for the brain and is supported by a over 2500 positive research articles. Long-term results of more than 5 years of treatment are required to document the side effects of any instrument. The Gamma Knife is documented to have exacting accuracy and may result in less side effects. The Journal of Neurosurgery publishes a special supplement issue every two years (2000, 2002, 2004 and 2006) to report the comparable results of Gamma Knife surgery for brain tumors and brain disorders.

Radiosurgery and radiotherapy LINAC machines were first produced in the early 1990's as an enhancement to older type radiation therapy machines. Many LINAC machines are still used to treat both body cancers and brain cancers. The accuracy needed to target within the brain is much greater that what is needed to target within the body. Technology that is developed only for brain treatment will usually deliver the best results with the least side effects.

Research awaits long term results from LINAC technology machines so that we can provide more information on clinical outcomes for decision making.

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