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Every year, tens of thousands of people world-wide have brain surgery
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without a single incision:
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there's no scalpel, no operating table, and the patient loses no blood.
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Instead, this procedure takes place in a shielded room
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with a large machine that emits invisible beams of light
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at a precise target inside the brain.
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This treatment is called stereotactic radiosurgery,
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and those light beams are beams of radiation:
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their task is to destroy tumors by gradually scrubbing away malignant cells.
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For patients, the process begins with a CT-scan,
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a series of x-rays that produce a three-dimensional map of the head.
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This reveals the precise location, size, and shape of the tumor within.
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The CT-scans also help to calculate something called "Hounsfield Units,"
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which show the densities of different tissues.
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This offers information about how radiation
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will propagate through the brain, to better optimize its effects.
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Doctors might also use magnetic resonance imaging, or MRI's,
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that produce finer images of soft tissue,
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to assist in better outlining a tumor's shape and location.
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Mapping its precise position and size is crucial
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because of the high doses of radiation needed to treat tumors.
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Radiosurgery depends on the use of multiple beams.
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Individually, each delivers a low dose of radiation.
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But, like several stage lights converging on the same point
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to create a bright and inescapable spotlight, when combined,
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the rays of radiation collectively produce enough power to destroy tumors.
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In addition to enabling doctors to target tumors in the brain
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while leaving the surrounding healthy tissue relatively unharmed,
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the use of multiple beams also gives doctors flexibility.
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They can optimize the best angles and routes through brain tissue
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to reach the target and adjust the intensity within each beam
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as necessary.
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This helps spare critical structures within the brain.
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But what exactly does this ingenious approach do to the tumors in question?
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When several beams of radiation intersect to strike a mass of cancerous cells,
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their combined force essentially shears the cells' DNA,
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causing a breakdown in the cells' structure.
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Over time, this process cascades into destroying the whole tumor.
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Indirectly, the rays also damage the area immediately surrounding the DNA,
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creating unstable particles called free radicals.
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This generates a hazardous microenvironment
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that's inhospitable to the tumor,
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as well as some healthy cells in the immediate vicinity.
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The risk of harming non-cancerous tissue is reduced
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by keeping the radiation beam coverage
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as close to the exact shape of the tumor as possible.
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Once radiosurgery treatment has destroyed the tumor's cells,
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the body's natural cleaning mechanism kicks in.
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The immune system rapidly sweeps up the husks of dead cells
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to flush them out of the body, while other cells transform into scar tissue.
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Despite its innovations, radiosurgery isn't always the primary choice
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for all brain cancer treatments.
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For starters, it's typically reserved for smaller tumors.
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Radiation also has a cumulative effect,
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meaning that earlier doses can overlap with those delivered later on.
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So patients with recurrent tumors
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may have limitations with future radiosurgery treatments.
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But these disadvantages weigh up against some much larger benefits.
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For several types of brain tumors,
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radiosurgery can be as successful as traditional brain surgery
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at destroying cancerous cells.
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In tumors called meningiomas, recurrence is found to be equal, or lower,
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when the patient undergoes radiosurgery.
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And compared to traditional surgery—
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often a painful experience with a long recovery period—
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radiosurgery is generally pain-free,
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and often requires little to no recovery time.
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Brain tumors aren't the only target for this type of treatment:
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its concepts have been put to use on tumors of the lungs, liver, and pancreas.
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Meanwhile, doctors are experimenting with using it to treat conditions
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such as Parkinson's disease, epilepsy, and obsessive compulsive disorder.
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The pain of a cancer diagnosis can be devastating,
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but advancements in these non-invasive procedures
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are paving a pathway for a more gentle cure.