Radiosurgery is now available in Armenia

Stereotactic radiosurgery is now available in Armenia at the "Erebuni" Radiotherapy Center, eliminating the need for residents of the country to seek this medical service abroad. Sergey Golub, head of the Radiotherapy Department at the center, spoke about the role of stereotactic surgery in cancer treatment and the capabilities of the "Erebuni" Radiotherapy Center during the "Oncology Days-2024" conference held in Yerevan.

As Sergey Golub explained, stereotactic radiosurgery involves delivering very high doses of ionizing radiation to metastatic sites in just a few treatment sessions. "Typically, this treatment includes one to five sessions. Classic radiosurgery, in general, is completed in a single session," he noted.

The head of the department explained that classical radiosurgery began with the treatment of intracranial metastases, and the first device used for this type of radiation therapy was the Gamma Knife. It served as an alternative to traditional neurosurgery by employing radiation therapy. The technique was proposed by Swedish neurosurgeon Lars Leksell, and its essence lies in delivering an extremely high dose of radiation to a lesion within the central nervous system. Today, radiosurgery is used not only for treating lesions in the central nervous system but also for other areas of the body, including the lungs, bones, and liver.

“This is the precise delivery of a very high dose of radiation. These are the two main aspects that require specialized technical and software solutions, which are implemented in the Varian Edge accelerator installed at the Erebuni Radiotherapy Center,” the specialist explained.

Radiation oncologist Natalia Kornievskaya highlighted the center’s capabilities in brachytherapy. The center is equipped with Varian's Bravos system and a comprehensive set of applicators and interstitial instruments.

She clarified that her presentation focused on the use of brachytherapy in treating gynecological and skin cancers. 

Specifically, in the treatment of gynecological cancers, brachytherapy— a contact-based radiation therapy method where the radiation source is placed within or near the tumor— is currently considered the gold standard.

​​For example, in cases of cervical cancer, brachytherapy is recommended from the very first stage and serves as an excellent alternative to surgical treatment.  

“Cervical squamous cell carcinoma is highly sensitive to radiation therapy, and in some cases, it is preferable to undergo a combined course of radiation therapy rather than surgery. Radiation therapy is performed in two phases. First, we apply external radiation to both the primary tumor and the regional metastatic zones. We aim to reduce the tumor size as much as possible with external radiation therapy,” explains Natalia Kornievskaya.  

“I often say it ‘melts like a snowball.’ The idea is that the smaller the residual tumor is after external radiation, the better the results with brachytherapy. Once the tumor is reduced, we direct a cancerous dose specifically to it using brachytherapy,” she added.  

According to the specialist, brachytherapy is also the best therapeutic option for patients with non-melanoma skin cancers in the first and second stages. This is particularly true for tumors located around sensitive areas such as the eyes, the tip of the nose, or the ears, where surgical treatment is challenging and often associated with cosmetic and functional complications.

“During surgical intervention, it is necessary to remove not only the tumor but also the surrounding healthy tissue. This defect then needs to be covered with a skin flap. In some cases, especially for elderly patients where anesthesia is required but difficult to administer, brachytherapy becomes the ideal solution.  

It is an excellent method for elderly patients with facial skin tumors, providing very good cosmetic outcomes. The treatment lasts 7–8 days, during which the patient comes and goes for the procedure. I believe this method should be the treatment of choice today,” said Natalia Kornievskaya.