Radiosurgery and radiotherapy: observations and clarifications.
OBJECTIVE
Radiosurgery and radiation therapy represent important but unique treatment paradigms for patients with certain neoplasms, vascular lesions, or functional disorders. The authors discuss their differences.


METHODS
Reviewing the authors' experiences shows how the roles of these approaches vary just as their techniques differ. The distinct differences include the method of target localization (intraoperative compared with pretreatment) and irradiation (focused compared with wide-field), their radiobiology (effects of a single high-dose compared with multiple fractions), the physicians and other health personnel involved in the conduct of these procedures (surgical team compared with radiation team), and the expectations that follow treatment. During the last decade, considerable confusion has grown regarding nomenclature, requisite physician training, and the roles of the physician and surgeon. Ten years ago, two task forces on radiosurgery were created by national organizations in neurosurgery and radiation oncology to address these issues of procedural conduct and quality-assurance requirements. At the present time these guidelines are widely ignored. Currently, many patients, payers, and regulatory agencies are bewildered. What are the differences among stereotactic radiosurgery, fractionated radiation therapy, and stereotactic radiation therapy? Radiosurgery is to radiation therapy as microsurgery is to "microtherapy."


CONCLUSIONS
In this report the authors discuss terminology, training, and physician roles in this expanding field.
Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh, Pennsylvania 15213, USA. kondziolkads@upmc.edu
Douglas
D
Kondziolka
L Dade
LD
Lunsford
Jay S
JS
Loeffler
William A
WA
Friedman
D001927:Brain Diseases / Q000532:radiotherapy / Q000601:surgery; D019583:Dose Fractionation, Radiation; D006801:Humans; D009493:Neurosurgery / Q000379:methods* / Q000592:standards; D010348:Patient Care Team; D010819:Physician's Role; D016634:Radiosurgery / Q000379:methods* / Q000592:standards; D011878:Radiotherapy / Q000379:methods* / Q000592:standards; D009626:Terminology as Topic