Stereotactic Radiosurgery

This information explains your stereotactic radiosurgery (SRS) treatment at Memorial Sloan Kettering Cancer Center (MSK), including how to prepare for it and care for yourself at home.

SRS is a treatment in which a high dose of radiation is given to a small area in the brain that contains the tumor. The healthy tissues near the tumor receive only a very low dose of radiation. SRS is given in one treatment.

Preparing For Your Treatment

On the day of your treatment, you may be in Radiation Oncology for up to 12 hours. You must bring a responsible adult to spend the entire day with you. Arrange this ahead of time.

If you cannot plan for someone to stay with you, tell your radiation oncology nurse before your treatment. Special arrangements can be made.

We do not have a lot of space in the waiting area, so do not bring more than 2 adults with you. Please do not bring children with you on the day of treatment. You should also plan to have someone stay at home with you for the first 24 hours after your treatment, if possible.

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The Day Before Your Treatment

  • Pack a bag to bring with you on the day of your treatment. Bring all the medications you are taking, as well as reading material or a video or DVD to watch. Bring anything else that will help you pass the time while you wait. If you wear glasses, you may not be able to wear them while your head frame is in place.
  • Shower and wash your hair the night before or the morning of the treatment. Do not use any hair spray, gel, or mousse after you wash your hair.

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The Day Of Your Treatment

Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of clear liquids (see Figure 1). 

Figure 2. 12 ounces of clear liquid

Examples of clear liquids include:

  • Clear broth, bouillon, or consommé (no particles of dried food or seasonings) 
  • Gelatin, such as Jell-O® 
  • Clear fruit juices (no pulp), such as white cranberry, white grape, or apple 
  • Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade® 
  • Coffee or tea, without milk or cream 

Things to remember

  • Wear loose-fitting, comfortable clothing. Wear a top with a crew or V-neck collar. Do not wear a turtleneck top or a shirt with a stiff collar. If your shirt has long sleeves, be sure that they can be comfortably rolled up. You may want to bring a sweater that opens in the front, such as a cardigan.
  • Bring any medication with you that you would normally take at home during the day.
  • You can bring a DVD or video cassette tape to watch while you are waiting for your treatment. You should also bring reading material.
  • We will give you breakfast and lunch, but you can bring your own food if you would like.

Where to park

Parking at MSK is available in the garage on East 66th Street between First and York Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block toward First Avenue, on the right (north) side of the street. A pedestrian tunnel connects the garage to the hospital. There are also nearby commercial garages: four on East 69th Street between First and Second Avenues and three on East 65th Street between First and Second Avenues. For questions about pricing, call 212-639-2338.

Where to go

Your treatment will take place at 425 East 67th Street. This is a side entrance of the main MSK building. When you enter the pavilion, turn left, and take the R elevators to the 2nd floor.

If you come in through the basement-level garage, take the A elevators to the first floor. Then, turn left and go past the Security desk at the 67th Street entrance and take the R elevators to the 2nd floor.

If you get lost, ask a security guard to help you call a radiation oncology nurse. He or she can be reached at extension 5615. From outside the hospital, the number is 212-639-5615.

What to expect

Your nurse will meet you in the waiting area. He or she will then take you into a room and check your blood pressure, pulse, and temperature. Your nurse will place an intravenous (IV) line into your vein so that you can get your medications throughout the day and contrast (dye) during your computed tomography (CT) scan. Please let us know if you are allergic to contrast. Finally, you will get a medication that will help you relax before your treatment.

Placement of the stereotactic head frame

You will have a stereotactic head frame placed. This frame helps us aim the radiation beams to the area being treated. It also helps to keep your head still during your CT scan and treatment.

For the placement, you will sit in a chair. Your doctor will inject a medication to numb your scalp in the 4 areas where the frame will be held. You may feel a burn or sting from the medication for a few minutes. Your doctor will place 4 small pins, 2 in your forehead, and 2 in the back of your head. While the pins are being placed, you will feel pressure or tightness. This should only last about 5 minutes. After that, you will only feel the weight of the 2-pound frame on your head. You will need to wear the frame all day, until your treatment is complete.

CT scan for treatment planning

Once your head frame is placed, your doctor will inject contrast into your IV. This helps give us a clearer image of the area to be treated. You will be brought to another room to have a CT scan. Your radiation therapists will help you lie on the table and will secure the head frame to the table. While the frame is secured to the table, you will not be able to move your head.

While you are having your scan, your radiation therapists will watch you through a window and will be able to hear you through the intercom. The scan can be stopped if you need anything and your therapists can come into the room. The scan will take about 20 minutes. Some patients sleep during the scan.

After your CT scan is finished, your doctors will use the images to plan your treatment. Your radiation therapists will take measurements and make some marks on your head with a pen. When you go home that evening, you can wash off these marks with soap and water.

Waiting for treatment

While you are waiting for your doctors to plan your treatment, your doctor or nurse will take you to a waiting area. You will spend most of your time in this room, about 6 to 7 hours. In the room, you can sit on a reclining lounge chair and rest your head on a pillow. You will be wearing the head frame, so if you have any discomfort, pressure, or pain during the day, tell your nurse. We can give you pain medication or help you find a more comfortable position.

You will get breakfast after your CT scan. Later, we will also serve you lunch. You cannot eat anything after 1:00 pm. You will be able to take your usual medications with small amounts of clear liquid.

While waiting for your treatment, you can sleep, read, or rest. There will be a television with a DVD and video cassette player in the room.

Do not get up or walk around without help from one of our staff. Please call someone any time you need to walk to the bathroom or get up to stretch.

At some point during the day, your nurse will review your discharge instructions. You will get any prescriptions that you need and an appointment for a magnetic resonance imaging (MRI) scan. You will also be scheduled for a follow-up appointment with your radiation oncologist. Your nurse will answer any questions you or your escort may have.

During your treatment

After the treatment planning is done, you will be taken into the treatment room. Your therapists will position you on the treatment table and secure the head frame to the table. They will recheck the measurements that they took before your CT scan to make sure that the frame has not moved. When your treatment is ready to begin, your therapists will leave the room. Although you will be alone during your treatment, your therapists can see and hear you at all times.

You will not see or feel the radiation as it is being given. You will see the radiation machine move around you during the treatment. You may also hear the humming sound of the machine. Your treatment will take about 20 minutes for each area we are treating. If you need anything, just talk, and we can stop the treatment if needed. Do not wave your hands or move around to get our attention.

After your treatment

After your treatment is complete, your therapists will help you get up. You will be brought to another waiting area where one of your doctors will remove your head frame. You may feel pressure across your forehead while the frame is being removed. The pressure can last from 10 to 30 minutes.

Your pin sites will be cleaned with Betadine® and then bacitracin ointment will be applied. The pin sites will be covered with a dressing wrapped around your head or with Band-Aids®. You will be observed for 1 hour after your treatment. Before you are discharged, your nurse will review the instructions and appointments given to you and your escort earlier in the day.

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After Your Discharge

  • Your escort should take you home after your treatment. You are not allowed to drive.
  • Someone should stay with you for the first 24 hours after your treatment.
  • You can resume most of your normal activities. However, please check with your doctor or nurse about when you can resume vigorous exercise.

Brain swelling

Some patients develop brain swelling in the area that was treated.

  • If your doctor thinks that this is a risk for you, we will give you a prescription for dexamethasone (Decadron®). It reduces the risk of swelling. If you are already taking it, the dose may be changed after your treatment. Your nurse will tell you to begin taking the dexamethasone either the first evening after your treatment or the following morning.
  • If you will be taking dexamethasone, we will give you a schedule on how much to take each day and how to slowly reduce the dose over time. Check the date you are scheduled to begin reducing it and follow the schedule carefully. The schedule may need to be adjusted if you have symptoms.
  • Call your doctor if you have any of the following signs or symptoms of brain swelling:
    • A headache that does not go away with acetaminophen (Tylenol®)
    • Unsteadiness when walking
    • Seizures
    • Changes in vision
    • Vomiting or nausea
    • A worsening of your original symptoms

Caring for your pin sites

  • There may be a small amount of drainage from the pin sites the first night after your treatment. Call your doctor if the drainage soaks any of the Band-Aids® or dressing so much that you have to change it.
  • The day after your treatment, remove the Band-Aids® or dressing, shower, and wash your hair.
  • Take care of your skin in the area of the pin sites to prevent an infection:
    • Apply bacitracin twice a day until the pin sites have healed.
    • Leave the area open to the air. Do not put the Band-Aids® back on.
    • Call your doctor if you develop redness, swelling, or drainage from the pin sites.
  • You may see swelling around the pin sites and around your eyes for several days after your treatment. This is from the numbing medication that was injected. You can put cool compresses on the area for comfort.
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Follow-Up Care

We will schedule a follow-up visit with your radiation oncologist. You will have a follow-up MRI about 8 weeks after your treatment. These appointment dates will be given to you before you are discharged.

We will call you the day after your treatment to see how you are doing. We will answer any questions you may have and review your discharge instructions.

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