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Role of Gamma Knife in Glioblastoma

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The most aggressive and common primary malignant brain tumour in adults is glioblastoma (GBM). Even with advancements in radiation therapy, chemotherapy, and neurosurgery, glioblastoma is still a difficult disease to treat. As much of the tumour as feasible is typically removed surgically as part of traditional treatment, which is then followed by radiotherapy and chemotherapy (most frequently with temozolomide).

Role of Gamma Knife in Glioblastoma
Role of Gamma Knife in Glioblastoma

However, GBM has a tendency to relapse even with the best care. This is where innovative techniques like Gamma Knife Radiosurgery (GKRS) come in handy, either as a salvage therapy in the event that the tumour returns or as a primary supportive treatment in certain situations.

Gamma Knife Radiosurgery: What is it?

Gamma Knife Radiosurgery_ What is it
Gamma Knife Radiosurgery_ What is it
  • A specific type of stereotactic radiosurgery (SRS) is the Gamma Knife. In spite of the name, no knife or incision is used.
  • 192 concentrated gamma radiation beams are employed, and they converge on the tumour.
  • This protects the surrounding healthy brain tissue while enabling the tumour to absorb a very high dosage of radiation.
  • The majority of patients return home the same day after receiving treatment, which is often done in a single session as an outpatient.

Common Glioblastoma Treatment

The conventional approach to treating GBM entails:

  • Surgical excision is the most safe way to remove a tumour.
  • Treatment with temozolomide used along with external beam radiation (EBRT).
  • Temozolomide used with adjuvant chemotherapy.
  • Recurrence is nearly unavoidable in spite of this multimodal strategy. Gamma Knife radiosurgery can help with this.

Why Is Gamma Knife a Good Option for Glioblastoma?

Because glioblastomas extend beyond the visible tumour boundaries, they are known to be infiltrative. This prevents total surgical excision. The Gamma Knife provides significant advantages in certain situations but does not replace surgery or traditional radiation therapy.

Why Is Gamma Knife a Good Option for Glioblastoma
Why Is Gamma Knife a Good Option for Glioblastoma

  1. Treatment of Residual Tumor

If tiny pieces of the tumour are still present close to important brain regions after surgery, the Gamma Knife can accurately target them.

  1. Controlling Recurrence

Despite treatment, glioblastomas frequently return. Targeting recurring tumours with a Gamma Knife is an effective way to avoid giving the entire brain further radiation.

  1. For Non-operable or Deeply Seated Tumours

Gamma Knife offers a non-invasive option when the tumour is situated in regions that are unsafe for surgery to access, like the brainstem, thalamus, or basal ganglia.

  1. Palliative Care

Gamma Knife can help control symptoms (such headaches, seizures, or weakness), lessen tumour size, and enhance quality of life when the tumour is in an advanced stage.

How is the process carried out?

  1. Planning and Imaging
  • A high-resolution MRI is used to precisely image the tumour.
  • To keep the head motionless, a lightweight head frame or mask is used.
  • A treatment plan customised to the size, form, and location of the tumour is created with the use of specialised software.

Gamma Knife Advantages for Glioblastoma

  • Non-invasive: No hospitalisation or open surgery is required.
  • Targeted and precise:Reduces harm to healthy brain tissue.
  • Repeatable: In the event of a recurrence, it can be utilised more than once.
  • One-day outpatient procedure; short treatment duration.
  • Better quality of life: Assists in managing tumour growth and symptoms.

Restrictions & Things to Think About

  • Gamma Knife is a component of a multimodal therapeutic approach; it is not a cure for glioblastoma.
  • Small, clearly defined tumour regions (usually less than 3–4 cm) respond best to it.
  • In freshly diagnosed patients, it does not take the place of surgery, chemotherapy, or standard radiation.
  • Risks include mild headaches, nausea, temporary brain swelling, and in rare cases, radiation-induced necrosis.

Aftercare

Following Gamma Knife, patients get routine MRI scans to evaluate tumour management and track recurrence. Depending on the situation, radiosurgery may be followed by ongoing chemotherapy or clinical trials.

In conclusion

Although glioblastoma is still a challenging brain tumour to treat, Gamma Knife Radiosurgery has become an effective treatment strategy. Although it is not a cure in and of itself, it is essential for treating deep-seated tumours, managing recurring or residual disease, and enhancing patient quality of life.

Gamma Knife is a symbol of hope for glioblastoma patients and their families since it provides a minimally invasive, safe, and effective treatment option as part of an entire care plan guided by skilled neurosurgeons and oncologists.

Sources:

  1. https://www.sciencedirect.com/science/article/abs/pii/S0028377024000031
  2. https://www.cduma.com/blog/treating-glioblastoma-with-radiosurgery
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC6267255/
  4. https://journals.lww.com/neur/fulltext/2020/68020/role_of_gamma_knife_radiosurgery_in_the_management.15.aspx
  5. https://drsridharpsoncologist.com/blog/gamma-knife-for-glioblastoma/
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You May Also Know Related to Gamma Knife
FAQ’s

Gamma Knife uses 192–201 precisely focused beams of gamma rays that converge at a single target point in the brain. This high dose of radiation damages the DNA of abnormal cells, stopping their growth or causing them to shrink, while minimizing exposure to nearby healthy tissue.

No, Gamma Knife is not a traditional surgery. It is a non-invasive outpatient procedure performed without any incision, stitches, or general anesthesia in most cases.

Gamma Knife is commonly used for:

Brain tumors (benign and malignant)
Metastatic brain lesions
Arteriovenous malformations (AVMs)
Trigeminal neuralgia
Acoustic neuromas (vestibular schwannomas)
Pituitary tumors
Certain functional disorders (like tremors)

The procedure is generally painless. Patients may feel mild pressure while the head frame (if used) is applied or may experience slight discomfort from anesthesia injections, but the treatment itself is not painful.

Depending on the condition and treatment plan, Gamma Knife may take 30 minutes to 3 hours. Most patients go home the same day.

Common side effects are usually mild and temporary, including:

Headache
Nausea
Fatigue
Mild scalp swelling or tenderness at the frame site
Rarely, some patients may experience delayed radiation effects such as brain swelling or radiation necrosis.

Most patients can return to their normal routine within 24–48 hours after the procedure.
You may feel mild fatigue for a few days.
Follow-up imaging is usually required after 1 year.

Gamma Knife has a high success rate and has been used worldwide for decades. Its effectiveness depends on the condition treated, size and location of the lesion, and overall patient health. In many cases, it offers results comparable to open surgery with fewer risks.

Yes, in some cases Gamma Knife treatment can be repeated if the disease recurs or if new lesions develop.

Yes. Gamma Knife is considered one of the safest and most precise forms of radiosurgery, with millions of patients treated globally and extensive clinical data supporting its use.

Eligibility depends on factors such as:

Size and location of the lesion
Overall health and age
Whether open surgery is too risky
A neurosurgeon and radiation oncologist will decide if Gamma Knife is the best option for you.

A detailed MRI or CT scan is performed to map the brain.
A lightweight head frame or mask is used for accuracy.
Your doctors plan the radiation dose and target areas using specialized software.

Local anesthesia is given if a head frame is used.
General anesthesia is usually not required, except for children or patients unable to remain still.

Costs vary depending on hospital, city, and condition treated. On average, Gamma Knife in India ranges from ₹1.5 lakh to ₹4.5 lakh. It is usually more affordable compared to treatment in Western countries. At AIIMS Delhi, it is much more affordable around ₹75,000 which makes it affordable for the patients in need.

AIIMS Delhi is one of the leading centres for Gamma Knife in India.

AIIMS uses the latest Gamma Knife Perfexion system.

It has successfully treated thousands of patients for brain tumors, blood vessel problems, and even eye cancers.

The treatment is done by expert neurosurgeons such as Dr. Deepak Agrawal and team.

Clinic timings for Gamma Knife OPD at AIIMS Delhi: Monday & Friday, 8:00 AM – 9:00 AM.

Cost is around ₹75,000 and is subsidized compared to private hospitals.

The whole procedure is usually done in one day:

  • Consultation & Planning – Doctors review your scans and decide the treatment.
  • Head Frame/Mask – A lightweight frame or mask is placed to keep your head still.
  • Imaging – MRI/CT scans are done to locate the exact target.
  • Treatment Planning – Specialists plan the dose and direction of radiation.
  • Gamma Knife Treatment – You lie on the machine; painless radiation beams treat the target (30 mins–3 hrs).
  • Recovery & Discharge – The frame is removed, and most patients go home the same day.
  • Follow-up – MRI after a few months to check results.

Before you get a treatment date, you need to complete a few steps:

  • OPD Registration – Visit the Neurosurgery OPD (Gamma Knife clinic at AIIMS, Mon & Fri 8–9 AM) and register.
  • Consultation with Doctor – Meet the neurosurgeon who will check your reports, MRI/CT scans, and medical history.
  • Investigations – Sometimes fresh MRI/CT or blood tests are needed for treatment planning.
  • Medical Fitness – Basic checks like blood pressure, sugar, heart condition, etc.

Financial/Insurance Approval –

  1. If using Ayushman Bharat or government schemes, you need approval papers.
  2. If self-paying, you will be given the estimated cost (~₹75,000 at AIIMS).
  • Consent & Admission Slip – Once doctors confirm you are fit and formalities are done, you sign the consent form.
  • Treatment Date Allotment – A date is given for your Gamma Knife procedure.

Once you receive your Gamma Knife date, you’ll need to do a few simple things before the procedure:

  • Admission Process – Report to AIIMS on the morning of your procedure and complete admission at the Neurosurgery ward/Daycare.
  • Paperwork – Carry your OPD slip, MRI/CT films, blood test reports, admission slip, and ID proof. If you are covered under Ayushman Bharat/insurance, keep those approval papers ready.
  • Consent Forms – You (or a family member) will sign consent for the procedure and anesthesia.
  • Medical Check-up – Doctors will check your BP, sugar, heart rate, and do a quick physical exam.
  • Fasting – Usually, you will be asked to not eat or drink for 6 hours before the procedure.
  • Pre-Procedure Prep – An IV line may be put, and medicines (sedation/antibiotics if needed) are given.
  • Treatment – You are then taken to the Gamma Knife room for frame/mask placement, imaging, and treatment.

After the procedure, you’ll be observed for a few hours and most patients are discharged the same day or next morning.

Urea & creatinine

No, You can have light breakfast.

Yes, you can take the medicine and then come for the treatment.

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