CURRENT CONCEPTS IN RADIOTHERAPY FOR BENIGN DISORDERS

CurrentConceptsinRadiotherapyforBenignDisorders1-0-25kapak

Parkinson’s Disease

Azamat HEKİMOĞLUa , Güler YAVAŞa
aAnkara Etlik City Hospital, Clinic of Radiation Oncology, Ankara, Türkiye

Hekimoğlu A, Yavaş G. Parkinson’s disease. In: Uysal B, Gamsız H, eds. Current Concepts in Radiotherapy for Benign Disorders. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.52-6.

ABSTRACT
The primary therapeutic approach for conditions characterized by movement disorders, such as Parkinson’s Disease (PD), typically involves pharmacological interventions. However, for a subset of patients unable to derive benefit from medication or encountering intolerable side effects, alternatives such as Deep Brain Stimulation (DBS) or surgical interventions targeting the basal ganglia and thalamus may be considered. Stereotactic radiosurgery (SRS) emerges as a noninvasive alternative for patients for whom medical therapy is contraindicated and surgical options like DBS are not feasible. Although SRS procedures can be performed using various devices like GammaKnife (GK), CyberKnife (CK), and LINAK-based systems, the bulk of research in this realm has been conducted with GammaKnife. Thalamotomy, targeting the ventralis intermedius nucleus (VIM), proves effective in addressing tremors of diverse origins. SRS-assisted thalamotomy has exhibited favorable outcomes in tremor management, with success rates ranging from 70-80%. Conversely, the efficacy of pallidotomy and SRS interventions targeting the internal globus pallidus (Gpi) for addressing bradykinesia, rigidity, and dyskinesia has not paralleled that of thalamotomy, prompting debate with pallidotomy success rates spanning from 0-80%. Notably, the European Academy of Neurology Movement Disorders Association Guidelines caution against the use of Stereotactic Radiosurgery using Gamma radiation due to its associated high risks. However, it is hoped that thalamotomy facilitated by stereotactic radiosurgery will be considered as a viable alternative only within specialized centers experienced in this modality, catering to patients who have exhausted other therapeutic avenues.

Keywords: Parkinson’s disease; stereotactic radiosurgery; CyberKnife; GammaKnife; thalamotomy

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