“Our radiosurgery technology, a pioneer in Spain, is changing the lives of patients”


Convinced that the future of neurosurgery lies in minimally invasive neurosurgery, Dr. Kita Sallabanda specialized in radiosurgery at the Karolinska Institute in Sweden, where this technique was “invented”. Nearly three decades later, his figures confirm his experience: about 5,000 patients treated with radiosurgery, in addition to the thousands he operated on as a neurosurgeon. President of the Spanish Society of Radiosurgery, dr. Sallabanda has taken up the challenge of positioning itself at the forefront of the sector, leading the Institute of Advanced Radiosurgery (IRCA), the first and only center in Spain with the most innovative technology: the ZAP-X machine , which treats with unprecedented efficiency and precision from malignant tumors and brain metastases to functional pathologies such as Parkinson’s disease and psychiatric disorders such as obsessive-compulsive disorders. You are the greatest reference in radiosurgery in Spain and one of the most renowned in the world. What is this specialty? Radiosurgery is a non-invasive treatment system that emerged in the middle of the last century from a neurosurgeon at the Karolinska Institute in Sweden who began treating patients with functional pathologies, Parkinson’s, epilepsy, trigeminal neuralgia… It is so called because through radiation the same effect as surgery is achieved, but without the need to open the head. Today, it has evolved a lot and is also used in oncology: it eliminates a cerebral metastasis without having to operate.

We are more accustomed to hearing about radiotherapy. It is the same?Radiosurgery is radiation therapy, yes, but with a very high dose of radiation, making it a radical treatment. For example, if a patient is to be treated for lung cancer, he needs a certain dose of radiation which is usually delivered in 28 to 32 days. Radiosurgery delivers the same dose in a single day. It is therefore radiotherapy but under very specific conditions and it is based on four criteria: single dose (even if we are already extending it to five days in large lesions and major pathologies), high dose (we give the same dose in one day which is usually administered over 28 or 32 days in standard radiotherapy treatment), and with very high precision. The range of motion is less than one millimeter, while that of standard radiotherapy can be up to one centimeter. This is very important as it protects the structures around the injury.

With what objectives was the Institute of Advanced Radiosurgery created? The IRCA was born from the desire of a group of neurosurgeons to bring to Spain the best and most advanced technology in the world for radiosurgical treatments of pathologies of the central nervous system, which did not exist in the care of public or private health. We take the initiative to be pioneers to better help our patients. As a renowned expert in radiosurgery and president of the Spanish Society of Radiosurgery, I was in charge of evaluating the existing technology in the world and we decided to bring the ZAP-X and create this Institute of Advanced Radiosurgery. It was born with the desire not only to care for patients, but also to transmit knowledge and to get involved in all research studies in the field. What is the ZAP-X and what are its advantages over conventional tools?

ZAP X is a state-of-the-art machine that incorporates elements of artificial intelligence and whose main advantages are that it is not aggressive, that it does not use cobalt sources and therefore does not pollute, and does not require a protective bunker to avoid emitting radiation outside. The machine is on the surface next to a window, which greatly humanizes the treatment, moreover its technical parameters are superior to any currently used technology.

What types of injuries and pathologies can be treated with this machine?

It is recommended for patients with malignant tumors, especially brain metastases, but it is also very effective for vascular pathologies, arteriovenous malformations, all benign tumors that can be very difficult to operate (meningiomas, neuromas, adenomas. ..), functional pathologies such as essential tremor or trigeminal neuralgia, psychiatric disorders such as obsessive-compulsive disorder, and something new and very important, it is very effective in treating cancer pain. Is it possible to eliminate this pain?

Until now, it was unsolvable. Every day like today, hundreds of thousands of patients are in palliative care units with pumps of morphine and other drugs. With radiosurgery we can do a much cheaper treatment, which also does not require the patient to be in a bed connected to a line and allows him to lead a normal life. We cannot save lives, but we can greatly improve the living conditions of these patients.

What is its level of implantation in our country?

It is currently the only machine in Spain, the fourth in Europe and the tenth in the world. When we brought her, there were only two in Germany and one in Switzerland. Now they are putting four in Paris, there will also be one in Poland, Italy and other countries, but we were visionary when we brought this technology to Spain.

How many patients have access to this treatment in Spain?

According to data from the Spanish Society of Medical Oncology (SEOM), in Spain, in 2022, 280,000 patients with different types of cancer were diagnosed. 40% of them produce brain metastases, ie around 110,000 patients. Among them, only 20% receive radiosurgery treatment, while it is 10 times more effective and does not leave these side effects. Spain does not have enough technology, but there is also a lack of knowledge on the part of doctors and patients. In other countries, patients demand the most appropriate and advanced treatment.

Is the ZAP-X treatment covered by insurers?

Yes, we have an agreement with Adeslas and we are in talks with DKV, with Fremap and little by little we are discussing with all the companies so that they can offer this treatment to their policyholders. But we have treated patients who come to us from all over the world, not just from Spain.

“Currently, only 20% of patients with brain metastases receive treatment with radiosurgery& rdquor;

Have you witnessed how technology can improve the lives of patients?

Without a doubt. And I can count some cases, like a woman who was a teacher and had breast cancer with six metastatic brain lesions. This 15 years ago was a taboo, it has not been dealt with. I did, treated all six metas and they disappeared. Unfortunately, two years later lung metastases appeared. The patient called me and said, “I’m not dying of brain metastases, I’m dying of lung cancer. I am very grateful that you left me these two and a half years of life because I saw my daughter finish university, my son with a girlfriend and I will die happy.” Another case, unrelated to cancer, is that of a woman with trigeminal neuralgia which caused her such excruciating pain that she attempted suicide.She was a destroyed woman, who could not even speak and did not want to live. We treated her with radiosurgery two years ago. I saw her again a few days ago and she went from that suicide attempt to living a completely normal life. This is how we are changing our lives with this treatment.Besides these cases that you have just related, of which stages of your career are you most proud and what are your next goals?

I am personally proud to have created the first Masters in Central Nervous System Radiosurgery in the world, which was very necessary because there is no specific university degree in any country. I am also the author of the only radiosurgery treatise in Spanish, which has already had two editions, and I am also proud of the quality of patient care: I see how they are improving and I am happy about it. In the chapter on the challenges, I would highlight three: training, technology and patients, that is, making radiosurgery known in Spain, investing in innovation and the evolution of technology and achieving as many patients as possible, because it is the best treatment for many pathologies.

**IRCA (C/ de la Loma, 1, 28003, Madrid).

“ZAP-X is a non-polluting technology of millimeter precision & rdquor;

With radiosurgery, we give in a single session the same dose of radiation that is usually given over 28 or 32 days in standard radiotherapy treatment

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