Convinced that the future of Neurosurgery lies in minimally invasive Neurosurgery, Dr. Kita Sallabanda specialized in radiosurgery at the Karolinska Institute in Sweden, the place where this technique was ‘invented’. Nearly three decades later, his numbers back up his experience: around 5,000 patients treated with radiosurgery, in addition to the thousands he has operated on as a neurosurgeon. President of the Spanish Society of Radiosurgery, Dr. Sallabanda has taken on the challenge of positioning himself at the forefront of the sector, directing 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 a precision never seen before, from malignant tumors and brain metastases to functional pathologies such as Parkinson’s disease and psychiatric disorders such as obsessive-compulsive disorder. You are the main reference in Radiosurgery in Spain and one of the most renowned in the world. What does this specialty consist of? 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 pathology, Parkinson’s, epilepsy, trigeminal neuralgia…. It is so called because through radiation it achieves the same effect as surgery but without the need to open the head. Nowadays, it has evolved a lot and is also used in oncology: it makes a brain metastasis disappear without having to operate.
We are more used to hearing about radiotherapy. Is it the same thing?Radiosurgery is radiotherapy, yes, but with very high doses of radiation, which makes it a radical treatment. For example, if a patient has to be treated for lung cancer, he needs a certain dose of radiation that is usually given in 28-32 days. Radiosurgery delivers the same dose in a single day. So it is radiotherapy but under very specific conditions and it is based on four criteria: single dose (although we are already extending it to five days in large lesions and important pathologies), high dose (we give in one day the same dose that is usually given in 28 or 32 days in standard radiotherapy treatment), and very high precision. The margin of movement is less than one millimeter, while that of standard radiotherapy can be up to one centimeter. This is very important because it protects the structures around the lesion.
With what objectives was the Institute of Advanced Radiosurgery created? 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 radiosurgery treatments of Central Nervous System pathology, which did not exist in either public or private healthcare. We took 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 will not only to treat patients, but also to impart knowledge and to get involved in all research studies in the field. What is ZAP-X and what are its advantages over the usual tools?
ZAP X is a state-of-the-art machine that incorporates elements of artificial intelligence and whose main advantages are that it is non-aggressive, that it does not use cobalt sources and therefore is non-polluting and does not require a protective bunker so as not to emit radiation outside. The machine is on the surface next to a window, which makes the treatment much more humane, and its technical parameters are superior to any technology currently in use.
What kind of lesions 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 pathology, arteriovenous malformations, all benign tumors that can be very difficult to operate on (meningiomas, neurenomas, adenomas…), functional pathology such as essential tremor or trigeminal neuralgia, psychiatric disorders such as obsessive-compulsive disorder, and as a novel and very important thing, it is very effective in treating oncologic pain. Is it possible to eliminate that pain?
Until now it was untreatable. Any day like today, there are hundreds of thousands of patients who are in palliative units with morphine pumps and other drugs. With radiosurgery we can do a much cheaper treatment, which also does not force the patient to be in a bed connected to an IV and allows him to live a normal life. We cannot save lives, but we can greatly improve the living conditions of these patients.
What is the level of implementation in our country?
It is currently the only machine in Spain, the fourth in Europe and the tenth in the world. When we brought it, there were only two in Germany and one in Switzerland. Now they are putting four in Paris, there will also be one in Poland, in Italy and in other countries, but we were visionaries in bringing 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), 280,000 patients with different types of cancer have been diagnosed in Spain in 2022. Of these, 40% produce brain metastases, i.e., around 110,000 patients. Of these, only 20% receive treatment by radiosurgery, when it is 10 times more effective and does not leave these side effects. Spain does not have sufficient 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 ZAP-X treatment covered by insurance companies?
Yes. We have an agreement with Adeslas and we are in talks with DKV, with Fremap and little by little we are talking with all the companies so that they can offer this treatment to their policyholders. But we have attended patients who come to us from all over the world, not only from Spain.
“Currently only 20% of patients with brain metastases receive treatment by radiosurgery”
Have you witnessed how technology can improve patients’ lives?
Without a doubt. And I can tell some cases, like a woman who was a teacher and had breast cancer with six metastatic lesions in the brain. This 15 years ago was taboo, it was not treated. I did it, I treated all six metastases and they disappeared. Unfortunately, two years later, lung metastases appeared. The patient called me and said, “I am not dying of brain metastasis, I am dying of lung cancer. I am very grateful that you have given me those two and a half years of life because I have seen my daughter finish college, my son with a girlfriend and I am going to die a happy mother”. Another case, unrelated to cancer, is that of a woman with trigeminal neuralgia that caused her such unbearable 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 has gone from that suicide attempt to having an absolutely normal life. That is how we changed her life with this treatment.Besides these cases you just recounted, what milestones in your career are you most proud of and what are your next goals?
I am personally proud of having created the first Master’s Degree in Central Nervous System Radiosurgery in the world, something that 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 the treatment given to patients: I see how they improve and I am happy. As far as challenges are concerned, I would point out three: training, technology and patients, that is to say, to make radiosurgery known in Spain, to invest in innovation and change technology and to reach 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 millimeter-precision, non-polluting technology”
With radiosurgery we give in a single session the same dose of radiation that is usually given in 28 to 32 days in standard radiotherapy treatment