Leksell Gamma Knife® Perfexion™

Preferred for a reason Why do medical professionals and patients prefer Gamma Knife Surgery?

More than 80,000 patients undergo No matter how complex or intricate the clinical Leksell Gamma Knife® radiosurgery every year. challenge, Gamma Knife surgery delivers the highest Pioneering knowledge, insight from physicians, levels of physician and patient satisfaction. This meticulous research and cutting-edge makes it the treatment of choice at leading hospitals technology—this is Leksell Gamma Knife surgery. and clinics around the world.

— 2 — Elekta perfects the art and science of stereotactic radiosurgery

Pioneered by Elekta, stereotactic radiosurgery involves delivering a single, high dose of radiation to a small and critically located target in the brain. This principle defines Gamma Knife surgery and it has dramatically widened treatment possibilities for physicians and patients.

Exceeding expectations Leksell Gamma Knife is specifically designed for non-invasive procedures. Gamma Knife surgery provides pinpoint accuracy, unmatched efficiency and outstanding results. Patients Setting the standard for radiosurgery benefit from fast, painless treatment, often This integrated system provides full cranial conducted in an outpatient surgical setting reach. The system is built to deliver outstanding without the need for general anesthesia or patient and staff comfort and better dosimetry even convalescence. Over 1 million patients performance than any other radiosurgical system. have undergone Gamma Knife surgery. Leksell Gamma Knife Perfexion—the system that fuses the skills of the physician with the science of radiosurgery.

— 3 — The ultimate cranial radiosurgical tool— Leksell Gamma Knife® Perfexion™

Leksell Gamma Knife is consistently regarded as the best non-invasive treatment for brain disorders. So how did we make the best even better? By listening to experts in radiosurgery and One-button automation Robotic efficiency Composite Shots enable sculpting then creating Leksell Gamma Knife The system offers physicians a fully With Leksell Gamma Knife Perfexion, the dose distribution, which is then Perfexion. automated, single push-button the multiple helmets of the previous delivered with the unmatched approach to operations that translates Leksell Gamma Knife models have accuracy associated with into dramatic time savings. The been replaced by a single robotic Gamma Knife surgery. cutting-edge design radically expands system with three collimator Unrivalled radiation protection treatment reach to cover a wider sizes. Because the collimator size Every feature of Leksell Gamma Knife range of anatomical structures. automatically changes according to Perfexion reflects patient and staff the treatment plan, treatment times Full reproducibility safety and comfort. The system are radically reduced. Leksell Gamma Knife Perfexion offers provides radiation shielding that is protocol reproducibility with full Improved workflow speeds up to 100 times better than backward compatibility to existing radiosurgery alternative technologies. Gamma Knife surgery protocols. The system comes complete with Room radiation levels are low enough That means building on the treatment Leksell GammaPlan®, the dedicated to allow for a window into the experience of over 1.2 million treatment planning system designed Leksell Gamma Knife Perfexion treatment room and the system can patients and close to 3,000 peer- to take full advantage of the features is designed to irradiate targets be accommodated within a normal- reviewed papers. and intelligence incorporated in in the brain. sized room. Leksell Gamma Knife Perfexion.

— 4 — Smooth and seamless treatment workflow

The ideal treatment procedure for physicians and patients is a single session that is swift, precise and elegant. This is where Gamma Knife surgery, together with the dedicated treatment planning system, excels. Each step in the process works to Diagnosis Frame Attachment Leksell® Stereotactic Frame is secured the highest possible standard of convenience and to the patient’s head throughout the entire treatment enables superior clinical ­efficiency. procedure to ensure maximum accuracy.

Complete integration The system digitally integrates diagnostic images, Improved workflow with treatment planning and dose delivery into a Leksell Gamma Knife Perfexion seamless information flow. Finally, the procedure is implemented via a single push-button operation. ··100% uptime (98% uptime guaranteed) ··Single run, one push-button for 99% of Highest comfort and safety all cases Patient comfort and well-being are priorities at every phase. The entire process is straightforward and the ··Two hours saved per patient compared patient is usually ready to return to normal life the to previous systems next day. ··Treatment planning done twice as fast

Workflow is so efficient that staff numbers are Data based on a study of 99 patients, conducted minimized while physicians’ valuable time at Hospital La Timone, Marseille, France (July-December 2006) and experience at is optimized. Cromwell Hospital, London, UK.

Imaging Images taken immediately before the treatment determine the precise shape, size and location of the target.

— 5 — Gamma Knife surgery— preferred for a reason

With very few exceptions, Gamma Knife surgery is given on a single occasion and without general anesthesia. After Gamma Knife surgery the patient normally leaves the hospital on the same day or the day after, making it a very cost-effective alternative Treatment planning Images are used to create a tailor- Treatment Targets are automatically irradiated according to to open surgery. made treatment plan to enable an optimal radiation dose the plan. Throughout the treatment procedure the patient is to the target. The treatment plan is then transferred to the monitored via the intercom system. During the procedure, 192 radiation beams from Gamma Knife system. cobalt-60 sources converge with high accuracy on the target. Each individual beam has low intensity and therefore does not affect the tissue it passes through on its way to the target. The beams converge in an isocenter where the cumulative radiation intensity becomes extremely high.

By moving the patient’s head in relation to the beams’ isocenter, the radiation dose can be optimized in relation to the shape and size of the target. The extreme precision of Leksell Gamma Knife—better than 0.5 mm—makes it possible to administer a high radiation dose to the lesion with minimal risk of damaging healthy tissue. Follow-up The effect of radiosurgery takes place over time.

— 6 — Professor Leksell with Leksell Stereotactic System®— a revolution in intracranial surgery

Reaching new heights The number of patients to undergo Gamma Knife of excellence surgery has risen from about 7,000 patients in 1991 to 1.1 million by 2018. Correspondingly, the number of Over 70 years ago, Professor Lars Leksell discovered units installed ­globally over the last fifteen years has that by minimizing surgical intervention in gone from 20 units in 1991, to over 300 units by 2018. the skull, the mortality rate could be reduced Solutions for tomorrow along with the trauma to the patient. Elekta is continually evolving innovative solutions This concept led to the birth of minimally and that redefine the neurological landscape. non-invasive neurosurgery and the inception Leksell Gamma Knife Perfexion is built with the of Elekta. technology to advance frontiers and deliver on the Setting the gold standard vision that guided Lars Leksell—to deliver highly It was Professor Leksell who invented the stereotactic effective and efficient treatment, at reasonable cost, frame so fundamental to Gamma Knife surgery. with as little trauma to the patient as possible. The stereotactic concept of directing x-ray beams 1949 Introduction of Leksell Stereotactic System into the brain was used surgically for the first 1968 First Leksell Gamma Knife prototype for time in 1951. This marks the birth of stereotactic clinical research radiosurgery—and with it, Leksell Gamma Knife. 1986 First commercially dedicated Leksell In the 1980s, the first commercial deliveries Gamma Knife of Leksell Gamma Knife systems were made. 1989 Leksell Gamma Knife Society formed The unsurpassed clinical effectiveness of 1999 Introduction of Leksell Gamma Knife C with the treatments conducted saw a dramatic Automatic Positioning System™ (APS) increase in the number of publications. Leksell Gamma Knife soon became the worldwide 2006 Launch of the fifth generation—Leksell gold standard for stereotactic brain surgery. Gamma Knife Perfexion

The collimator design of Leksell Gamma Knife Perfexion enables fully automated treatment delivery

— 7 — The unique collimator design enables swift The power of planning­— Leksell GammaPlan treatment of complex enables planning of structures through ® Leksell GammaPlan multiple lesions with Composite Shots and speed and efficiency. Dynamic Shaping. The concept behind Leksell ­GammaPlan® is to enable the physician to tailor a conformal treatment plan for a specific medical condition. Optimal tool for planning multiple targets Based on a new algorithm, using automatic Leksell GammaPlan has been developed in Leksell GammaPlan balancing of the radiation dose, the treatment collaboration with the professionals who actually planning of multiple brain metastases is now as easy ··Client-server architecture simultaneously use the system. This explains why so much attention as planning for a single target. supports multiple users to the online has been devoted to ensuring true user-friendliness, patient database speed and precision. Composite Shots and Dynamic Shaping ··Supports all imaging modalities (CT, MRI, The unique collimator design fea­tured in Software modules for easier planning angio, PET and MEG), also including Leksell Gamma Knife Perfexion enables the Using the latest technology, Gamma Knife software non-stereotactic image studies most com­plicated tumors to be treated with modules such as Inverse Planning, Re-Treatment ··Real-time dose calculation absolute precision. and DICOM-RT bring more power to your planning. ··Optimized planning of multiple targets This opens the platform for future upgrades, while Composite Shots enable dose sculpting of complex ··Composite Shots enable dose scupting of delivering on daily clinical needs for improved structures. And, Dynamic Shaping protects critical complex structures workflow, cost efficiency and treatment quality. anatomical structures in the vicinity of the target, thereby enabling a higher dose to the target. ··Dynamic Shaping protects critical Rapid, precise planning anatomical structures­ The system makes it possible to plan treatment of Regardless of complexity one or several lesions with as many isocenters as Leksell GammaPlan ensures the most precise and clinically deemed optimal. This is performed in a effective treatment is delivered, regardless of the matter of minutes. Irradiation of the lesions is then number and complexity of the targets—so physicians delivered with superior conformity and selectivity. can achieve new heights of patient success.

— 8 — A B C D E F

The sophisticated sector The collimator system consists The unique collimator design The system is developed with The couch can easily be adjusted A series of interlocks are mechanism enables automatic of 192 cobalt 60 sources, divided offers full cranial reach, enabling reliable, state-of-the-art industrial for optimal patient comfort. incorporated for a well- collimator configuration within into 8 sectors that can be treatment of a wide range of components for absolute stability, integrated system with seconds and is designed to individually positioned to any of anatomical structures. safety and precision. enhanced safety features. deliver high serviceability. 4 states: 4 mm, 8 mm, 16 mm The patient positioning system is or off. During treatment, these built to be highly robust, accurate sources are positioned via the and dependable. It moves sector mechanism to generate the patient into the correct the desired radiation beam, position according to the beams’ and enable treatment of highly isocenter, thereby optimizing the complex structures. radiation dose to the target.

A user-friendly, intuitive Graphical User Interface provides up-to-date information on your patient’s ID, treatment status and operational conditions.

The single-button approach enables fast and Radiation shielding levels are the market’s best, up flexible surgical procedures, saving time and to 100 times better than alternative technologies. resources even as patients are effectively treated. Overall radiation levels are low enough to permit a window in the treatment room.

— 9 — The entire system comprises the least possible number of moveable components in order to deliver unsurpassed accuracy.

From the very beginning, Elekta has been uncompromising in the levels of accuracy defined and delivered by Leksell Gamma Knife. For the future, unmatched accuracy is assured by Leksell Gamma Knife Perfexion.

A common definition of accuracy is “the measure of the difference between the desired or planned outcome and a measurable outcome.” Sub-millimeter accuracy Proven accuracy in every step results in clinical benefits

There is no other system capable of delivering accuracy of 0.50 mm when having a valid service Improved quality of life compared the standards of accuracy achieved by agreement. A study of 189 installed systems, to surgery Leksell Gamma Knife—a tested, proven fact. based on 332 commissioning protocols, proved an ··Less trauma average level of radio­logical accuracy of 0.15 mm. Elekta guarantees 0.50 mm ··Faster recovery In intracranial radiosurgery, clinical accuracy The only true stereotactic system ··Shorter hospital stays is the sum of the accuracy contributions that Only Leksell Gamma Knife offers a true ··Fewer surgery-related complications make up the entire treatment procedure— stereotactic system from the ground up, to Improved clinical outcome imaging, dose planning, patient positioning, facilitate precision with their sheer stability and radiological and mechanical accuracy. robustness. Leksell® Coordinate Frame immobilizes ··Optimal dose to the target the patient’s head throughout the procedure. ··Minimum dose exposure to Elekta guarantees that Leksell Gamma Knife surrounding tissue systems will perform with a total radiological

— 10 — Gamma Knife® surgery—based on clinical evidence Metastatic tumors, cumulative patients treated worldwide

In today’s cost-driven healthcare Constantly evolving practice 600k environment, it’s crucial to evaluate Gamma Knife surgery is constant­ly 434.01k .05k

expensive technology investments on expanding, with ongoing research for 9 39 the basis of hard facts and proven new indications and the development 365.81k 335k k 305.6k 8.17k 94 k

results. This is particularly true when of existing protocols. The design 27 1. k 78 25 6.

250k 1k 22

choosing the best care for patients of Leksell Gamma Knife makes it 205.03 14k 185.3 3. 1k 16 2. suffering from serious neurological especially suitable for treatment of 14 120.3k 16k 100.46k 1k k 82. 25k . diseases and cancer. In these cases, multiple targets, which in most cases 66. .98 53 k k .8k 41 .09k 32.08k 27 23 37 9 1.58k 17 21k 1 7. 4. 2.35k 1. radiosurgery with Leksell Gamma means brain metastases. 0 49 2 3 4 5 7 8 1 2 3 4 5 6 7 07 0 Knife offers a range of benefits and 1991 199 199 199 199 1996 199 199 1999 2000 2001 2002 2003 2004 2005 2006 20 2008 2009 201 201 201 201 201 201 201 201 Over 400,000 patients have been efficacies fully supported by years of treated for metastatic tumors with The percentage of centers submitting their numbers each year has varied between 68–100% evidence-based medicine. from 1968 to 2017. 1991 reflects cumulative numbers since 1968. Leksell Gamma Knife systems since Proven and documented results the first treatment in 1968. With Clinical results for Gamma Knife extremely good tumor control ­rate, The unique ability to treat multiple And with greater awareness among treatment have been extensively few side effects and the ability to treat brain metastases provides new patients, Gamma Knife surgery is published in peer-reviewed journals, multiple targets effectively, Gamma opportunities for the patient to prolong increasingly being requested when it which cite significant increases in Knife surgery occupies a unique life and gain better quality of life. comes to treatment of the brain. successful outcomes. Only Leksell position in this field. Gamma Knife can show this long-term With all the clinical and management­ performance and how it combines advantages of Gamma Knife surgery, cost-effectiveness with improved it has become a preferred method in quality of life for patients in both the care of metastatic disease. curative and palliative care.

— 11 — Playing a vital role in modern healthcare

With the increasing number of cancer incidence rates and an aging population, Gamma Knife surgery plays an important role in modern healthcare. Hospital management and medical staff choose Leksell Gamma Knife for its extreme accuracy, streamlined workflow and outstanding therapeutic response. It frees resources in the clinic, provides evidence-based medicine, and gives the clinic confidence and reliability.

Gamma Knife surgery helps reduce waiting lists for radiation therapy and neurosurgery clinics. It offers Several published studies demonstrate savings of Clinical need for more capacity high quality care for disorders of the brain, and short more than 50% of direct costs associated with Taking the most common Gamma Knife surgery treatment times with rapid patient recoveries mean microsurgery1. These gains are primarily due to the indications into ­account, 325 to 830 people per million lower costs for the healthcare system and society. minimal need for hospitalization and intensive care, are candidates for this treatment.3 Patients get back to work and normal life faster as well as the reduction of complications related to compared to convalescence after open surgery. This number will most certainly grow in the future. open surgery. The number of cancer cases is predicted to increase Another study shows that one Gamma Knife system by 50 percent—to 24.6 million new cases—by the can free up to 700 ICU beds per year2. year 2020.4 As 20–40% of all cancer patients develop brain metastases,5 Leksell Gamma Knife will definitely play an important role in future health­care.

— 12 — Flexibility and freedom of choice—a complete product family

Elekta is the world’s only radiosurgery solutions provider with a comprehensive range comprising systems, software and services.

These are the components necessary to build and support a stereotactic center of excellence with dedicated solutions for head and body. The breadth of Elekta’s portfolio allows a neurosurgery or radiation oncology center to develop a strong reputation based on exceptional patient care and profitable collaborations.

References [1] van Roijen L, et al. Costs and effects of open surgery versus SRS in treating vestibular schwannoma. Acta Neurochir, 1997. Rutigliano MJ, et al. The cost effectiveness of SRS versus surgical resection in the treatment of solitary metastatic brain tumours. Open Surgery, 1995.

[2] Netten, et al, Unit at Health & Social Care 1999. University of Kent Canterbury, Hospital and Community Health Service.

[3] Hamilton TM, Kano H and Lunsford LD. Gamma Knife radiosurgery: a review of epidemiology and practice. Leksell Gamma Knife Society; 2014.

[4] World Cancer Report, World Health Organization.

[5] American Cancer Society.

— 13 — Each Gamma Knife user receives Elekta works very closely with all users The successful evolution of Elekta’s automatic membership to the to understand their needs and learn solution developments over the years prestigious Leksell Gamma Knife from their findings. These insights are is a direct result of close collaboration Society. Today, this society is an invaluable for the development of with the members of the esteemed global network for sharing new products. Leksell Gamma Knife Society. clinical experience, scientific research and knowledge.

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