Looking for a better rate.

Considering FLASH-RT is currently the bees knees when it comes to maximizing the safety of large radiation doses by delivering it at warp speed, perhaps we should reconsider if toxicity rates with older school radiosurgery techniques are influenced by dose-rate. This group at Columbia did just that by examining outcomes at their institution following functional GammaKnife radiosurgery for vestibular schwannoma. Their cohort of 227 patients was split down the middle according to whether radiation was delivered above or below the median dose rate of 2.7 Gy / minute. While tumor control was excellent at 2 (97%) and 4 (88%) years out either way, patients treated with lower dose rates enjoyed significantly lower rates of post-treatment hearing loss and  facial nerve dysfunction. TBL: Absent an option for warp speed, this data provides and interesting hypothesis that radiosurgery at lower dose rates result in lower toxicity rates. | Smith, Neurosurgery 2019