Radiotherapy and Radiosurgery for Tumors of the Central Nervous System

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Key points

  • Options for the treatment of brain metastases include stereotactic radiosurgery, whole-brain radiotherapy, surgical resection, or some combination of these techniques, with the optimum therapy dependent on the size, number, and location of the brain lesions, the type and extent of primary tumor, and the patient’s performance status and preferences.

  • The standard of care for malignant gliomas remains maximal safe resection followed by concurrent conformal radiotherapy and temozolomide.

  • Metastatic

Whole-brain radiotherapy

Radiation therapy to the entire brain (whole-brain radiotherapy [WBRT]) uses a relatively simple technique, typically using 2 parallel opposed lateral fields with the patient in the supine position. In preparation for planning and treatment, the patient is positioned on a head rest and immobilized using either a custom-molded thermoplastic mask or simply tape (Fig. 1A). Before treatment, radiographic or computed tomographic (CT) images are acquired and a treatment plan is developed using

External-beam radiotherapy

External-beam radiotherapy (EBRT) for spine tumors typically uses 1 of the 3 following techniques: (1) a single radiation beam entering posterior aspect of the patient (PA field, Fig. 3A); (2) 2 parallel-opposed radiation beams entering the patient from both anterior and posterior (AP-PA fields); or (3) 3 or more radiation beams, often shaped by multileaf collimators (conformal 3D beam arrangement; see Fig. 3B). All of these EBRT techniques result in irradiation of the full width of the

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      Despite the advances in the development of treatment schemes, the high estimates of lethality generated by these tumors determine that the vital patient prognosis continues to be poor [2]. The introduction of Stupp Protocol (SP) has conferred a mean survival of around fifteen months [3,4]. The archived survival increment has aroused an interest for elucidating the effects of this therapeutic scheme on quality of life and Cognitive Function (CF) [5,6].

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