Radiosurgical Treatment of Progressive Malignant Brain Tumors
This chapter will focus on one of the most feared scenarios in clinical medicine: the neurologically well patient who harbors an unresectable malignant brain tumor that is growing despite extensive adjuvant therapy. All proven therapeutic avenues have been exhausted and the patient is doomed to a crushing neurological death, despite, at least for the moment, being neurologically normal. Far from occasional curiosities, these scenarios are becoming commonplace in busy oncology centers as advances in surgical technique, chemotherapy, and conformal radiotherapy allow patients to live long enough to develop these serious intracranial tumors. The clinician, therefore, is faced with a disturbing dilemma: what can be offered to these desperate patients when all proven methods of treatment have failed?
KeywordsSingle Shot Optic Chiasm Critical Structure Malignant Brain Tumor Conventional Radiotherapy
- Barnett, G.H., Linskey, M.E., Adler, J.R., Cozzens, J.W., Friedman, W.A., Heilbrun, M.P., Lunsford, L.D., Schulder, M., and Sloan, A.E. (2007) American Association of Neurological Surgeons, Congress of Neurological Surgeons Washington Committee Stereotactic Radiosurgery Task Force. J. Neurosurg. 106:1–5PubMedCrossRefGoogle Scholar
- Giller, C.A., Berger, B.D., Pistenmaa, D.A., Sklar, F., Weprin, B., Shapiro, K., Winick, N., Mulne, A.F., Delp, J.L., Gilio, J.P., Gall, K.P., Dicke, K.A., Swift, D., Sacco, D., Harris-Henderson, K., and Bowers, D. (2005) Robotically guided radiosurgery for children. Pediatr. Blood Cancer 45:304–310PubMedCrossRefGoogle Scholar
- Hall, E.J. (2000) Time, dose and fractionation in radiotherapy. In: Hall, E.J. (ed) Radiobiology for the radiologist, 5th edn, Chapter 22. Lippincott Williams and Wilkins, Philadelphia, PA, pp. 397–418Google Scholar
- Nishizaki, T., Saito, K., Jimi, Y., Harada, N., Kajiwara, K., Nomura, S., Ishihara, H., Yoshikawa, K., Yoneda, H., Suzuki, M., and Gibbs, I.C. (2006) The role of cyberknife radiosurgery/radiotherapy for brain metastases of multiple or large- size tumors. Minim. Invasive Neurosurg. 49:203–209PubMedCrossRefGoogle Scholar
- Shaw, E., Scott, C., Souhami, L., Dinapoli, R., Kline, R., Loeffler, J., and Farnan, N. (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05. Int. J. Radiat. Oncol. Biol. Phys. 47:291–298PubMedCrossRefGoogle Scholar