Radiosurgery for Gliomas

Radiosurgery for Gliomas

Jagannathan Jay, Pouratian Nader, Sheehan Jason P

US Neurology, 2009;5(1):45-9

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Abstract
Stereotactic radiosurgery is a neurosurgical modality that involves delivering a large dose of focused radiation to a lesion while sparing the surrounding normal brain tissue. The biological properties of some gliomas, specifically relating to their oxygenation and invasiveness, can make them good targets for stereotactic radiosurgery. Although randomized controlled studies are lacking, preliminary data suggest that radiosurgery may be a viable alternative for low-grade gliomas, with improved survival and a low rate of complications. Although the prognosis for malignant gliomas is poor even after radiosurgery, it is possible the radiosurgical treatment can allow the surgeon more flexibility in terms of operative planning and subsequently result in better quality of life for patients post-operatively.

Keywords
Glioma, radiobiology, radiosurgery, stereotaxy

Disclosure: The authors have no conflicts of interest to declare.
Received: November 20, 2008 Accepted: August 19, 2009
Correspondence: Jason P Sheehan, MD, PhD, Department of Neurosurgery, Box 800212, University of Virginia Health Sciences Center, Charlottesville, VA 22908. E: jsheehan@virginia.edu

In spite of their lack of propensity for hematogenous dissemination, the prognosis for adults afflicted with gliomas has not substantially improved, even with advances in neurosurgery, neuro-oncology, and radiation oncology.1,2 Although microsurgical resection remains the initial treatment of choice for most gliomas, these tumors may grow in eloquent areas, making gross total resection impossible. They are on occasion capable of local or distant recurrence, providing a challenging dilemma for the treatment team.3 First conceived by Lars Leksell in 1951, stereotactic radiosurgery (SRS) is a neurosurgical modality that combines stereotactic technique with highly focused high-energy radiation treatments, making it possible to deliver large doses of radiation to an extremely small target.4,5 By keeping the individual radiation highly focused, the normal brain parenchyma is protected while still allowing a large dose of radiation to be delivered to the desired target. In some cases, glioma tumors are well-suited for radiosurgery, as recurrent or residual tumors may be small and well circumscribed, thereby permitting easy targeting for radiosurgery. This article reviews the effectiveness of radiosurgery in the treatmentof gliomas.

Radiobiology of Gliomas and Utility in Stereotactic Radiosurgery
Malignant tumors usually contain a proportion of hypoxic cells, which are often resistant to damage by X-rays or gamma-rays.6 In assessing survival for these cells, there appears to be a point where the accumulation of sublethal insults at low doses has a cumulative effect. This may be the result of DNA being a target for cellular damage by ionizing radiation, and the resultant double-stranded breaks causing cell-cycle arrest and cell death.

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Keywords:
Glioma, radiobiology, radiosurgery, stereotaxy, glioma brain tumors, low grade glioma, optic glioma, pontine glioma, glioma glioblastoma multiforme, stereotactic surgery, stereotactic radiosurgery, brain biopsy, proton beam radiosurgery, radiosurgery acoustic neuroma, radiosurgery brain tumors, cyberknife radiosurgery,

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