Radiosurgical Options in Neuro-oncology: A Review on Current Tenets and Future Opportunities. Part I: Therapeutic Strategies

Abstract

Stereotactic radiosurgery can nowadays be considered not only as a potential adjuvant to surgical treatment of several neuro-oncological pathologies, including primary tumors and metastatic lesions, but in some cases also as a valuable alternative tailored option. In Part I of the review, we propose a dissertation focused on the different irradiation stereotactic radiosurgery techniques to date available for clinical indications more relevant to oncologists and oncologic surgeons, such as high-grade and low-grade gliomas, metastases and meningiomas. It is noteworthy that the most recent body of literature correlated with this topic shows that the therapeutic results presently achievable are revolutionizing the way patients are diagnosed and managed worldwide. As we sought to shed light on the current potentialities of stereotactic radiosurgery, we must consider that to exploit all the benefits provided by this shift in clinical practice, a profound awareness by all practitioners involved in the care of neoplastic patients is certainly warranted.

Intradural Intramedullary Mixed Type Hemangioma: Optimizing the Surgical Management through Intraoperative Neurophysiological Monitoring

“…Treatment of this neoplasm consists of total excision under high magnification using microsurgical techniques for the amenable tumor and stereotactic radiosurgery for the unresectable one [ 1 , 6 , 14 ]. As in many other neurosurgical interventions on highly vascularized lesions, or involving major vessels, the removal of spinal hemangiomas is at high risk of intraoperative bleeding.…”

Management of Gliomas: Overview of the Latest Technological Advancements and Related Behavioral Drawbacks

“…Therefore SRS seems to combine the effectiveness of the conformal 3D dose distributions with a reduced toxicity of fractionation; however, given the persistent possibility of malignant transformation of these lesions and cognitive impairment this therapeutic option remains debated [ 34 ]. Hopefully, the scientific contribution of several clinical trials aimed at better defining the radiobiological parameters of HGG and LGG is recently leading to some attempts to create tumor control probability models meant to revolutionize in the near future the radiotherapic and radiosurgical protocols that we are currently using in the clinical practice [ 32 , 35 ].…”

Stereotactic Ablative Radiotherapy for the Treatment of Clinically Localized Renal Cell Carcinoma

“…SABR is delivered with a variety of modalities, most commonly with either an isocentric linear accelerator or a nonisocentric X-ray unit mounted on a robotic arm (e.g., CyberKnife, Accuray, Sunnyvale, CA). SABR or SRS is well established in the treatment of a variety of malignancies including brain tumors [ 7 ] and medically inoperable stage I non-small cell lung cancer [ 8 ].…”