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Principles and Practice of Radiation Therapy

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Presentation on theme: "Principles and Practice of Radiation Therapy"— Presentation transcript:

1 Principles and Practice of Radiation Therapy
Chapter 34 Central Nervous System Tumors Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Central Nervous System
General information Neuron Divisions Central Peripheral

3 General Information Functions Divisions Control and coordination
Receives and relays information Divisions

4 Neuron Cell parts Cell body Dendrite Axon Myelin sheath

5 Neuron Types Sensory Motor Interneuron

6 Central Nervous System
General information Patterns of organization Sensory vs. motor White matter vs. gray matter

7 Central Nervous System
Brain Glial cells Blood-brain barrier Energy usage

8 Central Nervous System
Functional divisions of the brain Hindbrain Midbrain Forebrain Reticular formation

9 Central Nervous System
Anatomic divisions of the brain Meninges Cerebrospinal fluid (CSF)

10 Central Nervous System
Anatomic divisions of the brain Cerebrum Hemispheres Corpus callosum Lobes

11 Central Nervous System
Anatomic divisions of the brain Cerebellum Function

12 Central Nervous System
Anatomic divisions of the brain Brain stem Diencephalon Medulla oblongata Pons Midbrain

13 Central Nervous System
Anatomic divisions of the brain Limbic system Thalamus Hypothalamus

14 Central Nervous System
Anatomic divisions of the brain Spinal cord

15 Peripheral Nervous System
Divisions Sensory vs. motor Somatic vs. autonomic Sympathetic vs. parasympathetic

16 Central Nervous System Cancers
All central nervous system (CNS) tumors Glioblastoma multiforme (GBM) Spinal cord tumors Metastatic brain lesions General information Epidemiology Etiology Clinical presentation Detection and diagnosis Pattern of spread Disease classification Treatment Survival

17 General Information CNS tissue Neurons Glial cells Astrocytes
Oligodendrocytes Ependymal cells Microglia

18 General Information CNS tissue Meninges Schwann cells Choroid plexus
Lymphocytes

19 Epidemiology Incidence 20,500 new cases Deaths 12,700 deaths Pregnancy

20 Etiology Cause Risk factors Unknown Age Radiation Genetics
Other factors without clear scientific proof Electromagnetic fields Cellular telephones

21 Clinical Presentation
Location Symptoms Headache Mental status change Seizure Others

22 Detection and Diagnosis
Types Neurons/medulloblastomas

23 Detection and Diagnosis
Types Glial cells/gliomas Astrocytes/astrocytomas Grading Oligodendrocytes/oligodendrogliomas Ependymal cells/ependymomas

24 Detection and Diagnosis
Types Ganglioglioma Schwann cells/schwannoma

25 Detection and Diagnosis
Types Chordomas Meninges/meningioma

26 Pattern of Spread Noncapsulating Infiltration of CSF

27 Disease Classification
Staging Grading No standard grading system Prognosis based on cell type and grade

28 Treatment Surgery Chemotherapy Dexamethasone Purpose Needle biopsy
Craniotomy Shunt placement Chemotherapy Chemotherapy wafers Dexamethasone

29 Treatment Radiation therapy External beam Indication Blocking
Beam arrangement Whole-brain radiation therapy (WBRT) vs. supratentorial brain (STB) therapy Dose 5000 to 6500 cGy

30 Treatment Radiation therapy External beam Side effects

31 Treatment Radiation therapy Stereotactic radiosurgery Proton therapy
Indications Proton therapy

32 Survival Low-grade astrocytoma
Anaplastic (intermediate-grade) astrocytoma Glioblastomas Oligodendroglioma

33 GBM Epidemiology Most common primary brain tumor in adults Race Gender
Age

34 GBM Etiology Cause Unknown Risk factors Radiation Genetics

35 GBM Clinical Presentation
Location Symptoms Headache Seizure Focal neurologic deficits Mental status change

36 GBM Pattern of Spread Direct extension Predictable Do not metastasize

37 GBM Disease Classification
Stage Not staged Grade Grade IV astrocytomas

38 GBM Treatment Surgery Chemotherapy Radiation therapy Temozolomide
External beam 6000 cGy Brachytherapy Stereotactic radiosurgery (SRS)

39 GBM Survival No treatment – 3 months Median survival – 8.4 months
Optimal therapy – 12 months Age Younger than 40 years 40 to 60 years Older than 60 years

40 Spinal Tumors Epidemiology Etiology Incidence Gender Age Cause
2500 new cases Gender Age Etiology Cause Unknown Risk factors Genetics

41 Spinal Tumors Clinical Presentation
Symptoms Pain Cord compression Weakness

42 Spinal Tumors Detection and Diagnosis
Types Epidural Intradural extramedullary Most common Intradural intramedullary

43 Spinal Tumors Pattern of spread Staging Direct extension Enneking
Stage I Stage II Stage III

44 Spinal Tumors Treatment
Surgery Treatment of choice Chemotherapy Radiation therapy 5000 cGy

45 Spinal Tumors Survival
5-year survival − 90% Cause of death

46 Metastatic Brain Lesions
How do tumors metastasize? Source of metastases

47 Metastatic Brain Lesions Epidemiology and Etiology
Increasing incidence Estimated 100,000 new cases Cost

48 Metastatic Brain Lesions Etiology
Risk factors Certain cancers Age

49 Metastatic Brain Lesions Detection and Diagnosis
Signs and symptoms Headache Seizure Loss of function Hemorrhage Asymptomatic

50 Metastatic Brain Lesions Detection and Diagnosis
Computed tomography (CT) vs. magnetic resonance imaging (MRI)

51 Metastatic Brain Lesions Treatment
Purpose Palliation Cause of symptoms Headache Edema Seizure

52 Metastatic Brain Lesions Treatment
Surgery Craniotomy Indications Risks

53 Metastatic Brain Lesions Treatment
Chemotherapy Other drugs Dexamethasone Also called Decadron

54 Metastatic Brain Lesions Treatment
Radiation therapy WBRT Indications Radiosensitivity of tumor Dose/fractionation

55 Metastatic Brain Lesions Treatment
Radiation therapy SRS Indications

56 Metastatic Brain Lesions Survival
Outcome factors Survival Untreated Steroids only Surgery with WBRT Surgery alone SRS WBRT

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