The limiting factor in the clinical application of radiation for the treatment of brain tumours is its effect on the normal structures that must be included in the irradiated volume. A risk of radiation-induced complications is a necessary price of tumour control. The size of the risk of complications that the radiation oncologist is prepared to accept on behalf of the patient depends on the clinical situation, and in particular on the morphology of the tumour. The radiation oncologist must know as accurately as possible how the total dose should be varied with overall time, fractionation and volume in order to achieve an adequate result. Several authors have attempted to establish the radiation tolerance of the brain by constructing log dose — log time plots using documented cases of cerebral radionecrosis. Moreover a substantial amount of work has been carried out with experimental models of radiation-induced injury to the central nervous system. As a result, several tolerance formulas have been drawn up. Tolerance formulas are important because there are many experiments going on with dose and fractionation. The purpose of this chapter is to review clinical and experimental literature on the hazards associated with irradiation of the brain.
KeywordsAttenuation Corticosteroid Fractionation Oncol Neurol
Unable to display preview. Download preview PDF.
- Almquist S, Dahlgren S, Notter G, Sundbom L (1964) Brain necrosis after irradiation of the hypophysis in Cushing’s disease. Report of a case. Acta Radiol (Stockh) 2: 179–188Google Scholar
- Caveness WF (1981) Experimental observations: delayed necrosis in normal monkey brain. In: Gilbert HA, Kagan AR (ed) Radiation damage to the nervous system. Raven, New York, p 1Google Scholar
- Davidoff LM, Dyke CG, Elsberg CA, Tarley IM (1938) Effects of irradiation applied directly to the brain and spinal cord. I. Experimental investigations on Mallacus monkeys. Radiology 31: 451–463Google Scholar
- Lampert PW, Davis RL (1964) Delayed effects of radiation on the human central nervous system. “Early” and “late” delayed reactions. Neurology (Minneap) 14: 912–917Google Scholar
- Lyman RS, Kupalov PS, Scholz W (1933) Effects of roentgen rays on the central nervous system. Results of large doses on the brains of adult dogs. Arch Neurol Psychiatry 29: 56–87Google Scholar
- Pratt RA, DiChiro G, Weed JC (1977) Cerebral necrosis following irradiation and chemotherapy for metastatic choriocarcinoma. Surg Neuro! 7: 117–120Google Scholar
- Sheline GE (1980) Irradiation injury of the human brain: a review of clinical experience. In: Gilbert HA, Kagen AR (ed) Radiation damage to the nervous system. Raven, New York, p 39Google Scholar
- Zimmerman RD, Fleming CA, Lee BCP, Saint-Louis LA, Deuk MDF (1986) Periventricular hyperintensity as seen by magnetic resonance: prevalence and significance. AJNR 7: 13–20Google Scholar