Thinking about CNS Tumors

As part of this month’s focus on cancers of the central nervous system (CNS), we are pleased to provide a comprehensive review of one of the most common types of benign brain tumors: acoustic neuroma (AN), which is also known as a vestibular schwannoma or neurilemmoma. AN affects approximately 2 in 10,000 people and often manifests as irreversible hearing loss. Although about 20% to 40% of ANs either shrink or stop growing if left untreated, early intervention is crucial to preserving as much hearing as possible in those affected, as discussed in our lead article, Interdisciplinary management of acoustic neuromas. Heva Jasmine Saadatmand, MPH, and colleagues from New York’s Columbia University Medical Center, provide an excellent assessment of treatment options, expected response, and side effects in AN management.

The second CNS review article, Glioblastoma: Multidisciplinary treatment approaches, examines the most prevalent and most malignant primary tumor of the CNS. Unfortunately, overall survival of GBM patients has improved little over time, despite advances in molecular diagnostics, neurosurgery, radiation oncology, medical oncology, imaging, and immunotherapy, and remains a difficult challenge for all involved. Luis Moreno Sánchez, MD, who practices at several facilities in the Dominican Republic, describes treatment approaches for GBM, toxicities from treatment, diagnosis of recurrence, options for tumor recurrence, and extracranial metastatic disease.

In addition, our winning case report this quarter focuses on GBM. Metastases from glioblastoma disguised as a new primary malignancy discusses the use of surgical intervention and focal radiation therapy for a patient whose quality of life is affected by disease burden. Congratulations to Joshua L. Rodriguez-Lopez, BS, of Ponce Health Sciences University School of Medicine in Ponce, Puerto Rico!

A second case report, Pain flare and vertebral fracture following spine stereotactic radiosurgery for metastatic renal cell carcinoma, describes several key considerations associated with the use of spine stereotactic radiosurgery for a patient with lower extremity radicular pain, numbness and weakness and a medical history significant for renal cell carcinoma.

Finally, we help update you on volumetric-modulated arc therapy for prostate cancer in this month’s Technology Trends article. VMAT pioneer Cedric X. Yu, DSc, FAAPM, and other specialists weigh in on key issues, including constant-dose-rate VMAT compared to variable-dose-rate VMAT, single arc and double arc treatments, patient motion issues, and the use of pre-treatment imaging among other areas.

As you anticipate spring, we hope you enjoy our March issue and benefit from the insight and practical applications our articles provide. As always, thank you for your continued support of Applied Radiation Oncology in print and online at appliedradiationoncology.com!