Seminars in surgical oncology
-
Despite the ability of surgery, radiotherapy, and chemotherapy to prolong survival in patients with glioblastoma multiforme (GBM), most patients succumb to their disease, usually as a result of local tumor persistence or recurrence. Stereotactic radiosurgery (SRS) allows a substantial increase in total dose at sites of greatest tumor cell density while sparing most of the normal brain, resulting in significantly improved survival. SRS was designed as a technique to deliver a large single dose of radiation to a small and focal target: two of its hallmarks are the focal distribution of dose and the inverse relationship between dose and volume. ⋯ Larger lesions (> 30 mm diameter), especially those adjacent to eloquent cortex or critical white matter pathways, must be evaluated with caution. The potential for acute toxicity associated with SRS increases substantially for larger lesions. There is a significant survival advantage using SRS in many patients with gliomas, especially if appropriately used with surgery and other adjuvant therapy.