1. The Management of Radiation-Induced Brain Injury

Neoplasms of the central nervous system (CNS) are a pathologically diverse group of benign and malignant tumors for which a variety of management strategies, including observation, surgery, radiation therapy, and/or chemotherapy, are employed. Shown in Table 1 are the usual radiation doses used to treat primary and metastatic brain and spinal cord tumors, which span a broad range of total doses and doses per fraction. Regardless of the type of CNS tumor treated, what usually limits the dose of radiation that can be utilized, and therefore what typically determines the local control and cure rate of that tumor, are the tolerance doses of the adjacent or underlying normal tissues in and around the CNS. This chapter will outline the biologic and clinical principles of CNS radiation tolerance and the management of radiation-induced CNS injury.