title: Optimal Timing of Whole-Brain Radiation Therapy Following Craniotomy for Cerebral Malignancies.
abstract: BACKGROUND
  For patients with cerebral metastases that are limited in number, surgical resection followed by whole-brain radiation therapy is the standard of care. In addition, for high-grade gliomas, maximal surgical resection followed by local radiotherapy is considered the optimal treatment. Radiation is known to impair wound healing, including healing of surgical incisions. Radiotherapy shortly after surgical resection would be expected to minimize the opportunity for tumor regrowth or progression. Owing to these competing interests, the purpose of this study was to shed light on the optimal timing of radiotherapy after surgical resection of brain metastasis or high-grade gliomas.
  
  
  METHODS
  A review of the literature was conducted on the following topics: radiation and wound healing, corticosteroid use and wound healing, radiotherapy for tumor control for cerebral metastases and high-grade gliomas, and whole-brain radiation therapy or focal radiotherapy after craniotomy with focus on the timing of radiotherapy after surgery.
  
  
  RESULTS
  In animal models, wound integrity and healing was less impaired by radiotherapy administered 1 week after surgery. In humans, this timing would be expected to be significantly longer, on the order of several weeks.
  
  
  CONCLUSIONS
  Given the limited literature, insufficient conclusions can be drawn. However, animal data suggest a period of at least 1 week (but it is likely several weeks in humans) is necessary for reconstitution of wound strength before initiation of radiation therapy. A randomized prospective study is recommended to understand better the effect of the timing of radiation therapy following surgical intervention for brain metastasis or high-grade gliomas.
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Dhruv M
authors.initials: DM
authors.lastname: Patel
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Krystal L
authors.initials: KL
authors.lastname: Tomei
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Hansberry
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address: goldstir@njms.rutgers.edu.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Goldstein
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016371:Cranial Irradiation; D003399:Craniotomy; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects / Q000528:radiation effects
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Astrocytoma; Brain metastasis; Craniotomy; Glioblastoma multiforme; Optimal timing; Radiotherapy; Whole-brain radiation therapy