title: [NOVEL STRATEGY IN THE RADIOTHERAPY OF METASTATIC BRAIN TUMORS: SIMULTANEOUS WHOLE BRAIN RADIOTHERAPY AND INTEGRATED STEREOTACTIC RADIOSURGERY].
abstract: OBJECTIVE
  Treatment of central nervous system (CNS) tumors has always played an important role in development of radiotherapy techniques. Precise patient immobilisation, non-coplanar field arrangement, conformal treatment, arc therapy, radiosurgery, application of image fusion to radiation planning or re-irradiation were first introduced into clinical routine in the treatment of brain tumors.
  
  
  METHODS
  A modern multifunctional radiation instrument, Novalis TX has been installed at the University of Pécs two years ago. New methods, such as real time 3D image guided therapy, dynamic arc therapy and ultra-conformity offer further progress in treatment of CNS tumors. Whole brain irradiation and simultaneous fractionated stereotactic radiosurgery or integrated boost seem to be an optimal method in the treatment of not only soliter or oligo, but even a higher number (4-9) and not typically radiosensitive brain metastases. The new treatment strategy is illustrated by presentation of four case histories.
  
  
  RESULTS
  Treatment protocol was completed in all cases. Treatment period of 1.5 to 3 weeks, and treatment time of only a few minutes were not stressful for the patients. A quite remarkable clinical improvement as to general condition of the patients was experienced in three cases. Follow-up images confirmed either remission or a stable disease.
  
  
  CONCLUSIONS
  Simultaneous whole brain radiotherapy and integrated stereotactic radiosurgery is a reproducible, safe method that offers an effective irradiation with delivery of definitive dosage even in cases with radio-insensitive brain metastasis.
authors.forename: Judit
authors.initials: J
authors.lastname: Kalincsák
authors.forename: Zoltán
authors.initials: Z
authors.lastname: László
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Sebestyén
authors.forename: Péter
authors.initials: P
authors.lastname: Kovács
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Horváth
authors.forename: Tamás
authors.initials: T
authors.lastname: Dóczi
authors.lastname: Mangel László
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D016371:Cranial Irradiation; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008545:Melanoma / Q000556:secondary; D008875:Middle Aged; D016634:Radiosurgery; D012878:Skin Neoplasms / Q000473:pathology; D016896:Treatment Outcome