Assembling the brain trust: the multidisciplinary imperative in neuro-oncology

Abstract

1 on the challenges and future approaches to curing patients with primary brain tumours. We congratulate Cancer Research UK (CRUK) on convening this group of expert clinicians and scientists, and we applaud the authors' elegant synthesis of multiple complex issues. However, we note that among the disciplines represented by the 26 authors of this article, expertise in radiation oncology is conspicuously absent. The authors assert that CRUK "convened an international panel of brain cancer researchers with interests in neurobiology, preclinical tumour modelling, genomics, pharmaco logy, drug discovery and/or development, neuropathology, neurosurgery, imaging, radiotherapy and medical oncology, with the task of identifying the most important challenges that must be overcome if we are to eventually be in the position to cure all patients with a brain tumour" 1. Aside from radiation oncology, all of the neurooncological subspecialties listed above were represented. Beyond issues of author representation, radiotherapy is only discussed in the context of efforts to reduce the dose of radiation or to eliminate radiotherapy entirely from the treatment of patients with certain disease characteristics. Even in clinical situations in which attempts to reduce the radiation dose have failed (such as medulloblastoma) 2,3 , the authors contend that this is a function of

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“…The delineation of tumor boundaries is also of key importance for radiotherapy planning, an integral component in the treatment of brain tumors both after the initial surgery/biopsy and at recurrence, as recommended by the American Society for Radiation Oncology (ASTRO) guidelines [35,36]. Image-guided identification and selection of the radiotherapy target can significantly reduce the dose delivered to normal tissues while maximizing treatment efficacy using novel techniques such as intensity-modulated radiotherapy (IMRT) and imageguided radiotherapy (IGRT) [37].…”

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“…In a similar manner to surgical interventions, radiotherapy has also seen technological advancements, including intensity‐modulated radiation therapy, stereotactic radiosurgery and proton beam therapy, which have the potential to lead to improved delivery of effective radiation doses to tumour sites whilst sparing the surrounding healthy brain tissue [ 31 , 32 ].…”