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Radiotherapy is one of the cornerstones for treatment of patients with intracranial metastases. Whole brain radiotherapy (WBRT) as well as stereotactic radiosurgery are part of the non-surgical treatment for brain metastases. The toxicities associated with the treatment, among which we cannot neglect cognitive impairment, represent a current topic in an era marked by advances in oncological treatments with implications for the long-term survival of these patients. The mechanisms that involve the onset of cognitive decline are multiple and are still the subject of research. We propose to highlight the pathophysiological elements involved in cognitive impairment as well as strategies including hippocampal avoidance (HA) WBRT for different histological cancer type candidates for target therapies that cross the blood-brain barrier. Even if the implementation of HA-WBRT plus memantine as standard is still a subject for debate, for cases with multiple brain metastases or metastases unsuitable for targeted radiotherapy and a life expectancy > 4 months, it is necessary to apply a preventive strategy for the impairment of cognitive function. New studies to evaluate cognitive function for long term survivals, but also an evaluation of other factors including the number and volume of brain metastases, their intracranial and extracranial localization and the effect of modern oncological therapies must be included in future analyzes and studies. [ABSTRACT FROM AUTHOR]

Multidisciplinary treatment of brain tumors has been severely affected by the COVID-19 pandemic. In the context of a decrease in the number of neurosurgical interventions by over 50% in most centers from the countries affected by the pandemic, the setting of treatment priorities becomes essential. Due to the poor prognosis and bio-logical particularities related to rapid progression, grade IV malignant gliomas are a priority in treatment. The severe limitations of hospitalization possibilities in intensive care units and the reduction of the possibilities of administration of adjuvant treatment leads to the necessity to take into account the possibilities for timely administration of adjuvant treatment in the decision for the neurosurgical treatment in new glioblastoma multiforme cases. Multidisciplinary team evaluation of each case is mandatory in order to make a rational decision. Isocitrate dehydrogenase (IDH) mutation and methylation status of O6-methylguanine-DNA methyl-transferase (MGMT) should be assessed as far as possible. IDH wild-type status should be a decisive factor in prioritizing the treatment. For young patients with a favorable performance status, the standard treatment includes long-course radiotherapy with concurrent temozolomide treatment, followed by 6-cycle adjuvant treatment with temozolomide, even in a COVID-19 pandemic scenario. The optimal therapeutic choice in the case of elderly and/or frail patients includes a moderate hypofractionated radiotherapy regimen of 40 Gy in 15 daily fractions over 3 weeks, or a hypofractionated protocol with 25 Gy in 5 daily fractions, taking into account the age and Karnoffsky performance status. Also, the MGMT methylation status must be taken into account for the decision to omit chemotherapy and for the delivery of a short-course radiotherapy regimen (25 Gy in 5 fractions). Omission of chemotherapy should consider both the additional risk of SARS-CoV-2 infection and the limited benefit of temozolomide treatment in the case of unmethylated MGMT status. [ABSTRACT FROM AUTHOR]

Radiomics, a subdomain of artificial intelligence, consists in extracting a large volume of data from all medical imaging techniques and correlating them with clinical data in order to build predictive and prognostic models. Radiomics is related to radiogenomics that correlates genetic mutations and molecular and biological characteristics of tissues with information extracted from medical imaging. Both are state-of-the-art fields of translational biomedical research. The ability to predict early patient survival and response to treatment, but also the capacity to identify tumor subtypes non-invasively, could make radiomics a key player with an essential role in personalized oncology. In head and neck cancer radiotherapy, radiomic algorithms can predict not only the response to radiochemotherapy or induction chemotherapy but also the need for planning through adaptive radiotherapy (ART). Radiomics can also predict the risk of severe toxicities, especially that of xerostomia. Given the benefit that a de-escalation of treatment can bring in selected cases to improve the quality of life, radiomics is expected to be part of the therapeutic decision for head and neck cancers in the near future, and may help identify cases where de-escalation of multimodal therapy will not jeopardize the therapeutic benefit. [ABSTRACT FROM AUTHOR]