Treatment Procedure , Operative measures are performed in the appropriate neurosurgery clinic. Subsequently, the overall treatment concept is often defined in joint consultations in the clinic. This results in a close cooperation between neurosurgery, neurological or internal clinic and clinic for radio-oncology. In order to determine the most suitable overall treatment concept, additional diagnostic measures are necessary, which are modified in individual cases according to the current requirements or disease and tumor situations.
The basis is, in most cases, a nuclear magnetic resonance diagnosis before and after the operation of the region of the central nervous system in which the tumor has developed. In tumors, which tend to settle via the cerebral water pathways, an imaging diagnosis of the spinal cord canal is also necessary. In addition, these tumors require the recovery of brain water in order to detect any disrupted tumor cell nests (cerebrospinal fluid). In addition to the physical examination, including a special neurological examination, additional examinations such as EEG (electroencephalography), other X-ray examinations, rarely angiographies can be used. Positron emission tomography (PET) can also be used in individual cases.
In the case of germ cell tumors, the laboratory-chemical determination of the “tumor markers” in the serum and also in the brain water is necessary (bHCG, AFP). Finally, if irradiation is part of the treatment concept, all treatment documents (surgical report, pathology report, imaging, findings, doctor’s letters, etc.) must be made available to the radioonologist. The documentation is the basic prerequisite for planning and discussing correct irradiation.
The reconnaissance talks are aimed at discussing with the persons concerned and their relatives the treatment objectives, the course of the treatment and further details to be observed during and after the radiation treatment. The acute side effects and therapies follow. The conversations are individually aligned and take into account the currently available conditions of the disease and, above all, the individually provided details on radiation treatment. In addition to this, general behavioral aspects during radiation therapy are discussed.
During this conversation, open questions should be raised and, above all, the discussion should be aimed at removing possible worries and fears. The radio-oncologist provides the patient with an enlightenment arc, which includes the details that must be taken into account during radiotherapy and in which the side effects are explained. These can occur in principle during radiation therapy, but also arise as late complications months to years after the end of radiation therapy. The enlightenment arc is also used as a declaration of consent and must be signed by the affected patients before irradiation.
In the elucidation arc, rare theoretical side effects are also described, similar to a medicine leaflet. Very rare, although serious side effects, must also be mentioned. Due to the abundance of information provided during an introductory and reconnaissance talk, it has proven to be helpful if family members and / or trusted persons are taking part in this conversation. During this conversation, uncertainties should be addressed and explained. Further questions and issues can also be answered or clarified during radiation treatment.