Abstract
Central nervous system (CNS) neoplasms include benign and malignant processes, which may both be associated with high morbidity and mortality. Minimally conformal and highly conformal treatment techniques can both yield appreciable skin doses over the course of treatment.
Exacerbating factors can include target volumes in proximity to cutaneous tissues, bolus effects from masks used for immobilization, skin folds, radiation-induced alopecia, areas of skin in contact with clothing and pressure, areas of skin exposed to sun, and changes in soft tissue anatomy resulting from steroid use and high-dose radiation treatment. Steroid use can yield impaired immunity and protracted wound healing following radiation-induced desquamation. Stereotactic radiosurgery involves the securing of surgical posts, producing superficial wounds that can sometimes become infected. Moreover, patients with altered mental status may have difficulty complying with skin care instructions, especially with adherence to wound care protocols after skin breakdown.
Finally, of note, patients with brain metastases who receive concurrent systemic therapy, such as a BRAF-inhibitor for melanoma, may experience increased skin toxicity from the radiation component of their therapy.
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Braunstein, S.E., Yuen, F. (2016). Central Nervous System. In: Fowble, B., Yom, S., Yuen, F., Arron, S. (eds) Skin Care in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-31460-0_11
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