Brain Cancer

Central nervous system (CNS) cancers are the second most frequent malignancy in childhood. In recent years, significant advances in surgery, radiotherapy, and chemotherapy have improved survival in children with these tumors. However, a significant proportion of patients with CNS tumors suffer progressive disease despite such treatment.

Sri Gururangan and Henry Friedmanpresent a thoughtful reviewof advances in pediatric neurooncology.Coupled with the recent reviewof pediatric brain tumor biologywritten by Richard Gilbertson, thesearticles highlight the value that thepediatric neuro-oncology communityplaces on translating signal transductionmodifiers into clinical practice.[1]The remainder of this commentaryfocuses on the challenges and opportunitiesassociated with developingmore effective and less toxic therapiesfor children with brain tumors.

NEW ORLEANS-The chemotherapy drug temozolomide (Temodar) combined with radiation therapy more than doubled the 2-year survival rate in patients with glioblastoma multiforme (GBM), compared with radiation alone, according to data presented at the plenary session of the 40th Annual Meeting of the American Society of Clinical Oncology (abstract 2).

The purpose of this paper is to provide an overview of the clinical presentation, diagnosis, and treatment of brain metastases in patients with SCLC, with a focus on current trends and developments in the treatment of this disease.

SALT LAKE CITY-When surgery and chemotherapy have failed, stereotactic radiation therapy (RT) provides good local control of small, low-grade gliomas in children for many years, Karen J. Marcus, MD, said at the American Society for Therapeutic Radiology and Oncology 45th Annual Meeting (abstract 120). In the prospective trial, about two thirds of children in whom surgery or chemotherapy had not controlled the disease were alive with no progression 8 years after stereotactic RT

SEATTLE-Strokes (cerebro-vascular accidents) and second malignancies, especially thyroid carcinoma, are among the many late effects of radiation therapy in children with medulloblastoma, according to the 42-year experience at one institution. Maria Spavor, MD, a clinical fellow in pediatric hematology/oncology, British Columbia Children’s Hospital, Vancouver, presented the findings at the 16th Annual Meeting of the American Society of Pediatric Hematology/Oncology (abstract 1557).

Paraneoplastic disorders of the nervous system are important to the practicing oncologist, because these syndromes, although uncommon, produce significant neurologic dysfunction and disability. The neurologic disorder may be the first manifestation of an unrecognized systemic malignancy, and appropriate diagnosis of the paraneoplastic disorder can lead to a focused search for an underlying cancer. Paraneoplastic disorders may involve any component of the central or peripheral nervous system, and diagnosis requires careful neurologic assessment. The diagnosis is made by recognition of clinical neurologic syndromes and the use of selected laboratory studies as indicated by the clinical picture. Over the past 10 years, the application of molecular biologic techniques to the study of these disorders has elucidated much about the mechanisms that cause neurologic injury. In most cases, disordered humoral and cellular immunity has been demonstrated, and the role of novel targets for autoimmune attack is being clarified. For some paraneoplastic disorders, treatment of the underlying tumor may lead to improvement of the neurologic disorder. For others, various forms of immunosuppressive therapy may be indicated. Unfortunately, for several of the more common paraneoplastic syndromes such as paraneoplastic cerebellar degeneration or limbic encephalitis, treatment is still unsatisfactory, and further research into the exact pathophysiology is clearly needed. [ONCOLOGY 16:1539-1556, 2002]

LOS ANGELES-In a retrospective study, F-18-fluorodeoxyglucose (FDG)- PET images of the brain predicted histological grade and survival in patients with gliomas (see images). At this time, FDG-PET appears to be better than pathological grading for this purpose, Vasantha Padma, MD, of the Wallace-Kettering Neurosciences Institute, Kettering, Ohio, said at the 49th Annual Meeting of the Society of Nuclear Medicine (abstract 400).

Radiation therapy has long been a mainstay in the treatment of ependymoma. Concerns about the long-term effects of radiation therapy have made many parents and caregivers wary of this treatment modality. However, with the advent of conformal radiation and evidence

Glioblastoma multiforme remains virtually incurable, with reported median survivals of less than 2 years with standard treatment.[1] In recent years, thalidomide (Thalomid) has shown activity in high-grade gliomas as a single agent and in combination with nitrosoureas and carboplatin (Paraplatin).[2-4] I will describe three cases in which patients with recurrent, multicentric glioblastoma responded to thalidomide plus chemotherapy after failing initial treatment with conventional radiation and chemotherapy for a single malignant glioma.

Carcinomatous meningitis, specifically leptomeningeal metastases from solid tumors, has a dismal prognosis, with an overall median survival of 2 to 4 months. Lymphomatous meningitis has a better outlook, with a median survival of more than 6 months, but diagnosis may be delayed and treatment is not curative.

Legislation that would force all states to collect data on benign brain tumors got a hearing before a House subcommittee in mid-November. That was the critical first step needed before Rep. Barbara Lee (D-Calif), the measure’s sponsor, could

Neuroblastoma is a pediatric malignant tumor of the postganglionic sympathetic nervous system that usually develops in the adrenal gland or in nonadrenal abdominal or thoracic sites.[1] It is the most common malignancy in infants and the most common extracranial solid tumor of childhood, with approximately 650 cases diagnosed annually in the United States.[2] The dramatic age-related survival differences among neuroblastoma patients with a similar tumor stage emphasize the heterogeneity of neuroblastoma pathobiology. Early research efforts to understand the pathobiology of neuroblastoma[3-5] and the significant progress made in neuroblastoma molecular biology[6] have informed the clinical treatment of neuroblastoma.

According to a study conducted by the Radiation Therapy Oncology Group, thalidomide (Thalomid) in combination with radiation therapy shows promise in treating malignant brain tumors. Study findings were presented at the annual meeting of

Brain metastases are a common complication of systemic cancer and a significant cause of morbidity. For patients whose brain metastases remain untreated, the prognosis is poor. The advent of contrast-enhanced magnetic

With the understanding of the mechanism of malignant transformation has come the knowledge that oncogene products are frequently growth factors, growth factor receptors, or elements of growth factor signal-transduction pathways. Overexpression

Results of the lead-in phase of an ongoing randomized phase III trial of motexafin (Xcytrin) in patients with brain metastases, as well as preliminary results of an ongoing phase I trial of motexafin for glioblastoma multiforme, were presented at the 42nd

At the end of its session, Congress passed a children’s health bill (H.R. 4365) that established a variety of new health programs. One section of the bill authorizes the CDC to study environmental and other risk factors for childhood cancers,

NEW YORK-The cognitive and behavioral effects of brain tumors and their treatment are often invisible to patients, caregivers, and even clinicians, Robert A. Stern, PhD, said at a Cancer Care, Inc. teleconference for patients and their families. Dr. Stern is director of the Neuropsychology Program, Rhode Island Hospital, and associate professor of psychiatry and neurology, Brown University School of Medicine.

With worldwide use of cellular phones rising exponentially, a team of Swedish medical investigators is raising renewed concerns about the link between brain tumors and cell phones in a new, peer-reviewed article posted on the Medscape

MILWAUKEE-Light-emitting diodes (LEDs) developed by NASA for commercial plant growth research on the space shuttle are being used to remove brain tumors through photodynamic therapy. Harry Whelan, MD, and his colleagues have used the new LED red-light probes and the light-activated drug porfimer sodium (Photofrin) to attack difficult brain tumors in three patients. So far, all are doing extremely well, Dr. Whelan said in an interview with ONI.

Worldwide, approximately 100,000 patients have undergone stereotactic radiosurgery for a variety of intracranial lesions, of which brain metastases represent the most common treatment indication. This article summarizes the major issues surrounding the management of brain metastases, and also analyzes 21 independent reports of Gamma Knife– or linear accelerator–based radiosurgery, representing over 1,700 patients and more than 2,700 lesions. Variable reporting in the studies precludes a definitive, rigorous analysis, but the composite data reveal an average local control rate of 83% and median survival of 9.6 months, both of which are comparable to results in recent surgical reports. The most important prognostic factors for survival appear to be fewer than three lesions, controlled extracranial disease, and Karnofsky performance score (KPS). The exact impact of dose has not been clarified, but a dose-response relationship, especially for ³ 18 Gy, is emerging. The role of whole-brain radiotherapy remains unresolved. It may enhance local control but does not convincingly improve survival and, in some series, is associated with an increased risk of late complications. Chronic steroid dependence and increased intracranial edema do not appear to be common problems. This is an opportune time for the completion of ongoing randomized trials to validate these observations. [ONCOLOGY 13(10):1397-1409,1999]

Depression is the most common postoperative complication seen in patients who have undergone surgery for brain tumors, but it is seldom recognized or treated, according to preliminary findings of a study presented at the annual meeting of the

Brain metastases are the most common type of brain tumor in adults and are an increasingly important cause of morbidity and mortality in cancer patients. In recent years, important advances have been made in the diagnosis

One dose of radiation is proving to be an effective, less expensive method for treating patients with certain benign tumors at the base of the skull, a new study has found.

The Celgene Corporation is collaborating with the National Cancer Institute’s Radiation Treatment Oncology Group

Anew Radiation Therapy Oncology Group (RTOG) study will determine whether thalidomide combined with radiation therapy can lengthen survival and time to disease recurrence in adults with glioblastoma multiforme.

The patient’s medical history is remarkable only for asthma and mild emphysema. The family history included a grandmother with gastric cancer. The patient had been taking estrogen replacement therapy since menopause 3 years earlier, and she was

NEW YORK--Personality and brain function can change after brain surgery, yet patients and their families may not know what to expect or what to do about it, said Stanford University neuropsychologist Harriet Katz Zeiner, PhD, during a Cancer Care teleconference.

Radiosurgery uses stereotactic targeting methods to precisely deliver highly focused, large doses of radiation to small intracranial tumors and arteriovenous malformations (AVMs). This article reviews the most common