Tumors of the Central Nervous System, Volume 4: Brain Tumors (Part 2)

Brain tumor
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Article Information. Address reprint requests to: Frederick F. Lang, M. Keywords: ganglioglioma ; clinical outcome ; neuronal neoplasm Page Count: — View in gallery Graph showing the probability of survival, as determined by the Kaplan-Meier method, for the 58 patients with gangliogliomas treated by radical surgical resection. View in gallery Graph demonstrating the actuarial survival probability for patients with gangliogliomas located in the cerebral hemispheres 19 cases , spinal cord 30 cases , and brain stem nine cases.

View in gallery Graph showing the calculated event-free survival probability for patients with gangliogliomas located in the cerebral hemispheres, spinal cord, and brain stem. Brain-stem and spinal cord gangliogliomas had an increased risk of recurrence compared to gangliogliomas in the cerebral hemispheres p View in gallery Graph demonstrating the calculated event-free survival probability for low-grade gangliogliomas grade I compared to high-grade gangliogliomas grades II and III.

View in gallery Graphs showing the event-free survival probability for histologically low-grade grade I, solid lines and high-grade grades II and III, broken lines gangliogliomas located in the cerebral hemispheres left , spinal cord center , and brain stem right. View raw image Close. Brain-stem and spinal cord gangliogliomas had an increased risk of recurrence compared to gangliogliomas in the cerebral hemispheres p View raw image Close. Graph demonstrating the calculated event-free survival probability for low-grade gangliogliomas grade I compared to high-grade gangliogliomas grades II and III.

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Central nervous system gangliogliomas

Neurosurgery — Kalyan-Raman UP , Olivero WC : Ganglioglioma: a correlative clinicopathological and radiographical study of ten surgically treated cases with follow-up. Neurosurgery 20 : — , Kalyan-Raman UP, Olivero WC: Ganglioglioma: a correlative clinicopathological and radiographical study of ten surgically treated cases with follow-up. Brain —, false. Acta Pathol Jpn —, false. Hum Pathol —, false.

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J Neuropathol Exp Neurol —, false. Surg Neurol —, false. Acta Neuropathol — Takahashi H , Ikuta F , Tsuchida T , et al : Ultrastructural alterations of neuronal cells in a brain stem ganglioglioma. Acta Neuropathol 74 : — , Takahashi H, Ikuta F, Tsuchida T, et al: Ultrastructural alterations of neuronal cells in a brain stem ganglioglioma. Radiotherapy may also be administered in cases of "low-grade" gliomas when a significant tumor reduction could not be achieved surgically.

Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy rather than surgery and the prognosis in such cases is determined by the primary tumor, and is generally poor. The goal of radiation therapy is to kill tumor cells while leaving normal brain tissue unharmed.

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In standard external beam radiation therapy , multiple treatments of standard-dose "fractions" of radiation are applied to the brain. This process is repeated for a total of 10 to 30 treatments, depending on the type of tumor. This additional treatment provides some patients with improved outcomes and longer survival rates. Radiosurgery is a treatment method that uses computerized calculations to focus radiation at the site of the tumor while minimizing the radiation dose to the surrounding brain.

Radiosurgery may be an adjunct to other treatments, or it may represent the primary treatment technique for some tumors. Forms used include stereotactic radiosurgery, such as Gamma knife , Cyberknife or Novalis Tx radiosurgery. Radiotherapy is the most common treatment for secondary brain tumors. The amount of radiotherapy depends on the size of the area of the brain affected by cancer.

Conventional external beam "whole-brain radiotherapy treatment" WBRT or "whole-brain irradiation" may be suggested if there is a risk that other secondary tumors will develop in the future. Radiotherapy may be used following, or in some cases in place of, resection of the tumor. Forms of radiotherapy used for brain cancer include external beam radiation therapy , the most common, and brachytherapy and proton therapy , the last especially used for children.

People who receive stereotactic radiosurgery SRS and whole-brain radiation therapy WBRT for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone. Patients undergoing chemotherapy are administered drugs designed to kill tumor cells.

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Although chemotherapy may improve overall survival in patients with the most malignant primary brain tumors, it does so in only about 20 percent of patients. Chemotherapy is often used in young children instead of radiation, as radiation may have negative effects on the developing brain. The decision to prescribe this treatment is based on a patient's overall health, type of tumor, and extent of the cancer.

The toxicity and many side effects of the drugs, and the uncertain outcome of chemotherapy in brain tumors puts this treatment further down the line of treatment options with surgery and radiation therapy preferred. UCLA Neuro-Oncology publishes real-time survival data for patients with a diagnosis of glioblastoma multiforme. They are the only institution in the United States that displays how brain tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat high-grade glioma tumors.

Genetic mutations have significant effects on the effectiveness of chemotherapy. Loss of chromosome arms 1p and 19q also indicate better response to chemoradiation.

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A shunt may be used to relieve symptoms caused by intracranial pressure , by reducing the build-up of fluid hydrocephalus caused by the blockage of the free flow of cerebrospinal fluid. The prognosis of brain cancer depends on the type of cancer diagnosed. Medulloblastoma has a good prognosis with chemotherapy, radiotherapy, and surgical resection while glioblastoma multiforme has a median survival of only 12 months even with aggressive chemoradiotherapy and surgery.

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Tumors of the Central Nervous System, Volume 4: Brain Tumors (Part 2): Medicine & Health Science Books @ dipotsdern.ga Tumors of the Central Nervous System, Volume 2. Gliomas: Glioblastoma (Part 2) . Editors: Hayat, M.A. (Ed.) Free Preview. Emphasizes targeted therapy.

Brainstem gliomas have the poorest prognosis of any form of brain cancer, with most patients dying within one year, even with therapy that typically consists of radiation to the tumor along with corticosteroids. However, one type, focal brainstem gliomas in children, seems open to exceptional prognosis and long-term survival has frequently been reported.

Prognosis is also affected by presentation of genetic mutations. Certain mutations provide better prognosis than others. IDH1 and IDH2 mutations in gliomas , as well as deletion of chromosome arms 1p and 19q, generally indicate better prognosis. Glioblastoma multiforme GBM is the most aggressive grade IV and most common form of a malignant brain tumor. Even when aggressive multimodality therapy consisting of radiotherapy, chemotherapy, and surgical excision is used, median survival is only 12—17 months.

Standard therapy for glioblastoma multiforme consists of maximal surgical resection of the tumor, followed by radiotherapy between two and four weeks after the surgical procedure to remove the cancer, then by chemotherapy , such as temozolomide.

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Experimental treatments include targeted therapy , gamma knife radiosurgery , [54] boron neutron capture therapy and gene therapy. Oligodendrogliomas are incurable but slowly progressive malignant brain tumors. They can be treated with surgical resection , chemotherapy , radiotherapy or a combination. For some suspected low-grade grade II tumors, only a course of watchful waiting and symptomatic therapy is opted for.

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These tumors show a high frequency of co-deletions of the p and q arms of chromosome 1 and chromosome 19 respectively 1p19q co-deletion and have been found to be especially chemosensitive with one report claiming them to be one of the most chemosensitive tumors. Acoustic neuromas are non-cancerous tumors.

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Early intervention with surgery or radiation is recommended to prevent progressive hearing loss. Figures for incidences of cancers of the brain show a significant difference between more- and less-developed countries the less-developed countries have lower incidences of tumors of the brain. Nevertheless, statistics suggest that certain forms of primary brain tumors are more common among certain populations. The incidence of low-grade astrocytoma has not been shown to vary significantly with nationality. However, studies examining the incidence of malignant central nervous system CNS tumors have shown some variation with national origin.

Since some high-grade lesions arise from low-grade tumors, these trends are worth mentioning. Specifically, the incidence of CNS tumors in the United States, Israel, and the Nordic countries is relatively high, while Japan and Asian countries have a lower incidence.