Central Nervous System Cancers

Abstract

Primary and metastatic tumors of the central nervous system are a heterogeneous group of neoplasms with varied outcomes and management strategies. Recently, improved survival observed in 2 randomized clinical trials established combined chemotherapy and radiation as the new standard for treating patients with pure or mixed anaplastic oligodendroglioma harboring the 1p/19q codeletion. For metastatic disease, increasing evidence supports the efficacy of stereotactic radiosurgery in treating patients with multiple metastatic lesions but low overall tumor volume. These guidelines provide recommendations on the diagnosis and management of this group of diseases based on clinical evidence and panel consensus. This version includes expert advice on the management of low-grade infiltrative astrocytomas, oligodendrogliomas, anaplastic gliomas, glioblastomas, medulloblastomas, supratentorial primitive neuroectodermal tumors, and brain metastases. The full online version, available at NCCN.org, contains recommendations on additional subtypes.

Magnetic resonance image features identify glioblastoma phenotypic subtypes with distinct molecular pathway activities

“…The current clinical standard for disease relapse surveillance is tracking changes clinically and with MR imaging (27–29). Initial treatment for newly diagnosed GBM is maximal surgical resection while preserving neurologic function.…”

The outcomes of treatment of cauda equina ependymomas in adults

“…Тотальное удаление эпендимомы данного вида осуществля-лось с особой осторожностью. Соблюдался основ-ной принцип удаления: «maximally safe resection» (максимально щадящее удаление) [2,5,9]. В ходе выполнения операций было необходимо четко со-относить степень радикальности удаления опухоли и риск развития неврологического дефицита в по-слеоперационном периоде.…”

“…Согласно национальному руководству National Comprehensive Cancer Network (NCCN) [9] от 2013 г., разработанному в США, по ведению пациентов с первичными опухолями спинного мозга, рекомен-дуется прибегать к максимально щадящей резекции («maximally safe resection») с последующим наблюде-нием и проведением регулярных МРТ-исследо-ваний. В случае обнаружения продолженного роста или рецидива рекомендуется проведение повторно-го хирургического вмешательства или лучевой тера- пии.…”

Multicenter phase 2 study of patupilone for recurrent or progressive brain metastases from non–small cell lung cancer

“…Brain metastases from NSCLC are common at initial diagnosis or within a year of presentation, but can occur at any time during the course of their disease 3 . Standard therapies for brain metastases include symptomatic treatments (e.g., corticosteroids to reduce peritumoral edema and anticonvulsants to control seizures), surgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery, and chemotherapy 4, 5 . Despite aggressive treatment, prognosis is poor with median overall survival of approximately 7 months from diagnosis 6 , and 4–5 months from brain metastasis recurrence 7–9 .…”