NCCN Guidelines Insights: Central Nervous System Cancers, Version 1.2017

Abstract

For many years, the diagnosis and classification of gliomas have been based on histology. Although studies including large populations of patients demonstrated the prognostic value of histologic phenotype, variability in outcomes within histologic groups limited the utility of this system. Nonetheless, histology was the only proven and widely accessible tool available at the time, thus it was used for clinical trial entry criteria, and therefore determined the recommended treatment options. Research to identify molecular changes that underlie glioma progression has led to the discovery of molecular features that have greater diagnostic and prognostic value than histology. Analyses of these molecular markers across populations from randomized clinical trials have shown that some of these markers are also predictive of response to specific types of treatment, which has prompted significant changes to the recommended treatment options for grade III (anaplastic) gliomas.

Formation of new lymphatic vessels in glioma: An immunohistochemical analysis

“…Survival times vary among glioma patients according to the different grades of glioma, and the prognosis is worst for patients with GBM, which is associated with a 5‐year survival rate of less than 5% . GBM also has a high probability of recurrence, and even with successful initial surgical resection, almost all GBM patients experience tumor recurrence …”

Disparity between Inter-Patient Molecular Heterogeneity and Repertoires of Target Drugs Used for Different Types of Cancer in Clinical Oncology

“…We extracted information about targeted therapeutics used in clinical practice for treatment of the cancer types under investigation from the US Food and Drug Administration (FDA) portal [25] and from the National Comprehensive Cancer Network (NCCN) guidelines [32][33][34][35][36][37][38][39][40][41][42][43][44]. The inclusion criterion for a therapeutic was its FDA approval and/or recommendation by the NCCN, category higher than 2B.…”

“…Historically, the treatment standards have been formulated for most types of cancer [32][33][34][35][36][37][38][39][40][41][42][43][44]. However, the underlying treatment schemes are focused primarily on localization or histological characteristics of a tumor but do not consider most projections of its molecular phenotype.…”

Common Prognostic Scoring Systems for Patients Presenting with Brain Metastases

“…Approximately 25% of all cancer patients are diagnosed with brain metastases (BM), which tragically increases up to 64% throughout their treatment course [1][2][3][4]. The exact incidence of the newly diagnosed BM is unknown, but it is estimated to be 3 to 10 times the incidence of newly diagnosed primary brain tumors [5,6].…”