Personalisierte Neuroonkologie

Abstract

The treatment of patients with intrinsic brain tumors is radically changing. This change is currently not (yet) signified by the use of targeted therapy in clinical practice but more by the definition of molecular markers as predictors for response to therapy which have been used for a long time. While in the past the choice of treatment has been based solely on the tumor entity and its degree of malignancy derived from histological analyses, large randomized trials have now provided a solid basis for personalized molecular-guided treatment decisions. For instance, in the German NOA-08 trial a benefit of chemotherapy with temozolomide alone was only demonstrated in a subgroup of elderly patients with malignant gliomas displaying promoter hypermethylation of the DNA repair enzyme MGMT. This is only one of several examples where molecular analysis of tumor tissue becomes clinically relevant as these analyses can and should be taken into account for treatment decisions and not, as previously, just as an additional parameter for estimating prognosis. This article illustrates the current developments in the area of personalized neurooncology and critically reviews the impact on clinical decision-making in daily practice.

Can MGMT promoter methylation status be used as a prognostic and predictive marker for glioblastoma multiforme at the present time?

“…For example, Platten and colleagues [6] stated that the decision to forego radio-or chemotherapy should depend on the methylation status of the MGMT gene. For individuals over 65 years of age, this means that temozolomide chemotherapy alone should be administered in patients with a methylated MGMT promoter and radiotherapy alone in those with an unmethylated MGMT promoter.…”

Minimally invasive surgery of the anterior skull base: transorbital approaches

“…In cases of intradural soft tissue tumors larger samples of tissue are taken from the vital tumor margins because in addition to classical histological diagnosis and WHO grading, modern pathological examination identifies and quantifies important molecular markers (e.g. Ki67 labeling index, Ip19q, LOH) for adjuvant therapy [ 64 ], [ 65 ] in order to allow individualized neurooncological multimodal therapy [ 65 ].…”