TY  - CHAP
M1  - Book, Section
TI  - Chapter 37. Tumors of the Central Nervous System
A1  - Shonka, Nicole A.
A1  - Hsu, Sigmund H.
A1  - Yung, W.K. Alfred
A1  - Mahajan, Anita
A1  - Prabhu, Sujit
A2  - Kantarjian, Hagop M.
A2  - Wolff, Robert A.
A2  - Koller, Charles A.
Y1  - 2011
N1  - 
T2  - The MD Anderson Manual of Medical Oncology, 2e
AB  - Brain  tumors  are  a  heterogeneous  group  of  lesions  that  range  from  benign,  slow-growing  tumors  found  only  incidentally  on  autopsy  to  malignant,  rapidly  growing  tumors  that  cause  death  within  months.  The  most  common  intracranial  tumors  are  brain  metastases  from  systemic  cancer,  estimated  to  be  up  to  200,000  per  year  in  the  United  States,  based  on  a  10  to  15%  incidence  (1,2),  whereas  the  expected  number  of  all  new  cancer  diagnoses  in  2009  was  1.48  million  (3).  In  comparison,  the  incidence  of  primary  brain  tumors  in  2009  was  an  estimated  22,070  new  cases  (3).  Because  of  the  heterogeneous  histology  and  often  refractory  nature  of  these  tumors,  their  management  is  complex,  ideally  requiring  a  multidisciplinary  team  and  individualized  treatment.  Diagnosis  is  made  on  the  basis  of  histology,  so  an  accurate  characterization  of  the  lesion's  pathology  is  crucial,  often  necessitating  confirmation  at  a  specialized  cancer  center.  Optimal  outcomes  involve  the  coordination  of  neurosurgery,  radiation  oncology,  and  neuro-oncology,  although  low-grade  tumors  may  not  require  initial  therapy  other  than  observation  following  optimal  surgical  resection.  Despite  advances  in  neurosurgical  techniques,  radiation  therapy,  and  chemotherapy,  the  prognosis  for  patients  with  high-grade  gliomas  such  as  glioblastoma  (GB),  the  most  common  form  of  glioma,  remains  dismal.  For  patients  with  GB,  median  survival  is  approximately  1  year.  A  review  of  eight  consecutive  phase  II  chemotherapy  trials  for  recurrent  GB  demonstrated  only  a  6%  response  rate  (complete  response  [CR]  and  partial  response  [PR]),  with  a  6-month  progression-free  survival  (PFS)  of  15%  and  a  1-year  overall  survival  of  21%  (4).  It  is,  therefore,  important  to  consider  patients  with  high-grade  gliomas  for  entry  into  clinical  trials  at  all  stages  of  disease,  since  new  therapies  target  patients  from  initial  diagnosis  with  presurgical  protocols  to  salvage  therapy  at  relapse.  This  chapter  aims  to  provide  basic  principles  that  can  be  used  for  diagnosing  and  treating  patients  with  brain  tumors.  Areas  that  present  special  challenges  for  the  treating  physician  are  highlighted,  along  with  an  introduction  to  the  underlying  molecular  mechanisms  of  gliomagenesis.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2019/06/24
UR  - accessmedicine.mhmedical.com/content.aspx?aid=8312079
ER  -