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 - 2021/03/05 UR - accessmedicine.mhmedical.com/content.aspx?aid=8312079 ER -