Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview
Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] Guide
- General Information About Adult Brain Tumors
- Classification of Adult Brain Tumors
- Treatment Option Overview
- Management of Specific Tumor Types and Locations
- Recurrent Adult Brain Tumors
- Changes to This Summary (02 / 28 / 2014)
- About This PDQ Summary
- Get More Information From NCI
The second study was, therefore, more informative.[24,25] It was a multicenter study of 240 patients with primary malignant gliomas, 207 of whom had glioblastoma. At initial surgery, they received the carmustine versus placebo wafers, followed by radiation therapy (55 Gy-60 Gy). Systemic therapy was not allowed until recurrence, except in the case of anaplastic oligodendrogliomas, of which there were nine patients. Unlike the initial trial, patient characteristics were well balanced between the study arms. Median survival in the two groups was 13.8 months versus 11.6 months; P = .017 (HR = 0.73; 95% CI, 0.56-0.96). A systematic review combining both studies estimated a HR for overall mortality of 0.65; 95% CI, 0.48-0.86; P = .003.[26][Level of evidence: 1iA]
Treatment Options Under Clinical Evaluation
Patients who have brain tumors that are either infrequently curable or unresectable should be considered candidates for clinical trials. Information about ongoing clinical trials is available from the NCI Web site.
Heavy-particle radiation, such as proton-beam therapy, carries the theoretical advantage of delivering high doses of ionizing radiation to the tumor bed while sparing surrounding brain tissue. The data are preliminary for this investigational technique, and are not widely available.
Novel biologic therapies under clinical evaluation for patients with brain tumors include the following:[27]
- Dendritic cell vaccination.[28]
- Tyrosine kinase receptor inhibitors.[29]
- Farnesyl transferase inhibitors.
- Viral-based gene therapy.[30,31]
- Oncolytic viruses.
- Epidermal growth factor-receptor inhibitors.
- Vascular endothelial growth factor inhibitors.[27]
- Other antiangiogenesis agents.
Primary Tumors of the Spinal Axis
Surgery and radiation therapy are the primary modalities used to treat tumors of the spinal axis; therapeutic options vary according to the histology of the tumor.[2] The experience with chemotherapy for primary spinal cord tumors is limited; no reports of controlled clinical trials are available for these types of tumors.[2,32] Chemotherapy is indicated for most patients with leptomeningeal involvement (from a primary or metastatic tumor) and positive cerebrospinal fluid (CSF) cytology.[2] Most patients require treatment with corticosteroids, particularly if they are receiving radiation therapy.