The term "brain tumor" includes a variety of neoplasms growing within the central nervous system. They can be roughly distinguished into primary brain tumors and secondary tumors (metastases), originated from a primary tumor located outside the brain. The treatment options for brain tumors differ according to the subtypes. Brain tumors constitute a disease that is systemic to the brain; for this reason surgical resection, although effective for palliation and prolonged survival, is never curative. Radiation therapy is the most effective non surgical therapy for astrocytomas. Until recently, the use of chemotherapy in addition to cranial irradiation was more controversial. Typically chemotherapeutic agents, such as carmustine, procarbazine, lomustine and vincristine have been currently use. Approximately 5 years ago temozolomide was approved for the treatment of recurrent anaplastic astrocytoma and glioblastoma. Temozolomide is an orally active alkylating agent, with manageable side effects, that has demonstrated its efficacy against recurrent glioblastoma. More recently, a large randomised clinical trial showed a significant survival benefit for temozolomide in combination with radiotherapy compared with radiation alone. In particular, for newly diagnosed glioblastoma, combined daily radiotherapy with daily temozolomide followed by six cycles of adjuvant temozolamide improves overall survival. This benefit is especially observed in patients with a methylated promotor of the MGMT gene which encodes an alkyltransferase. Whereas primary brain cancer is a devastating but fortunately relatively rare disease, brain metastases occur much more frequently. It has been estimated that 20-50% of patients suffering from breast, lung or skin (melanoma) neoplasms will develop brain metastases. Whereas whole-brain radiotherapy is commonly applied, the efficacy of chemotherapy for the treatment of brain metastases is still undefined. Yet, there is now a growing consensus that systemic chemotherapy may be useful. Patients with brain metastases are a heterogeneous group and require individualized therapy. The approach to a patient with brain metastases should be based on the number of brain metastases, the extent of extracranial disease and performance status of the patient.
|Translated title of the contribution||Combined therapeutic approaches for primary and secondary brain tumors: The role of chemotherapy|
|Number of pages||5|
|Publication status||Published - Mar 2007|
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