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Neuro-oncology Oct 2017With the release of the 2016 edition of the World Health Organization (WHO) Classification of Central Nervous System Tumors, brain invasion in meningiomas has been added... (Review)
Review
With the release of the 2016 edition of the World Health Organization (WHO) Classification of Central Nervous System Tumors, brain invasion in meningiomas has been added as a stand-alone criterion for atypia and can therefore impact grading and indirectly adjuvant therapy. Regarding this rising clinical importance, we have reviewed the current knowledge about brain invasion with emphasis on its implications on current and future clinical practice. We found various definitions of brain invasion and approaches for evaluation in surgically obtained specimens described over the past decades. This heterogeneity is reflected by weak correlation with prognosis and remains controversial. Similarly, associated clinical factors are largely unknown. Preoperative, imaging-guided detection of brain invasion is unspecific, and intraoperative assessment using standard and new high-magnification microscopic techniques remains imprecise. Despite the increasing knowledge about molecular alterations of the tumor/ brain surface, pharmacotherapeutic options targeting brain invasive meningiomas are lacking. Finally, we summarize the impact of brain invasion on histopathological grading in the WHO classifications of brain tumors since 1979.In conclusion, standardized neurosurgical sampling and neuropathological analyses could improve diagnostic reliability and reproducibility of future studies. Further research is needed to improve pre- and intraoperative visualization of brain invasion and to develop adjuvant, targeted therapies.
Topics: Brain Neoplasms; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Grading; Neoplasm Invasiveness; World Health Organization
PubMed: 28419308
DOI: 10.1093/neuonc/nox071 -
Journal of Neuro-oncology Sep 2023Despite aggressive management consisting of surgery, radiation therapy (RT), and systemic therapy given alone or in combination, a significant proportion of patients... (Review)
Review
Despite aggressive management consisting of surgery, radiation therapy (RT), and systemic therapy given alone or in combination, a significant proportion of patients with brain tumors will experience tumor recurrence. For these patients, no standard of care exists and management of either primary or metastatic recurrent tumors remains challenging.Advances in imaging and RT technology have enabled more precise tumor localization and dose delivery, leading to a reduction in the volume of health brain tissue exposed to high radiation doses. Radiation techniques have evolved from three-dimensional (3-D) conformal RT to the development of sophisticated techniques, including intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), and stereotactic techniques, either stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Several studies have suggested that a second course of RT is a feasible treatment option in patients with a recurrent tumor; however, survival benefit and treatment related toxicity of reirradiation, given alone or in combination with other focal or systemic therapies, remain a controversial issue.We provide a critical overview of the current clinical status and technical challenges of reirradiation in patients with both recurrent primary brain tumors, such as gliomas, ependymomas, medulloblastomas, and meningiomas, and brain metastases. Relevant clinical questions such as the appropriate radiation technique and patient selection, the optimal radiation dose and fractionation, tolerance of the brain to a second course of RT, and the risk of adverse radiation effects have been critically discussed.
Topics: Humans; Re-Irradiation; Neoplasm Recurrence, Local; Brain Neoplasms; Radiotherapy, Conformal; Radiosurgery; Cerebellar Neoplasms
PubMed: 37624529
DOI: 10.1007/s11060-023-04407-2 -
Journal of Digital Imaging Aug 2018The detection of a brain tumor and its classification from modern imaging modalities is a primary concern, but a time-consuming and tedious work was performed by... (Comparative Study)
Comparative Study Review
The detection of a brain tumor and its classification from modern imaging modalities is a primary concern, but a time-consuming and tedious work was performed by radiologists or clinical supervisors. The accuracy of detection and classification of tumor stages performed by radiologists is depended on their experience only, so the computer-aided technology is very important to aid with the diagnosis accuracy. In this study, to improve the performance of tumor detection, we investigated comparative approach of different segmentation techniques and selected the best one by comparing their segmentation score. Further, to improve the classification accuracy, the genetic algorithm is employed for the automatic classification of tumor stage. The decision of classification stage is supported by extracting relevant features and area calculation. The experimental results of proposed technique are evaluated and validated for performance and quality analysis on magnetic resonance brain images, based on segmentation score, accuracy, sensitivity, specificity, and dice similarity index coefficient. The experimental results achieved 92.03% accuracy, 91.42% specificity, 92.36% sensitivity, and an average segmentation score between 0.82 and 0.93 demonstrating the effectiveness of the proposed technique for identifying normal and abnormal tissues from brain MR images. The experimental results also obtained an average of 93.79% dice similarity index coefficient, which indicates better overlap between the automated extracted tumor regions with manually extracted tumor region by radiologists.
Topics: Algorithms; Brain Neoplasms; Female; Fuzzy Logic; Genetics; Humans; Image Interpretation, Computer-Assisted; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Neoplasm Invasiveness; Neoplasm Staging; Sensitivity and Specificity
PubMed: 29344753
DOI: 10.1007/s10278-018-0050-6 -
Biomedicine & Pharmacotherapy =... Nov 2021Brain tumors are an abnormal growth of cells in the brain, also known as multifactorial groups of neoplasm. Incidence rates of brain tumors increase rapidly, and it has... (Review)
Review
Brain tumors are an abnormal growth of cells in the brain, also known as multifactorial groups of neoplasm. Incidence rates of brain tumors increase rapidly, and it has become a leading cause of tumor related deaths globally. Several factors have potential risks for intracranial neoplasm. To date, the International Agency for Research on Cancer has classified the ionizing radiation and the N-nitroso compounds as established carcinogens and probable carcinogens respectively. Diagnosis of brain tumors is based on histopathology and suitable imaging techniques. Labeled amino acids and fluorodeoxyglucose with or without contrast-enhanced MRI are used for the evaluation of tumor traces. T2-weighted MRI is an advanced diagnostic implementation, used for the detection of low-grade gliomas. Treatment decisions are based on tumor size, location, type, patient's age and health status. Conventional therapeutic approaches for tumor treatment are surgery, radiotherapy and chemotherapy. While the novel strategies may include targeted therapy, electric field treatments and vaccine therapy. Inhibition of cyclin-dependent kinase inhibitors is an attractive tumor mitigation strategy for advanced-stage cancers; in the future, it may prove to be a useful targeted therapy. The blood-brain barrier poses a major hurdle in the transport of therapeutics towards brain tissues. Moreover, nanomedicine has gained a vital role in cancer therapy. Nano drug delivery system such as liposomal drug delivery has been widely used in the cancer treatment. Liposome encapsulated drugs have improved therapeutic efficacy than free drugs. Numerous treatment therapies for brain tumors are in advanced clinical research.
Topics: Antineoplastic Agents; Brain Neoplasms; Chemotherapy, Adjuvant; Cranial Irradiation; Genetic Predisposition to Disease; Humans; Molecular Targeted Therapy; Neurosurgical Procedures; Radiotherapy, Adjuvant; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 34474351
DOI: 10.1016/j.biopha.2021.112119 -
CNS Oncology Jan 2018High-grade gliomas, including glioblastoma, are the most common malignant brain tumors in adults. Despite intensive efforts to develop new therapies for these diseases,... (Review)
Review
High-grade gliomas, including glioblastoma, are the most common malignant brain tumors in adults. Despite intensive efforts to develop new therapies for these diseases, treatment options remain limited and prognosis is poor. Recently, there have been important advances in our understanding of the molecular basis of glioma, leading to refinements in our diagnostic and management approach. There is new evidence to guide the treatment of elderly patients. A multitude of new agents have been investigated, including targeted therapies, immunotherapeutics and tumor-treating fields. This review summarizes the key findings from this research, and presents a perspective on future opportunities to advance the field.
Topics: Brain Neoplasms; Disease Management; Glioma; Humans; Neoplasm Grading
PubMed: 29241354
DOI: 10.2217/cns-2017-0026 -
Hematology. American Society of... Dec 2017Primary and secondary CNS lymphomas are aggressive brain tumors that pose an immense challenge to define in terms of molecular pathogenesis, as well as to effectively... (Review)
Review
Primary and secondary CNS lymphomas are aggressive brain tumors that pose an immense challenge to define in terms of molecular pathogenesis, as well as to effectively treat. During the past 10 years improvements in survival have been achieved with the implementation of anti-CD20 immunotherapy and optimization of dose-intensive consolidation strategies. The applications of whole-exome sequencing, comparative genomic hybridization, transcriptional profiling, and examination of the tumor microenvironment, particularly in the context of clinical investigation, provide insights that create a roadmap for the development and implementation of novel targeted agents for this disease. A body of genetic evidence strongly suggested that primary CNS lymphomas (PCNSLs) are likely largely dependent on NF-κB prosurvival signals, with enrichment of mutations involving the B-cell receptor pathway, in particular myeloid differentiation primary response 88 and cluster of differentiation 79B. The first set of early-phase investigations that target NF-κB in PCNSL have now been completed and support the NF-κB hypothesis but at the same time reveal that much work needs to be done to translate these results into meaningful advances in survival for a large fraction of patients. Insights into secondary prosurvival pathways that mediate drug resistance is a priority for investigation. Similarly, further evaluation of the immune-suppressive mechanisms in the CNS lymphoma tumor microenvironment is requisite for progress. Combinatorial interventions that promote the antitumor immune response have significant potential. With increasing availability of targeted agents, there is also a need to develop more sensitive imaging tools, not only to detect this highly invasive brain neoplasm but also potentially to define an evolving molecular phenotype to facilitate precision medicine.
Topics: Brain Neoplasms; Drug Resistance, Neoplasm; Humans; Immunotherapy; Lymphoma; NF-kappa B; Neoplasm Proteins; Receptors, Antigen, B-Cell; Rituximab; Signal Transduction; Tumor Microenvironment; Exome Sequencing
PubMed: 29222305
DOI: 10.1182/asheducation-2017.1.556 -
Breast Cancer Research : BCR Jan 2016Because of improvements in the treatment of patients with metastatic breast cancer, the development of brain metastases (BM) has become a major limitation of life... (Review)
Review
Because of improvements in the treatment of patients with metastatic breast cancer, the development of brain metastases (BM) has become a major limitation of life expectancy and quality of life for many breast cancer patients. The improvement of management strategies for BM is thus an important clinical challenge, especially among high-risk patients such as human epidermal growth factor receptor 2-positive and triple-negative patients. However, the formation of BM as a multistep process is thus far poorly understood. To grow in the brain, single tumor cells must pass through the tight blood-brain barrier (BBB). The BBB represents an obstacle for circulating tumor cells entering the brain, but it also plays a protective role against immune cell and toxic agents once metastatic cells have colonized the cerebral compartment. Furthermore, animal studies have shown that, after passing the BBB, the tumor cells not only require close contact with endothelial cells but also interact closely with many different brain residential cells. Thus, in addition to a genetic predisposition of the tumor cells, cellular adaptation processes within the new microenvironment may also determine the ability of a tumor cell to metastasize. In this review, we summarize the biology of breast cancer that has spread into the brain and discuss the implications for current and potential future treatment strategies.
Topics: Animals; Blood-Brain Barrier; Brain Neoplasms; Breast Neoplasms; Endothelial Cells; Female; Genetic Predisposition to Disease; Humans; Neoplasm Metastasis
PubMed: 26781299
DOI: 10.1186/s13058-015-0665-1 -
BMJ Case Reports Mar 2016
Topics: Adult; Astrocytoma; Brain Neoplasms; Confusion; Female; Humans; Neoplasm Recurrence, Local; Paresis; Temporal Lobe
PubMed: 27033282
DOI: 10.1136/bcr-2015-213013 -
International Journal of Molecular... Nov 2012Colorectal cancer is one of the most common digestive tract malignancies in the world. Owing to the newer and more effective systemic therapies, the life of colorectal... (Review)
Review
Colorectal cancer is one of the most common digestive tract malignancies in the world. Owing to the newer and more effective systemic therapies, the life of colorectal cancer patients can be remarkably prolonged, and the incidence of brain metastases is increasing. However, little is known about the underlying mechanisms of brain metastasis from colorectal cancer. Here we review the tumor microenvironment and metastasis associated molecules in brain metastases from colorectal cancer. A further understanding of these mechanisms will help us to propose better strategies for colorectal cancer patients with brain metastasis and improve their life quality.
Topics: Animals; Brain Neoplasms; Colorectal Neoplasms; Humans; Neoplasm Metastasis; Tumor Microenvironment
PubMed: 23443093
DOI: 10.3390/ijms131215784 -
CNS Oncology 2015Glioblastoma, the most aggressive of the gliomas, has a high recurrence and mortality rate. The nature of this poor prognosis resides in the molecular heterogeneity and... (Review)
Review
Glioblastoma, the most aggressive of the gliomas, has a high recurrence and mortality rate. The nature of this poor prognosis resides in the molecular heterogeneity and phenotypic features of this tumor. Despite research advances in understanding the molecular biology, it has been difficult to translate this knowledge into effective treatment. Nearly all will have tumor recurrence, yet to date very few therapies have established efficacy as salvage regimens. This challenge is further complicated by imaging confounders and to an even greater degree by the ever increasing molecular heterogeneity that is thought to be both sporadic and treatment-induced. The development of novel clinical trial designs to support the development and testing of novel treatment regimens and drug delivery strategies underscore the need for more precise techniques in imaging and better surrogate markers to help determine treatment response. This review summarizes recent approaches to treat patients with recurrent glioblastoma and considers future perspectives.
Topics: Animals; Brain Neoplasms; Glioblastoma; Humans; Neoplasm Recurrence, Local
PubMed: 25768333
DOI: 10.2217/cns.14.55