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Review| Volume 131, ISSUE 8, P874-882, August 2018

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Brain Tumors

  • J. Ricardo McFaline-Figueroa
    Affiliations
    Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Mass

    Department of Neurology, Brigham and Women's Hospital, Boston, Mass

    Harvard Medical School, Boston, Mass

    Department of Neurology, Massachusetts General Hospital, Boston
    Search for articles by this author
  • Eudocia Q. Lee
    Correspondence
    Requests for reprints should be addressed to Eudocia Q. Lee, MD, MPH, Dana-Farber Cancer Institute, Center for Neuro-Oncology, 450 Brookline Avenue, D-2110, Boston, MA 02115.
    Affiliations
    Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Mass

    Department of Neurology, Brigham and Women's Hospital, Boston, Mass

    Harvard Medical School, Boston, Mass
    Search for articles by this author
Published:January 23, 2018DOI:https://doi.org/10.1016/j.amjmed.2017.12.039

      Abstract

      Brain tumors are common, requiring general medical providers to have a basic understanding of their diagnosis and management. The most prevalent brain tumors are intracranial metastases from systemic cancers, meningiomas, and gliomas, specifically, glioblastoma. Central nervous system metastases may occur anywhere along the neuroaxis, and require complex multidisciplinary care with neurosurgery, radiation oncology, and medical oncology. Meningiomas are tumors of the meninges, mostly benign and often managed by surgical resection, with radiation therapy and chemotherapy reserved for high-risk or refractory disease. Glioblastoma is the most common and aggressive malignant primary brain tumor, with a limited response to standard-of-care concurrent chemoradiation. The new classification of gliomas relies on molecular features, as well as histology, to arrive at an “integrated diagnosis” that better captures prognosis. This manuscript will review the most common brain tumors with an emphasis on their diagnosis, oncologic management, and management of medical complications.

      Keywords

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      References

        • Arvold N.D.
        • Lee E.Q.
        • Mehta M.P.
        • et al.
        Updates in the management of brain metastases.
        Neuro Oncol. 2016; 18: 1043-1065
        • Ostrom Q.T.
        • Gittleman H.
        • Fulop J.
        • et al.
        CBTRUS Statistical Report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012.
        Neuro Oncol. 2015; 17: iv1-iv62
        • Nayak L.
        • Lee E.Q.
        • Wen P.Y.
        Epidemiology of brain metastases.
        Curr Oncol Rep. 2012; 14: 48-54
        • Cagney D.N.
        • Martin A.M.
        • Catalano P.J.
        • et al.
        Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study.
        Neuro Oncol. 2017; 19: 1511-1521
        • Kromer C.
        • Xu J.
        • Ostrom Q.T.
        • et al.
        Estimating the annual frequency of synchronous brain metastasis in the United States 2010-2013: a population-based study.
        J Neurooncol. 2017; 134: 55-64
        • Posner J.B.
        • Chernik N.L.
        Intracranial metastases from systemic cancer.
        Adv Neurol. 1978; 19: 579-592
        • Takakura K.
        • Teramoto A.
        • Nakamura O.
        • Manaka S.
        [Epidemiology of brain tumors (author's transl)].
        No to Shinkei. 1982; 34 (in Japanese): 465-472
        • DeAngelis L.M.
        • Posner J.B.
        Neurologic Complications of Cancer.
        2nd ed. Oxford University Press, New York, NY2009
        • Silberstein S.D.
        Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Neurology. 2000; 55: 754-762
        • Krumholz A.
        • Wiebe S.
        • Gronseth G.
        • et al.
        Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.
        Neurology. 2007; 69: 1996-2007
        • National Comprehensive Cancer Network
        Central nervous system cancers (version 1.2017).
        (Available at:)
        • Glantz M.J.
        • Cole B.F.
        • Glantz L.K.
        • et al.
        Cerebrospinal fluid cytology in patients with cancer: minimizing false-negative results.
        Cancer. 1998; 82: 733-739
        • Del Principe M.I.
        • Buccisano F.
        • Cefalo M.
        • et al.
        High sensitivity of flow cytometry improves detection of occult leptomeningeal disease in acute lymphoblastic leukemia and lymphoblastic lymphoma.
        Ann Hematol. 2014; 93: 1509-1513
        • Straathof C.S.
        • de Bruin H.G.
        • Dippel D.W.
        • Vecht C.J.
        The diagnostic accuracy of magnetic resonance imaging and cerebrospinal fluid cytology in leptomeningeal metastasis.
        J Neurol. 1999; 246: 810-814
        • Sperduto P.W.
        • Kased N.
        • Roberge D.
        • et al.
        Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases.
        J Clin Oncol. 2012; 30: 419-425
        • Patchell R.A.
        • Tibbs P.A.
        • Walsh J.W.
        • et al.
        A randomized trial of surgery in the treatment of single metastases to the brain.
        N Engl J Med. 1990; 322: 494-500
        • Vecht C.J.
        • Haaxma-Reiche H.
        • Noordijk E.M.
        • et al.
        Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery?.
        Ann Neurol. 1993; 33: 583-590
        • Borgelt B.
        • Gelber R.
        • Kramer S.
        • et al.
        The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group.
        Int J Radiat Oncol Biol Phys. 1980; 6: 1-9
        • Chang E.L.
        • Wefel J.S.
        • Hess K.R.
        • et al.
        Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial.
        Lancet Oncol. 2009; 10: 1037-1044
        • Aoyama H.
        • Shirato H.
        • Tago M.
        • et al.
        Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.
        JAMA. 2006; 295: 2483-2491
        • Kocher M.
        • Soffietti R.
        • Abacioglu U.
        • et al.
        Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study.
        J Clin Oncol. 2011; 29: 134-141
        • Chamberlain M.C.
        • Baik C.S.
        • Gadi V.K.
        • Bhatia S.
        • Chow L.Q.
        Systemic therapy of brain metastases: non-small cell lung cancer, breast cancer, and melanoma.
        Neuro Oncol. 2017; 19: i1-i24
        • Davies M.A.
        • Saiag P.
        • Robert C.
        • et al.
        Dabrafenib plus trametinib in patients with BRAFV600-mutant melanoma brain metastases (COMBI-MB): a multicentre, multicohort, open-label, phase 2 trial.
        Lancet Oncol. 2017; 18: 863-873
        • Goldberg S.B.
        • Gettinger S.N.
        • Mahajan A.
        • et al.
        Pembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial.
        Lancet Oncol. 2016; 17: 976-983
        • Louis D.N.
        • Perry A.
        • Reifenberger G.
        • et al.
        The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary.
        Acta Neuropathol. 2016; 131: 803-820
        • Durand A.
        • Labrousse F.
        • Jouvet A.
        • et al.
        WHO grade II and III meningiomas: a study of prognostic factors.
        J Neurooncol. 2009; 95: 367-375
        • Nakamura M.
        • Roser F.
        • Michel J.
        • Jacobs C.
        • Samii M.
        The natural history of incidental meningiomas.
        Neurosurgery. 2003; 53 (discussion 70-71): 62-70
        • Aizer A.A.
        • Bi W.L.
        • Kandola M.S.
        • et al.
        Extent of resection and overall survival for patients with atypical and malignant meningioma.
        Cancer. 2015; 121: 4376-4381
        • Brastianos P.K.
        • Horowitz P.M.
        • Santagata S.
        • et al.
        Genomic sequencing of meningiomas identifies oncogenic SMO and AKT1 mutations.
        Nat Genet. 2013; 45: 285-289
        • Clark V.E.
        • Erson-Omay E.Z.
        • Serin A.
        • et al.
        Genomic analysis of non-NF2 meningiomas reveals mutations in TRAF7, KLF4, AKT1, and SMO.
        Science. 2013; 339: 1077-1080
        • de Groot J.F.
        High-grade gliomas.
        Continuum (Minneap Minn). 2015; 21: 332-344
        • Sanson M.
        • Marie Y.
        • Paris S.
        • et al.
        Isocitrate dehydrogenase 1 codon 132 mutation is an important prognostic biomarker in gliomas.
        J Clin Oncol. 2009; 27: 4150-4154
        • Hartmann C.
        • Hentschel B.
        • Wick W.
        • et al.
        Patients with IDH1 wild type anaplastic astrocytomas exhibit worse prognosis than IDH1-mutated glioblastomas, and IDH1 mutation status accounts for the unfavorable prognostic effect of higher age: implications for classification of gliomas.
        Acta Neuropathol. 2010; 120: 707-718
        • Hegi M.E.
        • Diserens A.C.
        • Gorlia T.
        • et al.
        MGMT gene silencing and benefit from temozolomide in glioblastoma.
        N Engl J Med. 2005; 352: 997-1003
        • Esteller M.
        • Garcia-Foncillas J.
        • Andion E.
        • et al.
        Inactivation of the DNA-repair gene MGMT and the clinical response of gliomas to alkylating agents.
        N Engl J Med. 2000; 343: 1350-1354
        • Lacroix M.
        • Abi-Said D.
        • Fourney D.R.
        • et al.
        A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival.
        J Neurosurg. 2001; 95: 190-198
        • Sanai N.
        • Polley M.Y.
        • McDermott M.W.
        • Parsa A.T.
        • Berger M.S.
        An extent of resection threshold for newly diagnosed glioblastomas.
        J Neurosurg. 2011; 115: 3-8
        • Stupp R.
        • Mason W.P.
        • van den Bent M.J.
        • et al.
        Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma.
        N Engl J Med. 2005; 352: 987-996
        • Stupp R.
        • Hegi M.E.
        • Mason W.P.
        • et al.
        Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial.
        Lancet Oncol. 2009; 10: 459-466
        • Stupp R.
        • Taillibert S.
        • Kanner A.A.
        • et al.
        Maintenance therapy with tumor-treating fields plus temozolomide vs temozolomide alone for glioblastoma: a Randomized Clinical Trial.
        JAMA. 2015; 314: 2535-2543
        • Malmstrom A.
        • Gronberg B.H.
        • Marosi C.
        • et al.
        Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial.
        Lancet Oncol. 2012; 13: 916-926
        • Wick W.
        • Platten M.
        • Meisner C.
        • et al.
        Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial.
        Lancet Oncol. 2012; 13: 707-715
        • Perry J.R.
        • Laperriere N.
        • O'Callaghan C.J.
        • et al.
        Short-course radiation plus temozolomide in elderly patients with glioblastoma.
        N Engl J Med. 2017; 376: 1027-1037
        • Schiff D.
        • Lee E.Q.
        • Nayak L.
        • Norden A.D.
        • Reardon D.A.
        • Wen P.Y.
        Medical management of brain tumors and the sequelae of treatment.
        Neuro Oncol. 2015; 17: 488-504
        • Englot D.J.
        • Chang E.F.
        • Vecht C.J.
        Epilepsy and brain tumors.
        Handb Clin Neurol. 2016; 134: 267-285
        • Politsky J.M.
        Brain tumor-related epilepsy: a current review of the etiologic basis and diagnostic and treatment approaches.
        Curr Neurol Neurosci Rep. 2017; 17: 70
        • Glantz M.J.
        • Cole B.F.
        • Forsyth P.A.
        • et al.
        Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors: report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Neurology. 2000; 54: 1886-1893